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Barriers and facilitators for guideline adherence in diagnostic imaging: an explorative study of GPs' and radiologists' perspectives.

https://arctichealth.org/en/permalink/ahliterature298054
Source
BMC Health Serv Res. 2018 07 16; 18(1):556
Publication Type
Journal Article
Date
07-16-2018
Author
Ann Mari Gransjøen
Siri Wiig
Kristin Bakke Lysdahl
Bjørn Morten Hofmann
Author Affiliation
Department of Health sciences in Gjøvik, Norwegian University of Science and Technology in Gjøvik (NTNU), Teknologiveien 22, 2815, Gjøvik, Norway. ann.gransjoen@ntnu.no.
Source
BMC Health Serv Res. 2018 07 16; 18(1):556
Date
07-16-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Attitude of Health Personnel
Diagnostic Imaging - standards
Female
General Practitioners - standards
Guideline Adherence - standards
Humans
Male
Middle Aged
Norway
Perception
Practice Guidelines as Topic - standards
Practice Patterns, Physicians' - standards
Radiologists - standards
Abstract
Diagnostic imaging has been a part of medicine for the last century. It has been difficult to implement guidelines in this field, and unwarranted imaging has been a frequent problem. Some work has been done to explain these phenomena separately. Identifying the barriers to and facilitators of guideline use has been one strategy. The aim of this study is to offer a more comprehensive explanation of deviations from the guideline by studying the two phenomena together.
Eight general practitioners and 10 radiologists from two counties in Norway agreed to semi-structured interviews. Topics covered in the interviews were knowledge of the guideline, barriers to and facilitators of guideline use, implementation of guidelines and factors that influence unwarranted imaging.
Several barriers to and facilitators of guideline use were identified. Among these are lack of time, pressure from patients, and guidelines being too long, rigid or unclear. Facilitators of guideline use were easy accessibility and having the guidelines adapted to the target group. Some of the factors that influence unwarranted imaging are lack of time, pressure from patients and availability of imaging services.
There are similarities between the perceived barriers for guideline adherence and the perceived factors that influence unwarranted imaging. There may be a few reasons that explains the deviation from guidelines, and the amount of unwarranted imaging.
PubMed ID
30012130 View in PubMed
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Certification as support for resilience? Behind the curtains of a certification body - a qualitative study.

https://arctichealth.org/en/permalink/ahliterature305092
Source
BMC Health Serv Res. 2020 Aug 08; 20(1):730
Publication Type
Journal Article
Date
Aug-08-2020
Author
Dag Tomas Sagen Johannesen
Preben Hempel Lindøe
Siri Wiig
Author Affiliation
Department of Media and Social Sciences, The Faculty of Social Sciences, University of Stavanger, 4036, Stavanger, Norway. dag.t.johannesen@uia.no.
Source
BMC Health Serv Res. 2020 Aug 08; 20(1):730
Date
Aug-08-2020
Language
English
Publication Type
Journal Article
Keywords
Certification
Delivery of Health Care - organization & administration - standards
Humans
Norway
Qualitative Research
Abstract
Certification in healthcare often involves independent private sector bodies performing legally required or voluntary external assurance activities. These certification practices are embedded in international standards founded in traditional beliefs about rational and predictable processes for quality and safety improvement. Certification can affect organizational and cultural changes, support collaboration and encourage improvement that may be conducive to resilient performance. This study explores whether ISO 9001 quality management system certification can support resilience in healthcare, by looking at characteristics in the objectives, methods, and practice of certification from a certification body's perspective.
One of Norway's four certification bodies in healthcare was studied, using an explorative embedded single-case design. The study relies on document analysis of the international standards and associated guidances for the performance of certification bodies and thematic analyses of data from 60?h of observations of auditors in three certification processes and nine qualitative interviews with managers and personnel from the certification body. Results from the analyses were compared to identify discrepancies between the written and perceived certification approach and practice.
