Providing both quality of care and quality of life are primary goals in senior care regardless of the setting. Whether in skilled nursing centers or assisted living communities, quality is on everyone’s minds, from the leadership to care staff, residents and families. The phrases are used so frequently, but what do they mean?
Deconstructing Quality of Care
According to experts and the current literature on the topic, quality of care is a multidimensional and quite elusive phenomenon which is complicated to both define and assess. An authority on quality of care, Avedis Donabedian, suggests there are three elements involved including structure, process, and outcome. Structure refers to the many conditions that may affect the ability to deliver care to seniors including staffing levels, staffing mix, and characteristics of the environment. Process refers to work processes, routines and procedures. And, outcome is the end result of care, whether good, bad, adequate or not.
Two Dimensions of Quality: Care & Life
Another way to approach the meaning of quality is to break it into two different dimensions and examine each. Quality of care refers to clinical outcomes of issues like pressure injuries, the use of restraints, or falls. It focuses on both the quality of care delivered by nursing staff as well as the safety of the resident. On the other hand, quality of life encompasses the resident’s well-being and opportunities to make meaningful choices, to exercise autonomy and independence, and to engage in activities.
Assessing Quality
As complex as it is to define quality in senior care, it is also difficult to assess it. One approach is to examine primary data sources like self-reports from residents themselves, their relatives, care staff and through field observations of a researcher. This technique is both time intensive and expensive. The other way to access quality is through the use of secondary data sources like national data sets of clinical assessments. The most commonly used data source that everyone in skilled nursing is familiar with is the MDS or Minimum Data Set.
The Need for Task-Oriented Leadership
Most experts agree that effective leadership is a critical component to both quality of care and quality of life. Leadership is a topic of a great deal of research which focuses on different styles, traits and behavior. Regardless of the style, task-oriented leadership appears to be directly associated with higher quality in senior care. This type of leadership involves the behaviors of planning work activities, such as what to do, how to do it, when to do it, and who will do it. It also involves clarifying roles and objectives such as communicating plans, policies, job responsibilities, role expectations, requirements and goals. Monitoring operations and performance is also a key part of task-oriented leadership and involves gathering information about the processes, progress, performance and individual contributions within the care community.
Relationship-Oriented Leadership Is Needed, Too
On the other hand, relationship-oriented leadership includes supporting staff and involves consideration, acceptance and concern for their needs and feelings. It also focuses on building and developing skills as well as praising and showing appreciation of performance.
Finding A Balance
Whether the leader is transformational, democratic, or practices servanthood leadership, a balance of task- and relationship-oriented leadership may be the best formula to enhance and maintain quality of care and of life. Good leaders use a pattern of behavior that fits the situation and expresses a high concern for both the task and relationship.
Final Thoughts on Quality in Senior Care
Quality is the most important outcome concerning care and life in senior care. While it is often expressed, quality may be complicated to define and measure. Regardless of how it is approached, it does require a well-prepared and committed staff who is leading in both getting things done right and maintaining healthy and positive relationships.