Publikasjoner
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Opsal, Anne; Fossum, Mariann; Elf, Marie; Undheim, Marie & Johannessen, Terese
(2025).
Student nurses’ satisfaction and confidence: Blended learning skills training on satellite campuses.
Teaching and Learning in Nursing.
ISSN 1557-3087.
20(3),
s. e705–e712.
doi:
10.1016/j.teln.2025.02.010.
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Abstract
Background
In response to rural nursing shortages, some traditional on-campus bachelor of science in nursing degree programs have transitioned to a blended learning approach at satellite campuses. This significant shift requires an understanding of how students view the learning activities involved in skills training.
Aim
The aim of this study was to assess students in an education program in Southern Norway regarding their satisfaction in and self-confidence with skills training using blended learning. The program was hosted at satellite campuses of two universities.
Methods
For this cross-sectional study, 54 students completed a Student Satisfaction and Self-confidence in Learning scale and open-ended questions. Quantitative data were analyzed with descriptive statistics and qualitative data assessed using content analysis.
Results
Students who completed skills training reported high levels of satisfaction with the learning activities and support from their teachers. In addition, they demonstrated high self-confidence in practicing skills.
Conclusion
The current findings indicate that students appreciate blended learning strategies and the availability of skills training on satellite campuses along with supportive teaching practices.
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Lyng, Hilda Bø; Ree, Eline; Strømme, Torunn; Johannessen, Terese; Aase, Ingunn & Ullebust, Berit
[Vis alle 11 forfattere av denne artikkelen]
(2024).
Barriers and enablers for externally and internally driven implementation processes in healthcare: a qualitative cross-case study.
BMC Health Services Research.
24(1).
doi:
10.1186/s12913-024-10985-2.
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Background
Quality in healthcare is a subject in need of continuous attention. Quality improvement (QI) programmes with the purpose of increasing service quality are therefore of priority for healthcare leaders and governments. This study explores the implementation process of two different QI programmes, one externally driven implementation and one internally driven, in Norwegian nursing homes and home care services. The aim for the study was to identify enablers and barriers for externally and internally driven implementation processes in nursing homes and homecare services, and furthermore to explore if identified enablers and barriers are different or similar across the different implementation processes.
Methods
This study is based on an exploratory qualitative methodology. The empirical data was collected through the ‘Improving Quality and Safety in Primary Care – Implementing a Leadership Intervention in Nursing Homes and Homecare’ (SAFE-LEAD) project. The SAFE-LEAD project is a multiple case study of two different QI programmes in primary care in Norway. A large externally driven implementation process was supplemented with a tracer project involving an internally driven implementation process to identify differences and similarities. The empirical data was inductively analysed in accordance with grounded theory.
Results
Enablers for both external and internal implementation processes were found to be technology and tools, dedication, and ownership. Other more implementation process specific enablers entailed continuous learning, simulation training, knowledge sharing, perceived relevance, dedication, ownership, technology and tools, a systematic approach and coordination. Only workload was identified as coincident barriers across both externally and internally implementation processes. Implementation process specific barriers included turnover, coping with given responsibilities, staff variety, challenges in coordination, technology and tools, standardizations not aligned with work, extensive documentation, lack of knowledge sharing.
Conclusion
This study provides understanding that some enablers and barriers are present in both externally and internally driven implementation processes, while other are more implementation process specific. Dedication, engagement, technology and tools are coinciding enablers which can be drawn upon in different implementation processes, while workload acted as the main barrier in both externally and internally driven implementation processes. This means that some enablers and barriers can be expected in implementation of QI programmes in nursing homes and home care services, while others require contextual understanding of their setting and work.
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Lyng, Hilda Bø; Strømme, Torunn; Ree, Eline; Johannessen, Terese & Wiig, Siri
(2024).
Knowledge boundaries for implementation of quality improvement interventions; a qualitative study.
Frontiers in Health Services.
4.
doi:
10.3389/frhs.2024.1294299.