Standards and guidances for certification embed an elasticity between formal and consistent assessments of nonconformities in organizations and emphasize holistic approaches that brings added value. Auditors were then left with the latitude to navigate their auditing strategy during interaction with the auditees. Members of the certification body perceived and practiced a holistic and flexible auditing approach using opportunities to share knowledge, empower and make guidance for improvement.
ISO certification expects structures and systems to ensure consistent and objective certification processes. At the same time, it embodies a latitude to adopt flexible and context-specific certification approaches, as demonstrated by a certification body in this study, to give added value to the certified organizations. Such an ISO 9001 certification approach may support resilient performance in healthcare by nurturing the potential to respond and learn. These results are important for further development of methods that certification bodies use in the auditing encounter.
PubMed ID
32771012 View in PubMed
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Development and conduction of an active re-implementation of the Norwegian musculoskeletal guidelines.

https://arctichealth.org/en/permalink/ahliterature298350
Source
BMC Res Notes. 2018 Nov 03; 11(1):785
Publication Type
Journal Article
Date
Nov-03-2018
Author
Ann Mari Gransjøen
Siri Wiig
Kristin Bakke Lysdahl
Bjørn Morten Hofmann
Author Affiliation
Department of Health Sciences in Gjøvik, Norwegian University of Science and Technology in Gjøvik (NTNU), Teknologiveien 22, 2815, Gjøvik, Norway. ann.gransjoen@ntnu.no.
Source
BMC Res Notes. 2018 Nov 03; 11(1):785
Date
Nov-03-2018
Language
English
Publication Type
Journal Article
Keywords
Diagnostic Imaging - standards
Guideline Adherence - standards
Humans
Musculoskeletal Diseases - diagnostic imaging
Norway
Practice Guidelines as Topic - standards
Abstract
Significant geographical variations in the use of diagnostic imaging have been demonstrated in Norway and elsewhere. Non-traumatic musculoskeletal conditions is one area where this has been demonstrated. A national musculoskeletal guideline was implemented in response by online publishing and postal dissemination in Norway in 2014 by national policy makers. The objective of our study was to develop and conduct an intervention as an active re-implementation of this guideline in one Norwegian county to investigate and facilitate guideline adherence. The development and implementation process is reported here, to facilitate understanding of the future evaluation results of this study.
The consolidated framework for implementation research guided the intervention development and implementation. The implementation development was also based on earlier reported success factors in combination with interviews with general practitioners and radiologists regarding facilitators and barriers to guideline adherence. A combined implementation strategy was developed, including educational meetings, shortening of the guideline and easier access. All the aspects of the implementation strategy were adapted towards general practitioners, radiological personnel and the Norwegian Labor and Welfare Administration. Sixteen educational meetings were held, and six educational videos were made for those unable to attend, or where meetings could not be held.
PubMed ID
30390703 View in PubMed
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Employees' perceptions of patient safety culture in Norwegian nursing homes and home care services.

https://arctichealth.org/en/permalink/ahliterature309226
Source
BMC Health Serv Res. 2019 Aug 29; 19(1):607
Publication Type
Journal Article
Multicenter Study
Date
Aug-29-2019
Author
Eline Ree
Siri Wiig
Author Affiliation
SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway. eline.ree@uis.no.
Source
BMC Health Serv Res. 2019 Aug 29; 19(1):607
Date
Aug-29-2019
Language
English
Publication Type
Journal Article
Multicenter Study
Keywords
Adult
Aged
Attitude of Health Personnel
Communication
Cross-Sectional Studies
Female
Health Personnel - statistics & numerical data
Health services
Home Care Services - standards - statistics & numerical data
Homes for the Aged - standards - statistics & numerical data
Humans
Male
Middle Aged
Norway
Nursing Homes - standards - statistics & numerical data
Patient Care Team - standards - statistics & numerical data
Patient Safety - standards
Primary Health Care - statistics & numerical data
Safety Management - standards
Surveys and Questionnaires
Young Adult
Abstract
Most health care services are provided in the primary health care sector, and an increasing number of elderly is in need of these services. Nonetheless, the research on patient safety culture in home care services and nursing homes remains scarce. This study describes staff perceptions of patient safety culture in Norwegian home care services and nursing homes, and assesses how various patient safety culture dimensions contribute to explaining overall perceptions of patient safety.
