Change search
ReferencesLink to record
Permanent link

Direct link
An Inquiry into Satisfaction and Variations in User-Oriented Elderly Care
University West, Department of Social and Behavioural Studies, Division of Psychology and Organisation Studies.ORCID iD: 0000-0003-0629-353X
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 [en]
Satisfaction, elderly, care quality, user-orientated care
National Category
Applied Psychology
Research subject
SOCIAL SCIENCE, Psychology
Identifiers
URN: urn:nbn:se:hv:diva-8675ISBN: 9789198235395OAI: oai:DiVA.org:hv-8675DiVA: diva2:872215
Opponent
Supervisors
Available from: 2015-11-19 Created: 2015-11-18 Last updated: 2016-03-17Bibliographically approved
List of papers
1. Structure and process quality as predictors of satisfaction with elderly care
Open this publication in new window or tab >>Structure and process quality as predictors of satisfaction with elderly care
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
elderly care, process, quality of care, satisfaction, structure
National Category
Social Psychology
Research subject
SOCIAL SCIENCE, Psychology
Identifiers
urn:nbn:se:hv:diva-8657 (URN)10.1111/hsc.12230 (DOI)25809819 (PubMedID)
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
2. Safeness and Treatment Mitigate the Effect of Loneliness on Satisfaction with Elderly Care
Open this publication in new window or tab >>Safeness and Treatment Mitigate the Effect of Loneliness on Satisfaction with Elderly Care
2015 (English)In: The gerontologist, ISSN 0016-9013, E-ISSN 1758-5341Article in journal (Refereed) Epub ahead of print
Abstract [en]

Maximizing satisfaction among the older persons is the goal of modern individualized elderly care and how to best achieve this is of relevance for anyone planning and providing for elderly care services. Purpose of the study: What predicts satisfaction with care among older persons can be conceived as a function of process (how care is performed), and the older person. Inspired by the long-standing person versus situation debate, the present research investigated the interplay between person- and process aspects in predicting satisfaction with elderly care. Design and method: A representative nationwide sample was analyzed, based on a questionnaire sent out to 95,000 individuals using elderly care services. Results: The results showed that person-related factors (i.e., anxiety, health, and loneliness) were significant predictors of satisfaction with care, although less strongly than process-related factors (i.e., treatment, safeness, and perceived staff- and time availability). Among the person-related factors, loneliness was the strongest predictor of satisfaction among older persons in nursing homes. Interestingly, a path analysis revealed that safeness and treatment function as mediators in linking loneliness to satisfaction. Implications: The results based on a large national sample demonstrate that the individual aging condition to a significant degree can be countered by a well-functioning care process, resulting in higher satisfaction with care among older persons. 

Place, publisher, year, edition, pages
Oxford University Press, 2015
Keyword
Person-centered care, Elderly care, Individualized care, Person, Situation, Satisfaction, Loneliness
National Category
Applied Psychology
Research subject
SOCIAL SCIENCE, Psychology
Identifiers
urn:nbn:se:hv:diva-8660 (URN)10.1093/geront/gnu170 (DOI)25628300 (PubMedID)
Projects
Organisering för verksamhetskvalitet inom svensk äldreomsorg: Ett skifte i fokus från vad till hur
Available from: 2015-01-12 Created: 2015-11-12 Last updated: 2016-03-17Bibliographically approved
3. Advancing the Big Five of user-oriented elderly care and accounting for its variations
Open this publication in new window or tab >>Advancing the Big Five of user-oriented elderly care and accounting for its variations
2016 (English)In: International journal of health care quality assurance/MCB University Press, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 29, no 2, 162-176 p.Article in journal (Refereed) Published
Abstract [en]

Purpose – Care process quality (i.e., how care is enacted by a care worker toward a client at the interpersonal level) is a strong predictor of satisfaction in a wide range of health care services. The present research aims at describing the basic elements of care process quality as user-oriented care. Specifically, the questions of how and why quality in user-oriented care varies were investigated in the context of elderly care.

Design – Two municipalities were selected for in-depth field studies. First, in each municipality, we interviewed and observed care workers’ interactions with the older persons in both home care and nursing homes during two weeks (Study 1). Second, in an attempt to gain a deeper understanding of why process quality in terms of user-oriented care varies, we conducted interviews with care workers and care unit managers (Study 2).

Findings – A new taxonomy for categorising process quality variation, the Big Five of user-oriented care (Task-focus, Person-focus, Affect, Cooperation, and Time-use), is proposed. In addition, the perceived reasons for process quality variation are reported in our own developed Quality Agents Model, suggesting that variations in care process evaluations may be explained from different perspectives at multiple levels (i.e., older person, care worker-, unit-, department-, and municipality-level).

Value – The proposed taxonomy and model are useful for describing user-oriented care quality and the reasons for its variations. These findings are of relevance for future quality developments of elderly care services, but also may be adapted to applications in any other enterprise employing a user-oriented approach.

Place, publisher, year, edition, pages
Bradford: MCB University Press, 2016
Keyword
User satisfaction, user-oriented care, service quality, elderly care, individualized care, person-centred care
National Category
Social Work
Research subject
SOCIAL SCIENCE, Social work
Identifiers
urn:nbn:se:hv:diva-8651 (URN)10.1108/IJHCQA-03-2015-0040 (DOI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-1200
Available from: 2015-11-12 Created: 2015-11-12 Last updated: 2016-05-11Bibliographically approved
4. Organizing Principles and Management Climate in High-Performing Municipal Elderly Care
Open this publication in new window or tab >>Organizing Principles and Management Climate in High-Performing Municipal Elderly Care
2016 (English)In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 29, no 1, 82-94 p.Article in journal (Refereed) Submitted
Abstract [en]

Purpose – Previous research has shown that user-oriented care predicts older persons’ satisfaction with care. What is yet to be researched is how senior management facilitates the implementation of user-oriented care. The present study set out to investigate the organizing principles and management climate characterizing successful elderly care organizations.

Design – The care organization in one highly ranked municipality was selected and compared with a more average municipality. On-site semi-structured in-depth interviews with managers as well as participatory observations at managers’ meetings were conducted in both municipalities.

Findings – The results revealed three key principles for successful elderly care: 1) organizing care from the viewpoint of the older service user, 2) recruiting and training competent and autonomous employees, 3) instilling a vision for the mission which guides operations at all levels in the organization. Furthermore, using climate theory to interpret the material, in the highly successful municipality the management climate was characterized by affective support and cognitive autonomy, in contrast to a more instrumental work climate primarily focusing on organizational structure and doing things right characterizing the more average municipality.

Value – We suggest that guiding organizing principles are intertwined with management climate and that there are multiple perspectives that must be considered by the upper management, i.e., the views of the older persons, the co-workers, and the mission. The results can guide future care quality developments and increase the understanding of the importance of organizational climate at the senior management level.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2016
Keyword
Organizational climate, Leadership, Older people, Elderly care, Management, User-oriented care
National Category
Business Administration
Research subject
SOCIAL SCIENCE, Psychology
Identifiers
urn:nbn:se:hv:diva-8650 (URN)10.1108/LHS-06-2015-0018 (DOI)
Available from: 2015-11-12 Created: 2015-11-12 Last updated: 2016-03-17Bibliographically approved

Open Access in DiVA

No full text

Other links

Länk till avhandlingen Göteborgs universitet

Search in DiVA

By author/editor
Kajonius, Petri
By organisation
Division of Psychology and Organisation Studies
Applied Psychology

Search outside of DiVA

GoogleGoogle Scholar

Total: 34 hits
ReferencesLink to record
Permanent link

Direct link