Quality work in long-term care: the role of first-line leaders

Objective. To explore the first-line leaders’ role in quality work in long-term care in Norway, in order to determine how that work is related to such success characteristics as leadership, staff, patients, performance, information and information technology. Design. Cross-sectional telephone survey. The text was analysed using content analysis. Setting. Thirty-two Norwegian municipalities stratified according to region and population size. Participants. Sixty-four first-line leaders in nursing homes and home-based care. Main outcome measure. The clinical microsystem approach is used as a framework by defining and designing measureable variables. Results. Thirty-six leaders described how they initiated and motivated employees to be active in quality work; the remaining leaders indicated that they played a passive role. The first-line leaders played a key role in implementing national quality policies and regulations. The quantity of other success characteristics was low. Conclusions. The municipalities delegated the responsibility of implanting national policies to the first-line leaders. Missing were key quality success criteria such as macro- and meso-perspectives for the municipality as a whole and co-operation with other leaders in the organization and fostering of relevant learning. Quality work was fragmented rather than comprehensive and systematic.