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Table 2 Delphi results

From: Development of the Korean framework for senior-friendly hospitals: a Delphi study

Chapters/Categories/Standards Primary Secondary
Mean SD CVR Mean SD CVR
1. Management policy
 1.1 Developing a Senior-Friendly Hospitals
  1.1.1 The healthcare organization has policies and procedures for Senior-Friendly Hospitals. Validity 6.4 1.0 0.87 6.4 0.9 0.87
Feasibility 6.1 1.3 0.73 6.1 1.3 0.73
  1.1.2 The healthcare organization develops a written age-friendly policy that values and promotes older persons’ health, dignity, and participation in care. Validity 6.0 1.1 0.87 6.1 1.0 0.87
Feasibility 5.9 1.3 0.73 5.8 1.2 0.73
  1.1.3 The healthcare organization’s current quality and business plans identify age-friendliness as one of the priority issues. Validity 5.7 1.2 0.87 5.7 1.0 0.87
Feasibility 5.7 1.4 0.73 5.6 1.3 0.73
  1.1.4 The healthcare organization has a department of administration for coordination and implementation of the age-friendly policy. Validity 4.8 1.7 0.20 4.9 1.3 0.20
Feasibility 3.9 1.8 −0.33 3.7 1.3 −0.60
 1.2 Organizational support
  1.2.1 The healthcare organization identifies a budget for age-friendly services and materials. Validity 5.9 0.9 0.87 5.9 0.6 1.00
Feasibility 4.7 1.8 0.47 4.9 1.1 0.60
  1.2.2 The healthcare organization improves the function of its information system to support implementation, coordination, and evaluation of the age-friendly policy. Validity 5.9 0.8 1.00 6.0 0.7 1.00
Feasibility 4.9 1.2 0.47 4.8 0.9 0.47
  1.2.3 Qualified staff provides services to care for elderly people and their families. Validity 5.7 1.4 0.60 5.9 1.1 0.73
Feasibility 4.4 1.6 0.07 4.3 1.3 0.07
  1.2.4 All staff receives basic training in age, gender, and culturally sensitive practices that address knowledge, attitudes, and skills. Validity 5.7 1.0 0.87 5.8 0.7 1.00
Feasibility 5.1 1.6 0.33 5.1 1.4 0.47
  1.2.5 All clinical staff who provide care to older persons receive basic training in core competencies of elder care. Validity 6.3 1.1 0.87 6.4 0.6 1.00
Feasibility 5.9 1.5 0.60 5.9 1.4 0.60
  1.2.6 The healthcare organization encourages best practices and innovations for senior-friendly service. Validity 4.8 1.0 0.33 5.1 0.7 0.60
Feasibility 4.2 1.3 −0.20 3.9 0.9 −0.47
  1.2.7 Staff are involved in age-friendly policy-making, audit, and review. Validity 4.8 1.6 0.47 5.3 0.8 0.73
Feasibility 4.1 1.6 −0.20 3.9 1.0 −0.47
 1.3 Continuous monitoring and improvement
  1.3.1 The healthcare organization has plans for quality improvement for Senior-Friendly Hospitals. Validity 5.2 1.0 0.73 5.3 0.9 0.73
Feasibility 5.1 1.4 0.47 4.9 1.0 0.60
  1.3.2 A program for quality assessment of the age-friendly policy and its related activities is established. The assessment addresses development of organizational culture and perspectives of the seniors and the providers, as well as development of resources, performance of practices, and outcomes of care. Validity 4.9 1.3 0.47 5.3 1.0 0.87
Feasibility 4.7 1.5 −0.07 4.4 0.8 −0.33
  1.3.3 The healthcare organization supports resources needed for quality improvement and patient safety activities. Validity 6.2 1.1 0.87 6.4 0.6 1.00
Feasibility 5.9 1.2 0.73 5.9 0.8 0.87
  1.3.4 The healthcare organization includes sex- and age-specific analysis in its measurements of quality, safety, and patient satisfaction whenever appropriate. These data are available to staff for evaluation. Validity 5.6 1.1 0.87 5.5 0.7 1.00
Feasibility 5.6 1.3 0.60 5.7 0.9 0.87