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Introduction: Implementation and adoption of quality improvement interventions have proved difficult, even in situations where all participants recognise the relevance and benefits of the intervention. One way to describe difficulties in implementing new quality improvement interventions is to explore different types of knowledge boundaries, more specifically the syntactic, semantic and pragmatic boundaries, influencing the implementation process. As such, this study aims to identify and understand knowledge boundaries for implementation processes in nursing homes and homecare services. Methods: An exploratory qualitative methodology was used for this study. The empirical data, including individual interviews (n = 10) and focus group interviews (n = 10) with leaders and development nurses, stem from an externally driven leadership intervention and a supplementary tracer project entailing an internally driven intervention. Both implementations took place in Norwegian nursing homes and homecare services. The empirical data was inductively analysed in accordance with grounded theory. Results: The findings showed that the syntactic boundary included boundaries like the lack of meeting arenas, and lack of knowledge transfer and continuity in learning. Furthermore, the syntactic boundary was mostly related to the dissemination and training of staff across the organisation. The semantic boundary consisted of boundaries such as ambiguity, lack of perceived impact for practice and lack of appropriate knowledge. This boundary mostly related to uncertainty of the facilitator role. The pragmatic boundary included boundaries related to a lack of ownership, resistance, feeling unsecure, workload, different perspectives and a lack of support and focus, reflecting a change of practices. Discussion: This study provides potential solutions for traversing different knowledge boundaries and a framework for understanding knowledge boundaries related to the implementation of quality interventions.
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Johannessen, Terese; Fossum, Mariann; Elf, Marie & Opsal, Anne
(2024).
Exploring the undergraduate nursing students' experiences and learning strategies in distance nurse education: A qualitative study.
Nurse Education Today.
ISSN 0260-6917.
146,
s. 1–7.
doi:
10.1016/j.nedt.2024.106500.
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Background Distance nurse education is an essential contribution to sustainable access for nurses in rural and remotes areas. However, distance nurse education requires pedagogical changes, and we need more knowledge to design education programmes that can accommodate students who study off-campus. Objective To explore how undergraduate nursing students experience a distance education programme. Methods A qualitative explorative design. Students in a distance nurse education programme participated in six focus group interviews from March to September 2022. Data were subjected to qualitative content analysis. Results Students had a generally positive experience of the distance nurse education programme and were especially pleased with its flexibility. The two main themes were students' sense of belonging and social interactions and their participation in learning activities. Students cited face-to-face meetings as an important factor in having a sense of community, involvement, and continuous motivation for their studies. Students found study groups to be useful for learning and progress in the study subjects. Physical teaching sessions at a non-university site facilitated and motivated them to follow live streaming of lectures at home and to collaborate online with the study group between those meetings. Social interaction with the educator and other students in physical teaching sessions was important for discussions of the subject matter and for assistance with technical challenges. A predictable timetable was essential for the students to balance time for their studies with family and work responsibilities. Conclusion Students in the distance nurse programme preferred a combination of face-to-face meetings and live streaming. Study groups contributed to motivation, understanding of the course content, and a sense of community. It also helped to improve students' collaboration skills. These students have many professional and family obligations, so a predictable course plan was important to them.
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Bovenkamp, Hester van de; Pijkeren, Nienke van; Ree, Eline; Aase, Ingunn; Johannessen, Terese & Vollaard, Hans
[Vis alle 9 forfattere av denne artikkelen]
(2022).
Creativity at the margins: A cross-country case study on how Dutch and Norwegian peripheries address challenges to quality work in care for older persons.
Health Policy.
ISSN 0168-8510.
127.
doi:
10.1016/j.healthpol.2022.12.008.
