Abstract
Aim
Worldwide, long‐term care tends to shift from institutional care towards home care. In order to deliver high‐quality and adequate care, the type, amount and cost of care is determined by a patient needs assessment. However, there are indications that this patient needs assessment varies between comparable patients. In the Netherlands, some home care organizations aim to improve patient needs assessments by implementing improvement measures to reduce this practice variation. The goal of this study was to explore the type and perceived impact of those implemented improvement measures.
Design
A cross‐sectional explorative survey study was conducted among Dutch home care organizations between January and April 2021.
Methods
An online questionnaire with 26 items was developed by the research team, which was distributed through Dutch nationwide home care sector organizations, the Dutch nurses' association (V&VN) and the Dutch society for home care nursing (NWG).
Results
The survey was completed by 184 respondents, including home care nurses, managers and staff who are responsible for training, policy and quality of care. Intervision and peer review for home care nurses were the most common reported improvement measures that were implemented in home care organizations. The experiences of those improvement measures have been perceived as creating greater uniformity in the patient needs assessment, making home care nurses feel more supported and secure performing their patient needs assessment and that the provided care is more in line with patients' demand. Our findings give insights into type and perceived impact of improvement measures that Dutch home care organizations implemented. Further research is needed to find out whether improvement measures actually improve patient needs assessments and reduce practice variation.
Keywords: home care, improvement measures, nurses, patient needs assessment, practice variation
1. INTRODUCTION
Following increasing costs but also people's preferences, long‐term care worldwide is shifting from institutional care towards care at home (Organisation for Economic Co‐operation and Development, 2021). Home care in this study is defined as assistance with personal care and any kind of technical nursing care in the homes of patients (Van Eenoo et al., 2016), which reflects home care as it is delivered in most of the European countries (Tarricone & Tsouros, 2008). In OECD‐countries, the proportion of people in need of care receiving long‐term care at home was 68% in 2019. This demand is expected to grow further, as especially the proportion of the oldest population aged 80 years and older will averagely double between 2019 and 2050 from 4.6% to 9.8% (OECD, 2021). Consequently, one of the challenges is to ensure high quality of nursing care of home care provision. A high quality of care can be reached by continuing the professionalization of home care nurses (Landers et al., 2016). Nursing professionalization is defined as a process to develop a professional position and is among others associated with enhancing the nursing workforce, extending responsibilities and autonomy and involvement in decision‐making processes (Gunn, 2019).
One of the countries that made a huge development investigating in the professionalization of home care nurses is the Netherlands. In the Netherlands, being the setting of this study, home care is mostly delivered through registered bachelor and vocational trained nurses and certified nursing assistants (Rosendal, 2019). The demand for long‐term care at home is expected to increase, as the Dutch population aged 80 years and older will grow from 4.6% in 2020 to 10.9% in 2053 (Centraal Bureau voor de Statistiek, CBS = Statistics Netherlands, 2021). In the Netherlands, a reform of long‐term care in 2015 led to an extension of the responsibilities and autonomy of bachelor educated home care nurses (Kroneman et al., 2016). By that, patient needs assessments, which are the starting point of home care and determine the type, amount and cost of care, are performed by registered home care nurses who are trained on at least bachelor level. A patient needs assessment is aimed at strengthening self‐management and self‐reliance of the patient and the patient's network and is integrated into the nursing process by using clinical reasoning.
Performing patient needs assessments is a crucial task in the care process of home care nurses and there are signals that there appears to be practice variation in the assessed care for comparable patients (Buijs et al., 2002; Van Dorst et al., 2017). In a previous Delphi study, we adapted the definition of practice variation to the home care nursing context as “the extent to which home care nurses differ in the type, amount and duration of the care they assess for patients in a comparable context” (Van Dorst et al., 2022). Hence, the amount, and reasons for variation are not clear yet nor investigated (Brabers et al., 2019). Practice variation in patient needs assessment is not only discussed in the Netherlands. It has also been described in England, focusing on different ways of classifying and carrying out the patient needs assessment (Cowley et al., 2000) and across several other European countries in terms of variation in assessed formal care time (Van Hout et al., 2019).
