Scripps Gerontology Center, Department of Sociology and Gerontology, Miami University, Oxford, OH, USA.
Computer and Information Technology, Miami University Hamilton, Hamilton, OH, USA.
J Am Med Dir Assoc. 2022 Sep;23(9):1442-1447. doi: 10.1016/j.jamda.2022.05.012. Epub 2022 Jun 15.
Nursing home (NH) providers would benefit from adopting evidence-based measures for gathering and utilizing resident preference information in their daily care activities. However, providers face barriers when implementing assessment tools used to promote person-centered care (PCC). Although Agile methodology is not commonly used in NH settings, this case study shows how it can be used to achieve the goal of delivering preference-based, PCC, within a large NH. We present a road map for breaking down care processes, prioritizing, and implementing iterative plan, do, study, act cycles using Agile methodology to enhance group collaboration on quality improvement cycles, to achieve our goal of providing preference-based PCC. We first determined if care plans reflected each resident's important preferences, developed a method for tracking whether residents attended activities that matched their preferences, and determined if residents were satisfied that their preferences were being met. These efforts had positive effects throughout the NH particularly when COVID-19 limited visitors and significantly modified staff workflow. Specifically, Agile processes helped staff to know how to honor preferences during quarantines which necessitated a shift to individualized (and not group) approaches for meeting preferences for social contact, comfort, and belonging. The ready availability of preference-based reporting was critical to quickly informing new staff on how to meet residents' most important preferences. Based on lessons learned, we describe a developmental approach that other providers can consider for adoption. Implications of this work are discussed in terms of the need for provider training in Agile methodologies to support iterative improvements, the need for policies that reimburse providers for their efforts, and additional research around workflow processes.
养老院（NH）提供者从采用基于证据的措施中受益，这些措施用于在日常护理活动中收集和利用居民的偏好信息。然而，提供者在实施用于促进以患者为中心的护理（PCC）的评估工具时会遇到障碍。尽管敏捷方法在 NH 环境中并不常用，但本案例研究展示了如何在大型 NH 中使用它来实现提供基于偏好的 PCC 的目标。我们提供了一个路线图，用于分解护理流程、确定优先级并使用敏捷方法实施迭代计划、执行和行动循环，以增强小组在质量改进循环上的协作，从而实现我们提供基于偏好的 PCC 的目标。我们首先确定护理计划是否反映了每个居民的重要偏好，开发了一种跟踪居民是否参加与其偏好相匹配的活动的方法，并确定居民是否满意他们的偏好得到满足。这些努力在整个 NH 中产生了积极的影响，尤其是在 COVID-19 限制访客并显著改变员工工作流程时。具体来说，敏捷流程帮助员工在需要进行隔离时了解如何尊重偏好，这需要转向个性化（而不是团体）方法来满足社交接触、舒适和归属感等偏好。基于偏好的报告的随时可用对于快速告知新员工如何满足居民最重要的偏好至关重要。根据经验教训，我们描述了一种发展方法，其他提供者可以考虑采用。本工作的影响涉及到提供者在敏捷方法方面的培训需求，以支持迭代改进、需要为提供者的努力提供补偿的政策，以及围绕工作流程的进一步研究。
