Enhancing home care nursing in the Netherlands: how can organisations facilitate the improvement of needs assessments in home care nursing? A focus group study.

BACKGROUND: Home care nursing plays an essential role in the current and future societal challenges. In the Netherlands, home care nurses autonomously determine the type, cost and duration of nursing care at home. There are no guidelines for performing this needs assessment and organisations can implement the needs assessment according to their preferences. Recent research indicates variation in the assessed care of comparable patients. Also, there are various problems in the needs assessment process, mostly on organisational level. Organisations play a crucial role in the improvement of the needs assessment. However, it remains unclear how organizations address the challenges encountered during the needs assessment process and what specific difficulties they face. The aim of this study is to explore the challenges that organisations encounter in the process of the needs assessment and what approaches they handle to optimise the process of the needs assessment. METHODS: This study had a qualitative explorative design. Four focus group interviews were conducted with professionals including managers, policy- and quality officers, and home care nurses from different organisations who are involved in improvement processes regarding the needs assessment in Dutch home care organisations. The focus group interviews were audio-recorded and transcribed. Data were analysed using a thematic approach. RESULTS: 38 participants from 22 different home care organisations participated in the study. Three main themes emerged: (1) Problems in the process of the needs assessment, (2) Best practices in organisations, and (3) Professionals' improvement ideas. Organisations experience challenges especially due to a lack of a shared vision and different perspectives on the needs assessment. Many different approaches were seen between organisations that could influence practice variation, e.g. short-term assessments, intake routes or various roles and functions, such as senior home care nurses, ambassadors, or dual management. CONCLUSIONS: To optimise the needs assessment process, a clear and shared vision is needed among all involved organisations, health care professional and health insurers. Furthermore, more scientific evidence on interventions and strategic approaches in home care nursing are essential to provide organisations with guidance in improvement processes towards a better needs assessment. Third, home care organisations, other health care professionals, and health insurers must collaborate to create a more uniform process of the needs assessment.