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Linking Work Life Changes to Worker & Patient Outcomes: Evaluating the VNSNY Home Health Aide Partnering Collaborati PowerPoint Presentation
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Linking Work Life Changes to Worker & Patient Outcomes: Evaluating the VNSNY Home Health Aide Partnering Collaborative. Penny Feldman, Ph.D. Robert Rosati, Ph.D. Gail Quets, M.A. Gil Maduro, Ph.D. Theresa Schwartz, B.A. Visiting Nurse Service of New York Penny.feldman@vnsny.org

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Linking Work Life Changes to Worker & Patient Outcomes: Evaluating the VNSNY Home Health Aide Partnering Collaborative

Penny Feldman, Ph.D.

Robert Rosati, Ph.D.

Gail Quets, M.A.

Gil Maduro, Ph.D.

Theresa Schwartz, B.A.

Visiting Nurse Service of New York

Penny.feldman@vnsny.org

Funded by US HHS Office of Disability, Aging and Long-Term Care Policy Contract #HHSP23320044304EC

today s objectives
Today’s Objectives
  • Describe a multi-faceted work life/“culture change” intervention in home health care
  • Outline the evaluation
  • Discuss evaluation strategies & challenges
intervention objectives
Intervention Objectives

“Optimize the role of the HHA” ….

    • Strengthen ties to agencies that employ HHAs
    • Improve nurse supervision & support of HHAs
    • Promote common goal setting– patient, HHA & nurse
    • Transform HHA from “doer” to “supporter”

Resulting in….

  • Better nurse/HHA/patient communication
  • Improved HHA satisfaction
  • Reduced HHA turnover
  • Improved patient function (bathing, transfer, ambulation)
  • Services “matched” to needs
intervention
Intervention
  • Modified “Learning Collaborative” model
    • Senior leadership
    • 4-month “spread” process
    • Teams undertake common goal: “Everybody teaches. Everybody learns.”
    • Formal plans & accountability
    • Rapid implementation of change concepts
    • Focus on data – goals & measures
    • Group learning sessions, team meetings, content experts, coaching, theme calls, web site
  • Tools
    • ADL/Functional Health Improvement Tool
    • “Five Promises”
    • HHA Partnering “Best Practices”
    • HHA video/skills – reinforce training
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1. Introduce yourself and show your VNSNY I.D.

2. Discuss progress patient is making toward

achieving their functional health goals.

3. Review any changes in PPOC and/or duty sheets.

4. Ask HHA if there are any other observations or

concerns they have today.

5. Thank the HHA. Let him/her know when your

next visit will be and how to reach you.

The Five Promises Tool

EVERY interaction with a HHA, takes 5 minutes to……

slide8

Conceptual Model

  • Organizational/Structural Characteristics
  • Communication Processes
  • Governance
  • Information Technology
  • Leadership
  • Values
  • Style
  • Strategy

Core

Structural

Domains

Process

Domains

  • Work Design
  • Staffing
  • Resources/Training
  • Measurement/Rewards
  • Autonomy
  • Supervision
  • Communication
  • Support
  • Recognition, respect
  • Group Behavior
  • Collaboration
  • Consensus
  • Quality Emphasis
  • Patient Centeredness
  • Safety
  • Innovation
  • Outcome Measurement
  • Evidence-based Practice
  • Healthcare Worker Outcomes
  • Satisfaction
  • Health and Safety
  • Organizational Identification
  • Turnover
  • Patient Outcomes
  • Satisfaction
  • Safety
  • Self-care
  • Health and Function

Outcomes

challenges in implementing the intervention
Challenges in Implementing the Intervention
  • “Culture”: values, beliefs, expectations:
    • Nurses re patients and HHAs
    • HHAs re patients and nurses
    • Patients & families re services & goals
  • Organizational structure:
    • Aides employed by separate agencies
    • “Interdisciplinary” meetings: competing priorities, limited aide participation
  • Work design:
    • Isolation & dispersion of aides
    • High ratios of HHAs to nurses, HHAs to licensed agency coordinators
objectives of the evaluation
Objectives of the Evaluation

Assess impact of the HHA Collaborative:

  • HHA perceptions, satisfaction, turnover
  • Patient service use and costs
  • Patient discharge disposition & outcomes

Examine implementation challenges &

strategies:

  • Perceptions/attitudes – “culture change”
  • Usefulness of tools
  • Use of data
  • Matching services to patient needs
evaluation products to make the case for the intervention and facilitate replication
Evaluation Products: To “make the case” for the intervention and facilitate replication
  • Usual suspects: final report, articles
  • Intervention Guide – main audience: potential adopters
  • Policy/Practice Brief – main audience: federal and state policy makers, professional associations, union leaders, workforce experts, other stakeholders

*Six-person TEP review

evaluation design
Evaluation Design

Overall design

  • Random assignment of 42 service teams to “intervention” (21 teams) or “control” (21 teams); stratification by borough
    • Bronx, Brooklyn, Manhattan, Queens
  • Repeated measurement – before, during and post-intervention (see next slide)
  • Summative analysis – quantitative
    • Units of analysis: team, HHA, patient
  • Formative analysis – qualitative/quantitative
evaluation analytic approach
Evaluation: Analytic Approach

Impact analysis – quantitative*

  • Comparison of intervention and control groups: HHA perceptions, HHA outcomes, Patient service use, Patient outcomes
  • Use of appropriate multivariate regression models (e.g., ordinary least squares, ordered logit)
  • Case-mix adjustment for baseline patient differences and/or propensity score matching

Implementation analysis – multi-faceted (qualitative, some quantitative)

  • Focus on intervention group & stakeholders
    • Observation (learning sessions, meetings, theme calls)
    • Interviews & focus groups (participants, stakeholders)
    • Document analysis (e.g., team plans, reports, ADL tool documentation)
  • *No Primary Data Collection
questions to hhas
Questions to HHAs
  • How often
    • Do the nurses and therapists you work with give you the help you need to do a good job?
    • Do the nurses and therapists you work with treat you as an important member of the care team?
    • Are your opinions about patients heard and appreciated by the nurses and therapists you work with?
    • Do you discuss patients’ progress walking, bathing, and getting out of bed with the nurses and therapists you work with?
    • Do you talk to patients themselves about the progress they are making walking, bathing, and getting out of bed?
  • Do you agree or disagree : Overall, I am a satisfied employee
challenges in conducting the evaluation
Challenges in Conducting the Evaluation
  • Complexity of the intervention – multiple components, multiple teams, emphasis on team “buy-in” via adaptive practices – a moving target
  • Variations in implementation – how to document “fidelity” / “intensity”
  • Fluidity of the HHA workforce – across teams & over time
  • Reliance on existing data
  • Outcome measures (worker and patient) – are they sufficiently sensitive
conundrum of applied real world research
Conundrum of Applied “Real World” Research
  • If intervention impact demonstrated – to which component/s can it be attributed?
  • If no impact demonstrated – why not?
    • Poorly designed intervention?
    • Poorly implemented intervention?
    • Poorly designed evaluation?
  • Response
    • Employ conceptual & logic models at design phase
    • Document components
    • Measure fidelity
    • Randomize
    • Identify and analyze “pure” intervention & control aides & associated patients
conclusions benefits or risks of the research
Conclusions: Benefits [or Risks] of the Research
  • Understand benefits/costs of the intervention
  • Show linkage between organizational change and patient outcomes
  • Build a business case for work life investment
  • Document change strategies
  • Create a toolbox for diffusion of intervention
  • [Undermine support for future change if costs exceed benefits (due either to externalities or weak/no effect)]