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Implementation Science
Published in: Implementation Science 1/2014

Open Access 01-12-2014 | Research

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

Authors: Jenny Ploeg, Maureen Markle-Reid, Barbara Davies, Kathryn Higuchi, Wendy Gifford, Irmajean Bajnok, Heather McConnell, Jennifer Plenderleith, Sandra Foster, Sue Bookey-Bassett

Published in: Implementation Science | Issue 1/2014

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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 yearar 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.
Appendix
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Metadata
Title
Spreading and sustaining best practices for home care of older adults: a grounded theory study
Authors
Jenny Ploeg
Maureen Markle-Reid
Barbara Davies
Kathryn Higuchi
Wendy Gifford
Irmajean Bajnok
Heather McConnell
Jennifer Plenderleith
Sandra Foster
Sue Bookey-Bassett
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2014
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-014-0162-4

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