The quality of nursing home care has long been a cause for concern. The federal government has recently launched the Nursing Home Quality Initiative, in which Quality Improvement Organizations assist nursing homes in quality improvement (QI) activities. In addressing how well nursing homes are prepared for QI, this article examines the sort of QI activities that nursing homes are currently undertaking and the preparation of Administrators and Directors of Nursing to lead QI efforts. Drawing on data from surveys of 2 random samples of Kansas nursing homes, the article concludes that questions about QI activities in nursing homes tend to elicit socially acceptable answers unless the questions are carefully structured; that few nursing homes appear to have functioning QI programs; and that high leadership turnover and limited leadership training make it difficult for nursing homes to sustain effective QI programs.
Department of Health and Human Services. HHS releases quality data about individual nursing homes: pilot project in six states to help consumers make informed health decisions, 2002. Available at: http://www.hhs.gov/news/press/2002pres/20020424.html. Accessed July 22, 2002.
2.
United States Senate. The Condition of American Nursing Homes. A Study by the Subcommittee on Problems of the Aged and Aging. Committee on Labor and Public Welfare. Washington, DC: US Government Printing Office;1960.
3.
Harrington C, Carrillo H. The regulation and enforcement of federal nursing home standards, 1991-1997. Med Care Res Rev. 1999;56:471-494.
4.
Castle NG. Nursing homes with persistent deficiency citations for physical restraint use. Med Care. 2002;40:868-878.
5.
Berlowitz DR, Bezerra HQ, Brandeis GH, et al.Are we improving the quality of nursing home care? The case of pressure ulcers. J Am Geriatr Soc. 2000;48:59-63.
6.
Castle NG, Mor V. The use of physical restraints in nursing homes: a review of the literature since the nursing home reform act of 1987. Med Care Res Rev. 1999;55:139-170.
7.
Zinn JS, Brannon D, Weech R. Quality improvement in nursing care facilities: extent, impetus, and impact. Am J Med Qual. 1997;12:51-61.
8.
Schnelle JF, Newman D, White M, et al.Maintaining continence in nursing home residents through the application of industrial quality control. Gerontologist. 1993;33:114-121.
9.
Ray WA, Taylor JA, Meador KG, et al.A randomized trial of a consultation service to reduce falls in nursing homes. JAMA. 1997;278:557-562.
10.
Schnelle JF, McNees P, Crooks V, et al.The use of a computer-based model to implement an incontinence management program. Gerontologist. 1995;35:656-665.
11.
Frantz RA, Gardner S. Specht JK, et al.Integration of pressure ulcer treatment protocol into practice: clinical outcomes and care environment attributes. Outcomes Manag Nurs Pract. 2001;5: 112-120.
12.
Rantz MJ, Popejoy L, Petroski GF, et al.Randomized clinical trial of a quality improvement intervention in nursing homes. Gerontologist. 2001;41:525-538.
13.
Castle NG. Administrator turnover and quality of care in nursing homes. Gerontologist. 2001;41:757-767.
14.
Singh DA, Schwab RC. Predicting turnover and retention in nursing home administrators: management and policy implications. Gerontologist. 2000;40:310-319.
15.
Larsen PD. Factors influencing retention of directors of nursing at rural long-term care facilities. What difficulties do rural LTC facilities face in attracting and retaining qualified NA/DONs?Geriatr Nurs. 1993;14:261-264.
16.
Gifford DR, Patry G. Role of the PRO Program to Improve Nursing Home Quality. Providence, RI: Rhode Island Quality Partners;2002.
17.
Plsek PE. Quality improvement methods in clinical medicine. Pediatrics. 1999;103(suppl):203-214.
18.
Rondeau KV, Wagar TH. Organizational learning and continuous quality improvement: examining the impact on nursing home performance. Health Manage Forum. 2002;15:17-23.
19.
McLaughlin CP, Kaluzny AD, eds. Continuous Quality Improvement in Health Care: Theory, Implementation, and Applications. Gaithersburg, Md: Aspen Publishers, Inc;1999.
20.
Carey RG, Lloyd RC. Measuring Quality Improvement in Healthcare. New York: Quality Resources;1995.
21.
Hayes BE. Measuring Customer Satisfaction. Milwaukee, Wis: ASQC Quality Press;1992.
22.
Ford RC, Bach SA, Fottler MD. Methods of measuring patient satisfaction. Health Care Manage Rev. 1997;22:74-89.
23.
Irvine D, Evans MG. Job satisfaction and turnover among nurses: integrating research findings across studies. Nurs Res. 1995; 44:246-253.
24.
Goodell TT, Van Ess Coeling H. Outcomes of nurses' job satisfaction. J Nurs Adm. 1994;24:36-41.
Lighter DE. Group processes in health care quality improvement. In: Lighter DE, Fair DC, eds. Principles and Methods of Quality Management in Health Care. Gaithersburg, Md: Aspen Publishers, Inc;2000:11-36.
27.
Buerhaus PI, Norman L. It's time to require theory and methods of quality improvement in basic and graduate nursing education. Nurs Outlook. 2001;49:67-69.
28.
Bureau of Labor Statistics. Occupational outlook handbook, 2002. Available at: http://www.bls.gov/oco/ocosO14.htm%23training. Accessed September 12, 2002.