  1.3.5 The healthcare organization has processes to ensure a senior-friendly lens is applied to patient experience processes (e.g. patient/family engagement, senior-specific patient satisfaction processes). Validity 5.3 1.2 0.60 5.3 0.8 0.73
Feasibility 5.0 1.4 0.20 5.1 0.8 0.47
  1.3.6 The healthcare organization manages elderly patients’ satisfaction. Validity 5.3 1.2 0.60 5.3 0.8 0.73
Feasibility 5.2 1.3 0.47 5.1 0.8 0.73
  1.3.7 Results for patient satisfaction are reported to the leadership and shared with the associated staff. Validity 5.2 1.3 0.60 5.4 0.7 0.87
Feasibility 5.2 1.1 0.47 4.9 0.8 0.60
2. Care process
 2.1 Patient assessment
  2.1.1 The medical staff performs early initial assessment of patient’s needs for health promotion and disease prevention, including lifestyle, nutritional status, psycho-social-economic status, fall prevention, etc. Validity 6.5 0.7 1.00 6.7 0.5 1.00
Feasibility 5.8 1.0 0.87 5.6 0.8 0.87
  2.1.2 The discharge plan is established and recorded according to the patient condition, at admission as inpatients. Validity 6.0 1.1 0.73 6.0 0.8 0.87
Feasibility 4.5 1.1 −0.07 4.5 0.5 −0.07
  2.1.3 The healthcare organization has protocols for assessment of patient’s condition-related needs for health promotion, disease management, and rehabilitation. Validity 6.1 0.8 1.00 6.0 0.5 1.00
Feasibility 5.1 1.0 0.47 4.8 0.6 0.47
  2.1.4 The assessment is documented in the patients’ record. Validity 5.8 0.9 0.87 5.7 0.8 0.87
Feasibility 5.4 1.2 0.60 5.2 0.9 0.60
  2.1.5 The healthcare organization has guidelines on high-risk screening for seniors. Validity 6.3 1.0 0.87 6.4 0.9 0.87
Feasibility 5.0 1.3 0.20 4.9 0.6 0.47
  2.1.6 Doctors for outpatient care carry out assessments for first-visit patients and complete the first-visit record (initial assessment record). Validity 5.9 1.3 0.73 6.1 0.9 0.87
Feasibility 4.7 1.6 −0.07 4.1 1.0 −0.60
  2.1.7 Use of medications is reviewed at admission and regularly at outpatient services. Validity 5.9 1.3 0.73 6.0 0.9 0.87
Feasibility 4.4 1.4 0.07 4.5 0.7 0.20
  2.1.8 The assessment of a patient’s needs is done at first contact with the healthcare organization and is kept under review and adjusted as necessary according to changes in the patient’s clinical condition or on request. Validity 5.6 1.4 0.60 5.9 0.8 0.87
Feasibility 4.5 1.6 −0.07 4.6 0.9 −0.07
 2.2 Intervention and management
  2.2.1 Doctors provide the patients (and caregivers) information about patients’ health condition and involve them in the care process. Validity 5.8 0.9 0.87 5.7 0.6 1.00
Feasibility 4.9 1.2 0.20 4.8 0.9 0.33
  2.2.2 Doctors re-establish care planning according to major changes in the patients’ conditions. Validity 5.7 1.2 0.73 5.8 0.7 0.87
Feasibility 5.0 1.4 0.33 4.8 0.9 0.60
  2.2.3 The intervention and expected results are documented and evaluated in the records. Validity 5.7 1.1 0.87 5.7 0.6 1.00
Feasibility 5.2 1.4 0.60 5.0 1.0 0.73
  2.2.4 Information on healthy aging and information on specific risks or conditions is available to patients, families, visitors, and staff. Validity 5.9 0.9 0.87 5.8 0.9 0.73
Feasibility 4.6 1.5 0.07 4.5 0.9 −0.07
  2.2.5 Information given to the patient (and the caregiver) is recorded in the patient’s record. Validity 5.7 1.0 0.73 5.7 0.7 1.00
Feasibility 5.2 1.4 0.33 5.3 1.0 0.60
  2.2.6 Clinical departments incorporate health promotion, rehabilitation, and risk management into their clinical practice guidelines or pathways as appropriate. Validity 5.1 1.2 0.47 5.1 0.7 0.73
Feasibility 4.4 1.1 −0.07 4.1 0.8 −0.33
  2.2.7 Diagnostic investigations and procedures should accommodate age-related changes, tolerance, and ability. Validity 6.2 0.9 1.00 6.1 0.7 1.00
Feasibility 5.1 1.4 0.60 4.9 0.9 0.73
