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. 2025 Apr 8;25(1):511.
doi: 10.1186/s12913-025-12640-w.

Improving and supporting quality of care in Dutch nursing homes: a quantitative study

Bellis van den Berg  1 , Marrit B Zuure  2 , Paulien Vermunt  3 , Mariëlle Zondervan-Zwijnenburg  3 , Mirella Minkman  3   4
Affiliations

Improving and supporting quality of care in Dutch nursing homes: a quantitative study

Bellis van den Berg et al. BMC Health Serv Res. .

Abstract

Background: Previous research showed the potential of quality improvement programs in nursing home care. However, studies that quantitatively evaluate the effectiveness of quality of care improvement programs are scarce. In this study, we examine the results of a Dutch nation-wide programme that was established to support the implementation of the Quality Framework for Nursing Home care.

Methods: The Dignity & Pride at every Facility (D&PF) program was accessible to all Dutch nursing home facilities. Problem analysis per facility was conducted by means of a quantitative Quality Scan targeting all eight themes of the quality framework. Based on the baseline measurements nursing home facilities received tailored support from an external expert coach. The Quality Scan was repeated at the end of the support trajectories, 9 to 24 months later depending on the type of support provided. Scan data of 331 nursing home facilities was used to quantify the effectiveness of the D&PF program, the contribution of tailored support and the influence of organizational factors on care outcomes.

Results: The entire pool of participating facilities scored better on the final scan (M = 3.21, SD = 0.74) than on the baseline scan (M = 2.64, SD = 0.87, p < 0.001). Greater improvements on theme level were seen when (partial) support was provided by an external expert coach. The probability of achieving high scores on care outcomes (person-centred care, resident safety and well-being) was significantly increased with high scores on organizational conditions. A multilevel model demonstrated that the themes Learning and improvement, Responsive workforce and Use of resources were statistically significant associated with positive care outcomes.

Conclusion: This study demonstrates significant improvements across all themes of the quality framework and provides supporting evidence for the positive contribution of tailored on-site support of external expert coaches. This study also indicates that a supportive organizational environment and a learning-oriented culture are of significant importance for good care outcomes in terms of safety, person-centred care and resident well-being.

Keywords: Learning culture; Nursing homes; Organizational changes; Organizational conditions; Person-centred care; Quality improvement; Resident safety.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All data were collected and handled in accordance with the relevant privacy protection guidelines. According to Dutch law our study does not fall under the remit of the ‘Medical Research Involving Human Subjects Act’ and no approval by a medical ethics committee was necessary [50]. This act is based on the Helsinki declaration of the World Medical Association and is executed by the Central Committee on Research Involving Human Subjects (CCMO). Respondents received information about the participation of the facility in the quality improvement programme and about the goals and content of the questionnaire. Verbal informed consent was obtained from respondents who completed a questionnaire anonymously, and their response expressed their willingness to participate. No email addresses, contact information and socio-demographic information of respondents were collected to ensure privacy and anonymity of respondents. Completing the questionnaires did not bring about a (temporary) change in the subject’s lifestyle, questions were not psychologically probing [51, 52]. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Dutch Quality Framework for Nursing Home care (QF-NH)
Fig. 2
Fig. 2
Design of the D&PF improvement trajectories and data collection
Fig. 3
Fig. 3
Change in baseline vs. final scan scores on the eight quality themes, for Plus and Intensive support trajectories. *Error bars depict standard error (SE)
Fig. 4
Fig. 4
The relation between approach to support per theme and the improvement of quality scores. *Error bars indicate the standard error (SE)
Fig. 5
Fig. 5
The relation between approach to support per theme and the improvement of quality scores, for care outcomes and organization conditional themes separately. *Error bars depict standard error (SE)
See this image and copyright information in PMC

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