Intervening with care : creating new infrastructures for learning and increasing quality of elderly care

Abstract: Substantial changes in public elderly care in Sweden have been resulting in a standing need of updating staff competence to match the new demands and maintain quality. Since the ability to learn is of importance when confronting changing conditions, organizations in general, as well as the authorities responsible for elderly care, invest large amounts of resources in learning in the workplace. However, the success of such investments depends on the interactions among numerous individual and organizational factors.This thesis has aimed at increasing our understanding of the process and consequences of the learning intervention Steps for Skills in the context of elderly care, by addressing three specific research aims. The first aim focused on the psychosocial environment as a precondition for learning. The perceived learning climate was addressed in Study 1, and correlations were found between leaders’ and employees’ perceived learning climate and, to some extent, between employees’ perceived learning climate and work group skills.The second aim focused on the consequences of the intervention for employees in terms of their psychosocial environment and the building of new infrastructures for learning. Changes in perceived learning climate and their relation to the transfer of knowledge were addressed in Study 2. It was found that the intervention had influenced the perceived learning climate differently for different groups. In addition, the use of the new knowledge depended on the learning climate. The consequences for employees were also addressed in Study 3 by examining the relation between process and outcome. Results showed that although the same method was used, the content of the improvement work differed, influencing employees’ perceptions of the learning climate, resource adequacy and workload differently.The third research aim focused on the consequences of the intervention for elderly by addressing elderly care quality, conceived as autonomy-support. The results from Study 4 identified too many constraining interactions for elderly care to be described as an autonomy-supportive. It is concluded that general quality improvement work does not guarantee increased autonomy-support. All in all, these results show that context and process matter, and also provide information concerning quality improvement through learning interventions.