Importance of Team Functioning as a Target of Quality Improvement Initiatives in Nursing Homes: A Qualitative Process Evaluation

Introduction: Quality improvement interventions demonstrate variable degrees of effectiveness. The aim of this work was to (1) qualitatively explore whether, how, and why an academic detailing intervention could improve evidence uptake and (2) identify perceived changes that occurred to inform outcomes appropriate for quantitative evaluation. Methods: A qualitative process evaluation was conducted involving semistructured interviews with nursing home staff. Interviews were analyzed inductively using the framework method. Results: A total of 29 interviews were conducted across 13 nursing homes. Standard processes to reduce falls are well-known but not fully implemented due to a range of mostly postintentional factors that influence staff behavior. Conflicting expectations around professional roles impeded evidence uptake; physicians report a disconnection between the information they would like to receive and the information communicated; and a high proportion of casual and part-time staff creates challenges for those looking to effect change. These factors are amenable to change in the context of an active, tailored intervention such as academic detailing. This seems especially true when the entire care team is actively engaged and when the intervention can be tailored to the varied determinants of behaviors across different team members. Discussion: Interventions aiming to increase evidence-based practice in the nursing home sector need to move beyond education to explicitly address team functioning and communication. Variability in team functioning requires a flexible intervention with the ability to tailor to individual- and home-level needs. Evaluations in this setting may benefit from measuring changes in team functioning as an early indicator of success.

• Publication year

  2019

• Venue

  Journal of Continuing Education in the Health Professions

• Publication date

  2019-02-21

• Fields of study

  Medicine

• Identifiers
  DOI 10.1097/CEH.0000000000000238PMID 30789377PMCID 6400643
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Association of a Communication Training Program With Use of Antipsychotics in Nursing Homes

  2017cited by this paper
• Improving the appropriateness of antipsychotic prescribing in nursing homes: a mixed-methods process evaluation of an academic detailing intervention

  2017cited by this paper
• What we know about designing an effective improvement intervention (but too often fail to put into practice)

  2016cited by this paper
• Appropriate prescribing in nursing homes demonstration project (APDP) study protocol: pragmatic, cluster-randomized trial and mixed methods process evaluation of an Ontario policy-maker initiative to improve appropriate prescribing of antipsychotics

  2015cited by this paper
• Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews

  2015cited by this paper
• Quality of care and long-term care administrators’ education: Does it make a difference?

  2015cited by this paper
• The Hidden Complexity of Long-Term Care: how context mediates knowledge translation and use of best practices.

  2014cited by this paper
• Implementation of Mental Health Huddles on Dementia Care Units*

  2014cited by this paper
• Explaining the Success or Failure of Quality Improvement Initiatives in Long-Term Care Organizations From a Dynamic Perspective

  2014cited by this paper
• The evolving role of health care aides in the long-term care and home and community care sectors in Canada

  2013cited by this paper
• Using the framework method for the analysis of qualitative data in multi-disciplinary health research

  2013cited by this paper
• The use of data for process and quality improvement in long term care and home care: a systematic review of the literature.

  2012cited by this paper
• Medication reconciliation during the transition to and from long-term care settings: a systematic review.

  2012cited by this paper
• Shared mental models of integrated care: aligning multiple stakeholder perspectives.

  2012cited by this paper
• Residential long-term care: public solutions to access and quality problems.

  2011cited by this paper
• Qualitative data analysis: the framework approach.

  2011cited by this paper
• Interventions for preventing and reducing the use of physical restraints in long-term geriatric care.

  2011cited by this paper
• Role understanding and effective communication as core competencies for collaborative practice

  2009cited by this paper
• Impact of medical director certification on nursing home quality of care.

  2009cited by this paper
• Implementation Matters: A Review of Research on the Influence of Implementation on Program Outcomes and the Factors Affecting Implementation

  2008cited by this paper
• Effective interprofessional teams: “Contact is not enough” to build a team

  2008cited by this paper
• Interprofessional education: effects on professional practice and health care outcomes.

  2008cited by this paper
• Team training and stroke rehabilitation outcomes: a cluster randomized trial.

  2008cited by this paper
• Educational outreach visits: effects on professional practice and health care outcomes.

  2007cited by this paper
• Utility of Treatment Implementation methods in clinical trial with rehabilitation teams.

