Study protocol for the development, trial, and evaluation of a strategy for the implementation of qualification-oriented work organization in nursing homes

Corinna Burfeindt; Ingrid Darmann-Finck; Carina Stammann; Constance Stegbauer; Claudia Stolle-Wahl; Matthias Zündel; Heinz Rothgang

doi:10.1186/s12912-024-01883-3

Study protocol for the development, trial, and evaluation of a strategy for the implementation of qualification-oriented work organization in nursing homes

BMC Nurs. 2024 Mar 26;23(1):201. doi: 10.1186/s12912-024-01883-3.

Authors

Corinna Burfeindt^{1

2}, Ingrid Darmann-Finck^{3

4}, Carina Stammann⁵, Constance Stegbauer⁵, Claudia Stolle-Wahl⁶, Matthias Zündel⁶, Heinz Rothgang^{7

3}

Affiliations

¹ SOCIUM Research Center On Inequality and Social Policy Mary-Somerville-Straße 3, University of Bremen, 28359, Bremen, Germany. c.burfeindt@uni-bremen.de.
² High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany. c.burfeindt@uni-bremen.de.
³ High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.
⁴ Department for Health Care Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Grazer Straße 4, 28359, Bremen, Germany.
⁵ Department of Evaluation and Implementation Research, aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany.
⁶ Centre for Nursing Research and Counselling, Hochschule Bremen City University of Applied Sciences, Am Brill 2-4, 28195, Bremen, Germany.
⁷ SOCIUM Research Center On Inequality and Social Policy Mary-Somerville-Straße 3, University of Bremen, 28359, Bremen, Germany.

Abstract

Background: Staffing ratios in nursing homes vary among the federal states of Germany, but there are no rational grounds for these variations. In a previous study, a new instrument for the standardized calculation of staffing requirements in nursing homes was developed (Algorithm 1.0). The development was based on a new empirical data collection method that derives actual and target values for the time and number of care interventions provided. Algorithm 1.0 found an increased requirement of 36% of staff in German nursing homes. Based on these results, the German legislature has commissioned a model program to trial and evaluate a complex intervention comprising increased staffing combined with strategies for organizational development.

Methods: The mixed-methods study consists of (i) developing a concept for restructuring the work organization, (ii) the application of this concept combined with increased staffing in 10 nursing homes (complex intervention), and the further development of the concept using a participatory and iterative formal evaluation process. The intervention consists of (a) quantitative measures of increased staffing based on a calculation using Algorithm 1.0 and (b) qualitative measures regarding organizational development. The intervention will be conducted over one year. The effects of the intervention on job satisfaction and quality of care will be evaluated in (iii) a comprehensive prospective, controlled summative evaluation. The results will be compared with ten matched nursing homes as a control group. Finally, (iv) prototypical concepts for qualification-oriented work organization, a strategy for the national rollout, and the further development of Algorithm 1.0 into Algorithm 2.0 will be derived.

Discussion: In Germany, there is an ongoing dynamic legislation process regarding further developing the long-term care sector. The study, which is the subject of the study protocol presented here, generates an evidence-based strategy for the staffing requirements for nursing homes.

Ethics and dissemination: This study was approved by the Ethics Committee of the German Association of Nursing Science (Deutsche Gesellschaft für Pflegewissenschaft) on 02.08.2023 (amended on 20.09.2023). Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals.

Trial registration number: German Clinical Trails Register DRKS00031773 (Date of registration 09.11.2023).

Keywords: Evaluation; Long-term care; Long-term care facilities; Long-term care systems research; Nursing homes; Organizational development; Staffing ratios; Work organization in long-term care facilities.