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Their results demonstrated that caregivers could increase the perceived feelings of dignity by getting to know the patients on a personal level at the start of their residency. In addition, Cairns et al.

Relationship-centered care and dignity aren't entirely new concepts, though, and can already be seen in various existing roles in healthcare, such as the roles described by Huizenga et al. The collaborator focuses on facilitating cooperation between various disciplines within healthcare to achieve optimal patient care.

The manager lastly coordinates the developments affecting patients, and prevents fragmentation of care Huizenga et al. This demonstrates that at least some of the roles health care professionals fulfill already contain elements of relation-oriented care, but not all of them.

Few researchers have explicitly examined the benefits of the shift in focus toward relation-oriented care. Only one study by Wilson and Davies suggests that residents of nursing homes express more positive feelings with relation-oriented care compared with task-oriented care. However, there are other sources that suggest that specific aspects of relation-oriented care, such as dignity, may also be worthwhile to develop.

For example, Adra et al. This means that there is at least some evidence that suggests relation-oriented care is actually beneficial, which may provide further incentive to increase the amount of relation-oriented care in practice.

Although previous research findings suggest the shift to relation-oriented care can be considered to be a positive one, there appear to be multiple obstacles that prevent this shift from fully being implemented in all parts of healthcare.

For instance, Thompson et al. In addition, since patients often have to pay for their own health care, this causes them to view their caregivers as service providers, rather than medical experts.

This further hinders caregivers' ability to form a personal relationship, as it is now seen as a commercial transaction rather than an interpersonal relation. The authors also mention that routine work may prevent health care professionals from showing their true expertise. This in turn may again negatively influence their own self-image, which prevents them from forming optimal relationships with patients Thompson et al.

Thus, it seems that the negative image surrounding health care professionals may inhibit them from developing meaningful relations with patients. In addition to image-related obstacles, many authors also highlight high work pressure as a potential obstacle for relation-oriented care e.

A high workload means that caregivers have less time to invest into a meaningful relationship with their patients Kinnear et al. It should be noted that caregivers often see relationship building as an additional burden, even though this is actually inherent to the work itself Wilson and Davies, ; Cairns et al. This suggests that the work itself may not need to be changed to allow for relation-oriented care, but instead, caregivers' perception about the meaning of their work should be changed, which could be addressed by relationship-centered dialogue e.

One final obstacle has to do with a lack of education and developmental opportunities in health care. Similarly, research by Duffy et al. Lastly, Burger et al.

As such, a lack of education implies caregivers won't have the required skills or confidence to successfully build up a relation-oriented relationship with patients.

In sum, research points out three major obstacles that can prevent the development of relation-oriented relationships in health care: Bad image among caregivers, high workload, and a lack of developmental opportunities. During our search, various themes arose regarding the needs of caregivers relating to their role transitions. These are the needs for shared values, personal development, personal empowerment, team development, and demonstrating expertise. In their article about meaningful work in elder care, Blomberg et al.

Rather than being an individual matter, the need for shared values is actually considered to be a culture-related issue, which implies that the health care organization as a whole should promote a culture of shared values and meaningful work in order to improve caregivers' relationships with clients and other third parties DeHart et al.

Thus, in order to make role transitions possible, it appears the need for shared values should be addressed first. Although caregivers often want to feel competent at work in order to fulfill their roles effectively Burger et al. Developing caregivers' competences is thought to be an important part of role transitions, as it will add to their feelings of self-efficacy From et al.

In addition, rather than offering single training efforts, it seems best for health care institutions to offer continuous developmental opportunities to actually improve health care From et al.

Thus, caregivers' need for development should be addressed in order to allow for better role transitions. Oftentimes, caregivers aren't given the opportunity to be involved in decision-making processes related to personal and organizational change. This lack of empowerment causes them to lose sight of their ability to control and change their own role within health care, leading to a lack of own initiatives for change Burger et al.

Focusing on opportunities, rather than obstacles, may aid in achieving a sense of empowerment among caregivers Blomberg et al. As such, these results suggest providing a sense of empowerment is not only necessary, but also achievable. Not only should individual caregivers be offered sufficient developmental opportunities, but according to various authors, teams in their entirety should be developed as well Yeatts and Cready, ; Blomberg et al.

One way of achieving this, is through the introduction of self-managing teams, which in addition to developing the team itself, also leads to increased feelings of autonomy, competence, and empowerment Yeatts and Cready, Yeats and Cready also note that sufficient time should be made for self-managing teams to operate without sacrificing time spent on core caregiving tasks, and that managerial support is essential for team success.

In that case, having self-managing teams could be a good way of creating more developmental opportunities for caregivers. Both caregivers and their employers report that the roles of caregivers are often interpreted as encompassing fewer tasks than they actually entail Huizenga et al. Health care organizations often do not recognize the potential of caregivers, which leads caregivers to not recognize and act upon their own expertise Huizenga et al.

