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Structure and process quality as predictors of satisfaction with elderly care
University West, Department of Social and Behavioural Studies, Division of Psychology and Organisation Studies. (Socialpsykologi)ORCID iD: 0000-0003-0629-353X
Högskolan i Skövde, Institutionen för hälsa och lärande. (Social Psychology)ORCID iD: 0000-0001-7164-0433
2015 (English)In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524Article in journal (Refereed) Epub ahead of print
Abstract [en]

The structure versus process approach to quality of care presented by Donabedian is one of the most cited ever. However, there has been a paucity of research into the empirical validity of this framework, specifically concerning the relative effects of structure and process on satisfaction with elderly care as perceived by the older persons themselves. The current research presents findings from a national survey, including a wide range of quality indicators for elderly care services, conducted in 2012 at the request of the Swedish National Board of Health and Welfare in which responses from 95,000 elderly people living in 324 municipalities and districts were obtained. The results revealed that the only structural variable which significantly predicted quality of care was staffing, measured in terms of the number of caregivers per older resident. More interestingly, process variables (e.g. respect and access to information) explained 40% and 48% of the variance in satisfaction with care, over and above the structural variables, in home care and nursing homes respectively. The findings from this large nationwide sample examining Donabedian's model suggest that quality in elderly care is primarily determined by factors pertaining to process, that is, how caregivers behave towards the older persons. This encourages a continued quality improvement in elderly care with a particular focus on process variables.

Place, publisher, year, edition, pages
John Wiley & Sons , 2015.
Keyword [en]
elderly care, process, quality of care, satisfaction, structure
National Category
Social Psychology
Research subject
SOCIAL SCIENCE, Psychology
Identifiers
URN: urn:nbn:se:hv:diva-8657DOI: 10.1111/hsc.12230PubMedID: 25809819OAI: oai:DiVA.org:hv-8657DiVA: diva2:869071
Projects
Organisering för verksamhetskvalitet inom svensk äldreomsorg: Ett skifte i fokus från vad till hur
Available from: 2015-05-12 Created: 2015-11-12 Last updated: 2016-03-17Bibliographically approved
In thesis
1. The Impact of Care Process on Satisfaction with Elderly Care
Open this publication in new window or tab >>The Impact of Care Process on Satisfaction with Elderly Care
2014 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

This licentiate thesis is based on the growing interest in Swedish elderly care. The aim of this thesis is to investigate what generates satisfaction with elderly care among older persons. The dominant ideology in both privately and publically run elderly care is individualized care, also called person-centered care, which holds the older person’s satisfaction as one of the main quality indicators. The proportion of older people is increasing and to maintain high levels of satisfaction with elderly care will require more knowledge. Data from the National Board of Health and Welfare’s (2012) nationwide survey on seniors’ experiences with elderly care was collected. Statistical analyses of this sample formed the basis for the results of the thesis and were reported in two papers. Study I used Donabedian’s (1988) model of quality of care in terms of structure, process, and outcome, and all municipal units in Sweden were included (N = 324). The results showed that structural variables (i.e. budget, staff, and training level) have minimal or no relationships with older persons’ satisfaction with care, while process variables (i.e. experiences of respect, information, and influence) have strong relationships with satisfaction with care. Study II made use of the long-standing person versus situation- model in social psychology, and was analyzed on an individual level (N = 95,000). The results showed that care process factors (i.e. experiences of treatment, safeness, staff- and time-availability) had a stronger relationship, than individual factors (i.e. health, anxiety, and loneliness) with satisfaction with care. The results also showed that older persons with home care generally felt better treated than older persons in nursing homes, but also felt less safe. Mediational analyses, based on this comprehensive elderly data, suggest that the individual aging condition of loneliness can be countered by providing safeness and treatment, resulting in high satisfaction with care. In conclusion, satisfaction with elderly care in Sweden today can largely be explained from a psychological perspective by the older persons’ perception of the care process, not by the amount of structural resources or the conditions of the aging persons. These findings could help facilitate the future quality development in municipalities and care organizations.

Place, publisher, year, edition, pages
Göteborg: Department of Psychology, Göteborgs Universitet, 2014. 31 p.
Series
Avhandling/Göteborgs universitet, Psykologiska institutionen, ISSN 1101 - 718X
Keyword
elderly care, quality, satisfaction, individualized care, äldreomsorg, äldreboende, nöjdhet
National Category
Applied Psychology
Research subject
SOCIAL SCIENCE, Psychology
Identifiers
urn:nbn:se:hv:diva-8662 (URN)
Presentation
2014-12-05, 11:32
Opponent
Supervisors
Available from: 2015-11-17 Created: 2015-11-12 Last updated: 2016-03-17Bibliographically approved
2. An Inquiry into Satisfaction and Variations in User-Oriented Elderly Care
Open this publication in new window or tab >>An Inquiry into Satisfaction and Variations in User-Oriented Elderly Care
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The foundation for this thesis is an ongoing discussion about quality in Swedish elderly care: Which are the most important factors that contribute to elderly care in terms of satisfaction among older persons, and what are the primary reasons for their differences? Aims. The principal aim was to examine what determines satisfaction with elderly care in home care and nursing homes, using the perspective of older persons (Studies I and II). The secondary aim was to analyze why these determinants differ, using the perspective of care workers, managers, and observers (Studies III and IV). Methods. Study I analyzed aggregated statistical data from the level of municipalities and districts (N = 324) based on the Swedish elderly care quality reports “Open Comparisons”, while Study II analyzed individual data based on the original ratings in the annual, nationwide elderly surveys (N = 95,000). Study III describes field observations and interviews with care workers and managers in two municipalities, one with a high rating for user satisfaction and one with an average rating. Study IV describes investigations in these two municipalities concerning their organizing principles and departmental level management climate. Results. The results relating to the principal aim showed that process factors (such as respect, information, and influence) are related considerably more closely than structural factors (such as budget, staffing levels, and training levels) to satisfaction with care. Other process factors (such as treatment, safeness, staff and time availability) were also able to alleviate person factors (such as health, anxiety, and loneliness). Moreover, the results relating to the secondary aim showed that differences in user-oriented elderly care are mainly due to interpersonal factors between the caregiver and the older person. Care workers, however, reported that other factors (such as organizing principles and leadership support) influence the quality of the care process. Overall, older persons who receive home care generally report higher satisfaction with care than those in nursing homes, and feeling less safe. It is possible that differences in the process of aging explain this. Value. This thesis shows that satisfaction with elderly care can be largely explained by psychological quality at the individual level. The sizes of structural resources and organizing principles at the municipal level have minimal effect (< 5%). The thesis also presents a theoretical multiple-level Quality Agents Model to explain the sources of differences in satisfaction with care, and it presents recommendations for elderly care practices. A renewed focus on the psychology of satisfaction may contribute to the development of quality in elderly care.

Place, publisher, year, edition, pages
Göteborg: Department of Psychology, University of Gothenburg, 2015. 66 p.
Series
Avhandling / Göteborgs universitet, Psykologiska institutionen, ISSN 1101-718X ; 324
Keyword
Satisfaction, elderly, care quality, user-orientated care
National Category
Applied Psychology
Research subject
SOCIAL SCIENCE, Psychology
Identifiers
urn:nbn:se:hv:diva-8675 (URN)9789198235395 (ISBN)
Opponent
Supervisors
Available from: 2015-11-19 Created: 2015-11-18 Last updated: 2016-03-17Bibliographically approved

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