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Spreading and sustaining best practices for home care of older adults: a grounded theory study.

Ploeg J, Markle-Reid M, Davies B, Higuchi K, Gifford W, Bajnok I, McConnell H, Plenderleith J, Foster S, Bookey-Bassett S - Implement Sci (2014)

Bottom Line: Improving health care quality requires effective and timely spread of innovations that support evidence-based practices.Factors that facilitated progression through these phases were (1) leading with passion and commitment, (2) sustaining strategies, and (3) seeing the benefits.Further research will help to understand how best practices are spread externally to other organizations.

View Article: PubMed Central - PubMed

Affiliation: School of Nursing, Faculty of Health Sciences, Aging, Community and Health Research Unit, Department of Health, Aging and Society, McMaster University, 1280 Main Street West, Room HSc3N25C, Hamilton L8S 4K1, ON, Canada. ploegj@mcmaster.ca.

ABSTRACT

Background: Improving health care quality requires effective and timely spread of innovations that support evidence-based practices. However, there is limited rigorous research on the process of spread, factors influencing spread, and models of spread. It is particularly important to study spread within the home care sector given the aging of the population, expansion of home care services internationally, the high proportion of older adult users of home care services, and the vulnerability of this group who are frail and live with multiple chronic conditions. The purpose of this study was to understand how best practices related to older adults are spread within home care organizations.

Methods: Four home care organizations in Ontario, Canada that had implemented best practices related to older adults (falls prevention, pain management, management of venous leg ulcers) participated. Using a qualitative grounded theory design, interviews were conducted with frontline providers, managers, and directors at baseline (n = 44) and 1 year later (n = 40). Open, axial, and selective coding and constant comparison analysis were used.

Results: A model of the process of spread of best practices within home care organizations was developed. The phases of spread included (1) committing to change, (2) implementing on a small scale, (3) adapting locally, (4) spreading internally to multiple users and sites, and (5) disseminating externally. Factors that facilitated progression through these phases were (1) leading with passion and commitment, (2) sustaining strategies, and (3) seeing the benefits. Project leads, champions, managers, and steering committees played vital roles in leading the spread process. Strategies such as educating/coaching and evaluating and feedback were key to sustaining the change. Spread occurred within the home care context of high staff and manager turnover and time and resource constraints.

Conclusions: Spread of best practices is optimized through the application of the phases of spread, allocation of resources to support spread, and implementing strategies for ongoing sustainability that address potential barriers. Further research will help to understand how best practices are spread externally to other organizations.

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Model of spread.
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Fig1: Model of spread.

Mentions: A grounded theory of the spread process was developed, and the corresponding model is illustrated in Figure 1. The theory includes a five-phased process of spread, three key factors that facilitated this process, and contextual factors within which the process occurred. The five-phase process included (a) committing to change, (b) implementing on a small scale, (c) adapting locally, (d) spreading internally, and (e) disseminating externally. The three key factors that facilitated the spread process included (a) leading with passion and commitment, (b) sustaining strategies, and (c) seeing the benefits. The spread process occurred within a community care context characterized by wide geographic distribution of staff, heavy workloads, high turnover, and constant change. In-depth data analysis revealed that three of the four organizations demonstrated internal spread (see Table 3 for detailed descriptions of the spread process for sites 1 and 2). Data analysis for the fourth organization indicated that there had been minimal spread of the innovation (see Table 4 for a description of the non-spread site). In the following sections, each of the phases, facilitating factors and contextual factors are described and illustrated with quotes identified by organization and participant number (e.g., participant 01-03 is the third participant from organization 01).Figure 1


Spreading and sustaining best practices for home care of older adults: a grounded theory study.

Ploeg J, Markle-Reid M, Davies B, Higuchi K, Gifford W, Bajnok I, McConnell H, Plenderleith J, Foster S, Bookey-Bassett S - Implement Sci (2014)

Model of spread.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4225037&req=5

Fig1: Model of spread.
Mentions: A grounded theory of the spread process was developed, and the corresponding model is illustrated in Figure 1. The theory includes a five-phased process of spread, three key factors that facilitated this process, and contextual factors within which the process occurred. The five-phase process included (a) committing to change, (b) implementing on a small scale, (c) adapting locally, (d) spreading internally, and (e) disseminating externally. The three key factors that facilitated the spread process included (a) leading with passion and commitment, (b) sustaining strategies, and (c) seeing the benefits. The spread process occurred within a community care context characterized by wide geographic distribution of staff, heavy workloads, high turnover, and constant change. In-depth data analysis revealed that three of the four organizations demonstrated internal spread (see Table 3 for detailed descriptions of the spread process for sites 1 and 2). Data analysis for the fourth organization indicated that there had been minimal spread of the innovation (see Table 4 for a description of the non-spread site). In the following sections, each of the phases, facilitating factors and contextual factors are described and illustrated with quotes identified by organization and participant number (e.g., participant 01-03 is the third participant from organization 01).Figure 1

Bottom Line: Improving health care quality requires effective and timely spread of innovations that support evidence-based practices.Factors that facilitated progression through these phases were (1) leading with passion and commitment, (2) sustaining strategies, and (3) seeing the benefits.Further research will help to understand how best practices are spread externally to other organizations.

View Article: PubMed Central - PubMed

Affiliation: School of Nursing, Faculty of Health Sciences, Aging, Community and Health Research Unit, Department of Health, Aging and Society, McMaster University, 1280 Main Street West, Room HSc3N25C, Hamilton L8S 4K1, ON, Canada. ploegj@mcmaster.ca.

ABSTRACT

Background: Improving health care quality requires effective and timely spread of innovations that support evidence-based practices. However, there is limited rigorous research on the process of spread, factors influencing spread, and models of spread. It is particularly important to study spread within the home care sector given the aging of the population, expansion of home care services internationally, the high proportion of older adult users of home care services, and the vulnerability of this group who are frail and live with multiple chronic conditions. The purpose of this study was to understand how best practices related to older adults are spread within home care organizations.

Methods: Four home care organizations in Ontario, Canada that had implemented best practices related to older adults (falls prevention, pain management, management of venous leg ulcers) participated. Using a qualitative grounded theory design, interviews were conducted with frontline providers, managers, and directors at baseline (n = 44) and 1 year later (n = 40). Open, axial, and selective coding and constant comparison analysis were used.

Results: A model of the process of spread of best practices within home care organizations was developed. The phases of spread included (1) committing to change, (2) implementing on a small scale, (3) adapting locally, (4) spreading internally to multiple users and sites, and (5) disseminating externally. Factors that facilitated progression through these phases were (1) leading with passion and commitment, (2) sustaining strategies, and (3) seeing the benefits. Project leads, champions, managers, and steering committees played vital roles in leading the spread process. Strategies such as educating/coaching and evaluating and feedback were key to sustaining the change. Spread occurred within the home care context of high staff and manager turnover and time and resource constraints.

Conclusions: Spread of best practices is optimized through the application of the phases of spread, allocation of resources to support spread, and implementing strategies for ongoing sustainability that address potential barriers. Further research will help to understand how best practices are spread externally to other organizations.

Show MeSH
Related in: MedlinePlus