As a guidance when performing patient needs assessments, a framework including six norms was developed by the Dutch nursing association (Verpleegkundigen & Verzorgenden Nederland, V&VN) (V&VN, 2014) (Textbox 1). However, the literature shows that home care nurses experience problems about the patient needs assessment (Bleijenberg et al., 2018; De Veer et al., 2020). An earlier study showed obstacles that home care nurses encounter in performing an optimal patient needs assessment, such as a short period of time in which the patient needs assessment has to be done, the influence of health insurers and the barriers in legislation and regulations (De Veer et al., 2020). In another study, it has been shown that home care nurses feel unfamiliar with procedures related to the patient needs assessment (Bleijenberg et al., 2018). Moreover, they feel a need for a guideline or an instrument that provides guidance to them (ebd.). However, there are several guidelines available, which, in another study, were not unanimous found to be helpful and were not much used (De Veer et al., 2020). It is unknown whether the framework for assessing patient needs and organizing care is used by home care nurses and how they perceive it. Overall, different studies showed that home care nurses encounter obstacles when carrying out patient needs assessments and feel a need for more guidance. This makes clear that home care organizations need to take action to support home care nurses in performing patient needs assessments.
TEXTBOX 1. Framework for assessing patient needs and organizing care (V&VN, 2014).
Framework for assessing patient needs and organizing care.
The Dutch nurses' association formulated which norms the patient needs assessment must meet in order to deliver high‐quality and appropriate care. The following six norms are described:
A patient needs assessment is performed based on professional autonomy.
A patient needs assessment is performed by a home care nurse educated on bachelor or master level.
A patient needs assessment is aimed at strengthening self‐direction and self‐reliance.
Decision‐making related to assessing patient needs and organizing care takes place based on the nursing process.
Reporting complies with the guideline of the Dutch nurses' association.
The nursing transfer complies with the guideline of the Dutch nurses' association.
In the Netherlands, some home care organizations already have taken action aiming to improve the patient needs assessment to reduce practice variation, while creating more uniformity. For instance, common improvement measures are intervision and peer review. Intervision is a method to systematically reflect on professional experiences in a group of colleagues leading to solutions or advices (Van de Beek & Schaub‐de Jong, 2018). Peer review is a retrospective reflection with a peer group on a particular situation led by a supervisor (Bennet‐Britton et al., 2021; Markowski et al., 2021). Peer review in home care has been implemented nationwide by the Dutch Ministry of Health, Welfare and Sport and parties of home care nursing in order to ensure continuously professional development for home care nurses through training and reflective practice (Hoofdlijnenakkoord, 2018). However, the type and experiences of peer review and other implemented improvement measures are unknown. Therefore, the aim of this study is to identify the type and perceived impact of improvement measures in Dutch home care organizations to improve the patient needs assessment performed by home care nurses. Based on this, the following research questions will be addressed: What type of improvement measures are implemented in home care organizations to improve the patient needs assessments? What are the experiences of implemented improvement measures perceived by professionals in home care organizations whose tasks are related to the patient needs assessment? Answering these questions can provide input for further research on reasons for improvement measures that can be tested and are in line with the professional practice to improve the patient needs assessment in home care in countries where patient needs assessments are performed by health care professionals, such as nurses.
2. MATERIALS & METHODS
2.1. Study design
A cross‐sectional explorative survey study was conducted between January and April 2021. This study is part of a nationwide research project funded by the Dutch Ministry of Health, Welfare and Sport investigating the causes and extent of practice variation in patient needs assessments in home care in the Netherlands, and factors influencing practice variation. This has been explored with a literature study and a Delphi study and will be further investigated with a large observational study using data from patient files from approximately 30 home care organizations. At a later stage, interventions to improve the needs assessment and reduce practice variation will be developed. This study explores the current practice of home care organizations with regard to the types of and experiences with implemented improvement measures as input for the intervention development in the later stage.
