Collective learning is a widespread aim in long-term care. When professionals share detailed information on their perspective regarding quality of care, they can enter each other’s perspective and create a new joint perspective which may generate a broader meaning together. Reflective spaces are helpful in learning processes as tacit and explicit knowledge is bridged when people come together to reflect on concrete care practices. This study aimed to evaluate the use of the narrative quality instrument ‘The story as a quality instrument’ as a means for collective learning to realize quality improvement.

A qualitative evaluation was performed in 2021-2022 on six field sites of four large care organizations providing long-term care to older adults in the Netherlands. On every field site. The story as a quality instrument was applied: an action plan was formulated based on narrative portraits of older adults in a quality meeting and 8-12 weeks later the progress was evaluated. The data collection concerned the transcripts of both meetings and the observation reports of the researchers. Data were analyzed using thematic analysis.

Four mechanisms became visible that stimulate learning among participants to reach quality improvement: in-depth discussion, exchange of perspectives, abstraction, and concretization. The participants reported on several outcomes regarding individual learning such as change of attitude, looking to older adults more holistically and the realization that possibilities to work on quality improvement could be small and part of everyday work. Participants learned from each other, as they gained insight into each other’s perspectives. The added value concerned getting insight into the individual perceptions of clients, the concrete areas for improvement as outcome, and the diverse people and functions represented. Time was found to be the main challenge for the application of the instrument. Furthermore, the anonymity and quality of the portraits, structural embedding of the instrument and communication were four main conditions for future execution.

The story as a quality instrument is deemed promising for practice, as it allows care professionals to learn in a structured way from narratives of older adults in order to improve the quality of care.