Work itself then becomes more routine-based, creating a knowledge gap when complex questions arise from clients Thompson et al. Thus, caregivers' expertise should be acknowledged by organizations in order to further express said expertise. Based on various sources, we were also able to compile a list of competences that are deemed necessary for caregivers in order to fulfill their changing roles effectively Hasson and Arnetz, ; Burger et al.

These include:. Although this list may not be exhaustive, it provides an extensive overview of various skills that may be useful in developing caregivers' roles. Although many authors stress the importance of developing caregivers' competences, few authors have actually researched how this should be achieved specifically.

However, some suggestions from intervention studies include having caregivers design their own learning trajectory, making sure learnt theory is immediately and effectively applicable to practice, and having co-workers i.

It should be noted that internal experts should always be supported by other specialists and have sufficient knowledge about the subject, in addition to having didactic skills and having managerial support as well. To our knowledge, this study presents one of the first systematic reviews of the changing role of health professionals in nursing homes.

This study aimed to investigate the changing role of health care professionals in nursing homes, as well as the conditions that make this change possible. This was achieved by means of a systematic review of the health care literature, whereby the literature was sub-divided over three main themes: Changes in nursing home roles, caregiver needs relating to role transitions, caregiver skills and competences.

In terms of the first goal, we can conclude that the role health care professionals fulfill in nursing homes has shifted from standardized, task-oriented care to more individualized, relation-oriented care. For the health care professional, this means building up a mutual relationship with the care receiver and other third parties, for example through an increased emphasis on client dignity.

Although various existing roles already take into account various aspects of client-oriented care, such as the roles of communicator, collaborator, and manager as defined by Huizenga et al.

However, despite the admitted importance of this change, and as an answer to our second research question, many caregivers still view the shift to relation-oriented care as a burden, as there are still various obstacles that prevent them from implementing this change e. In addition, the literature specifies a variety of needs that need to be fulfilled in order to implement this change effectively, such as the needs for shared values, personal development, personal empowerment, team development, and demonstrating expertise.

Lastly, the shift to relation-oriented care will also require various new competences, such as communication skills, attentiveness, negotiation skills, flexibility, teamwork, expertise, and coaching and leadership skills. In short, although there is a general consensus that the role of the health care is shifting to be more relation-oriented, there are still various obstacles that need to be overcome, various needs that need to be fulfilled, and multiple competences that need to be developed in order to make this possible on a larger scale.

Although we tried to limit the amount of limitations as much as possible, there are still some factors that should still be kept in mind when interpreting the conclusions presented in this article. Firstly, we limited our scope to only include those articles that referred to a specific form of health care i. It should be noted that despite this limitation, various aspects of nursing homes are indeed representative of other forms of care as well.

Nonetheless, we urge readers to be cautious when generalizing these results to other parts of health care. Although this is not something that was caused by our methodology specifically, it does mean that the results presented in this article should be interpreted with potential self-report bias in mind. However, since caregivers' own perceptions will most likely determine the course of health care development in the first place, these results remain valid nonetheless.

Thirdly, because of the rigor of our methodology, only a relatively small number of articles ended up being discussed in this study.

However, since the final selection has been extensively screened beforehand in terms of methodological quality and relevance, we feel that the lack of quantity is mitigated by having a high-quality sample instead. Lastly, we included a relatively large amount of qualitative studies compared to quantitative studies, which may indicate a lack of quantitative support at first sight.

However, since we did not filter based on study type i. Lastly, we did not make a distinction between various types of nursing homes that exist, such as government vs. Although some authors did specify the type of nursing home investigated, many did not. However, we think this omission does not significantly impact the overall conclusions of our review.

Our review has various implications for both theory and practice. In terms of theory, this study adds to the existing health care literature by being among the first to systematically examine the changing role of health professionals in nursing homes. By limiting the scope to the years to , it provides a state-of-the-art overview that can be used as a base for future health care research.

Furthermore, this study also adds to the literature on meaningful work by linking the concept of meaningful work to health care, which is directly relevant to the field of occupational health research.

Lastly, our review provides a methodological framework that could be used in future research as a standardized method for investigating role changes in not just the health care sector, but other sectors as well. In terms of practice, our review offers a concise overview of guidelines that can be used by health care institutions and individual caregivers to adequately prepare for the expected change in nursing home roles.

Specifically, our review highlights the nature of the changing role of the health care professional in nursing homes, as well as the potential obstacles, needs, and required competences that need to be addressed in order to make the role transition as smooth as possible.

HR professionals and managers working in health care could use this information to further improve their business and development strategies.