2.2. Population
The population of this study were a convenience sample of home care nurses (either employed in an organization that offers home care or self‐employed) (Textbox 2), managers of home care organizations, policy officers, quality officers and training managers of home care organizations, whose tasks are related to the improvement of the patient needs assessment in terms of policy or guidelines, quality improvement or training in their organization. There was no predetermined sample size as it was mainly about including a response from as many home care organizations as possible across the country.
TEXTBOX 2. Organizational forms of home care organizations and contracted and non‐contracted care in the Netherlands.
In total, there are 3,070 Dutch home care organizations (Vektis, 2020). Home care organizations in the Netherlands can be organized in a salaried employment form, a cooperative form, or a partnership of self‐employed persons. Home care can also be delivered through mediation agencies or self‐employed home care nurses. The offered care can be both contracted and non‐contracted by health insurers. Health insurers are responsible for purchasing sufficient and high‐quality health care for their policyholders and conclude contracts with healthcare providers, that is home care organizations. This is called contracted care (Van Gerwen et al., 2019). However, some home care organizations choose to not conclude contracts with health insurers due to, in their opinion, low proposed budget caps or because contracts make them feel restricted in their professional activities. This so‐called non‐contracted care ensures more freedom of choice for patients with regard to healthcare providers, but is not always fully reimbursed by health insurers and, as a result, a patient may pay the remaining amount himself. Moreover, it emerged that the costs per patient for non‐contracted care providers are 87% higher compared to contracted care providers (Puijk et al., 2017).
To picture the different perspectives on the experiences with improvement measures and to maximize the response rate in the target group, professionals in different functions were approached by distributing an open survey link through the websites and newsletters of three Dutch nationwide home care sector organizations on February 26, 2021. Furthermore, the home care nurses section of the Dutch nurses' association (V&VN), and the Dutch society for home care nursing (Nederlands Wijkverpleegkundigen Genootschap, NWG) received the survey link to share in their community in the first week of March 2021. The researchers involved, and the institutions they work for, shared the survey link on social media (LinkedIn and Twitter) and their professional network, also in the first week of March 2021. The survey was online from February 26, 2021 until March 31, 2021.
2.3. Data collection
Data were collected using the online survey software Qualtrics XM. Participation was voluntary and anonymous. Information about the reason and goal of the study, and privacy, were included in the distributed emails and the questionnaire.
2.3.1. Ethics
Respondents gave their informed consent for participation by filling out the online questionnaire. This study was not subject to the Medical Research Involving Human Subjects Act (Wet maatschappelijke ondersteuning, WMO).
2.3.2. Questionnaire
Based on expert group meetings with professionals working in home care, a questionnaire was developed and pre‐tested in January and February 2021 by the research team. Guiding principles and goals for developing the survey were to explore (1) what type of improvement measures have already been initiated by home care organizations, (2) the experiences organizations perceived with the initiated improvement measures and (3) if and how the initiated improvement measures have been evaluated in organizations. The online survey contained 26 questions and consisted of three sections: (a) background information, (b) type of improvement measures and (c) perceived impact of the improvement measures (see survey in the Appendix A).
Background information were collected using in total 10 questions about the demographics/background of the respondent: sex (woman, man, other), age (in years), function in the home care organization (home care nurse, manager, policy‐, quality‐ and training officer), and about the home care organization the respondent works for. This included the size of the organization (1 to >200 employees), the organizational form (salaried employed, cooperative, partnership of self‐employed persons, agency, self‐employed), the type of care it delivers (only contracted, only non‐contracted, more contracted, more non‐contracted, equal) (Textbox 2), membership of a sector organization (yes/no) and requirements on educational level imposed on home care nurses to carry out the patient needs assessment (bachelor in nursing/bachelor in nursing – public health/bachelor in nursing supplemented with post‐bachelor home care nursing or patient needs assessment training/bachelor in nursing and willingness to take an internal or external patient needs assessment training).