  2007cited by this paper
• Multidisciplinary teamwork in US primary health care.

  2007cited by this paper
• Collaboration, credibility, compassion, and coordination: professional nurse communication skill sets in health care team interactions.

  2006cited by this paper
• Falls and their prevention in elderly people: what does the evidence show?

  2006cited by this paper
• Team functioning and patient outcomes in stroke rehabilitation.

  2005cited by this paper
• Estimating Intervention Effectiveness: Synthetic Projection of Field Evaluation Results

  2005cited by this paper
• Realistic Evaluation

  2004cited by this paper
• Can health care teams improve primary care practice?

  2004cited by this paper
• The Role of Perceived Team Effectiveness in Improving Chronic Illness Care

  2004cited by this paper
• Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project.

  2002cited by this paper
• Forming professional identities on the health care team: discursive constructions of the ‘other’ in the operating room

  2002cited by this paper
• Practical Strategies for Combining Qualitative and Quantitative Methods: Applications to Health Research

  1998cited by this paper
• Shared mental models in expert team decision making.

  1993cited by this paper
• Principles of educational outreach ('academic detailing') to improve clinical decision making.

  1990cited by this paper
• Improving Drug-Therapy Decisions through Educational Outreach

  1983cited by this paper
• Improving drug-therapy decisions through educational outreach. A randomized controlled trial of academically based "detailing".

  1983cited by this paper
• Research methods in social relations

  1961influential reference
• Additional File 5: Brennan Et Al Measuring Team Factors Thought to Influence the Success of Quality Improvement in Primary Care: a Systematic Review of Instruments Table S7: Characteristics of Instruments Included for Review of Measurement Properties (stage Four)

  year unknowncited by this paper

• Examining and Evaluating Team Science Competencies Through Sensemaking

  2025cites this paper
• Insights Into How Digital Health Interventions Shape Outcomes for Emerging Adults Living With Type 1 Diabetes: Qualitative Realist Process Evaluation

  2025cites this paper
• Audit and group feedback in nursing home physician groups: lessons learned from a qualitative study

  2025cites this paper
• Factors Influencing Interprofessional Quality Improvement in Nursing Homes: A Systematic Review.

  2025cites this paper
• Factors influencing interprofessional collaboration in general and during multidisciplinary team meetings in long-term care and geriatric rehabilitation: a qualitative study

  2024cites this paper
• DEMATEL and ISM analysis of factors influencing coal spontaneous combustion in longwall gobs

  2024cites this paper
• Knowledge and culture influences on quality of care: A mixed methods approach

  2024cites this paper
• Understanding Whether and How a Digital Health Intervention Improves Transition Care for Emerging Adults Living With Type 1 Diabetes: Protocol for a Mixed Methods Realist Evaluation

  2023cites this paper
• The Perioperative Pain Management Bundle is Feasible

  2023cites this paper
• Understanding health information exchange processes within Canadian long-term care: A scoping review.

  2022cites this paper
• Interprofessional Collaboration in Long-Term Care and Rehabilitation: A Systematic Review.

  2022cites this paper
• Contextual factors influencing complex intervention research processes in care homes: a systematic review and framework synthesis

  2022cites this paper
• Towards Better Perioperative Pain Management in Mexico: A Study in a Network of Hospitals Using Quality Improvement Methods from PAIN OUT

  2021cites this paper
• Individual and Organizational Conditions Leading to Quality of Care in Healthcare: A Fuzzy-Set Qualitative Comparative Analysis

  2021influential citation
• Barriers and facilitators to implementing evidence-based guidelines in long-term care: a qualitative evidence synthesis

  2021cites this paper
• Improving antibiotic initiation and duration prescribing among nursing home physicians using an audit and feedback intervention: a theory-informed qualitative analysis

  2021cites this paper
• Perceived Impacts of Solution-Focused Coaching Training for Pediatric Rehabilitation Practitioners: A Qualitative Evaluation

  2021cites this paper
• Effect of Academic Detailing on Promoting Appropriate Prescribing of Antipsychotic Medication in Nursing Homes

  2020cites this paper
• Facilitators and Barriers Surrounding the Role of Administration in Employee Job Satisfaction in Long-Term Care Facilities: A Systematic Review

  2020cites this paper