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HELSEVEL-H-Gode og effektive helse-, omsorgs- og velferdstjenester

Improving Quality and Safety in Primary Care-Implementing a Leadership Intervention in Nursing Homes and Homecare

Alternative title: Ledelse av kvalitet og sikkerhet i primærhelsetjenesten

Awarded: NOK 11.6 mill.

Would you be happy for your parents to be primary care patients if service managers lacked the competence and means to ensure safe healthcare services? This is often the current situation in the Norwegian primary care service, where there is an urgent need for improved quality and safety competencies among leaders in home care and nursing homes. The SAFE-LEAD Primary Care project, builds on the outcomes of the recent EU FP7 project QUASER. The project adapts, implements, and evaluates a research-based quality and safety improvement tool (QUASER-guide) in Norwegian nursing homes and home care. The overall aim of this implementation study is to build leadership competence and guide primary care managers in their efforts to advance and improve vital quality and safety strategies, attitudes and practices. By using a high degree of user involvement and co-research (7 co-researchers) the project has developed the SAFE-LEAD guide in a paper version and an online version, and the belonging intervention. The intervention was piloted in one nursing home and one home care service from Dec 2017 to Feb 2018. A two-stage leadership intervention has been conducted from April 2018 - end March 2019 in 4 nursing homes and 4 home care services in 5 Norwegian municipalities in 3 different counties (rural/city). The project measures effect on quality and safety by studying improved knowledge, attitudes and practice in nursing homes and home care. Before the intervention start (March 2018) and after stage 1 (Oct 2018), we conducted an online survey. In addition we conducted intervews, observations and focusgroup interviews as part of the process evaluation over the one year intervention period, ending in March 2019. The project has developed a context mapping tool for nursing homes and home care for mapping of contextual factors in all intervention units over the intervention period. The results show that managers consider the safe-lead guide and the intervention as a good tool to systematize the quality and safety work. The guide contributes with new concepts and eases the dialog about quality and safety. In addition the guide creates a structure to talk about quality and safety. A key finding relates to the importance of leadership continuity for being able to succeed in using and adoping the guide and the intervention.The guide and intervention create a reflexive space to talk about quality and safety that managers miss in their everyday practice. The web Version of the guide is mainly used in the study and we have identified areas of improvement of the guide. Moreover, the SAFE-LEAD context has been evaluated and updated in terms of stronger focus on user instruction, purpose and explanation of how it over time can contribute to map changes of key importance for interventions. The Norwegian results are compared With the Dutch Project results in order to understand the role of context in leading quality and safety. This comparison has in particular focused on conceptualisation of quality in different national contexts, the role of geographic location and the quality challenges relating to rural/city location.

Prosjektet har bidratt til implementering og uttesting av et forskningsbasert verktøy for å støtte ledere i deres arbeid med kvalitet og sikkerhet. Prosjektet har bidratt til økt oppmerksomhet og kompetanse rundt kvalitet og sikkerhet for deltakerne og et bredere publikum gjennom målrettede formidlingsaktiviteter i prosjektet. Prosjektet har bidratt til ny teoriutvikling og til kontekstkartleggingsverktøy til bruk for både forskere og praksisfeltet. Prosjektet har bidratt til ny kunnskap om brukerinvolvering i forskning og styrket samarbeid mellom universitetsbaserte forskere og medforskere i praksisfeltet.

The SAFE-LEAD Primary Care proposal addresses a vital component of health services research i.e. the efficiency of measures to improve service quality and safety. The proposal addresses current gap in implementation research by focusing on the influence of contextual factors in determining the effect of an quality and safety leadership intervention for healthcare managers in primary care. The leadership intervention will implement the QUASER-guide, which is an evidence based quality improvement tool for healthcare managers,developed as part of the EU FP7 funded QUASER project. The guide is based on a longitudinal study of quality and safety practices in hospitals in five European countries. The overall aim of SAFE-LEAD Primary Care is to translate, test, evaluate, and measure the effects of the intervention on quality and safety improvement knowlegde, attitudes, and practices in nursing homes and homecare. In order to do so, we will conduct a mixed-methods study in 4 nursing homes and 4 homecare services in Norwegian municipalities (rural/city, large/small service providers). A leadership intervention will be tested in different primary care contexts including a KAP survey study (knowlegde, attitudes, practice) in all participating insitutions (8),and an indept qualitative case study in 4 institutions of quality and safety leadership processes and practices. The Norwegian results will be compared with Dutch results from similar QUASER-guide implementation projects in collaboration with merited Dutch researchers. The proposal builds on the expertise and research network already developed in the FP7 QUASER consortium (2010-2013)involving researchers from University of Stavanger,Erasmus University, Netherlands and patient and relatives as co-researchers in the research team. In addition the national stakeholders: the Patient Ombudsman Vestfold, and participants from 2 Centres for Development of Institutional and Home Care Services are partners in the team.

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HELSEVEL-H-Gode og effektive helse-, omsorgs- og velferdstjenester