The questions about the type of improvement measures consisted of 8 questions. It was asked whether improvement measures were actually started and since when. Furthermore, which improvement measures about the patient needs assessment were initiated (intervision/peer review/internal training/external training/supervision/internal audit/other). Also, the reason for the improvement measure and whether the organization had a plan or goal for initiating it was measured. Finally, 8 items about the perceived impact of the initiated improvement measures were asked. This included questions whether the initiated improvement measure was perceived to enhance the patient needs assessment, but also whether and how the results of improvement measures have been evaluated and made visible.
2.4. Data analysis
Data were analysed using descriptive statistics (i.e. frequencies and percentages, means and SD for normally distributed data). Open‐ended questions were analysed using qualitative content analysis. The data analysis was carried out using IBM SPSS and MS Excel.
3. RESULTS
3.1. Respondents and background characteristics
301 surveys were retrieved. Incomplete surveys were excluded from analysis (n = 117). A total of 184 surveys were included into analysis. Most of the respondents were home care nurses (n = 161, 87.5%), working salaried employed (n = 165, 89.6%) in a home care organization with more than 100 employees (n = 119, 64.6%) that delivers mostly contracted care (n = 167, 90.7%) (Table 1).
TABLE 1.
Characteristics of the respondents and organizations
| Characteristics respondent and organization | N |
|---|---|
| Total response, N (%) | 301 (100) |
| Finished, N (%) | 184 (61.1) |
| Age (years), mean (SD) | 43.2 (12.3) |
| Gender: female, n (%) | 166 (90.2) |
| Function | |
| Home care nurse, n (%) | 161 (87.5) |
| Other w.r.t. needs assessment a , n (%) | 23 (12.5) |
| Membership in sector organization, n (%) | 121 (65.7) |
| Salaried employed, n (%) | 165 (89.6) |
| Type of delivered care | |
| (Mostly) contracted, n (%) | 167 (90.7) |
| (Mostly) non‐contracted, n (%) | 14 (7.6) |
| Size of organization | |
| <100 employees | 65 (35.3) |
| >100 employees | 119 (64.6) |
| Required educational level to perform needs assessment | |
| Bachelor, n (%) | 58 (31.5) |
| Bachelor + additional training, n (%) | 124 (67.3) |
Abbreviation: w.r.t., with regard to.
Managers of home care organizations, Policy officers, quality officers, training managers in home care organizations.
3.2. Type of implemented improvement measures
Table 2 gives an overview of all types of started or planned improvement measures that were reported. In total, 126 respondents (68.4%) indicated that their organization started any improvement measure, and 104 (82.5%) of them reported a reason to do so. The respondents reported several reasons to start an improvement measure such as practice variation (n = 33), the need for uniformity of the patient needs assessment (n = 26) and quality improvement (n = 24) (Table 3). Among the respondents who indicated to have started or planned a specific improvement measure in their organization (N = 135), the most reported were intervision (n = 101, 75.8%) and peer review (n = 105, 77.7%). Almost a quarter of the respondents reported other measures (n = 31, 22.9%). Examples were case conferences, improvement plans and checklists, e‐learning programs, setting up workgroups or coaches for the patient needs assessment and providing more information about the patient needs assessment for home care nurses through newsletters, internal symposia or regular meetings. The respondents reported how the improvement measures were implemented (as recurring or single action, on a voluntary or compulsory basis, as implemented action or small‐scale test). Intervision and peer review were mostly reported as already implemented (intervision n = 76, 56.3%; peer review n = 78, 57.7%), often as a recurring action (intervision n = 87, 64.4%; peer review n = 100, 74%). Most of the improvement measures were reported to take place on a compulsory basis for home care nurses, although intervision scored high in both, voluntary (n = 56, 41.4%) and compulsory (n = 50, 37%) participation.
TABLE 2.
