Browsing by Author "Sullivan, Jennifer L."

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    Blended Facilitation as an Effective Implementation Strategy for Quality Improvement and Research in Nursing Homes
    (Lippincott Williams & Wilkins, 2019) Pimentel, Camilla B.; Mills, Whitney L.; Palmer, Jennifer A.; Dillon, Kristen; Sullivan, Jennifer L.; Wewiorski, Nancy J.; Snow, Andrea Lynn; Allen, Rebecca S.; Hopkins, Susan D.; Hartmann, Christine W.; Geriatric Research Education & Clinical Center; University of Massachusetts Worcester; US Department of Veterans Affairs; Veterans Health Administration (VHA); Providence VA Medical Center; Harvard University; Hebrew SeniorLife; VA Boston Healthcare System; Boston University; University of Alabama Tuscaloosa
    Background: Blended facilitation, which leverages the complementary skills and expertise of external and internal facilitators, is a powerful strategy that nursing stakeholders and researchers may use to improve implementation of quality improvement (QI) innovations and research performed in nursing homes. Problem: Nursing homes present myriad challenges (eg, time constraints, top-down flow of communication, high staff turnover) to QI implementation and research. Approach: This methods article describes the theory and practical application of blended facilitation and its components (external facilitation, internal facilitation, relationship building, and skill building), using examples from a mixed QI and research intervention in Veterans Health Administration nursing homes. Conclusions: Blended facilitation invites nursing home stakeholders to be equal partners in QI and research processes. Its intentional use may overcome many existing barriers to QI and research performed in nursing homes and, by strengthening relationships between researchers and stakeholders, may accelerate implementation of innovative care practices.
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    Impact of Intervention to Improve Nursing Home Resident-Staff Interactions and Engagement
    (Oxford University Press, 2018) Hartmann, Christine W.; Mills, Whitney L.; Pimentel, Camilla B.; Palmer, Jennifer A.; Allen, Rebecca S.; Zhao, Shibei; Wewiorski, Nancy J.; Sullivan, Jennifer L.; Dillon, Kristen; Clark, Valerie; Berlowitz, Dan R.; Snow, Andrea Lynn; Boston University; Baylor College of Medicine; Geriatric Research Education & Clinical Center; University of Massachusetts Worcester; Harvard University; Hebrew SeniorLife; University of Alabama Tuscaloosa; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA Boston Healthcare System
    Background and Objectives: For nursing home residents, positive interactions with staff and engagement in daily life contribute meaningfully to quality of life. We sought to improve these aspects of person-centered care in an opportunistic snowball sample of six Veterans Health Administration nursing homes (e.g., Community Living Centers-CLCs) using an intervention that targeted staff behavior change, focusing on improving interactions between residents and staff and thereby ultimately aiming to improve resident engagement. Research Design and Methods: We grounded this mixed-methods study in the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change. We implemented the intervention by (a) using a set of evidence-based practices for implementing quality improvement and (b) combining primarily CLC-based staff facilitation with some researcherled facilitation. Validated resident and staff surveys and structured observations collected pre and post intervention, as well as semi-structured staff interviews conducted post intervention, helped assess intervention success. Results: Sixty-two CLC residents and 308 staff members responded to the surveys. Researchers conducted 1,490 discrete observations. Intervention implementation was associated with increased staff communication with residents during the provision of direct care and decreased negative staff interactions with residents. In the 66 interviews, staff consistently credited the intervention with helping them (a) develop awareness of the importance of identifying opportunities for engagement and (b) act to improve the quality of interactions between residents and staff. Discussion and Implications: The intervention proved feasible and influenced staff to make simple enhancements to their behaviors that improved resident-staff interactions and staff-assessed resident engagement.