Using client experiences for quality improvement in long-term care organizations.

OBJECTIVE To examine whether client experiences measured with the Consumer Quality Index (CQ-index or CQI) questionnaires are used in Dutch nursing homes and homes for the elderly for quality improvement. DESIGN Information was gathered through face-to-face interviews with day-to-day workers, quality managers and middle and senior management representatives on the subjects of quality policy and CQI. SETTING Twelve long-term care organizations in the Netherlands. STUDY PARTICIPANTS A total of 47 employees were interviewed. RESULTS Long-term care organizations that systematically incorporate client experiences into their quality system are more active in using the CQI for quality improvement: information was disseminated throughout the organization, project groups pointed out quality improvement initiatives and every worker was involved in this process. These organizations had often held a certificate for their quality policy for some length of time. In other organizations, CQI information was used less systematically. For instance, only the quality manager was involved, or improvement initiatives were left to employees working in the primary process. The actual improvement initiatives varied. For example, employees created more individual time for clients to avoid the feeling of being rushed; other organizations changed the food delivery to enhance food enjoyment. CONCLUSIONS Although measuring client experiences obligatory, it is not sufficient guarantee that client feedback is used for quality improvement. Although measuring client experiences has led to various improvement initiatives, their effectiveness remains unclear. There is need for guidance on effective improvement of client experiences.