All reported types of started or planned improvement measures, N = 135
| Improvement measure N = 135 | Started or planned/not started or planned/I do not know | Recurring/single action/I do not know | Voluntary/compulsory/I do not know | Implemented/small‐scale test/I do not know | Initiative: Home care nurse/home care nurse & other a /other a /n/a |
|---|---|---|---|---|---|
| Intervision, n (%) | 101 (75.8) | 87 (64.4) | 56 (41.4) | 76 (56.3) | 40 (29.6) |
| 23 (17.0) | 14 (10.3) | 50 (37.0) | 25 (18.5) | 38 (28.1) | |
| 11 (8.1) | 34 (25.1) | 29 (21.4) | 34 (25.1) | 37 (27.4) | |
| 20 (14.8) | |||||
| Peer review, n (%) | 105 (77.7) | 100 (74.0) | 42 (31.1) | 78 (57.7) | 39 (28.8) |
| 24 (17.7) | 8 (5.9) | 64 (47.4) | 26 (19.2) | 35 (25.9) | |
| 6 (4.4) | 27 (20.0) | 29 (21.4) | 31 (22.9) | 37 (27.4) | |
| 24 (17.7) | |||||
| Internal training, n (%) | 83 (61.4) | 44 (32.5) | 26 (19.2) | 64 (47.4) | 25 (18.5) |
| 40 (29.6) | 38 (28.1) | 59 (43.7) | 11 (8.1) | 27 (20.0) | |
| 12 (8.8) | 53 (39.2) | 50 (37.0) | 60 (44.4) | 42 (31.1) | |
| 41 (30.3) | |||||
| External training, n (%) | 54 (40.0) | 24 (17.7) | 32 (23.7) | 44 (32.5) | 21 (15.5) |
| 59 (43.7) | 39 (28.8) | 42 (31.1) | 13 (9.6) | 16 (11.8) | |
| 22 (16.3) | 72 (53.3) | 61 (45.1) | 78 (57.7) | 38 (28.1) | |
| 60 (44.4) | |||||
| Supervision, n (%) | 50 (37.0) | 43 (31.8) | 29 (21.4) | 37 (27.4) | 20 (14.8) |
| 61 (45.1) | 12 (8.8) | 30 (22.2) | 14 (10.3) | 11 (8.1) | |
| 24 (17.7) | 80 (59.2) | 76 (56.3) | 84 (62.2) | 34 (25.1) | |
| 70 | |||||
| Internal audits, n (%) | 79 (58.5) | 64 (47.4) | 10 (7.4) | 62 (45.9) | 12 (8.8) |
| 38 (28.1) | 6 (4.4) | 65 (48.1) | 8 (5.9) | 17 (12.5) | |
| 18 (13.3) | 65 (48.1) | 60 (44.4) | 65 (48.1) | 58 (42.9) | |
| 48 (35.5) | |||||
| Other actions a , n (%) | 25 (18.5) | 28 (20.7) | 20 (14.8) | 22 (16.3) | 13 (9.6) |
| 26 (19.2) | 5 (3.7) | 13 (9.6) | 9 (6.67) | 9 (6.67) | |
| 84 (62.2) | 102 (75.5) | 102 (75.5) | 104 (77.0) | 10 (7.4) | |
| 103 (76.3) |
Note: Examples for ‘other’ actions are case conferences, improvement plans and checklists, e‐learning programs, setting up workgroups or coaches for the needs assessment and providing more information about the needs assessment for home care nurses through newsletters, internal symposia or regular meetings.
Managers of home care organisations, Policy officers, quality officers, training managers in home care organisations.
TABLE 3.
