Structure and process quality as predictors of satisfaction with elderly care

• Published in: Health & social care in the community Vol. 24; no. 6; pp. 699 - 707
• Main Authors: Kajonius, Petri J., Kazemi, Ali
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.11.2016; Hindawi Limited
• Subjects: Access to information; Aged; Caregivers; centered care; Client satisfaction; Elder care; elderly care; Environmental & Occupational Health; framework; Health Services for the Aged; Home Care Services; Home health care; Humaniora-samhällsvetenskap; Humanities and Social sciences; Humans; Kvinna, barn och familj (WomFam); Nursing Homes; of-care; Older people; Outcome and Process Assessment (Health Care); patient; Patient Satisfaction; perceptions; Personal Satisfaction; Polls & surveys; process; Public; Quality management; Quality of care; Quality of Health Care; satisfaction; Social Psychology; Social Work; Socialpsykologi; Sociologi; Sociology; Staffing; structure; Sweden; Variables; Welfare; Woman, Child and Family (WomFam); process; satisfaction; quality of care; elderly care; structure
• ISSN: 0966-0410; 1365-2524; 1365-2524
• DOI: 10.1111/hsc.12230

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.