The Influence of Organizational Systems on Information Exchange in Long-Term Care Facilities

Abstract

Person-centered care is heavily dependent on effective information exchange among health care team members. We explored the organizational systems that influence resident care attendants' (RCAs) access to care information in long-term care (LTC) settings. We conducted an institutional ethnography in three LTC facilities. Investigative methods included naturalistic observations, in-depth interviews, and textual analysis. Practical access to texts containing individualized care-related information (e.g., care plans) was dependent on job classification. Regulated health care professionals accessed these texts daily. RCAs lacked practical access to these texts and primarily received and shared information orally. Microsystems of care, based on information exchange formats, emerged. Organizational systems mandated written exchange of information and did not formally support an oral exchange. Thus, oral information exchanges were largely dependent on the quality of workplace relationships. Formal systems are needed to support structured oral information exchange within and between the microsystems of care found in LTC.

A Novel Implementation Strategy in Residential Care Settings to Promote EBP: Direct Care Provider Perceptions and Development of a Conceptual Framework

“…The peer reminders were simply expected to provide a structured reminder to their peers at predetermined times during scheduled meetings. This formalized opportunity for information exchange was consistent with HCA's experiences with oral communication and was expected to improve information sharing (Caspar et al., ). This proposed simple knowledge translation intervention targets the most numerous group of long‐term care staff members who, strategically, have the most direct contact with the residents and provide the majority of care.…”

“…We also anticipated the limited capacity of long‐term care, including resource constraints (Berta et al., ; Cammer et al., ), extensive turnover of staff and leaders (Jones et al., ), and the fact that the main direct care provider or healthcare aide (HCA) is an unregulated staff member with variable education and experience (Estabrooks, Squires, Carleton, Cummings, & Norton, ). Lastly, we anticipated the established processes of long‐term care, including how relationships and philosophies shape the care provided and the use of best practices (Cammer et al., ), the limited scope of practice of HCAs (Corazzini et al., ), and how HCAs, excluded from formalized communication, rely on oral information exchange (Caspar, Ratner, Phinney, & MacKinnon, ). The proposed knowledge translation intervention is a peer reminder, defined as an HCA designated to remind, guide, and encourage fellow HCAs to carry out specific care practices with residents of long‐term care.…”

“…Three recent qualitative studies situated in long‐term care settings identified the quality of HCAs’ work relationships to be critical for them to share information, to try new ideas and to use evidence (Cammer et al., ; Caspar et al., ; Janes, Sidani, Cott, & Rappolt, ). Caspar et al.…”

“…Caspar et al. () observed how direct care providers shared care information orally with their peers but this depended on the quality of their work relationships with one another. Cammer et al.…”

Innovative methods in health information behaviour research

“…Considering the increasing burden on informal caregivers and local community services to support patients diagnosed with life-threatening and life-limiting diseases (Fourie, 2012), this paper is welcomed for raising awareness about the impact that infrastructures and policies might have on many issues that can impact on information behaviour, e.g. informing patients, information exchange and work practices of multi-disciplinary teams (Caspar et al, 2016;Ion, 2019;Quinlan, 2009;Reid et al, 2018). The paper also confirms the value of the key work of Dorothy Smith (2005) (also stressed in Kearney et al, 2018), and the importance of moving beyond interests in individuals only.…”