Inventory of reported improvement measures
| Inventory of improvement measures | |
|---|---|
| Any improvement measure started | N = 184 |
| Yes, n (%) | 126 (68.4) |
| No, but planned, n (%) | 9 (4.8) |
| No, n (%) | 8 (4.3) |
| I do not know, n (%) | 41 (22.2) |
| Start year of improvement measure | N = 135 |
| 2015, n (%) | 35 (25.9) |
| 2016, n (%) | 11 (8.1) |
| 2017, n (%) | 12 (8.8) |
| 2018, n (%) | 11 (8.1) |
| 2019, n (%) | 22 (16.3) |
| 2020, n (%) | 17 (12.5) |
| 2021, n (%) | 4 (2.9) |
| I do not know, n (%) | 23 (17.0) |
| Reason for having started an improvement measure | N = 126 |
| Yes, n (%) | 104 (82.5) |
| No, n (%) | 6 (4.7) |
| I do not know, n (%) | 16 (12.7) |
| Reasons | |
| Practice variation | 33 |
| Need for uniformity of the needs assessment | 26 |
| Quality improvement | 24 |
| Improvement of the needs assessment | 14 |
| Efficiency | 11 |
| Lack of knowledge | 11 |
3.3. Perceived impact of the improvement measures
The perceived impact of the improvement measures are shown in Figure 1 (perceived improvement), Figure 2 (perceived effectiveness outcomes) and Table 4 (evaluation of improvement measures and communication of its results). All started improvement measures were perceived to improve patient needs assessments. The perceived effectiveness of an improvement measure was mostly seen in greater uniformity in the patient needs assessment (n = 69, 51.1%). In addition, respondents reported that home care nurses felt more supported (n = 73, 54.1%) and more secure (n = 67, 49.6%) in performing their patient needs assessment after the improvement measure was implemented. They also perceived that the care was more in line with the patients' demand after implementing an improvement measure (n = 66, 48.9%). The respondents stated whether the improvement measures have been followed up. Almost half of them reported that the implemented improvement measures have been evaluated by the organization (n = 65, 48.1%) (see Table 4).
FIGURE 1.
Perceived improvement of the needs assessment through improvement measure. Examples for ‘other’ improvement measure are case conferences, improvement plans and checklists, e‐learning programs, setting up workgroups or coaches for the needs assessment and providing more information about the needs assessment for home care nurses through newsletters, internal symposia or regular meetings.
FIGURE 2.
Perceived effectiveness outcomes of improvement measure
TABLE 4.
Evaluation of improvement measures in home care organizations
| Evaluation of improvement measures | N |
|---|---|
| Measure has been evaluated | N = 135 |
| Yes, n (%) | 65 (48.1) |
| No, n (%) | 70 (51.8) |
| How has the measure been evaluated? | |
| (Team) meeting | 35 |
| Survey | 13 |
| Audit | 6 |
| Other | 8 |
| Results of the evaluation | |
| Follow‐up actions | 12 |
| Importance of professional behaviour of home care nurses | 11 |
| Importance of trainings | 8 |
| Importance of exchange with colleagues | 7 |
| Uniformity | |
| As result of improvement measure | 8 |
| Awareness that it is needed | 6 |
| Communication of the results of the evaluation | |
| Results have been communicated | N = 135 |
| Yes, n (%) | 63 (46.6) |
| No, n (%) | 42 (31.1) |
| I do not know, n (%) | 30 (22.2) |
| How have the results been communicated? | |
| (Team) meeting | 20 |
| E‐mail/ intranet/ newsletter | 16 |
| Incorporated into plan, manual or training | 10 |
| Report | 6 |
4. DISCUSSION
The aim of this study was to identify the type and perceived impact of improvement measures in Dutch home care organizations to improve the patient needs assessments performed by home care nurses. Most respondents reported that their home care organizations have started or planned an improvement measure to improve the quality of patient needs assessments. The most common improvement measures that were reported by the respondents were intervision and peer review. Improvement measures have been perceived to create greater uniformity in the patient needs assessment, making home care nurses feel more supported and secure performing their patient needs assessment and resulting in care that is more in line with patients' demand.
