Solving major social challenges will require both perseverance and innovation. Social sector organizations that have a high capacity for continuous, productive innovation are better able to respond to change and sustain their impact in the long-term. What does the Rockefeller Foundation mean by innovation?
Measurement tools, quality standards, and external oversight mechanisms all are important for providing quality care, but they do not ensure a capacity to use the measures correctly, implement the standards effectively, or respond to oversight as intended.
Specifically, it discusses the needed technology and resources that are generally not present in long-term care settings, ways to improve organizational capacity, and the effectiveness of the guidelines and quality management initiatives in long-term care. Although this chapter focuses mostly on nursing homes, many of the issues discussed are applicable directly or with some adaptation to those providing services in other long-term care settings, such as residential care facilities and home health care.
These initiatives include the following: Regulatory standards articulated in OBRA 87 have provided nursing homes with a specific definition of quality e. One effect was to focus nursing homes on their residents and on achievable quality.
Standardized clinical information systems have been developed in the form of the MDS.
This data set is designed to help nursing homes organize their clinical activities to meet regulatory expectations for quality of care. Evidence-based practice guidelines, Increasing organization capacity provide the best scientific advice available on how to treat common health problems, have been developed for some long-term care settings and common geriatric conditions e.
These guidelines bridge the gap between the clinical research literature and the providers, often in algorithms or steps to guide assessment and treatment and thus lead to better outcomes.
Some nursing homes have embraced improvement philosophies and methods that have primarily been successful in settings outside of health care.
These quality improvement systems focus on consumer perspectives and preferences, organize staff efforts Increasing organization capacity care processes, and guide management activities.
Taken together, these four initiatives logically begin with policies to define goals for better nursing home care and they help providers meet these goals. The logic of this approach tempts a generalization to other long-term care settings.
However, there is no strong evidence that these approaches have solved major quality problems in nursing home care. This chapter focuses on the evidence about the effectiveness of practice guidelines, initiatives in quality management systems in long-term care, and the limitations of organizational capacity to translate knowledge into improved care.
Practice guidelines were developed with the hope that they would improve health outcomes and, often more importantly, contain costs see, e.
They try to make user-friendly synthesis of evidence available to providers who are unable to evaluate broad scientific and clinical literature.
Accordingly, health care organizations are using careful evidence-based processes to develop guidelines. Unfortunately, studies of acute and primary care report limited implementation of guidelines, although they have also begun to identify barriers to their use and propose ways of overcoming them see, e.
Although long-term care is less studied than acute care, guidelines appear neither routinely nor effectively implemented by nursing home providers, nor widely known by direct care nursing home staff. However, like practice guidelines, it is difficult to demonstrate objectively that quality management systems have significantly improved nursing home care.
Even though originally developed for the industrial sector, they are being increasingly adopted by health care organizations Berwick, ; Laffel and Blumenthal, ; IOM, ; Blumenthal and Kilo, ; Shortell et al.
Quality management principles include the following: However, there are only anecdotal reports by nursing home providers that quality improvement systems have been implemented or that implementation has resulted in improved outcomes. Moreover, this anecdotal evidence is contradicted by two studies that used controlled designs to evaluate the effectiveness of continuous quality improvement interventions McKenna et al.
The Ohio pressure ulcer project reported no improvement in pressure ulcers McKenna et al. The incontinence study Schnelle et al.
The researchers concluded that although practice guidelines could be implemented to improve outcomes, such improved outcomes did not in themselves provide sufficient incentive for nursing homes to maintain the program without the external monitoring and consultation provided by research staff.
Limited trained staff time and organizational capacity are a barrier to improved performance in nursing homes.
The improvement principles mentioned above are demanding to implement, even in organizations that are relatively rich in resources and expertise, which most long-term care organizations are not.
Most applications and most research on quality management have focused on hospitals. A recent review of the literature by Shortell and colleagues revealed some evidence of improved outcomes and reduced costs in clinical care from quality improvement techniques.
It did not find evidence of organization-wide improvements in clinical performance. Another recent review suggested that in studied hospitals, the techniques had little impact on organizational culture Gerowitz, The missing components are the number and competence of staff and the amount and type of needed resources.
OBRA 87 regulations, practice guidelines, and quality management systems fail to emphasize these critical capacity issues, perhaps because the technical expertise of long-term care providers and the necessary tangible resources are assumed.
Practice guidelines, for example, provide specific recommendations about how to treat nursing home residents based on the best knowledge available in the clinical research literature. None of the guidelines, however, include a description either of the personnel necessary to implement recommended treatment steps or of the implementation costs Schnelle et al.devise ways to increase and strengthen its capacity.
Indeed, capacity building must rest on the notion that change is the norm and not a passing anomaly (Amherst H. Wilder Foundation ).
This paper develops a conceptual model for thinking about effective ways to build the capacity of nonproﬁts.
devise ways to increase and strengthen its capacity. Indeed, capacity building must rest on the notion that change is the norm and not a passing anomaly (Amherst H.
Wilder Foundation ). This paper develops a conceptual model for thinking about effective ways to build the capacity of nonproﬁts. Capacity building is not just about the capacity of a nonprofit today -- it's about the nonprofit’s ability to deliver its mission effectively now, and in the future.
Capacity building is an investment in the effectiveness and future sustainability of a nonprofit. Specifically, it discusses the needed technology and resources that are generally not present in long-term care settings, ways to improve organizational capacity, and the effectiveness of the guidelines and quality management initiatives in long-term care.
Increasing Organizational Capacity 2 organizations and treats them as if they were a lower form of simple organism. The result is a tendency to reduce the public discourse regarding K education to the.
IncreasIng OrganIzatIOn capacIty IntrOductIOn Course outline • This course provides an overview of the strategies and tools necessary for the development of effective, long‐lasting organizational capacity in project management.