For instance, the competences provided in our review could be used by HR professionals for the training and development of existing health care personnel, or even for the selection and assessment of new personnel. The obstacles and needs we highlight can be used by managers to generate a better understanding of the potential issues that individual caregivers might run into during their careers, as well as simultaneously providing general solutions to these issues.

In addition, individual caregivers may use the information presented in this paper as a means of facilitating bottom-up feedback in health care institutions. More specifically, this may help caregivers give insight into their own concerns regarding their changing roles, which they can subsequently use to communicate these concerns to their superiors.

In short, based on our results, we would recommend health care professionals and their managers to enter into dialogue with one other to discuss the needs and obstacles of caregivers.

Having a mutual conversation will likely generate the best possible circumstances for creating smooth role transitions. Considering our limitations and implications, various suggestions for future research can be made. Because our search was limited to only including health care research related to nursing homes, it makes sense to broaden this scope in future research by including other forms of health care as well. In addition, quantitative empirical research could focus on filling the gaps that were highlighted in the current study, such as the lack of objective measures and the lack of longitudinal research.

Furthermore, it would be interesting to not only rely on self-reports of caregivers, but also reports from other parties, such as care receivers and their families. Lastly, it would be interesting to see whether or not our findings can be generalized to fields other than health care as well. Thus, future research could focus on using the methodological framework presented in this paper as a base for investigating role changes in other sectors. The role of the health care professional has shifted from a task-oriented approach to a relation-oriented approach, and brings along with it a new set of obstacles, needs, and competences that needs to be addressed to allow for a smooth transition.

AvS outlined and executed the methodology of the article, and was responsible for writing the abstract, introduction and parts of the discussion section, rewriting and integrating the conclusions made by the other authors in the main body, as well as formulating new conclusions in the process. Contributed to revising and final approval. JvW was responsible for assisting in the execution of the methodology, writing various parts of the main body, parts of the discussion section, and providing the initial conceptualization of the review.

IK was responsible for assisting in the execution of the methodology, for writing various parts of the main body, parts of the discussion section. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Adra, M. Constructing the meaning of quality of life for residents in care homes in the Lebanon: perspectives of residents, staff and family. Older People Nurs. Arnetz, J. Bing-Jonsson, P.

Sufficient competence in community elderly care? Results from a competence measurement of nursing staff. BMC Nursing Blomberg, K. Meanings over time of working as a nurse in elderly care.

Open Nurs. Burger, S. The most successful organizations at transformational change provide their clinical leaders with the appropriate leadership skills training which frequently include some degree of training in improvement science and adequate resources. Physician leaders especially should be provided with time away from their clinical duties to work with their nursing partners and their teams.

There are a variety of improvement tools available e. However, a standardized approach using a common language to improvement should be used [ 16 ]. Clinically based improvement teams are generally supported by internal quality consultants, project managers, data analysts, and financial analysts in the most successful organizations [ 12 — 14 ].

For this reason, successful organizations pay particular attention to measurement systems and data management and analysis. In this way, everyone from the board of trustees, chief executive officer, and senior leadership team to middle management and front-line clinical leaders and providers fully know why the organization exists and for what purpose, who they are as an organization and what they stand for, and where the organization is collectively going [ 27 — 29 ].

In many ways, the mission, vision, and core values are fundamental to the overall culture of an organization, which is fundamental to the success of any transformational change effort.

Treacy and Wiersema [ 30 ] noted in the early s that the top performing companies, the companies that were the leaders in their industry, narrowed their business to focus on delivering superior value to their customers in one of three value disciplines—product leadership, customer intimacy, or operational excellence [ 31 ].

Importantly, these market leaders generated a sustainable competitive advantage through industry leadership in only one of these three value disciplines, while sustaining performance that met industry standards in the other two value disciplines. An organization that chooses customer intimacy as its value discipline is interested in providing their customers with a total solution, not just a product or service.

These organizations are passionate about helping the customer understand what is needed, ensuring a great solution is implemented, and having a great relationship with each and every customer. Structurally, decision-making is often delegated to employees who are closest to the customer.

Importantly, market leadership in customer intimacy must be coupled product differentiation and operational efficiency—in other words, market leaders in customer intimacy sustain industry standard performance in the other two value disciplines.

It is a focus on the core processes of invention, product development, and market exploitation. The structure of these organizations tends to be loosely defined in order to enable experimentation as well as creative and entrepreneurial behaviors that lead them into new solutions.

Again, market leadership in product leadership must be coupled with operational efficiency and customer responsiveness. In these organizations, operations are standardized and tightly managed and employees are clear about their responsibilities and their authority.

Management systems are focused on integrated, reliable, and high-speed transactions, and compliance to norms. In an effort to bring value to customers, these cultures focus on waste and reward efficiency. These organizations are also highly dependent on teamwork through which every team member holds every other team member accountable for achieving the organizations process and outcome measures.