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Background Peripheral areas are often overlooked in health-care research but they in fact deserve specific attention. Such areas struggle to maintain access to good quality health-care services due to their geographical context. At the same time, new interventions or promising innovations often emerge in places where creativity is urgently needed. In this paper, we explore this creativity at the margins in older persons care organizations in peripheral areas, which other healthcare providers and policymakers can learn from. Methods This exploratory study is based on two large research projects on the quality of care for older persons in Norway and the Netherlands. We performed secondary analysis of interviews with quality managers and other quality workers and used additional document analysis and expert interviews to deepen our analysis. Results The results show that older persons care organizations working in peripheral areas must deal with a number of challenges caused by their geographical context, e.g. geographical distances (between services and to the geographical center), workforce shortages, and landscape characteristics. We found that organizations use different strategies to tackle these challenges, such as scaling up, brightening up and opening up. These strategies, conceptualized as creativity at the margins, impact quality work in different ways, for example by enabling more person-centered care. Conclusion We conclude that both policymakers and research should overcome their peripheral blindness by learning from and supporting creativity at the margins in future policies and research.
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Aase, Ingunn; Ree, Eline; Johannessen, Terese; Strømme, Torunn; Ullebust, Berit & Holen-Rabbersvik, Elisabeth
[Vis alle 10 forfattere av denne artikkelen]
(2021).
Talking about quality: how ‘quality’ is
conceptualized in nursing homes and
homecare.
BMC Health Services Research.
21.
doi:
10.1186/s12913-021-06104-0.
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Background The delivery of high-quality service in nursing homes and homecare requires collaboration and shared understanding among managers, employees, users and policy makers from across the healthcare system. However, conceptualizing healthcare professionals’ perception of quality beyond hospital settings (e.g., its perspectives, defining attributes, quality dimensions, contextual factors, dilemmas) has rarely been done. This study therefore explores the meaning of “quality” among healthcare managers and staff in nursing homes and homecare. Methods The study applies a cross-sectional qualitative design with focus groups and individual interviews, to capture both depth and breadth of conceptualization of quality from healthcare professionals in nursing homes and homecare. We draw our data from 65 managers and staff in nursing homes and homecare services in Norway and the Netherlands. The participants worked as managers (n = 40), registered nurses (RNs) or assistant nurses (n = 25). Results The analysis identified the two categories and four sub-categories: “Professional issues: more than firefighting” (subcategories “professional pride” and “competence”) and “patient-centered approach: more than covering basic needs” (subcategories “dignity” and “continuity”). Quality in nursing homes and homecare is conceptualized as an ongoing process based on having the “right competence,” good cooperation across professional groups, and patient-centered care, in line with professional pride and dignity for the patients. Conclusion Based on the understanding of quality among the healthcare professionals in our study, quality should encompass the softer dimensions of professional pride and competence, as well as a patient-centered approach to care. These dimensions should be factors in improvement activities and in daily practice.
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Aase, Ingunn; Ree, Eline; Johannessen, Terese; Holen-Rabbersvik, Elisabeth; Thomsen, Line Hurup & Strømme, Torunn
[Vis alle 11 forfattere av denne artikkelen]
(2021).
Strategies and lessons learnt from user involvement in researching quality and safety in nursing homes and homecare.
International Journal of Health Governance.
ISSN 2059-4631.
26(4),
s. 384–396.
doi:
10.1108/IJHG-05-2021-0044.
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Purpose The purpose is to share strategies, rationales and lessons learnt from user involvement in a quality and safety improvement research project from the practice field in nursing homes and homecare services. Design/methodology/approach This is a viewpoint paper summarizing how researchers and co-researchers from the practice field of nursing homes and homecare services (nurse counsellors from different municipalities, patient ombudsman and next-of-kin representatives/and elderly care organization representant) experienced user involvement through all phases of the research project. The project included implementation of a leadership intervention. Findings Multiple strategies of user involvement were applied during the project including partnership in the consortium, employment of user representatives (co-researchers) and user-led research activities. The rationale was to ensure sound context adaptation of the intervention and development of tailor-made activities and tools based on equality and mutual trust in the collaboration. Both university-based researchers and Co-researchers experienced it as useful and necessary to involve or being involved in all phases of the research project, including the designing, planning, intervention implementation, evaluation and dissemination of results. Originality/value User involvement in research is a growing field. There is limited focus on this aspect in quality and safety interventions in nursing homes and homecare settings and in projects focussing on the leadership' role in improving quality and safety.
