SPECIAL SESSION: A Program of Research on Nursing Home Care: Discovering Internal Capacity for Improvement, Intervention Development, Implementation and Outcomes

Description/Overview: In this research program, I have been exploring the question of what management practices facilitate better outcomes in nursing homes. I conducted several studies using both quantitative and qualitative methods address this question. In this research my team discovered how a nursing home’s internal capacity to improve worker effectiveness exists within its relationship, interaction and communication patterns. Thus the type of management practices needed for better outcomes do not belong solely to managers — they must be used by all levels and types of nursing home staff. The quality of interactions among staff is important because the most intractable problems in nursing home care, such as falls, need the attention of multiple care providers such as nursing, social work, physical therapy and medicine. To be successful therefore requires effective interdependence. Building on this earlier research, my team proposed that a particular barrier to implementing evidence-based programs has been that they do not fully address staff interdependencies inherent in care for falls or other geriatric syndromes. We hypothesized that an intervention that helps nursing home staff establish relationship networks and communication channels to support learning and behavior changes, would improve uptake of a traditional falls reduction program. Standard approaches to improving nursing home outcomes use quality improvement (QI) programs which focus on individual mastery, didactic modules, audit and feedback, and academic detailing. In contrast, social constructivism theory and complexity science suggest that learning is a social process that occurs within the context of relationships and interactions; thus alone, traditional QI will not result in optimal behavior changes. Accordingly, we developed an educational/behavioral intervention (CONNECT) in which staff learned to improve connections within and between workgroups, improve information exchange, and seek diverse perspectives in problem-solving. In this presentation I will describe the rationale for a system level intervention, the translation approach using complexity science, and report the results of a randomized pilot-study in a sample of eight nursing homes.