Evaluation of culture change practices and its impact on by sja20118

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									   Evaluation of culture change
practices and its impact on quality of
  care outcomes in nursing homes
   around the Bluegrass Region

           Doris M. Castellanos-Cruz
          Martin School of Public Policy
         Masters in Health Administration
                Capstone Project
                  April 16, 2008
                          Outline
 Introduction
      -Bluegrass Region
      -Skilled Care
      -Culture Change

 Purpose

 Methods

 Findings

 Recommendations
                                    2
Bluegrass Region




                   3
                     Skilled Care
Skilled nursing or rehabilitation staff manage,
  observe and evaluate care.

Staff consists of:
      -Registered nurse
      -Licensed & vocational nurses (CNA)
      -Physical and occupational therapists
      -Social worker
      -Pharmacists


                                                  4
        Skilled nursing experience

Follow fixed schedules
     -Bathing
     -Eating
     -Resting
     -Recreation


Share a bedroom and bath with someone they have
 never met

                                               5
                 Culture Change
 Create an organizational structure that reflects
  resident’s dignity, independence and rights
 Reduce institutional feel

Goals:
1. Improve resident satisfaction and quality of life
2. Improve resident’s function and health status
3. Improve staff efficiency and productivity

                                                       6
                           Quality

Quality of care                  Quality of life
-Infection rates                 -Resident satisfaction
-Number of medications           -Individualized activity plans
-Medication errors               -Staff satisfaction
-Acquired pressure sores         -Staff turnover
-Physical restrains              -Staff absenteeism




                                                                  7
Culture Change



   quality of life =
   quality of care

employee satisfaction =
     quality of care



                          8
                    Purpose


Evaluate culture change practices among nursing
homes in the Bluegrass Region and find out if
facilities that have adapted culture change attributes
are more likely to achieve better quality of care
outcomes than facilities that do not




                                                         9
                        Methods
Sample
  -Nursing home facilities (n=33)


Data Collection
      -NHOA care complaints 10/2006-9/2007
      -CMS health deficiencies 10/2006-12/2007
      -Type of ownership
      -Initiative participation
      -Interviews


                                                 10
                             Methods
Data Analysis
                             MAU model

   Assess and evaluate degree of culture change practice

   Grant’s Four Stages of Culture Change

   Organizational areas
    -Decision-making
    -Staff roles
    -Physical environment
    -Leadership
    -Organizational design                                  11
                              MAU Model results
                                  Degree of Culture Change

        100

        90

        80

        70

        60
Score




        50                                                                                     MAU Score

        40

        30

        20

        10

         0
              1   3   5   7   9    11   13   15   17   19   21   23   25   27   29   31   33
                                             Facilities
                                                                                                     12
                            Data Analysis

                       Correlation Analysis

Check for multicollinearity

                    Correlation Analysis results
           Variables           Result       Association

         Deficiencies &        r=.481      Moderate/Weak
          Complaints

        Degree of culture      r=.769         Strong
         change & Any
         culture change



                                                           13
                 Data Analysis

                Regression Analysis

Measure the relationship between culture change
 practices and number of complaints, deficiencies,
 type of ownership and initiative participation

All regressions were based on a 95% confidence level



                                                     14
                            Regressions
Degree of culture change=f{deficiencies, complaints}

   Negative statistical significant relationship between Degree of culture
    change practice and number of deficiencies

   No statistical significant relationship between Degree of culture change
    practice and number of complaints reported

                     Regression Statistics Results
                       R Square                 0.42

                Deficiencies Coefficient        -1.26

                Complaints Coefficient          -0.42


                                                                               15
                           Regressions
Any culture change=f{ownership, initiative participation}

 Both independent variables had a statistical significant
  relationship with culture change practice
       -Ownership: (-) significant
       -Initiative participation: (+) positive significant

                   Regression Statistics Results
                      R Square            0.22

               Ownership Coefficient      -0.6

               Initiative participation   0.37
                      Coefficient                            16
                                   Regressions
Degree of culture change=f{deficiencies, complaints, ownership, initiative participation}


     Number of deficiencies: (-) significant
     Initiative participation: (+) significant
     Complaints: no statistical significant relationship
     Type of ownership: no statistical significant relationship


                                 Regression Statistics Results
                                  R Square                  0.44
                          Deficiencies Coefficient         -1.31
                          Complaints Coefficient           -0.12
                           Ownership Coefficient           -5.61
                           Initiative participation        11.43
                                  Coefficient

                                                                                    17
                Data limitations
Small sample size
    -Only 33 skilled nursing facilities

Data variation
    -CMS and NHOA reports




                                          18
                      Findings
 Association between increase in culture change
  practices and decrease in number of deficiencies

 For-profit facilities tend to be more hesitant to change

 Culture change practices increase for facilities that
  participate in initiative program



                                                          19
                   Recommendations
 Become involve in quality programs
       -Advancing Excellence in America’s Nursing Home coalition


 Begin the implementation process of culture change
       -Obtain commitment and continuity of corporate leadership


 Strategic planning committee
       -Guide the process
       - Prevent to loose focus
       - Optimize the use of human and financial resource


                                                                   20
                 Recommendations
Resident-directed care and activities

 Expand choices
 Provide time options for bathing
 Assist residents in determining their own schedules, activities
  and care plans
 Communicate the vision, principles, and values of resident-
  centered care to all staff




                                                               21
                  Recommendations
Home environment

 Design residents rooms for privacy, personalization, and
  individual needs or preferences
 Introduce plants, pets, children, or familiar artifacts from the
  resident’s past
 Change the environment as much as possible from institution
  to home
 Implement neighborhood or household designs


                                                                     22
                 Recommendations
Relationship with staff family, resident and community

   Commit to consistent staff assignment
   Promote a sense of community
   Involve family members in decision making
   Provide intergenerational activities
   Honor death and dying with dignity




                                                         23
                 Recommendations
Staff empowerment

 Involve multidisciplinary staff in care planning and care
  conferences
 Enable staff to self-schedule
 Implement cross-training across departments and staff roles
 Promote staff development and autonomous decision
 Develop self-directed work teams



                                                                24
                Recommendations
Collaborative management or shared leadership

 Implement practices to improve staff satisfaction through
  enhance work environments
 Improve core leadership competencies and expand
  participation on leadership teams
 Promote open communication through consensus
 Decentralizing decision making about hiring and promotion
 Encouraging multidisciplinary teamwork and problem solving



                                                           25
                 Recommendations
Measurement based quality improvement processes

 Adopt principles of evidence-based management

 Evaluate based on key measurements like clinical, workforce,
  customer satisfaction, quality of life, and other outcomes




                                                                 26
                 Relevant Courses
 Organizational Change and Strategic Planning (HA 602)

 Qualitative Methods of Research (HA 621)

 Public Program Evaluation (PA) 622)

 Decision Analysis and Decision Support Systems (HA 623)




                                                            27
                 Acknowledgements
                            Committee

Chair: Dr. Philip Berger

Committee member: Dr. Sarah Wackerbarth

Reader: Dr. Jeff Talbert

Outside practitioner: Kathy Gannoe, MPA
Executive Director Nursing Home Ombudsman Agency of the Bluegrass, Inc.


Martin School PhD student: Gabriel Serna
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Questions?



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