Implementation of a Heart Failure Quality Initiative in a Skilled Nursing Facility: Lessons Learned

Abstract

Skilled nursing facilities (SNFs) are organizations that represent complex adaptive systems, offering barriers to the implementation of quality improvement (QI) initiatives. The current article describes the authors’ efforts to use the approach of reflective adaptive process to implement a new model of care (i.e., the Skilled Heart Unit Program) for effective heart failure (HF) care in one SNF. A team of stakeholders from the local hospital system and a local SNF was convened to design and implement this new model. Evaluation of the implementation processes confirmed the value of the implementation approach, which centered on team-based approaches, staff engagement, and flexibility of processes to respect the SNF’s needs and culture. Interviews with facility staff and the administrator revealed their perceptions that the strategy resulted in better HF care, enhanced teamwork between staff and clinicians, and improved staff job satisfaction. This work provides a unique blueprint of strategic QI implementation for patients with HF in the SNF setting. [ Journal of Gerontological Nursing, 41 (5), 26–33.]

Skilled Nursing Facility Use and Hospitalizations in Heart Failure

“…26 Furthermore, a SNF HF quality initiative program led to better HF care and enhanced teamwork among the SNF staff in addition to improving staff satisfaction. 27 …”

Heart failure in nursing homes: A scoping review of educational interventions for optimising care provision

“…One reason for such challenges is the high rates of staff turnover ( Castle, 2006 , Castle and Engberg, 2005 , Gandhi et al., 2021 , Thomas et al., 2013 ), associated with low levels of staff resilience and wellbeing leading to burnout ( Mallon et al., 2023 ). High rates of staff turnover can also directly impact the implementation and sustainability of heart failure guidelines ( Nazir et al., 2015 ), with three of the studies included in this review citing staff turnover as a significant barrier ( Heckman et al., 2018b , Kim et al., 2016 , Sullivan, 2017 ). Most interventions included in this review had a duration of 1-6 months, with only one reporting outcomes at 12-months post baseline ( Hancock et al., 2012 ).…”

Care Transitions Between Hospitals and Skilled Nursing Facilities: Perspectives of Sending and Receiving Providers

“…Identifying such facilitators and barriers is a critical step in fostering collaboration between hospitals and post-acute care facilities (2, 6, 14–17). Identifying these barriers also responds to calls from national quality improvement efforts for the building of meaningful, mutual health care partnerships that consider factors beyond clinical acuity, including facility culture (11), staff engagement and trust (11, 16), and the financial risks and benefits associated with cost reduction and quality improvement efforts (10). To our knowledge, this is the first time that this type of comprehensive approach has been applied to hospital-to-SNF care transitions in the United States.…”