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

Implementation Science

Sue Bookey-Bassett¹  Sandra Foster¹  Jennifer Plenderleith¹  Heather McConnell⁵  Irmajean Bajnok⁵  Wendy Gifford²  Kathryn Higuchi²  Barbara Davies³  Maureen Markle-Reid⁶  Jenny Ploeg⁴ 

[1] Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton L8S 4K1, ON, Canada;School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa K1H 8M5, ON, Canada;Nursing Best Practice Research Centre, School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa K1H 8M5, ON, Canada;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;International Affairs and Best Practice Guidelines Programs, Registered Nurses Association of Ontario, 158 Pearl Street, Toronto M5H 1L3, ON, Canada;Aging, Chronic Disease and Health Promotion Interventions, School of Nursing, Aging, Community and Health Research Unit, Clinical Epidemiology and Biostatistics, McMaster University, Faculty of Health Sciences, 1280 Main St. W., Health Sciences Centre, Room 3N25B, Hamilton L8S 4K1, ON, Canada

关键词: Grounded theory;    Older adults;    Home care;    Practice guidelines;    Spread;   

Others  :  1139491
DOI  :  10.1186/s13012-014-0162-4

 received in 2014-03-30, accepted in 2014-10-21,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Ploeg et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Ovretveit J: Widespread focused improvement: lessons from international health for spreading specific improvements to health services in high-income countries. Int J Qual Health Care 2011, 23(3):239-246.
• [2]Perla RJ, Bradbury E, Gunther-Murphy C: Large-scale initiatives in healthcare: a scan of the literature. J Healthc Qual 2013, 35(1):30-40.
• [3]Berwick DM: Disseminating innovations in health care. JAMA 2003, 289(15):1969-1975.
• [4]Buchanan DA, Fitzgerald L, Ketley D: The Sustainability and Spread of Organizational Change: Modernizing Healthcare. Routledge, New York; 2006.
• [5]Dilling JA, Swensen SJ, Hoover MR, Dankbar GC, Donahoe-Anshus AL, Murad MH, Mueller JT: Accelerating the use of best practices: the Mayo Clinic model of diffusion. Jt Comm J Qual Saf 2013, 39(4):167-176.
• [6]Davies B, Edwards N, Ploeg J, Virani T: Insights about the process and impact of implementing nursing guidelines on delivery of care in hospitals and community settings. BMC Health Serv Res 2008, 8:29. doi: 10.1186/1472-6963-8-29 BioMed Central Full Text
• [7]Massoud MR, Nielsen GA, Nolan K, Schall M, Sevin C: A Framework for Spread: From Local Improvements to System-Wide Change. IHI Innovation Series White Paper. Institute for Healthcare Improvement, Cambridge; 2006.
• [8]Norton WE, McCannon CJ, Schall MW, Mittman BS: A stakeholder-driven agenda for advancing the science and practice of scale-up and spread in health. Implement Sci 2012, 7(1):123-157.
• [9][http:/ / www.changemodel.nhs.uk/ pg/ groups/ 12163/ Spread+of+innovation/ ?community=Spread+of+innovation] webcite National Health Service: Spread of Innovation. National Health Service; 2014. []
• [10]Lomas J: Formalized Informality: An Action Plan to Spread Proven Health Innovations. New Zealand Ministry of Health, Wellington; 2008.
• [11]Edwards N: Scaling-Up Health Innovations in Public Health: A Brief Review of the Current State of the Science. 2010.
• [12]Nieva VF, Swift E, Fair S: Report on Scale Up & Spread Activities 2011. Agency for Healthcare Research and Quality, Rockville, Maryland; 2011.
• [13]Bodenheimer T: The Science of Spread: How Innovations in Care Become the Norm. HealthCare Foundation, California; 2007.
• [14]Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004, 82(4):581-629.
• [15]Rogers EM: Diffusion of Innovations. Free Press, New York; 2003.
• [16]Ferlie E, Fitzgerald L, Wood M, Hawkins C: The nonspread of innovations: the mediating role of professionals. Acad Manage J 2005, 48:117-134.
• [17]Essen A, Lindblad S: Innovation as emergence in healthcare: unpacking change from within. Soc Sci Med 2013, 93:203-211.
• [18]Fraser S: Tips for assessing how good practice spreads. Clin Govern Bull 2002, 3(1):7-9.
• [19]Nolan K, Schall MW, Erb F, Nolan T: Using a framework for spread: the case of patient access in the Veterans Health Administration. Jt Comm J Qual Patient 2005, 31:339-347.