Cross-sectional surveys were conducted among healthcare professionals in Norwegian home care services (N?=?139) and nursing homes (N?=?165) in 2018, response rates being 67.5% and 65%, respectively. A Norwegian version of the international recognized Nursing Home Survey on Patient Safety Culture was used. Descriptive statistics and t-tests were used to explore staff perceptions of patient safety culture. We used multiple regression analyses to explore the degree to which patient safety culture dimensions could explain overall perceptions of patient safety.
The number of patient safety dimensions having an average score of more than 60% positive responses was seven out of 10 in nursing homes, and nine out of 10 in home care. Staffing had the lowest scores in both health care services. Home care services scored significantly higher than nursing homes on teamwork (eta squared?=?.053), while nursing homes scored somewhat higher on handover (eta squared?=?.027). In home care, total explained variance of overall perceptions of patient safety was 45%, with teamwork, staffing, and handoffs as significant predictors. The explained variance in nursing homes was 42.7%, with staffing and communication openness as significant predictors.
There are differences in perceptions of patient safety culture between nursing homes and home care services. Staffing is important for patient safety perceptions in both health care services. In home care, teamwork seems to be a significant contributing factor to patient safety, and building sound teams with mutual trust and collaboration should therefore be an essential part of managers' work with patient safety. In nursing homes, the main focus when building a good patient safety culture should be on open communication, ensuring that staff's ideas and suggestions are valued.
PubMed ID
31464630 View in PubMed
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Exploring challenges in quality and safety work in nursing homes and home care - a case study as basis for theory development.

https://arctichealth.org/en/permalink/ahliterature306334
Source
BMC Health Serv Res. 2020 Apr 03; 20(1):277
Publication Type
Journal Article
Date
Apr-03-2020
Author
Terese Johannessen
Eline Ree
Ingunn Aase
Roland Bal
Siri Wiig
Author Affiliation
Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Kjell Arholms gate 39, 4021, Stavanger, Norway. terese.johannessen@uis.no.
Source
BMC Health Serv Res. 2020 Apr 03; 20(1):277
Date
Apr-03-2020
Language
English
Publication Type
Journal Article
Keywords
Clinical Competence
Focus Groups
Health Personnel
Home Care Services - standards
Humans
Interviews as Topic
Norway
Nursing Homes - standards
Patient Safety - standards
Quality of Health Care - standards
Abstract
Management, culture and systems for better quality and patient safety in hospitals have been widely studied in Norway. Nursing homes and home care, however have received much less attention. An increasing number of people need health services in nursing homes and at home, and the services are struggling with fragmentation of care, discontinuity and restricted resource availability. The aim of the study was to explore the current challenges in quality and safety work as perceived by managers and employees in nursing homes and home care services.
The study is a multiple explorative case study of two nursing homes and two home care services in Norway. Managers and employees participated in focus groups and individual interviews. The data material was analyzed using directed content analysis guided by the theoretical framework 'Organizing for Quality', focusing on the work needed to meet quality and safety challenges.
Challenges in quality and safety work were interrelated and depended on many factors. In addition, they often implied trade-offs for both managers and employees. Managers struggled to maintain continuity of care due to sick leave and continuous external-facilitated change processes. Employees struggled with heavier workloads and fewer resources, resulting in less time with patients and poorer quality of patient care. The increased external pressure affected the possibility to work towards engagement and culture for improvement, and to maintain quality and safety as a collective effort at managerial and employee levels.
Despite contextual differences due to the structure, size, nature and location of the nursing homes and home care services, the challenges were similar across settings. Our study indicates a dualistic contextual dimension. Understanding contextual factors is central for targeting improvement interventions to specific settings. Context is, however, not independent from the work that managers do; it can be and is acted upon in negotiations and interactions to better support managers' and employees' work on quality and safety in nursing homes and home care.
PubMed ID
32245450 View in PubMed
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Exploring hospital certification processes from the certification body's perspective - a qualitative study.