  2.2.8 The healthcare organization provides multidisciplinary assessment, intervention, and evaluation of seniors. Validity 6.1 0.9 1.00 5.9 0.7 0.87
Feasibility 4.2 1.6 −0.07 4.0 1.1 −0.47
 2.3 Community partnership and continuity of care
  2.3.1 A list of health and social care providers working in partnership with the healthcare organization is available. Validity 4.7 1.3 0.20 4.9 0.9 0.33
Feasibility 5.5 1.6 0.60 5.3 1.2 0.60
  2.3.2 The healthcare organization provides to the patients (and caregivers) information about other health and social care providers. Validity 4.9 1.5 0.33 5.1 0.8 0.47
Feasibility 5.2 1.7 0.33 5.0 1.1 0.33
  2.3.3 Qualified staff is in charge of referral services and the healthcare organization has an operation process. Validity 4.7 1.4 0.07 4.5 1.2 0.07
Feasibility 4.7 1.9 0.07 4.6 1.4 0.07
  2.3.4 There is a written plan for collaboration with partners to improve the patients’ continuity of care. Validity 4.5 1.6 0.07 4.7 1.4 0.33
Feasibility 4.9 1.6 0.33 4.9 1.0 0.60
  2.3.5 There is an agreed upon procedure for information exchange practices between organizations for all relevant patient information. Validity 5.3 1.4 0.47 5.4 1.1 0.73
Feasibility 5.1 1.7 0.33 5.1 1.2 0.60
  2.3.6 Patients (and their families as appropriate) are given understandable follow-up instructions at out-patient consultation, referral, or discharge. Validity 5.9 1.2 0.73 6.0 1.0 0.87
Feasibility 5.1 1.0 0.60 5.0 0.8 0.73
  2.3.7 The receiving organization is given in timely manner a written summary of the patient’s condition and health needs, and interventions provided by the referring organization. Validity 5.7 1.2 0.73 5.9 1.0 0.87
Feasibility 5.3 1.5 0.47 5.3 1.0 0.73
  2.3.8 (Optional) A plan for rehabilitation describing the role of the organization and the cooperating partners is documented in the patient’s record. Validity 5.1 1.4 0.33 5.1 0.9 0.60
Feasibility 3.9 1.8 −0.20 3.5 1.1 −0.73
  2.3.9 (Optional) The healthcare organization provides outreaching care services to the community elders. Validity 4.1 1.4 −0.33 3.7 0.7 −0.87
Feasibility 3.5 1.6 −0.47 3.2 0.9 −0.73
 2.4. Ethical management of healthcare organization
  2.4.1 The healthcare organization has processes to solicit and follow patients’ advance directives that address care planning issues beyond “Do Not Resuscitate” orders. Validity 6.3 1.0 0.87 6.5 0.8 0.87
Feasibility 5.5 1.2 0.73 5.3 1.0 0.73
  2.4.2 The healthcare organization has processes to deal with elder abuse issues when they are suspected or identified. Validity 6.6 0.5 1.00 6.6 0.5 0.87
Feasibility 6.0 1.0 0.87 6.2 0.8 1.00
3. Communication and services
 3.1 Communication
  3.1.1 The healthcare organization staff speaks to older persons in a respectful manner using understandable language and words. Validity 6.0 1.1 0.87 6.1 0.6 1.00
Feasibility 5.3 1.0 0.73 5.1 0.6 0.73
  3.1.2 Information on the operation of the healthcare organization, such as opening hours, medical expenses, and registration procedures is provided in an age-appropriate way. Validity 5.7 1.2 0.73 5.8 0.8 1.00
Feasibility 5.1 1.1 0.47 4.9 0.6 0.47
  3.1.3. Display the printed educational materials designed for the elderly; display pictures or materials. Validity 5.9 1.0 0.87 5.9 0.7 1.00
Feasibility 5.1 1.2 0.33 4.9 0.8 0.47
  3.1.4 The healthcare organization provides adequate information and involves the older persons and their families at all stages of care. Validity 6.4 0.6 1.00 6.3 0.6 1.00
Feasibility 5.4 1.1 0.73 5.3 0.8 0.73
  3.1.5 The healthcare organization respects older persons’ ability and right to make decisions on their care. Validity 6.0 0.8 1.00 6.1 0.6 1.00
