Management and Leadership
Quality management
approaches focusing on quality of structures, processes and results of LTC providers
COUNTRY / LOCATION: Germany
Keywords: outcome indicators, residential care, quality, care home
Keywords: outcome indicators, residential care, quality, care home
Outcome indicators for rating the quality of care provided by care homes for older people
Summary
The overall aim of the project was to identify appropriate and scientifically valid outcome indicators for care homes. Not enough attention has been focused on outcome indicators for quality of care in LTC institutions in Germany, compared to the quality of structures and processes. This applies to both external quality controls and internal quality management systems. To rectify this, representatives of organisations in the Federal Association of Non-statutory Welfare and those representing private and local service provider associations at federal level secured funding from the Federal Ministry of Health and the Federal Ministry of Family Affairs, Senior Citizens, Women and Health. The project idea was stimulated by the desire to build on current internal quality management efforts and develop general standards for German LTC institutions. A further aim was to signal to the market their allegiance to quality care and subsequently generate new business contacts.
In the course of this project, quality indicators and tools were developed in order to measure and rate quality of care in a reliable manner. Indicators were tested during a ten-month period in 46 care homes. Voluntary, not for profit, private and public institutions participated.
The results of the project have been widely accepted among experts as future standards for outcome measurement; national implementation is pending.
What is the main benefit for people in need of care and/or carers?
There are now thoroughly tested methods on how the quality of care and residents' life in long-term care institutions can be reliably measured and rated: this indicator system will provide reliable statements on quality of care outcomes in full-time care institutions that can be used to improve care.
In addition, the satisfaction levels of relatives with regard to the care provided by institutions are recorded in an extra part of the questionnaire. This information can also be used for improvements to care.
What is the main message for practice and/or policy in relation to this sub-theme?
This system will allow outcomes to be compared across institutions. It also allows the focus of attention to be more keenly placed on the person in need of care and enables long-term care institutions to be benchmarked.
Why was this example implemented?
This project aimed to provide a scientifically grounded and practical set of tools through which outcomes related to quality of residential care of older people could be 'measured', rated and compared. Hitherto, in Germany standards of measuring care quality are existing (and legally anchored), but they are limited to structural and procedural quality indicators. Therefore, it seemed necessary to develop outcome quality criteria that are suitable for external quality assessments and internal quality management of institutions, or comparison between institutions.
In addition, there was a need to develop a system that reflected a more a comprehensive concept of quality of care which included health and social aspects of quality of life and self-reliance of the residents.
Description
The Federal Ministry of Health and the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (Division 305) commissioned this research. The project was implemented from December 2008 to November 2010 with two collaborating research institutes: the Institute of Nursing Science at the Bielefeld University (IPW) and the Institute for Social Research and Social Policy (ISG). The steering group consisted of representatives from: care providers from a range of institutions.
The first stage of the project consisted of examining which quality criteria/outcome indicators worked well in research and practice and how they were recorded or rated. This was the basis on which a new set of tools was developed. They were field-tested throughout the entire Federal Republic of Germany in 46 care homes, and experiences were gathered and improvements made. The care homes participating in the project were sponsored by voluntary, not for profit, private, and municipal bodies.
The resulting indicators were divided into the following categories:
- Health-related indicators in three areas: maintenance and support for independence; prevention of illness or disability; assistance with special needs - and an additional 15 indicators, such as 'maintenance and improvement of mobility', ‘prevention of pressure sores', and 'use of patient restraint straps'.
- Indicators for identifying aspects of quality of life in two areas: housing and housekeeping assistance; daytime activities and social relations - and 11 additional indicators, such as 'cleanliness and odour' and 'risk of social deprivation'.
- There were several indicators developed to address the quality of care concerning the links and interfaces of services; they included for example measurement of informal carers’ involvement (informal carers’ rating of the institution), the use of shared documentation, or whether current and future care had been planned with the resident and his/her informal carers.
In accordance with the Charter on the Rights of people in Need of Assistance and Care, the quality of the resident's life is foremost when rating the quality of care.
A well-structured data collection method is needed. Most of the data can either be retrieved from the long-term care files of the respective residents or from data gathered by the Health Insurance Medical Service, so that agencies do not have to collect large amounts of additional data.
However, such an indicator-based system requires completed surveys of residents, using techniques that are in line with specific rules and conducted at regular intervals; and software developments are required for their evaluation.
What are/were the effects?
The aim of the project which was to select and test a set of scientifically valid indicators to measure outcome quality in German care homes was achieved successfully. Among experts the results of the research project are seen as an important contribution to rate the outcome quality in the central areas of residential care.
The outcomes of the project may promote the development of internal quality at institutions and also provide an important basis for quality assessments by external institutions as well as for the quality reporting which has been legally stipulated in Social Code Book XI.
According to the ideas developed in the course of this project, a collaboration of internal quality management and external audits could be useful. The identification and recording of indicators by written surveys among informal carers can be achieved quite easily (and has already been implemented by many institutions).
The area wide implementation of the indicators is pending. There are discussions to replace currently applied ‘transparency criteria’ in the future by the new outcome indicators and to anchor them in a prospective revision of LTC insurance law.
In addition, the percentage of informal carers who rated the cooperation with the respective institution as positive was recorded.
An application of the findings to the field of outpatient care is not possible due to the different conditions.
Starting out from the work of the steering group, the Federal Ministry of Health and the Federal Ministry for Family Affairs, Senior Citizens, Women and Health will continue the purposeful cooperation with other members of the steering group and with further associations.
What are the strengths and limitations?
Strengths
- The main achievement of the project is the development of a set of scientifically constructed and evaluated outcome indicators for measuring quality of care.
- With the help of such a system, outcomes for quality of care can finally be placed in the centre of quality assurance and quality assessment.
- The indicators increase institutional responsibilities and will provide a strong incentive for them to ensure “high quality care" in the interest of their residents.
Weaknesses
- Area wide implementation has not yet happened and will need to be taken forward in the future in order to sustain momentum. It is unclear how this can be supported at present.
Opportunities
- The resulting battery of indicators is being discussed among experts to be implemented as a standard to inspect and benchmark the quality of German care homes.
- The most important effects for the residents will be the strengthening and improvement of internal quality management, which is of vital significance for sustainable quality assurance.
- Further research and pilot projects will be necessary, since the project group itself reported some thematic fields that could not be covered within the present project, but might nevertheless be crucial for residential care quality (e.g. palliative care aspects).
Credits
Author: Petra Weritz-Hanf, Ministerialrätin Division 306: Health in Old Age, Assistance in Cases of Dementia, Federal Ministry for Family Affairs, Senior Citizens, Women and YouthReviewer 1: Roelf van der Veen
Reviewer 2: Ricardo Rodriguez
Verified by:
Links to other INTERLINKS practice examples
- Geriatric Network and Geriatric Academy Brandenburg
- RAI-benchmarking: An instrument for leadership and development
- The E-Qalin quality management system
External Links and References
- University of Bielefeld, Institute for Nursing Sciences (German)
- Bundesministerium für Gesundheit & Bundesministerium für Familie, Senioren, Frauen und Jugend (Hg.) (2011) Entwicklung und Erprobung von Instrumenten zur Beurteilung der Ergebnisqualität in der stationären Altenhilfe (Abschlussbericht). Berlin: BMG/BMFSFJ.
