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What, Why, and How Care Protocols are Implemented in Ontario Nursing Homes*

Published online by Cambridge University Press:  18 March 2013

Whitney Berta ,
Liane Ginsburg ,
Erin Gilbart ,
Louise Lemieux-Charles  and
Dave Davis
Whitney Berta*
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto
Liane Ginsburg
Affiliation:
School of Health Policy and Management, York University
Erin Gilbart
Affiliation:
2by2 Strategies
Louise Lemieux-Charles
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto
Dave Davis
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto Division of Medical Education, American Association of Medical Colleges
*
†Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à:Whitney Berta, Ph.D. Institute of Health Policy, Management, and Evaluation University of Toronto 155 College Street – Suite 425 Toronto, ON M5T 3M6 (whit.berta@utoronto.ca)
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Abstract

The aim of this study was to better understand care protocol implementation, including the influence of organizational-contextual factors on implementation approaches, in long-term care homes operating in Ontario. We surveyed directors of care employed in all 547 Ontario LTC homes, and combined survey data with secondary organizational data on rural/urban location, nursing home size, chain membership, type of ownership, and accreditation status. Motivations for the use/selection of care protocols in nursing homes primarily derived from beliefs in continuous improvement and in evidence-based care. Protocol selection was largely participative, involving management and staff. External information sources were important for protocol implementation, and in-service education was the chief means of training and educating staff. Significant differences in approaches to implementation were evident in association with differences in ownership. Three key success factors for implementation were identified: contextualizing the practice change, adequately resourcing for implementation, and demonstrating connections between practice change and outcomes.

Résumé

Le but de cette étude était de mieux comprendre la mise en oeuvre de protocoles des soins, y compris l’influence des facteurs organisationnels et contextuels sur les approches de mise en oeuvre dans les maisons de soins de longue durée (MSLD) en Ontario. Nous avons sondé les directeurs de soins employés dans tous les 547 maisons de soins de longue durée (MSLD) en Ontario, et avons combiné les données d’enquête avec des données sécondaires concernant l’emplacement rural ou urbain, les dimensions de la maison de soins infirmiers, l’appartenance à une chaîne, le type de propriété, et le status d’accréditation. Les motivations pour l’utilisation ou la sélection de protocoles des soins dans les maisons de soins infirmiers dérivent principalement des croyances en amélioration continue et des soins fondés sur des preuves. Le choix des protocoles a été largement participative, impliquant la gestion et le personnel. Les sources d’informations externes sont importants pour la mise en oeuvre des protocoles, et l’éducation permanente était le principal moyen de l’éducation et la formation du personnel. Des différences significatives dans les méthodes de mise en oeuvre sont devenue évidentes dans le cadre des différences de la propriété. On a identifié trois facteurs essentiels de la réussite dans la mise en oeuvre: la contextualisation d’un changement dans la pratique; le ressourcement pour la mise en oeuvre; et la démonstration du rapport entre les changements dans les pratiques et les résultats.

Keywords

vieillissmentvieillissementapplication des connaissancestransfert des connaissancesprotocoles de soinssoins de longue duréeagingcare protocolsknowledge translationknowledge applicationlong-term carepractice standards
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 32 , Issue 1 , March 2013 , pp. 73 - 85
Copyright
Copyright © Canadian Association on Gerontology 2013

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Footnotes

*

We owe thanks to Raisa Deber for valuable feedback on earlier versions of our proposal, and to M-THAC (From Medicare to Home and Community) and CIHR for providing seed funding through the Research Opportunities Fund. We acknowledge the valuable work of Gary Teare in earlier phases of this research and on prior related publications (Teare et al., 2001). We thank members of our advisory committee for generously sharing their insights and experience: Diane Buchanan, Mindy Ginsler, Larry Chambers, Nancy Cooper, Lois Cormack, Jane Brenneman Gibson, David Harvey, Robert Rich, Paul Tuttle, Philippa Welch, Evelyn Williams, and Jack Williams. The Ontario Long Term Care Association (OLTCA), the Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS), and the Registered Nurses Association of Ontario (RNAO) have been wonderful in promoting our research to their members. We are indebted to Ava John-Baptiste and Lina Fung for their assistance with data coding and analysis. This research was funded in large part by the Canadian Institutes of Health Research (CIHR), Knowledge Translation Strategies for Health Research Program, and through the Faculty of Medicine Dean’s Fund, University of Toronto.

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