Is Variation in Resident-Centered Care and Quality Performance Related to Health System Factors in Veterans Health Administration Nursing Homes?

Abstract

The purpose of this research was to explore and compare common health system factors for 5 Community Living Centers (ie Veterans Health Administration nursing homes) with high performance on both resident-centered care and clinical quality and for 5 Community Living Centers (CLC) with low performance on both resident-centered care and quality. In particular, we were interested in “how” and “why” some Community Living Centers were able to deliver high levels of resident-centered care and high quality of care, whereas others did not demonstrate this ability. Sites were identified based on their rankings on a composite quality measure calculated from 28 Minimum Data Set version 2.0 quality indicators and a resident-centered care summary score calculated from 6 domains of the Artifacts of Culture Change Tool. Data were from fiscal years 2009-2012. We selected high- and low-performing sites on quality and resident-centered care and conducted 12 in-person site visits in 2014-2015. We used systematic content analysis to code interview transcripts for a priori and emergent health system factor domains. We then assessed variations in these domains across high and low performers using cross-site summaries and matrixes. Our final sample included 108 staff members at 10 Veterans Health Administration CLCs. Staff members included senior leaders, middle managers, and frontline employees. Of the health system factors identified, high and low performers varied in 5 domains, including leadership support, organizational culture, teamwork and communication, resident-centered care recognition and awards, and resident-centered care training. Organizations must recognize that making improvements in the factors identified in this article will require dedicated resources from leaders and support from staff throughout the organization.

Collaborative capacity and patient-centered care in the Veterans’ Health Administration Community Living Centers

“…25,26 Indeed, the persistent challenge of turnover underscores how important other organizational structure and context factors, such as staffing resources, control over work, and rewards for performance, may be in generating an organizational context that supports collaborative capacity. [40][41][42] Our findings also highlight relevant patient perspectives as residents in nursing homes regularly interact with staff and teams. Higher team effectiveness via improved collaborative capacity as well as a focus on integrating a patient's preferences into treatment plans, can improve patient satisfaction and engagement in their care.…”

“…25,26 Indeed, the persistent challenge of turnover underscores how important other organizational structure and context factors, such as staffing resources, control over work, and rewards for performance, may be in generating an organizational context that supports collaborative capacity. 40–42…”

Qualitative Methods in Health Policy and Systems Research: A Framework for Study Planning

“…Design and context studies center on a range of topics not captured by our other subcategories. This includes topics of structure (e.g., colocated care or integration of health care organizations; Ramanuj et al, 2018; Zhu et al, 2018) as well as process (e.g., work practices, teamwork, and communication; Ramanuj et al, 2018) and social context (e.g., culture or leadership support; Ramanuj et al, 2018; Sullivan et al, 2018). Financing studies often center on topics of financial streams or models but may include a range of related topics.…”

The Relationship between Costs and Quality in Veterans Health Administration Community Living Centers: An Analysis Using Longitudinal Data

“…Preliminary results suggest that high‐ and low‐performing facilities differ on teamwork and communication, leadership support, and organizational culture (Sullivan et al. ). These types of studies have the potential to identify changes and interventions for improving performance in the lower‐performing facilities.…”