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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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Related in: MedlinePlus

Facilitators of spread (close-up from model of spread in Figure1).
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Fig2: Facilitators of spread (close-up from model of spread in Figure1).

Mentions: Three factors facilitated the spread process: (a) leading with passion and commitment, (b) sustaining strategies, and (c) seeing the benefits (see Figure 2). These factors were clearly evident in the three organizations where internal spread occurred, but were largely absent in the non-spread site (see Table 4).Figure 2


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)

Facilitators of spread (close-up from model of spread in Figure1).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Facilitators of spread (close-up from model of spread in Figure1).
Mentions: Three factors facilitated the spread process: (a) leading with passion and commitment, (b) sustaining strategies, and (c) seeing the benefits (see Figure 2). These factors were clearly evident in the three organizations where internal spread occurred, but were largely absent in the non-spread site (see Table 4).Figure 2

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