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

Abstract

BackgroundImproving 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.MethodsFour 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.ResultsA 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.ConclusionsSpread 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.

Integrative review of benefit levers’ characteristics for system‐wide spread of best healthcare practices

“…(), Edwards and Grinspun () and Ploeg et al . (), while one document addressed three benefit levers, e.g. UNAIDS and WHO () and one document all four benefit levers (NHS ).…”

Making quality improvement stick and stay

“…Involve all professions, all departments/programs 3,4,15,19,20,22,30,34 26. Involve patients and families 3,20 27. Support the human dimension through rewards, self-efficacy, engagement/involvement in decision-making 4,6,15 28.…”

“…Establish forum for submitting QI ideas from staff, patients, and families (Personal communication, EXTRA Team: Lynda Weaver, MHA, MEd, CE; Isabelle Bossé, BA; Dionne Sinclair, RN, MScN, MCHM, CHE; José Pereira, MBChB, DA, CCFP, MSc) 15. Communicate benefits of improved process to set the stage for spread21,[26][27][28] …”

Clarifying Definitions for the Massage Therapy Profession: the Results of the Best Practices Symposium†

“…Grounded theory is often used to help develop theories and in the creation of conceptual models and frameworks from social research, and examples can be found from research in nursing, athletic training, and medicine, as well as other fields. (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) Applying a grounded theory methodology is inductive, in that the researcher begins with no set hypothesis and allows the theory to emerge from the what happened at their table; group dialogue then built upon the previous discussion.…”