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Johannessen, Terese; Ree, Eline; Aase, Ingunn; Bal, Roland & Wiig, Siri
(2021).
Exploring managers’ response to a quality and safety leadership
intervention: findings from a multiple case study in Norwegian nursing homes and homecare services.
BMJ Open Quality.
10(3).
doi:
10.1136/bmjoq-2021-001494.
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Background Improvement interventions would be easier to treat if they were stable and uninfluenced by their environment, but in practice, contextual factors may create difficulties in implementing and sustaining changes. Managers of healthcare organisations play an important role in quality and safety improvement. We need more research in the nursing home and homecare settings to support managers in their quality and safety improvement work. The aim of this study was to explore managers’ response to a leadership intervention on quality and safety improvement. Methods This study reports findings from the SAFE-LEAD intervention undertaken from April 2018 to March 2019. The research design was a multiple case study of two nursing homes and two homecare services in four municipalities in Norway. We used a combination of qualitative methods including interviews, workshops, observations, site visits and document analysis in our data collection that took place over a 1-year period. Results Management continuity was key for the implementation process of the quality and safety leadership intervention. In the units where stable management teams were in place, the intervention was more rooted in the units, and changes in quality and safety practice occurred. The intervention served as an arena for managers to work with quality and safety improvement. We found that the workshops and use of the leadership guide contributed to a common understanding and commitment to quality and safety improvement among the managers. Conclusions This is a longitudinal study of managers’ response to a leadership intervention targeted to improve quality and safety work in nursing home and homecare settings. Our research demonstrates how the mechanisms of stable management and established structures are crucial for quality and safety improvement activities. Management continuity is key for participating in interventions and for using the leadership guide in quality and safety work.
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Johannessen, Terese; Ree, Eline; Aase, Ingunn; Bal, Roland & Wiig, Siri
(2020).
Exploring challenges in quality and safety
work in nursing homes and home care – a
case study as basis for theory development.
BMC Health Services Research.
20.
doi:
10.1186/s12913-020-05149-x.
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Background Management, culture and systems for better quality and patient safety in hospitals have been widely studied in Norway. Nursing homes and home care, however have received much less attention. An increasing number of people need health services in nursing homes and at home, and the services are struggling with fragmentation of care, discontinuity and restricted resource availability. The aim of the study was to explore the current challenges in quality and safety work as perceived by managers and employees in nursing homes and home care services. Method The study is a multiple explorative case study of two nursing homes and two home care services in Norway. Managers and employees participated in focus groups and individual interviews. The data material was analyzed using directed content analysis guided by the theoretical framework ‘Organizing for Quality’, focusing on the work needed to meet quality and safety challenges. Results Challenges in quality and safety work were interrelated and depended on many factors. In addition, they often implied trade-offs for both managers and employees. Managers struggled to maintain continuity of care due to sick leave and continuous external-facilitated change processes. Employees struggled with heavier workloads and fewer resources, resulting in less time with patients and poorer quality of patient care. The increased external pressure affected the possibility to work towards engagement and culture for improvement, and to maintain quality and safety as a collective effort at managerial and employee levels. Conclusion Despite contextual differences due to the structure, size, nature and location of the nursing homes and home care services, the challenges were similar across settings. Our study indicates a dualistic contextual dimension. Understanding contextual factors is central for targeting improvement interventions to specific settings. Context is, however, not independent from the work that managers do; it can be and is acted upon in negotiations and interactions to better support managers’ and employees’ work on quality and safety in nursing homes and home care.
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Johannessen, Terese; Ree, Eline; Strømme, Torunn; Aase, Ingunn; Bal, Roland & Wiig, Siri
(2019).
Designing and pilot testing of a leadership intervention to improve quality and safety in nursing homes and home care (the SAFE-LEAD intervention).
BMJ Open.
9(6),
s. 1–11.
doi:
10.1136/bmjopen-2018-027790.