• [20]Simmons R, Fajans P, Ghiron L: Scaling-Up Health Service Delivery: From Pilot Innovations to Policies and Programme. World Health Organization, Geneva, Switzerland; 2008.
• [21]Tarricone R, Tsouros AD: Home Care in Europe: the Solid Facts. World Health Organization, Regional Office Europe; 2008.
• [22]Association CHC: Portraits of Home Care in CANADA. Author, Mississauga, Canada; 2013.
• [23]Genet N, Boerma WGW, Kringos DS, Bouman A, Francke AL, Fagerström C, Melchiorre MG, Greco C, Devillé W: Home care in Europe: a systematic literature review. BMC Health Serv Res 2011, 11:207. BioMed Central Full Text
• [24]Thomé B, Dykes AK, Hallberg IR: Home care with regard to definition, care recipients, content and outcome: systematic literature review. J Clin Nurs 2003, 12(6):860-872.
• [25]Goodman C, Robb N, Drennan V, Woolley R: Partnership working by default: district nurses and care home staff providing care for older people. Health Soc Care Community 2005, 13(6):553-562.
• [26]Goodman C, Davies SL, Norton C, Fader M, Morris J, Wells M, Gage H: Can district nurses and care home staff improve bowel care for older people using a clinical benchmarking tool? Br J Community Nurs 2013, 18:581-587.
• [27][http:/ / www.population-health.manchester.ac .uk/ primarycare/ npcrdc-archive/ archive/ Our_Research.cfm.htm] webcite National Primary Care Research and Development Centre (NPCRDC): Our Research. 2014. []
• [28]Oliver D, Foot C, Humphries R: Making Our Health and Care Systems Fit for an Ageing Population. The King¿s Fund, UK; 2014.
• [29][10.1186/1471-2288-14-47] webcite Davies S, Goodman C, Manthorpe J, Smith A, Carrick N, Iliffe S: Enabling research in care homes: an evaluation of a national network of research ready care homes. BMC Med Res Method, 2014, 14(47). doi:.
• [30]Lamont SS: ¿See and Treat¿: spreading like wildfire? A qualitative study into factors affecting its introduction and spread. Emerg Med J 2005, 22(8):548-552.
• [31]Martin SC, Greenhouse PK, Merryman T, Shovel J, Liberi CA, Konzier J: Transforming care at the bedside: implementation and spread model for single-hospital and multihospital systems. J Nurs Adm 2007, 37(10):444-451.
• [32]Ryvicker M, Marren J, Sobolewski S, Acampora T, Flannery M, Buff E, Hess AMR, Rosati RJ, Schwartz T, Hollander P: Spreading improvement strategies within a large home healthcare organization. J Healthc Qual 2008, 30(2):48-58.
• [33]Grinspun D, Virani T, Bajnok I: Nursing best practice guidelines: the RNAO (Registered Nurses Association of Ontario) project. Hosp Q 2001, 5(2):56-60.
• [34][http://rnao.ca/bpg/bpso] webcite Registered Nurses¿ Association of Ontario: Best Practice Spotlight Organizations. []
• [35]Edwards N, Davies B, Ploeg J, Dobbins M, Skelly J, Griffin P, Ralphs-Thibodeau S: Evaluating best practice guidelines. Can Nurs 2005, 101(2):19-23.
• [36]Ploeg J, Davies B, Edwards N, Gifford W, Miller PE: Factors influencing best-practice guideline implementation: lessons learned from administrators, nursing staff and project leaders. Worldv Evid-Based Nu 2007, 4(4):210-219.
• [37]Ploeg J, Skelly J, Rowan M, Edwards N, Davies B, Grinspun D, Bajnok I, Downey A: The role of nursing best practice champions in diffusing practice guidelines: a mixed methods study. Worldv Evid-Based Nu 2010, 7(4):238-251. doi:10.1111/j.1741-6787.2010.00202.x
• [38]Gifford WA, Davies BL, Graham ID, Tourangeau AE, Woodend K, Lefebre NL: Developing leadership capacity for guideline use: a pilot cluster randomized control trial. Worldv Evid-Based Nu 2013, 10:51-65.
• [39]Matthew-Maich N, Ploeg J, Jack S, Dobbins M: Leading on the frontlines with passion and persistence: a necessary condition for guideline uptake. J Clin Nurs 2012, 22:1759-1770. doi:10.1111.jocn.12027
• [40]Higuchi KS, Davies BL, Edwards N, Ploeg J, Virani T: Implementation of clinical guidelines for adults with asthma and diabetes: a three year follow-up evaluation of nursing care. J Clin Nurs 2011, 20:1329-1338.
• [41]Davies B, Edwards N, Ploeg J, Virani T, Skelly J, Dobbins M: Determinants of the Sustained Use of Research Evidence in Nursing: Final Report. Canadian Health Services Research Foundation, Ottawa, ON; 2006.
• [42]Creswell JW: Qualitative Inquiry and Research Design: Choosing among Five Approaches. Sage, Thousand Oaks, CA; 2013.