Everybody knows the battle plan and the rule book, and when the buzzer sounds everyone knows what he or she has to do. The heroes in this kind of organization are people who fit in, who came up through the ranks. In operationally excellent organizations, the employee of the year is the best team player and peer recognition is the best complement.

Organizations that are market leaders in operational excellence must meet industry-level standards in the other two value disciplines—product differentiation and customer responsiveness.

Operational excellence is really about achieving process reliability through continuous process improvement. Avedis Donabedian proposed the structure-process-outcomes framework to achieve operational excellence. Only by putting the right structures in place with effective and reliable processes can the best outcomes be achieved.

When outcomes are measured and followed closely, processes can be evaluated and changed or modified, when necessary and as appropriate, in order to produce even better outcomes [ 32 ]. Processes refer to how care is provided in the delivery system—for example, how different providers interact and work together to take care of patients. Several health care systems have organized the structural elements of their delivery system using a systems engineering approach. The industrial engineering literature would describe an individual hospital as a macrosystem consisting of multiple, individual microsystems and mesosystems Fig.

The Institute of Medicine suggested that focusing on how small clinical, unit-based teams function and interact with other unit-based teams will lead to transformational change of the overall health care delivery system in its report, Crossing the Quality Chasm [ 35 ].

The business school professor, James Brian Quinn, noted that the top performing Fortune companies all focused on their smallest replicable units, i. In addition, senior leaders, including the chief executive officer and members of the board of trustees, were trained in quality improvement and held hospital leaders accountable for improving safety, patient-family experience, and outcomes [ 54 , 55 ]. Clinical microsystems appear to be another key driver of successful transformational change [ 12 , 14 , 16 , 49 ], especially when the clinical microsystems are led by empowered, accountable clinical leaders who are trained in process improvement.

Front-line leaders will be in the best position to fully know and understand how their individual microsystem functions best. Front-line leaders are ideally positioned to monitor key processes at the unit level and should be trusted to make the right decisions on how best to improve process reliability in order to achieve the best possible outcomes.

Only through process reliability can excellence in operations be achieved. It then follows that operational excellence leads to improved outcomes. Quality healthcare is a complex system of people and processes. When they work effectively together, health care organizations are capable of great clinical outcomes, patient, family, and employee experiences.

This complexity requires that clinical leaders and managers and their line employees take full ownership of care, integrating all of the system knowledge and capability in direct service to the patient. Structuring an organization to enable the line to fully own the outcome produces results. Being collaborative across traditional health care boundaries ensures ones outcome is sustainable.

The relationship between physicians, nurses, allied health professionals, patients, and families is a critical component of success in any operationally excellent organization. Health Aff. Article Google Scholar. Health spending in OECD countries: obtaining value per dollar. Why Not the Best? Results from the National Scorecard on U. Health System Performance, Squires D, Anderson C.

Issue Brief Commonw Fund. Google Scholar. Schoenman JA, Chockley N. The concentration of health care spending. Washington, D. Variation in health outcomes: the role of spending on social services, public health, and health care, Emerging perspectives on transforming the healthcare system: key conceptual issues.

Med Care. Article PubMed Google Scholar. Redfern S, Christian S. Achieving change in health care practice. J Eval Clin Pract. Alas R. Organizational change from learning perspective. Problems and perspectives in management. Transformational change in health care systems: an organizational model.

Health Care Manag Rev. Redesigning health systems for quality: lessons from emerging practices. Organizational transformation: a systematic review of empirical research in health care and other industries. Med Care Res Rev. J Health Organ Manag. Bohmer RMJ. The hard work of health care transformation. N Engl J Med. Embertson MK. The importance of middle managers in healthcare organizations.

J Healthc Manag. PubMed Google Scholar. Restructuring with the middle-management advantage. Health Care Manag. The role of hospital managers in quality and safety: a systematic review. BMJ Open. Zismer DK, Brueggemann J. Physician Exec. Health care leadership and the dyad model. Patton P, Pawar M. Nurs Admin Q.

The role of the nurse-physician leadership dyad in implementing the Baby-Friendly Hospital Initiative. Nurs Womens Health. Sanford K, Moore S. Dyad leadership in healthcare: when one plus one is greater than two. Philadelphia: Wolters Kluwer; Oostra RD. Physician leadership: a central strategy to transforming healthcare. Front Health Serv Manage. Reinventing the academic health center. Acad Med.

Moghal N. Mission, vision, and values statements in healthcare: what are they for? Donnellan JJJ. Treacy M, Wiersema F. The discipline of market leaders. New York: Perseus Publishing; Customer intimacy and other value disciplines.

Harv Bus Rev. Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q. Wheeler DS. Organization-wide approaches to patient safety. Innov Entrepreneurship Health.

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