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Objective To describe the design of a leadership intervention for nursing home and home care, including a leadership guide for managers to use in their quality and safety improvement work. The paper reports results from the pilot test of the intervention and describes the final intervention programme. Design Qualitative design, using the participation of stakeholders. Methods The leadership guide and intervention were designed in collaboration with researchers, coresearchers and managers in nursing homes and home care organisations, through workshops and focus group interviews. The pilot test consisted of three workshops with managers working on the leadership guide, facilitated and observed by researchers, and evaluated by means of observation and focus group interviews with the participants. The analysis combined the integration of data from interviews and observations with directed content analysis. Setting Norwegian nursing homes and home care services. Participants Managers at different levels in three nursing homes and two home care services, coresearchers, and patient and next-of-kin representatives. Results The managers and coresearchers suggested some revisions to the leadership guide, such as making it shorter, and tailoring the terminology to their setting. Based on their suggestions, we modified the intervention and developed learning resources, such as videos demonstrating the practical use of the guide. Evaluation of the pilot test study showed that all managers supported the use of the guide. They adapted the guide to their organisational needs, but found it difficult to involve patients in the intervention. Conclusions A participatory approach with stakeholders is useful in designing a leadership intervention to improve quality and safety in nursing homes and home care, although patient participation in its implementation remains difficult. The participatory approach made it easier for managers to adapt the intervention to their context and to everyday quality and safety work practice.
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Wiig, Siri; Aase, Karina; Johannessen, Terese; Holen-Rabbersvik, Elisabeth; Hurup-Thomsen, Line & Bovenkamp, Hester van de
[Vis alle 8 forfattere av denne artikkelen]
(2019).
How to deal with context? A context-mapping tool for quality and safety in nursing homes and homecare (SAFE-LEAD Context).
BMC Research Notes.
12,
s. 1–8.
doi:
10.1186/s13104-019-4291-3.
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Objective The objective of this paper is to develop a context-mapping tool (SAFE-LEAD Context) adapted to the nursing home and homecare setting. These two contexts represent a substantial variability, but studies focusing on the types and roles of contextual factors in quality and safety in these care settings are lacking. Results We conducted a step-wise collaborative design process consisting of mapping of key contextual factors as perceived by managers in Norwegian nursing homes and homecare, then created a draft tool discussed in a consortium workshop with co-researchers, and ran an international cross-country comparison. The SAFE-LEAD Context tool is inspired by the Consolidated Framework for Implementation Research (CFIR). The tool incorporates factors describing the outer setting of nursing homes and homecare at the national and local levels, in addition to factors describing the inner setting. The tool is flexible yet more detailed than current frameworks and capable of grading and describing the included contextual factors over time in the nursing home and homecare settings. A systematic approach using the SAFE-LEAD Context tool will support and improve the understanding and evaluation of quality and safety improvement interventions.
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Ree, Eline; Johannessen, Terese & Wiig, Siri
(2019).
How do contextual factors influence quality and safety work in the Norwegian home care and nursing home settings? A qualitative study about managers’ experiences.
BMJ Open.
9(7).
doi:
10.1136/bmjopen-2018-025197.
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Objective Although many contextual factors can facilitate or impede primary care managers’ work with quality and safety, research on how these factors influences the managers’ continuous improvement efforts is scarce. This study explored how primary care managers experience the impact of a variety of contextual factors on their daily quality and safety work. Design The study has a qualitative design. Nine semistructured qualitative interviews were conducted at the participants’ workplaces. Systematic text condensation was used for analysis. Setting Five nursing homes and three home care services in Norway. Participants Female primary care managers at different levels, working in different units and municipalities varying in size and location. Results The participants cited the lack of time and money as a significant impediment to quality and safety, and these resources had to be carefully allocated. They emphasised the importance of networks and competence for their quality and safety work. Delegation of responsibility among employees helped create engagement, improved competence and ensured that new knowledge reached all employees. External guidelines and demands helped them to systematise their work and explain the necessity of quality and safety work to their employees, if they were compliant with daily clinical practice in the organisation. Conclusions Numerous contextual factors influence the managers by determining the leeway that they have in quality and safety work, by setting the budgetary constraints and defining available competence, networks and regulation. At first glance, these factors appear fixed, but our findings underscore the importance of primary care managers acting on and negotiating the environment in which they conduct their daily quality and safety work. More research is needed to understand how these managers strategise to overcome the impediments to quality and safety.