Feasibility 4.9 1.1 0.20 4.7 0.7 0.07
 3.2 Service
  3.2.1 The healthcare organization makes every effort to adapt its administrative procedures to the special needs of older persons, including older persons with low educational levels or with cognitive impairments. Validity 6.0 1.0 0.87 6.1 0.6 1.00
Feasibility 4.7 1.6 0.07 4.7 1.0 0.20
  3.2.2 The healthcare organization identifies and supports older persons with financial difficulties to receive appropriate care. Validity 5.9 0.9 0.87 5.9 0.6 1.00
Feasibility 4.8 1.1 0.33 4.9 0.7 0.47
  3.2. The healthcare organization has volunteer programs to support patients and visitors in reception, navigation, transport, reading, writing, accompanying, or other help as appropriate in outpatient and inpatient services. Validity 5.4 0.8 0.87 5.2 0.8 0.73
Feasibility 4.9 1.3 0.20 4.8 0.9 0.33
  3.2.4 The healthcare organization has a volunteer program that provides opportunities for older persons, including community seniors, patients, and their families to participate in the healthcare organization’s volunteer services. Validity 4.7 1.3 0.33 4.8 1.0 0.47
Feasibility 4.7 1.5 0.07 4.6 0.8 0.07
4. Physical environment
 4.1 General environment and equipment
  4.1.1 The healthcare organization has a policy for facilities that is considered a senior-friendly view (Universal protocol, CODE-plus, etc.). Validity 6.0 0.8 1.00 5.8 0.7 1.00
Feasibility 4.8 1.3 0.20 4.7 1.0 0.20
  4.1.2 The facilities, including waiting areas, are clean and comfortable throughout. Validity 5.5 1.2 0.73 5.2 0.7 0.87
Feasibility 4.7 1.8 0.20 4.6 1.2 0.33
  4.1.3 The facilities are equipped with good lighting, non-slip floor surfaces, stable furniture, and clear walkways. Validity 6.1 0.8 1.00 6.1 0.6 1.00
Feasibility 5.3 1.5 0.33 5.3 1.1 0.73
  4.1.4 The toilet and bathing facilities and heads of the healthcare organization beds are equipped with an emergency alarm system. Validity 6.5 0.8 1.00 6.7 0.7 1.00
Feasibility 6.1 1.3 0.73 6.1 1.2 0.87
  4.1.5 The healthcare organization has barrier-free washrooms equipped with basic washing facilities. Validity 6.4 0.8 1.00 6.6 0.7 1.00
Feasibility 5.3 1.5 0.47 5.5 1.1 0.87
  4.1.6 There are hand railings on both sides of hallways. Validity 6.5 0.8 1.00 6.7 0.7 1.00
Feasibility 5.9 1.3 0.73 6.0 1.1 0.87
  4.1.7 Bed heights are appropriate for older persons. Validity 6.4 0.8 1.00 6.5 0.7 1.00
Feasibility 5.0 1.6 0.47 5.1 1.2 0.73
 4.2 Transportation
  4.2.1 The main healthcare organization premises has convenient transportation connections. Validity 4.9 1.7 0.33 4.9 1.0 0.47
Feasibility 3.5 1.5 −0.73 3.4 0.8 −1.00
  4.2.2 The healthcare organization’s main entrance has a passenger drop-off/pick-up area and there is staff providing assistance. Validity 4.9 1.2 0.47 5.0 0.7 0.87
Feasibility 4.1 1.2 −0.20 3.9 0.9 −0.47
  4.2.3 For people with disabilities, there is enough space for them to get on/off and they are provided with mobility aids (e.g. wheelchair). Validity 5.7 1.0 0.87 5.3 0.6 0.87
Feasibility 5.0 1.6 0.33 4.9 0.7 0.33
 4.3 Signage and identification
  4.3.1 Simple and easily readable signage is posted throughout the healthcare organization to facilitate orientation and personalize providers and services. Validity 5.3 1.3 0.33 5.4 1.1 0.60
Feasibility 5.1 1.5 0.20 5.1 1.3 0.33
  4.3.2 The healthcare organization applies common signage for direction and makes it easy for older persons to identify. Validity 5.3 1.3 0.33 5.4 1.1 0.60
Feasibility 4.9 1.4 0.20 4.8 1.3 0.20
  4.3.3 Healthcare staff is easily identifiable using name cards. Validity 5.1 1.4 0.33 5.1 1.1 0.47
Feasibility 5.1 1.5 0.20 4.9 1.2 0.20
  1. CVR content validity ratio