• [43]Denzin NK, Lincoln YS: The SAGE Handbook of Qualitative Research. Sage, Thousand Oaks; 2011.
• [44]Strauss A, Corbin J: Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Sage, Thousand Oaks; 1998.
• [45]McCann TV, Clark E: Grounded theory in nursing research: part 2 - critique. Nurse Res 2003, 11(2):19-28.
• [46]Laws RA, Kemp LA, Harris MF, Davies GP, Williams AM, Eames-Brown R: An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study. Implement Sci 2009, 4:66. doi: 10.1186/1748-5908-4-66 BioMed Central Full Text
• [47]Matthew-Maich N, Ploeg J, Dobbins M, Jack S: Supporting the uptake of nursing guidelines: what you really need to know to move guidelines into practice. Worldv Evid-Based Nu 2012, 10(2):104-115. doi:10.1111/j.1741-6787.2012.00259
• [48]Sinuff T, Cook D, Giacomini M, Heyland D, Dodek P: Facilitating clinician adherence to guidelines in the intensive care unit: a multicenter, qualitative study. Crit Care Med 2007, 35:2083-2089.
• [49]Lofland J, Snow DA, Anderson L, Lofland LH: Analyzing Social Settings: A Guide to Qualitative Observations and Analysis. Wadsworth, Belmont; 2005.
• [50]Graham ID, Tetroe J, Gagnon M: Knowledge dissemination end of grant knowledge translation. In Knowledge Translation in Health Care: Moving from Evidence to Practice. 2nd edition. Edited by Straus SE, Tetroe J, Graham ID. Wiley Blackwell, Oxford, UK; 2013:75-92.
• [51]Green PL, Plsek PE: Coaching and leadership for the diffusion of innovation in health care: a different type of multi-organization improvement collaborative. J Qual Improve 2002, 28(2):55-71.
• [52]Elenkov DS, Manev IM: Top management leadership and influence on innovation: the role of sociocultural context. J Air Waste Manage Assoc 2005, 31:381-402.
• [53]Greenhalgh T, Robert G, Bate P, Kyriakidou O, Macfarlane F, Peacock R: How to Spread Good Ideas: A Systematic Review of the Literature on Diffusion, Dissemination and Sustainability of Innovations in Health Service Delivery and Organisation. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO), London; 2004.
• [54]Ivers NM, Sales A, Colquhoun H, Michie S, Foy R, Francis JJ, Grimshaw JM: No more `business as usual¿ with audit and feedback interventions: towards an agenda for a reinvigorated intervention. Implement Sci 2014, 9:14. BioMed Central Full Text
• [55]Buchanan D, Fitzgerald L, Ketley D, Gollop R, Jones JL, Lamont SS, Neath A, Whitby E: No going back: a review of the literature on sustaining organizational change. Int J Management Rev 2005, 7(3):189-205.
• [56]Davies B, Edwards N: Sustaining knowledge use. In Knowledge Translation in Health Care: Moving from Evidence to Practice. 2nd edition. Edited by Straus SE, Tetroe J, Graham ID. Wiley Blackwell, Oxford, UK; 2013:237-248.
• [57]Doyle C, Howe C, Woodcock T, Myron R, Phekoo K, McNicholas C, Saffer J, Bell D: Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement. Implement Sci 2013, 8:127. doi:10.1186/1748-5908-8-127 BioMed Central Full Text
• [58]Stirman SW, Kimberly J, Cook N, Calloway A, Castro F, Charns M: The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci 2012, 7:17. BioMed Central Full Text
• [59]Denton M, Zeytinoglu I, Davies S, Lian J: Job stress and job satisfaction of home care workers in the context of health care restructuring. Int J Health Serv 2002, 32:327-357.
• [60]Collins DB, Holton EFI: The effectiveness of managerial leadership development programs: a meta-analysis of studies from 1982 to 2001. Human Resource Devel Quarterly 2004, 15:217-248.
• [61]MacPhee M, Bouthilette F: Developing leadership in nurse managers: the British Columbia nursing leadership institute. Nurs Leadership 2008, 21:64-75.
• [62]Johns B, Torres TT: Costs of scaling up health interventions: a systematic review. Health Policy Plann 2005, 20(1):1-13.
• [63]May C, Finch T, Mair F, Ballini L, Dowrick C, Eccles M, Gask L, MacFarlane A, Murray E, Rapley T, Roger A, Treweek S, Wallace P, Anderson G, Burns J, Heaven B: Understanding the implementation of complex interventions in health care: the normalization process model. BMC Health Serv Res 2007, 7:148. BioMed Central Full Text
• [64]May C, Sibley A, Hunt K: The nursing work of hospital-based clinical practice guideline implementation: an explanatory systematic review using normalisation process theory. Int J Nur Stud 2014, 51:289-299.