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Wiig, Siri; Ree, Eline; Johannessen, Terese; Strømme, Torunn; Storm, Marianne & Aase, Ingunn
[Vis alle 13 forfattere av denne artikkelen]
(2018).
Improving quality and safety in nursing
homes and home care: the study
protocol of a mixed-methods research
design to implement a leadership
intervention.
BMJ Open.
8:e020933(3),
s. 1–8.
doi:
10.1136/bmjopen-2017-020933.
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Introduction Nursing homes and home care face challenges across different countries as people are living longer, often with chronic conditions. There is a lack of knowledge regarding implementation and impact of quality and safety interventions as most research evidence so far is generated in hospitals. Additionally, there is a lack of effective leadership tools for quality and safety improvement work in this context. Methods and analysis The aim of the ‘Improving Quality and Safety in Primary Care—Implementing a Leadership Intervention in Nursing Homes and Homecare’ (SAFE-LEAD) study is to develop and evaluate a research-based leadership guide for managers to increase quality and safety competence. The project applies a mixed-methods design and explores the implications of the leadership guide on managers’ and staffs’ knowledge, attitudes and practices. Four nursing homes and four home care services from different Norwegian municipalities will participate in the intervention. Surveys, process evaluation (interviews, observations) and document analyses will be conducted to evaluate the implementation and impact of the leadership intervention. A comparative study of Norway and the Netherlands will establish knowledge of the context dependency of the intervention. Ethics and dissemination The study is approved by the Norwegian Centre for Research Data (2017/52324 and 54855). The results will be disseminated through scientific articles, two PhD dissertations, an anthology, presentations at national and international conferences, and in social media, newsletters and in the press. The results will generate knowledge to inform leadership practices in nursing homes and home care. Moreover, the study will build new theory on leadership interventions and the role of contextual factors in nursing homes and home care.
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Johannessen, Terese; Ree, Eline; Wiig, Siri; Bovenkamp, Hester van de & Bal, Roland
(2018).
Reviewing macro level factors for understanding quality and patient safety improvements effort across countries.
I Haugen, Stein; Barros, Anne; Gulijk, Coen van; Kongsvik, Trond & Vinnem, Jan Erik (Red.),
Safety and Reliability – Safe Societies in a Changing World. Proceedings of ESREL 2018, June 17-21, 2018, Trondheim, Norway.
CRC Press.
ISSN 9781351174657.
s. 205–213.
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Aase, Ingunn; Ree, Eline; Wiig, Siri & Johannessen, Terese
(2022).
Ikke bare forskere forsker.
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Johannessen, Terese & Aase, Ingunn
(2021).
Episode nr. 5:Sammenhengen mellom lederguiden og lederforskriften.
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Johannessen, Terese
(2020).
Stress, press og andre utfordringer: tre steg til bedre kvalitet i helsetjenesten.
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Johannessen, Terese
(2020).
Forbedring av kvalitet og sikkerhet i sykehjem og hjemmetjenester.
[Journal].
Lister 24 .
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Johannessen, Terese & Sneberg, Cathrine
(2020).
Tre steg til bedre kvalitet i sykehjem og hjemmetjenesten.
www.forskning.no.
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Johannessen, Terese; Ree, Eline; Wiig, Siri; Bovenkamp, Hester van & Bal, Roland
(2018).
Reviewing macro level factors as a foundation for understanding quality and patient safety improvement efforts across countries.
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Johannessen, Terese & Wiig, Siri
(2017).
SAFE LEAD Primary Care.
