Quality, Resources, Safety & Satisfaction, Time (QRST): A pilot study
By Anastasia Mallidou
Background: This pilot study is based on my postdoctoral fellowship project titled: “Developing an understanding of organizational slack in healthcare sector”. There is evidence that organizational (slack) resources (e.g., staff, time, space, etc.) positively influence performance and innovation as well as staff and resident outcomes. To date, no systematic efforts have been made to support the argument that organizational slack is a resource for change. The purpose of this study was to understand how healthcare aides (HCAs) spend their working time with residents during dayshifts in a long term care unit; to explore whether there is any slack time and another way to organize HCAs time; and to measure potential changes in time spent with residents, caregiver satisfaction, and resident incidents (e.g., falls) during the study period and after the implementation of an intervention to enhance available organizational resources (i.e., slack time).
Methods: A convenience sample of 9 HCAs employed in a nursing home in the greater area of Edmonton consented to participate. Data were collected using structured observations, a short survey questionnaire, semi-structured interviews (intervention), and other sources such as incident book, and the TREC (Translating Research in Elder Care) survey. During 9 weeks in a 6-month period, 1-4 HCAs were shadowed for 5-8 hours per day-shift (approximately 700 hours in total) and observed for time spent in personal care, assisting with eating, socializing, helping residents involve in activities, paper work, networking, personal time, and other activities such as preparing and delivering trays to rooms, laundry, garbage, supplies to rooms, fill in oxygen tanks, and so on. Pre-/post-intervention measures of job satisfaction and resident incidents were taken.
Findings: During the study HCAs spent a) over 50% of their working time in resident personal care with 35% of time spent in performing 1-3 minute activities; b) less than 1% in socializing; and c) approximately 23% of time in other activities. At the end of the observational period, HCAs reported higher levels of job satisfaction, while resident falls decreased indicating that changes occurred in HCAs and resident outcomes.
Conclusions and Recommendations: The preliminary findings suggest that a) restructuring HCAs’ routine practices may minimize the 1-3 minute activities, which can be interpreted as interruptions to continuity of care. Fewer interruptions may increase the amount and quality of time with residents; and b) in-service workshops (as an intervention) may positively influence HCAs’ routine practices in improving job satisfaction, proficiency, and in developing a resident safety culture.
From 2011 Spring Communiqué
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