https://arctichealth.org/en/permalink/ahliterature306245
Source
BMC Health Serv Res. 2020 Mar 23; 20(1):242
Publication Type
Journal Article
Date
Mar-23-2020
Author
Dag Tomas Sagen Johannesen
Siri Wiig
Author Affiliation
Department of Economic, risk management and planning, University of Stavanger, 4036, Stavanger, Norway. dag.t.johannesen@uia.no.
Source
BMC Health Serv Res. 2020 Mar 23; 20(1):242
Date
Mar-23-2020
Language
English
Publication Type
Journal Article
Keywords
Certification - organization & administration
Hospitals
Humans
Interviews as Topic
Norway
Observation
Qualitative Research
Reproducibility of Results
Abstract
Hospital certification is an external assessment mechanism to assure quality and safety systems. Auditors representing the certification body play a key role in certification processes, as they perform the assessment activities and interact with the involved healthcare organizations. There is limited knowledge about the approaches and methods that auditors use, such as role repertoire, conduct, and assessment practice. The purpose of this study was to explore auditors' practice in hospital certification processes, guided by the following research questions: What styles do auditors apply in hospital certification processes, and how do auditors perceive their role in hospital certification processes?
The study was performed in two stages. In the first stage, non-participant observations (59?h) were conducted, to explore the professional practice of three lead auditors in certification processes of Norwegian hospitals. In the second stage, semi-structured interviews were conducted with these three observed lead auditors. The role repertoires and conducts identified were analyzed by using a deductive approach according to a surveyor (equivalent with auditor) styles typology framework.
Two distinct auditor styles ("explorer" and "discusser") were identified among the three studied auditors. Both styles were characterized by their preference for an opportunistic and less structured type of interview practice during certification audits. All three auditors embedded a guiding approach (reflections about findings, stimulate improvements, experience transfer from other industries) to their perception and practice of certification audits, interacting with the auditees. The use of group interviews instead of individual interviews during certification audits, was the rule of their professional practice.
The auditors' perceptions and styles demonstrated a multifaceted certification reality, in contrast to what is often presumed as consistent, stringent and independent practices. These findings may have implications for reliability judgements when developing hospital certification programs, and for the refinement of the current framework used here to study the different auditing practices.
PubMed ID
32293437 View in PubMed
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Exploring links between resilience and the macro-level development of healthcare regulation- a Norwegian case study.

https://arctichealth.org/en/permalink/ahliterature304985
Source
BMC Health Serv Res. 2020 Aug 18; 20(1):762
Publication Type
Journal Article
Date
Aug-18-2020
Author
Sina Furnes Øyri
Geir Sverre Braut
Carl Macrae
Siri Wiig
Author Affiliation
Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway. sina.f.oyri@uis.no.
Source
BMC Health Serv Res. 2020 Aug 18; 20(1):762
Date
Aug-18-2020
Language
English
Publication Type
Journal Article
Keywords
Government Regulation
Health Services Research
Hospital Administration
Hospitals - standards
Humans
Norway
Organizational Case Studies
Quality Improvement - legislation & jurisprudence
Abstract
The relationship between quality and safety regulation and resilience in healthcare has received little systematic scrutiny. Accordingly, this study examines the introduction of a new regulatory framework (the Quality Improvement Regulation) in Norway that aimed to focus on developing the capacity of hospitals to continually improve quality and safety. The overall aim of the study was to explore the governmental rationale and expectations in relation to the Quality Improvement Regulation, and how it could potentially influence the management of resilience in hospitals. The study applies resilience in healthcare and risk regulation as theoretical perspectives.
The design is a single embedded case study, investigating the Norwegian regulatory healthcare regime. Data was collected by approaching three regulatory bodies through formal letters, asking them to provide internal and public documents, and by searching through open Internet-sources. Based on this, we conducted a document analysis, supplemented by interviews with seven strategic informants in the regulatory bodies.
