Practice Change and Culture Change in Implementing Geriatric Care Initiatives

Abstract

Previously, this column has addressed interdisciplinary teamwork and communication in the delivery of acute and critical care for the elderly. The authors have encouraged new looks at these “old” issues and emphasized the importance of interdisciplinary teamwork and communication to improve patient safety and quality of care for hospitalized older adults. A third issue remains: How can we achieve sustained change in unit culture when implementing practice improvements in the care of older adult patients? Implementation science is anewandburgeoning interdisciplinary field devoted to the study of methods to promote the translation and uptake of research findings into routine health care practice and policy (see www.implementationscience. com/info/about). Implementation of safety and quality improvement initiatives in geriatric acute/ critical care, such as daily delirium assessment, early mobility, restraint-free care, polypharmacy/ geriatric medication risk review, and fall prevention, often require changes in clinician attitudes, practice routines, and care systems. Recent investigations of the barriers to and facilitators of safety culture focus on organization and systems characteristics, management style, individual determinants of behavior change, and sustained adoption of evidence-based practices. On a local and pragmatic level, the unit manager sets the tone and provides important guidance, role-modeling, and facilitation of practice change. We have gleaned the following key actions for successful nurse manager facilitation from the literature, our observations, and experience in implementing a patient communication practice improvement initiative. These actions are consistent with recommendations from the Nurses Improving Care