Exploring the role of managers in quality and safety work in nursing homes and homecare services: A multiple case study

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

Development of computer software support for interpretive structural modelling

Includes bibliographical references.Interpretive Structural Modelling is a computer-driven method for dealing with complexity, by allowing individuals or groups to interpret the inter-relationships between different aspects or elements of a problem. In doing this interpretation, the elements are structured, and from this structuring, a graphical model is produced, allowing the modeller(s) to better understand the problem. The main contribution of this thesis was to develop a computer package for Interpretive Structural Modelling (ISM), for use at the School of Engineering Management at the University of Cape Town. The package was developed for the IBM PC

Designing a Methodology for Marketing Intelligence Systems – The Case of Brand Image Diagnostics

In situations of information overload and complexity, consumers consult their existing knowledge regarding brands as a guide in consumption decisions. This knowledge manifests as brand association networks (BANs) in consumers’ minds and reflects what the consumer thinks of when being confronted with a brand stimulus. BANs therefore characterize a brand’s image that determines consumers’ attitudes and behaviour. BANs serve as diagnostic instruments to explain a brand’s success or failure and to plan or control marketing activities. Traditionally, BANs are elicited directly from consumers utilizing survey-based instruments. However, in a dynamic and interactive environment, user-generated content (UGC) is increasingly relevant for a brand’s image and thus should be exploited for the elicitation of BANs. However, established elicitation instruments either follow another elicitation paradigm (i.e. surveys or interviews), or are unable to cope with volume, velocity, and variety of UGC as a big data source (e.g. content analysis). Hence, exploiting UGC for BAN elicitation requires the development of new, computer-supported instruments. Following a design science research approach, we contribute a novel methodology as our artefact to extract BANs from UGC using text-mining and net- work analysis. We evaluate our solution and demonstrate its utility for brand management on a study of automotive brands

Vocational and Life Skills Quarterly Report: Quarter 8 (April-June 2018)

The Vocational and Life Skills Program (VLS) was created by Nebraska Legislative Bill 907 in 2014 with the goals of reducing recidivism and increasing employment for individuals who are incarcerated, have been incarcerated within the prior 18 months, or are under Parole or Probation supervision. Eight programs were funded in Grant Cycle 2, which ran from July 2016-June 2018. The Nebraska Center for Justice Research (NCJR) evaluation was initiated in May 2016 with the primary goal of identifying types of programming and services that best serve the population by reducing recidivism and increasing employment. NCJR provided support to grantees through trainings and site visits as needed, and managed all participant data entered into the online data management system created specifically for VLS. NCJR continues to provide feedback and information to the Nebraska Department of Correctional Services (NDCS) regarding the implementation process and data updates on a monthly and quarterly basis. Grant Cycle 2 procedures were built by NDCS VLS, program providers, and NDCS reentry using information gathered during the first grant cycle. Lessons learned helped VLS to increase its capacity to provide programming as well as the ability to gather data on participants. VLS continues to update service providers to ensure the best programming is available to Nebraska participants. It also continues to improve its ability to connect reentry resources to one another to better serve participants. The establishment of a reentry advisory council and having an opportunity to speak to Nebraska State Legislators greatly increased the visibility of the VLS programming in the state. This report details evaluation updates and participant data from the entire grant cycle (2). All graphs and tables are current through Quarter 8

Member Information Manual

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Vocational and Life Skills Quarterly Report - Grant Cycle 2, Quarter 5

The Vocational and Life Skills advisory group was established and met for the first time on September 12, 2017. Key advisory participants include wardens, associate wardens, grantees, facility staff including unit and case managers, grant administrator, grants monitor, legal counsel, UNO evaluators, community custody inmate, VLS coordinator, reentry administrator, reentry manager, deputy director of programs and the inspector general. This meeting included crucial and lively discussion on how to improve programming, remove barriers, increase program participant success and meet unmet needs. The topic of aging population and assistance for this group among the institutions and at the Community Correctional Center Lincoln (CCC-L) was brought to our attention. Since that time, we have provided CCC-L and CCC-O with a variety of transportation options for the aging within our population. The standing agenda for the Vocational and Life Skills advisory group includes 1) performance by individual grantees, 2) best practices, 3) barriers to success and 4) unmet needs. The minutes from this meeting are attached. On Friday, September 1, 2017, the Vocational and Life Skills program conducted one of their quarterly meetings hosting roughly 50 stakeholders. At this meeting ReConnect was awarded the Nebraska Department of Corrections “Grantee of the Year” award. ReConnect has made a very large impact and contribution to the Vocational and Life Skills program, but more importantly to the participants that attend ReConnects classes inside the prison walls. In April, the Nebraska Auditor of Public Accounts found the management fee in ResCare’s budget to be an unallowable expense. ResCare was provided the opportunity to modify their budget to reflect actual expenses. ResCare declined changing their budget and on August 8, 2017, notified NDCS that all services will be terminated at the end of September. On September 30, 2017, ResCare completed their final participation within the Vocational and Life Skills program. To continue to provide programming at the Nebraska Correctional Center for Women and Nebraska State Penitentiary, Metropolitan Community College is providing the Employment Readiness Program, which teaches resume writing, interviewing skills, and trauma informed peer support

Vocational and Life Skills Quarterly Report: Quarter 7 (January-March 2018)

The Vocational and Life Skills Program was created by Nebraska Legislative Bill 907 in 2014 with the goals of reducing recidivism and increasing employment for individuals who are incarcerated, who have been incarcerated within the prior 18 months or who are under parole or probation supervision. Participants must begin programming under these conditions, but they may continue programming as the program sees fit for his or her individual needs. Eight programs were funded in Grant Cycle 2, which runs from July 2016-June 2018. The Nebraska Center for Justice Research (NCJR) evaluation was initiated in May 2016 with the primary goal of identifying types of programming and services that best serve the population by reducing recidivism and increasing employment. We provide support to grantees through trainings and site visits as needed and manage all participant data that is entered into the online data management system that was created specifically for Vocational and Life Skills data collection. We also provide feedback and information to the Nebraska Department of Correctional Services (NDCS) on the implementation process and data updates on a monthly and quarterly basis. This grant cycle has built upon the work of many programs and the NDCS reentry team in the first grant cycle, which has increased capacity to provide programming as well as increased the ability to gather data on participants in these programs. In recent months, VLS has benefitted from continued service expansion in programming as well as more local and state interest in connecting reentry resources to one another to better serve participants. The establishment of a reentry advisory council and having an opportunity to speak to Nebraska State Legislators greatly increased the visibility of the Vocational and Life Skills programming in the state. This report details evaluation updates and participant data from Quarter 1 through Quarter 7 of this grant cycle. New information from Quarter 7 is added to the text of this report from previous quarters. All graphs and tables are current through Quarter 7

Vocational and Life Skills Quarterly Report - Grant Cycle 2, Quarter 6

The vocational and life skills grants were awarded in June and programs could begin program design and hiring, effective July 1, 2016. During the 6th Quarter of grant cycle 2 the Vocational and Life Skills program attracted some attention from the media about the great work being done by some of our grantees. In December Channel 8 News in Lincoln ran a story on Mental Health Association titled: Prisoners Get A Second Chance At Life http://www.klkntv.com/story/37010828/prisoners-get-second-chance-at-lif