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.
Highlights
Improving health care quality requires effective and timely spread of innovations that support evidence-based practices
There are no widely agreed on definitions of the terms spread and scale-up, it has been suggested that scale-up is more commonly used in international health while spread is used more frequently to refer to improvement changes in high-income countries [1]
We use the definition of spread as “the process through which new working methods developed in one setting are adopted, perhaps with appropriate modifications, in other organizational contexts” [4] p. xxiii
Summary
Improving health care quality requires effective and timely spread of innovations that support evidence-based practices. A steering committee composed of frontline staff, champions, managers, and the project lead was established to lead the process of developing and implementing a tool related to pain. CCACs provide a first point of contact for public access to government-funded home care, community services, and long-term care homes This organization has five geographically dispersed branches. Using the RNAO guideline on Assessment and Management of Venous Leg Ulcers, tools were developed to support the care coordination of service providers (nurses and others) who were providing care to clients with venous leg ulcers These tools included a detailed care pathway to guide service provision in light of degree of leg ulcer healing, posters related to the wound care pathway, and laminated flip cards with detailed guidelines for implementing the new care pathway. An advanced practice consultant was hired to provide clinical expertise related to wound care and assist with staff education
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