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Process Evaluation of a Participatory, Multimodal Intervention to Improve Evidence‐Based Care in Long‐Term Care Settings

BACKGROUND
Evidence-based improvements in long-term care (LTC) are challenging due to human resource constraints.


AIMS
To evaluate implementation of a multimodal, participatory intervention aimed at improving evidence-based care.


METHODS
Using a qualitative descriptive design, we conducted and inductively analyzed individual interviews with staff at midpoint and end-point to identify action plan implementation processes and challenges. The 9-month intervention engaged professional and unregulated staff in an on-site workshop and provided support for their development and implementation of site-specific action plans.


RESULTS
Ten of 12 enrolled sites participated for the full study period. Interviews were conducted with 44 and 69 participants at midpoint and end-point, respectively. Seven of 10 sites focused their action plan on team functioning and communication. Main achievements described at end-point were improved team communication, better staff engagement, and improved teamwork. Internal and external supports for action plan implementation were described as critical for success.


DISCUSSION
Three factors influenced change: vertically and horizontally linked teams, external facilitator support for action plan implementation, and coaching by Best Practice Coordinators that emphasized organizational change and normalization of evidence-based practice.


IMPLICATIONS
Team functioning and communication are forerunners of clinical practice changes in LTC. An off-site model of facilitation is promising and may provide a more efficient means to reach a wider array of LTC settings.


LINKING EVIDENCE TO ACTION
Practice changes need engagement of all staff.