The rationale for introducing the Quality Improvement Regulation focused on challenges associated with implementation, lack of management competencies; need to promote quality improvement as a managerial responsibility. Some informants worried that the generic regulatory design made it less helpful for managers and clinicians, others claimed a non-detailed regulation was key to make it fit all hospital-contexts. The Government expected hospital managers to obtain an overview of risks and to adapt risk management and quality improvement measures to their specific context and activities.
Based on the rationale of making the Quality Improvement Regulation flexible to hospital context, encouraging the ability to anticipate local risks, along with expectations about the generic design as challenging for managers and clinicians, we found that the regulators did consider work as done as important when designing the Quality Improvement Regulation. These perspectives are in line with ideas of resilience. However, the Quality Improvement Regulation might be open for adaptation by the regulatees, but this may not necessarily mean that it promotes or encourages adaptive behavior in actual practice. Limited involvement of clinicians in the regulatory development process and a lack of reflexive spaces might hamper quality improvement efforts.
PubMed ID
32811492 View in PubMed
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Exploring physicians' decision-making in hospital readmission processes - a comparative case study.

https://arctichealth.org/en/permalink/ahliterature296522
Source
BMC Health Serv Res. 2018 Sep 19; 18(1):725
Publication Type
Journal Article
Date
Sep-19-2018
Author
Malin Knutsen Glette
Tone Kringeland
Olav Røise
Siri Wiig
Author Affiliation
Faculty of Health, Western Norway University of Applied Sciences, Haugesund, Norway. Malinknutsen.glette@hvl.no.
Source
BMC Health Serv Res. 2018 Sep 19; 18(1):725
Date
Sep-19-2018
Language
English
Publication Type
Journal Article
Keywords
Aged
Case-Control Studies
Decision Making
Delivery of Health Care
Female
General Practitioners - psychology
Humans
Interviews as Topic
Male
Middle Aged
Norway
Nursing Homes
Observation
Patient Discharge
Patient Handoff
Patient Readmission
Patient Safety
Qualitative Research
Abstract
Hospital readmissions is an increasingly serious international problem, associated with higher risks of adverse events, especially in elderly patients. There can be many causes and influential factors leading to hospital readmissions, but they are often closely related, making hospital readmissions an overall complex area. In addition, a comprehensive coordination reform was introduced into the Norwegian healthcare system in 2012. The reform changed the premises for readmissions with economic incentives enhancing early transfer from secondary to primary care, making research on readmissions in the municipalities more urgent than ever. General practitioners (GPs) and nursing home physicians, have traditionally held a gatekeepers function in hospital readmissions from the municipal healthcare service, as they are the main decision-makers in questions of hospital readmissions. Still, the GPs' gatekeeper function is an under-investigated area in hospital readmission research. The aim of the study was to increase knowledge about factors that lead to hospital readmissions among elderly in municipal healthcare, with special attention to GPs' and nursing home physicians' decision making.
The study was conducted as a comparative case study. Two municipalities affiliated with the same hospital, but with different readmission rates were recruited. Twenty GPs and nursing home physicians from each municipality were recruited and interviewed. Forty hours of observation were conducted during the huddles in one long-term and one short-term nursing home in each municipality.
Seven themes describing how different factors influence physicians' decision-making in the hospital readmission process in two municipalities were identified. Poor communication, continuity and information flow account for hospital readmissions in both municipalities. Several factors, including nurse staffing and competence, patients and their families, time constraints and experience affected physicians' decision-making.
Communication, continuity and information flow contributed to hospital readmissions in both municipalities. The cross-case analysis revealed slight differences between municipalities. More research focusing on GPs' and nursing home physicians' decision-making, nursing home nurses and home care nurses' experience of hospital readmissions and discharges is needed.
PubMed ID
30231903 View in PubMed
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Hospital physicians' views on discharge and readmission processes: a qualitative study from Norway.

https://arctichealth.org/en/permalink/ahliterature309236
Source
BMJ Open. 2019 08 27; 9(8):e031297
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
08-27-2019
Author
Malin Knutsen Glette
Tone Kringeland
Olav Røise
Siri Wiig
Author Affiliation
Department of Health and Caring Sciences, Western Norway University of Applied Sciences - Haugesund Campus, Haugesund, Norway Malinknutsen.glette@hvl.no.