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Informasjonsutveksling med helsedirektoratet angående forbedring av kvalitet og sikkerhet i norske kommuner og pågående kvalitetsprosjekter i kommunene. Diskusjon om mulig samarbeid.
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Ree, Eline; Strømme, Torunn; Wiig, Siri & Johannessen, Terese
(2017).
The role of contextual factors for quality improvement work in nursing homes and home care services.
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Johannessen, Terese
(2017).
Exploring the role of managers in improving quality and safety in nursing homes.
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Johannessen, Terese; Wiig, Siri & Ree, Eline
(2022).
Exploring the role of managers in quality and safety work in nursing homes and homecare services: A multiple case study.
Universitetet i Stavanger.
ISSN 9788284390628.
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Introduction: Working on quality and safety in nursing home and homecare services is difficult. Ever-increasing demands from an ageing population and political pressure to keep patients at home are among the challenges facing nursing homes and homecare. There is less knowledge of patient safety risks and adverse events in primary care than in specialised healthcare. Aim: This thesis explores the role of managers in quality and safety work in nursing homes and homecare services. Moreover, the thesis designs, implements, and evaluates a leadership intervention in nursing homes and homecare services to support managers’ quality and safety work. Methods: This study was designed as a two-phase longitudinal multiple case study consisting of design and pilot testing; and implementation and evaluation of the SAFE LEAD intervention. The intervention is based on a leadership guide and includes several workshops and learning activities facilitated by researchers. In phase 1, the intervention was designed with researchers, co-researchers and managers from two nursing homes and one homecare service. The pilot test of the leadership intervention was conducted in one nursing home and one homecare service. Data collection consisted of focus group interviews and observation of managers. Phase 2 started by exploring quality and safety challenges as perceived by managers and employees in two nursing homes and two homecare services prior to participation in the leadership intervention. The study then continued with a longitudinal study of the implementation and evaluation of the leadership intervention and its influence on managers quality and safety work. Data collection in phase 2 included focus group interviews, observations, workshops and site visits with managers and employees. Data analyses in phases 1 and 2 included deductive content analysis and interweaving of observation and interview data. Results: The results describe all activities from development to evaluation of a leadership intervention and its influence on managers’ quality and safety improvement work in nursing homes and homecare services. Paper I detailed the involvement of stakeholders and demonstrated how a participatory approach was important for adaptations of a leadership guide to nursing home and homecare contexts. An intervention that managers could use in their work practice was developed and pilot tested in one nursing home and one homecare service. A key finding in Paper I is the role of context and the need to tailor intervention material (web and booklet) to the context and to the needs, time constraints, language, and interests of managers. Paper II explored managers’ and employees’ perceptions of quality and safety challenges in two nursing homes and two homecare services before the intervention took place. Managers and employees found that quality and safety challenges depended on several factors and implied multiple trade-offs. Managers struggled with external change processes, budget cuts that affected common understanding of and commitment to quality and safety improvement at managerial and staff levels. Paper III showed that the intervention workshops and leadership guide contributed to a common understanding and commitment to quality and safety in the management teams. The leadership intervention influenced managers’ work practice in different ways depending on capacity and needs in the organisations. The leadership guide and the workshops created a social and reflexive arena for quality and safety work in which managers could focus on these topics. Moreover, it provided the managers with a tool for clearer sense of quality and safety work in different settings. Managers found it important that someone established a structure and took responsibility for scheduling and organising quality meetings. However, management continuity and the establishment of structures were crucial for the intervention to be adopted. Conclusion: The longitudinal insight in this thesis broadens the understanding of contextual impact on quality and safety work in nursing homes and homecare services and showed the comprehensive work with translating knowledge into practice. The thesis demonstrates the importance of participatory approach and involvement of stakeholders when designing a leadership intervention. Managers and employees perceived interrelated quality and safety challenges and found context work to be time consuming to make quality and safety improvement common efforts in the organisations. The leadership intervention created a place for reflection for managers and brought a more structured process and commitment to organisational quality and safety work.
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16. apr. 2024 11:06
