Conditions for successfully implementing resident-oriented care in nursing homes

ViVa! Health Care Group, Velsen, The Netherlands.
Scandinavian Journal of Caring Sciences (Impact Factor: 0.89). 04/2009; 23(2):298-308. DOI: 10.1111/j.1471-6712.2008.00623.x
Source: PubMed


This study reports an investigation of the conditions for a successful introduction of a resident-oriented care model on six somatic and psychogeriatric intervention wards in three Dutch nursing homes. This study aims to answer the following research question: 'What are the conditions for successfully implementing resident-oriented care?' To answer the research question, the organisational change process was monitored by using the '7-S' model of Peters and Waterman as a diagnostic framework. Based on this model, the following change characteristics were studied: structure, strategy, systems, staff, skills, style and shared values. Our study involved a one group pretest/post-test design. To measure the conditions for change, we operationalised the factors of the 7-S model serving as a diagnostic framework and studied their presence and nature on the intervention wards. For this purpose qualitative interviews were held with the change agents of the nursing homes and the wards' supervisors. To determine the degree of 'success' of the implementation, we measured the extent to which resident-oriented care was implemented. For this purpose a quantitative questionnaire was filled in by the nurses of the intervention wards. By relating the extent to which resident-oriented care was implemented to the differences in change conditions, we were able to distinguish the 'most' from the 'least' successful intervention ward and so, pointing out the conditions contributing to a successful implementation of resident-oriented care. The results showed that, in contrast to the least successful intervention ward, the most successful intervention ward was characterised by success conditions related to the 7-S model factors strategy, systems, staff and skills. The factor structure did not contribute to the success of the implementation. Success conditions appeared to be related to the ward level and not to the organisational or project level. Especially the supervisors' role appeared to be crucial for a successful implementation.

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    • "When implementing new regulations, authorities and work-place managers must clearly communicate the new vision that changes are designed to create [40] and ensure staff participate in the change process [40,41]. Furthermore, Berkhout et al. found that conditions for successful implementation were important at the ward level in particular, and that more attention should be given to educating nursing staff about changes [22]. The findings in our study support the need for educating nursing staff, given that only two of the nurses knew about the new regulations. "
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