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Building Organizational Capacity
Pages 220-234

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From page 220...
... Although this chapter focuses mostly on nursing homes, many of the issues discussed are applicable directly or with some adaptation to those providing services in other long-term care settings, such as residential care facilities and home health care. RECENT INITIATIVES TO IMPROVE CAREGIVING CAPACITY IN LONG-TERM CARE A number of initiatives have been put in place in recent years to facilitate the ability of nursing homes to produce better outcomes for people using long-term care.
From page 221...
... This data set is designed to help nursing homes organize their clinical activities to meet regulatory expectations for quality of care. Practice Guidelines.
From page 222...
... QUALITY MANAGEMENT SYSTEMS Many nursing homes report that they have made significant investments and progress in the quality improvement area. However, like practice guidelines, it is difficult to demonstrate objectively that quality management systems have significantly improved nursing home care.
From page 223...
... The researchers concluded that although practice guidelines could be implemented to improve outcomes, such improved outcomes did not in themselves provide sufficient incentive for nursing homes to maintain the program without the external monitoring and consultation provided by research staff. Limited trained staff time and organizational capacity are a barrier to improved performance in nursing homes.
From page 224...
... Furthermore, most nursing homes, even highly motivated ones, lack the technical expertise and tangible resource capacity necessary to translate OBRA 87 regulations, practice guidelines, and quality improvement systems into practice. The rest of this chapter discusses two broad issues relevant to improving quality of care: (1)
From page 225...
... Without standardized protocols nursing homes cannot plan or budget accurate quality assessments. The MDS is generated from the perception of a nursing home workforce that is largely paraprofessional, temporary, and in need of more professional supervision.
From page 226...
... nursing homes that score poorly do, in fact, implement different care processes than nursing homes that score well; and 3. significant and stable variation in the quality indicator performance scores will allow identification of both "good" and "bad" nursing homes.
From page 227...
... In summary, better automated information systems to organize MDS data are essential to improve care in nursing homes. IDENTIFYING EFFECTIVE INTERVENTIONS The initiatives for improving care processes and outcomes include recommendations for assessment and treatment.
From page 228...
... Although simple, these interventions are often more timeconsuming to implement than the usual care processes conducted in nursing homes. Also, the labor costs associated with implementing care processes may be even more than those associated with conducting assessments.
From page 229...
... In addition, nursing aides themselves have reported in three separate studies that they have insufficient time to implement toileting programs or interventions designed to improve food intake among residents, and to individualize care (Kayser-Iones and Schell, 1997; LekanRutledge et al., 1998; Walker et al., 1999~. Finally, observational studies contrast the actual time spent providing usual care to the increased time required to implement care processes that promote better outcomes.
From page 230...
... The interventions produce comparatively better results during the research period, in part because usual care processes are done too infrequently to promote better outcomes, or provide excessive physical assistance, which undermines the resident's ability to perform independently. Unfortunately, usual care practices are less time-consuming and less costly than promoting strategies that lead to more independence and better outcomes.
From page 231...
... Implementing an improvement model successfully entails adding further to the already high measurement burden incurred by nursing homes. In industrial and service settings, where the improvement management model is most successful, very frequent and even continuous records of work processes are available.
From page 232...
... Nonetheless, long-term care is years away from having a cost-effective process and information monitoring technology that is acceptable to all stakeholders and is as useful as the systems used in industrial settings. In the absence of such a technology, it is not surprising that nursing homes and other healthcare settings have experienced difficulty in implementing successful improvement models.
From page 233...
... . This report emphaizes the inadequacy of staffing levels in nursing homes and the consequent deficiency in long-term care services.
From page 234...
... Serve as test sites for policy makers who need a realistic appraisal of the cost and feasibility of implementing regulatory standards being considered for legislative approval. CONCLUSION This chapter argues that most nursing homes, even highly motivated ones, may lack the technical expertise and resources including but not limited to staffing levels necessary to translate OBRA 87 regulations, practice guidelines, and quality improvement systems into practice.


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