Improvement measures involving reflective practice in groups, such as intervision and peer review, were the most reported implemented measures in this study. Reflective practice is the “ability to gain understanding of specific issues in practice through critically contextualizing, observing and analysing to generate new knowledge and insights which can enhance practice” (Fleming, 2007). This is commonly used in many professional disciplines. For example, in health care education peer reviews are described to support the confidence and team working skills of students (Markowski et al., 2021). In English general practice settings, peer review is described to support clinician learning and the learning culture (Bennet‐Britton et al., 2021). In nursing, reflective practice methods are used for continuous improvement of knowledge in clinical practice and education (Patel & Metersky, 2022). Nursing peer reviews are also commonly used as a structured care evaluation in the US to ensure quality and policy adherence and integrate professional autonomy in hospital setting (Kirkland‐Kyhn & Teleten, 2018). Interventions such as intervision, peer review or clinical supervision are a kind of reflective practice that follow Donald Schön's approach on reflection‐on‐action, in which one's own professional action is analysed afterwards to identify learnings for future actions (Schön, 1983). This makes them appropriate to use in the context of performing patient needs assessments, especially as there is no clear guideline available which makes a structured and reflective evaluation even more important. Therefore, this could be one explanation for intervision and peer review being the most reported started improvement measures in this study. Another explanation could be that peer review has been recommended in home care nursing nationwide by the Dutch Ministry of Health, Welfare and Sport and parties of home care nursing (Hoofdlijnenakkoord, 2018).
In this study, intervision and peer review were perceived to make home care nurses feel more supported and secure performing the patient needs assessment. This can also be found in the literature that states that nurses feel more supported (Sundgren et al., 2020), self‐assured and more confident to take responsibility (Howard & Eddy‐Imishue, 2020) through reflective practice. Other benefits mentioned in the literature are empowerment, sharing of good practice and further personal and professional development through peers (O'Neill et al., 2019). This makes reflection in a peer setting a helpful tool for professional growth. Especially the performance of the patient needs assessment is a great development towards professional autonomy for home care nurses that also involves leadership. It is a new task of high responsibility that requires self‐esteem and empowerment for further professionalization. Reflective practice can obviously guide this process, giving safety and support to home care nurses.
Through intervision and peer review, respondents in this survey perceived that the care is more in line with patients' demand and that those measures create more uniformity in the assessed care. As far as we know, there is no literature that investigated the effects of reflective practices in this field, such as intervision or peer review, on these specific outcomes. It is known that reflective practice translates experience into knowledge (Schön, 1983), which is assumed to improve the quality of patient care (Patel & Metersky, 2022). Looking at all benefits mentioned, a regular reflection with peers on the patient needs assessment may indeed have the potential to create more uniform care according to patients’ demand. It can be beneficial to investigate this in further research.
To appreciate the findings, some strengths and limitations need to be addressed. One of the strengths is that the characteristics of respondents about age and gender of employees in home care (i.e. mean age of 43.2 years, 90.2% female) and type of delivered care (i.e. contracted care 90.7%, non‐contracted care 7.6%) are a good reflection of the population characteristics concerning age and gender (i.e. mean age of 44.5 years, 93.5% female) (Arbeidsmarkt Zorg en Welzijn, 2021) and the type of delivered care (i.e. contracted care 96.5%, non‐contracted care 3.5%) (Vektis, 2020). Furthermore, this is, to the best of our knowledge, the first study that explores how home care organizations are working on the improvement of the patient needs assessment and, therefore, the quality of care.
There are also some limitations. First, there was no validated instrument available that addresses the topic of this study. Therefore, the questionnaire was developed by the research team based on discussions with professionals working in home care. The content and comprehensibility of the questionnaire were pre‐tested in the research team and a home care nurse. Also, since there are 3,040 different home care organizations in the Netherlands (Vektis, 2020) and we did not ask in which organization the respondents were appointed, it is difficult to get insight into the range and specification of respondents. However, the results offer insight that improvement measures are being implemented and what measures are being taken.
