Stakeholder engagement for successful practice change in long‐term care: Evaluating the Feasible and Sustainable Culture Change Initiative (FASCCI) model

Abstract

AbstractBackground and ObjectivesInterventions aimed at increasing the provision of relational and person‐centred care in long‐term care (LTC) homes that do not address contextual and system issues most often fail. Promoting positive change in LTC homes requires a multilevel, systems approach. The objective of this study was to evaluate the feasibility and effectiveness of the Feasible and Sustainable Culture Change Initiative (FASCCI) model for change for improving the provision of person‐centred mealtime practices in a LTC home.MethodsA single‐group, time series design was used to assess the impact of the FASCCI model for change on outcome measures across four time periods (pre‐intervention, 2‐month, 4‐month and 6‐month follow‐up). Mealtime observations (n=38) using the Mealtime Scan (MTS+) were completed over the course of six‐months in a single dining room. Interviews (n=21) were also conducted to examine treatment fidelity and to ascertain the study participants’ perceptions of the process for making improvements using the FASCCI model.ResultsWe observed increases in care staffs’ capacity to consistently provide relational and person‐centred care during mealtimes. Mealtime environment scores started increasing immediately following the intervention, with statistically significant improvements noted in all mealtime environment scales by six‐months, including the: physical environment (z=‐3.43, p=0.004); social environment (z=‐4.17, p<0.001); relationship‐centred care (z= ‐4.121, p<0.001); and overall quality of dining environment (z= ‐4.08, p<0.001). Analysis of data from qualitative interviews demonstrated that use of the FASCCI model resulted in improved team leadership, communication, and collaborative decision‐making.ConclusionsThis study offers evidence that the FASCCI model provides a promising approach for improving the provision of relationship‐centred mealtime practices in LTC homes. Our findings reinforce the importance of cultivating and implementing workforce practices that increase staff empowerment and enable and encourage collaborative decision‐making. We found these practices to be essential to the outcomes associated with the improved relationship‐centred care practices that occurred during this study. This is consistent with the small but growing body of evidence demonstrating that staff empowerment has a significant effect on overall quality of resident care.