Source
BMJ Open. 2019 08 27; 9(8):e031297
Date
08-27-2019
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Attitude of Health Personnel
Communication
Decision Making
Delivery of Health Care
Humans
Interviews as Topic
Norway
Patient Discharge
Patient Readmission
Physicians - psychology
Qualitative Research
Abstract
To explore hospital physicians' views on readmission and discharge processes in the interface between hospitals and municipalities.
Qualitative case study.
The Norwegian healthcare system.
Fifteen hospital physicians (residents and consultants) from one hospital, involved in the treatment and discharge of patients.
The results of this study showed that patients were being discharged earlier, with more complex medical conditions, than they had been previously, and that discharges sometimes were perceived as premature. Insufficient capacity at the hospital resulted in pressure to discharge patients, but the primary healthcare service of the area was not always able to assume care of these patients. Communication between levels of the healthcare service was limited. The hospital stay summary was the most important, and sometimes only, form of communication between levels. The discharge process was described as complicated and was affected by healthcare personnel, by patients themselves and by aspects of the primary healthcare service. Early hospital discharges, poor communication between healthcare services and inadequacies in the discharge process were perceived to affect hospital readmissions.
The results of this study provide a better understanding of hospital physicians' views on the discharge and hospital readmission processes in the interface between the hospital and the primary healthcare service. The study also identifies discrepancies in governmental requirements, reform regulations and current practices in municipalities and hospitals.
PubMed ID
31462486 View in PubMed
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Improving quality and safety in nursing homes and home care: the study protocol of a mixed-methods research design to implement a leadership intervention.

https://arctichealth.org/en/permalink/ahliterature294993
Source
BMJ Open. 2018 03 28; 8(3):e020933
Publication Type
Clinical Trial
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Date
03-28-2018
Author
Siri Wiig
Eline Ree
Terese Johannessen
Torunn Strømme
Marianne Storm
Ingunn Aase
Berit Ullebust
Elisabeth Holen-Rabbersvik
Line Hurup Thomsen
Anne Torhild Sandvik Pedersen
Hester van de Bovenkamp
Roland Bal
Karina Aase
Author Affiliation
SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
Source
BMJ Open. 2018 03 28; 8(3):e020933
Date
03-28-2018
Language
English
Publication Type
Clinical Trial
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Attitude of Health Personnel
Guidelines as Topic
Home Care Services - standards
Humans
Leadership
Netherlands
Norway
Nursing Homes - standards
Patient Safety - standards
Program Evaluation
Quality Improvement
Research Design
Surveys and Questionnaires
Abstract
Nursing homes and home care face challenges across different countries as people are living longer, often with chronic conditions. There is a lack of knowledge regarding implementation and impact of quality and safety interventions as most research evidence so far is generated in hospitals. Additionally, there is a lack of effective leadership tools for quality and safety improvement work in this context.
The aim of the 'Improving Quality and Safety in Primary Care-Implementing a Leadership Intervention in Nursing Homes and Homecare' (SAFE-LEAD) study is to develop and evaluate a research-based leadership guide for managers to increase quality and safety competence. The project applies a mixed-methods design and explores the implications of the leadership guide on managers' and staffs' knowledge, attitudes and practices. Four nursing homes and four home care services from different Norwegian municipalities will participate in the intervention. Surveys, process evaluation (interviews, observations) and document analyses will be conducted to evaluate the implementation and impact of the leadership intervention. A comparative study of Norway and the Netherlands will establish knowledge of the context dependency of the intervention.
The study is approved by the Norwegian Centre for Research Data (2017/52324 and 54855). The results will be disseminated through scientific articles, two PhD dissertations, an anthology, presentations at national and international conferences, and in social media, newsletters and in the press. The results will generate knowledge to inform leadership practices in nursing homes and home care. Moreover, the study will build new theory on leadership interventions and the role of contextual factors in nursing homes and home care.
Notes
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PubMed ID
29599394 View in PubMed
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19 records – page 1 of 2.