5. CONCLUSION
The findings of this explorative cross‐sectional nationwide study give insight into improvement measures that home care organizations implemented to improve patient needs assessments in home care, and the perceived impact with these improvement measures. Based on our results it appears that there is a need for improvement about the patient needs assessment in home care organizations. We see that home care organizations already have taken action, in most cases with reflective practices such as intervision and peer review. However, we do not know whether this improvement measures actually improve patient needs assessments and reduce unwarranted practice variation. Therefore, it might be beneficial to further explore the relation between intervision/peer review and practice variation. Also, further research is needed to explore the extent and causes of practice variation to find out what improvement measures might improve the patient needs assessment and reduce practice variation in countries where patient needs assessments are performed in home care.
FUNDING INFORMATION
This study is part of a research project funded by the Dutch nurses' association (V&VN) on behalf of the Dutch Ministry of Health, Welfare and Sport. The funding bodies did not play a role in the study design, the writing of the manuscript, or the decision to submit the manuscript for publication. The views expressed are those of the authors and not necessarily those of the Dutch nurses' association (V&VN) or the Dutch Ministry of Health, Welfare and Sport.
CONFLICT OF INTEREST
The authors declare that they have no conflict of interest.
ACKNOWLEDGEMENT
The authors would like to thank all respondents to take part in this survey, and all parties were involved in the distribution.
APPENDIX A. SURVEY (ENGLISH TRANSLATION)
| A. Background information | ||
| 1 | What is your gender? |
|
| 2 | What is your age? | Open‐ended |
| 3 | What is your position in the organization you work at? |
|
| 4 | Is the organization you work at member of a branch organization? |
|
| 4a | If chosen ‘Yes, of another’: Can you indicate which branch organization? | Open‐ended |
| 5 | How would you characterize the organizational form of the organization you work at? |
|
| 6 | Can you indicate what type of care your organization delivers? |
|
| 7 | How many employees work in your organization in home care? |
|
| 8 | What are the educational requirements for home care nurses to perform a needs assessment? |
|
| 8a | If chosen ‘other’: What requirement are that? | Open‐ended |
| B. Type of improvement measures | ||
| 9 | Have there improvement measures been implemented in your organization in the period from 2015 until now to improve the needs assessment? |
|
| 10 | Have your organization had a reason to implement an improvement measure? |
|
| 10a | If chosen ‘yes’: Can you specify the reason? | Open‐ended |
| 11 |
Can you indicate for each improvement measure whether you have implemented or plan the following improvement measure? Intervision Peer review Internal training External training Supervision Internal audits other |
|
| 11a | If chosen ‘other’: Can you specify the improvement measure? | Open‐ended |
| 12 | Can you indicate when you started to implement the improvement measure? |
|
| 13 |
How has the improvement measure been implemented in your organization (for each improvement measure)? Intervision Peer review Internal training External training Supervision Internal audits other |
Participation
Return
Status of implementation
|
| 14 |
Who took the initiative to implement the improvement measure (for each measure)? Intervision Peer review Internal training External training Supervision Internal audits other |
|
| C. Perceived impact of improvement measures | ||
| 15 | Has the improvement measure been evaluated? |
|
| 15a | If chosen ‘yes’: Can you specify how it has been evaluated? | Open‐ended |
| 16 | What was the most important outcome of the improvement measure? | Open‐ended |
| 17 |
‘By implementing this improvement measure the needs assessment has been improved’ Intervision Peer review Internal training External training Supervision Internal audits other |
|
| 18 | Have the outcomes of the improvement measure been described in your organization? |
|
| 18a | If chosen ‘yes’: How have the outcomes been described? | Open‐ended |
| 19 | The outcomes of the improvement measure is perceived by |
|
| 19a | If chosen ‘other’: Can you specify how? | Open‐ended |
Schwenke, M. , van Dorst, J. , Zwakhalen, S. , de Jong, J. D. , Brabers, A. E. M. , & Bleijenberg, N. (2023). Measures to improve patient needs assessments and reduce practice variation in Dutch home care organizations. Nursing Open, 10, 3052–3063. 10.1002/nop2.1552
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.