Staff Engagement Research Articles

Abstract TP139: Coordinating Stroke and Sleep Care with Field Staff and Champions: Difference-Makers in a Quality Improvement Program Addressing Sleep Apnea in Stroke Patients

Background: The Addressing Sleep Apnea Post-Stroke/TIA (ASAP) clinical trial aimed to enhance OSA management at six VA medical centers through a hybrid implementation trial, requiring coordination across hospital medicine, sleep medicine, nursing, and neurology in both inpatient and outpatient settings. This analysis evaluated the trial’s efforts to standardize early OSA screening in stroke/TIA patients. Methods: This mixed-methods evaluation used configurational comparative methods (CCMs) to identify key contextual factors for successful implementation, examining the joint effects of multiple factors. The stepped-wedge trial ran from May 2019 to January 2024 across three implementation waves. The primary outcome was the Group Organization (GO) score, which measured team cohesion in managing sleep apnea among cerebrovascular patients. Data sources included observational data, qualitative interviews, and administrative data across three periods (A, B, C), calibrated into dichotomous or multi-value categories for analysis. Results: Four key difference-makers distinguished more successful sites (GO score ≥6) from others: routines for ordering inpatient OSA tests, patient care coordination during hospitalization, involvement of field staff, and strong local champions. The ability to order and complete sleep studies was crucial for timely OSA diagnosis. Field staff (e.g., respiratory technicians, polysomnographic technologists, research) played a critical role in coordinating care during inpatient stays and post-discharge. Key pathways to success included active field staff engagement and strong champion support, particularly in the final phase. Less successful sites faced barriers like geographic separation and staff shortages. The figure describes the values for each of these factors at the 4 more successful versus 2 less successful sites. Conclusions: The study highlights the importance of flexibility in integrating new practices, particularly in stroke care requiring multi-specialty coordination. Findings provide a roadmap for healthcare systems implementing similar interventions, emphasizing leadership, coordinated care, and robust tracking for program success.

The double-edged sword effect of conscientiousness on the work engagement of medical staff in Chinese public hospitals

The double-edged sword effect of conscientiousness on the work engagement of medical staff in Chinese public hospitals

A qualitative process evaluation of SBIRT implementation in pediatric trauma centers using the Science to Service Laboratory implementation strategy.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice that can identify adolescents who use alcohol and other drugs and support proper referral to treatment. Despite an American College of Surgeons mandate to deliver SBIRT in pediatric trauma care, trauma centers throughout the United States have faced numerous patient, provider, and organizational level barriers to SBIRT implementation. The Implementing Alcohol Misuse Screening, Brief Intervention, and Referral to Treatment Study (IAMSBIRT) aimed to implement SBIRT across 10 pediatric trauma centers using the Science-to-Service Laboratory (SSL), an empirically supported implementation strategy. This manuscript aimed to assess trauma center staff preferences and experience with the didactic training, performance feedback, and ongoing coaching elements of the SSL via a retrospective qualitative process evaluation. Nurses, social workers, and site leaders that participated in IAMSBIRT were recruited to complete qualitative exit interviews guided by the Consolidated Framework for Implementation Research. Qualitative interviews were recorded, transcribed, and analyzed by two coders using a directed content analysis approach in NVivo software. Codes were then translated into frequently endorsed themes by the IAMSBIRT study research team. Thirty-six exit interviews were conducted with site leaders, social workers, and nurses across the 10 IAMSBIRT pediatric trauma centers. Findings revealed key strengths as well as areas for improvement across the IAMSBIRT preparation phase and the three elements of the SSL: didactic training, performance feedback, and ongoing coaching. Trauma center staff generally reported that all three elements of the SSL were high quality and helpful for supporting SBIRT implementation. However, staff also noted that performance feedback and ongoing coaching were generally only available to center leadership or to individuals selected by leadership, making it challenging for non-leaders to troubleshoot SBIRT delivery. Findings from the qualitative process evaluation revealed discrepancies in the experience of the SSL strategy between those in leadership roles and those involved in direct care delivery. These results suggest the need for several modifications to the SSL strategy, including increasing engagement of direct care staff in all elements of the SSL throughout the implementation process. Clinicaltrials.gov NCT03297060 . Registered 29 September 2017.

‘What Matters to Staff Programme’: eight steps to improve staff well-being at work

Background and aimThe What Matters to Staff programme was designed at the Royal Free Hospital to address a key priority of improving workforce well-being. The initial aim was to set...

An evaluation of the wastes and obstacles within the context of lean management in emergency services

The objective of this study is to evaluate the types of waste within the context of lean management practices in emergency departments and to provide recommendations for addressing the challenges associated with their implementation. The aim is to enhance the effectiveness of performance improvement processes and to improve patient satisfaction. The opinions of 8 experts in the field were collected and analyzed using fuzzy AHP. The analysis revealed that defects (29%) are the most common type of waste in emergency departments, with a significant impact on efficiency and patient safety. This is followed by extra handling (15%) and waiting time (13%). Addressing these issues, along with other types of waste such as wasted talent, movement, transportation, inventory, and overproduction, is critical to improving overall operational performance. The overcoming of integration challenges necessitates the implementation of a multifaceted strategy, which should encompass the commitment of leadership, the engagement of staff, and the establishment of a culture of continuous improvement. The success of lean management is contingent upon several factors, including leadership support, multidisciplinary collaboration, process streamlining, and the ability to navigate resistance to change.

Barriers and Facilitators of User Engagement With Digital Mental Health Interventions for People With Psychosis or Bipolar Disorder: Systematic Review and Best-Fit Framework Synthesis.

Digital mental health interventions (DMHIs) to monitor and improve the health of people with psychosis or bipolar disorder show promise; however, user engagement is variable, and integrated clinical use is low. This prospectively registered systematic review examined barriers and facilitators of clinician and patient engagement with DMHIs, to inform implementation within real-world settings. A systematic search of 7 databases identified empirical studies reporting qualitative or quantitative data about factors affecting staff or patient engagement with DMHIs aiming to monitor or improve the mental or physical health of people with psychosis or bipolar disorder. The Consolidated Framework for Implementation Research was used to synthesize data on barriers and facilitators, following a best-fit framework synthesis approach. The review included 175 papers (150 studies; 11,446 participants) describing randomized controlled trials; surveys; qualitative interviews; and usability, cohort, and case studies. Samples included people with schizophrenia spectrum psychosis (98/150, 65.3% of studies), bipolar disorder (62/150, 41.3% of studies), and clinicians (26/150, 17.3% of studies). Key facilitators were a strong recognition of DMHIs' relative advantages, a clear link between intervention focus and specific patient needs, a simple, low-effort digital interface, human-supported delivery, and device provision where needed. Although staff thought patients would lose, damage, or sell devices, reviewed studies found only 11% device loss. Barriers included intervention complexity, perceived risks, user motivation, discomfort with self-reflection, digital poverty, symptoms of psychosis, poor compatibility with existing clinical workflows, staff and patient fears that DMHIs would replace traditional face-to-face care, infrastructure limitations, and limited financial support for delivery. Identified barriers and facilitators highlight key considerations for DMHI development and implementation. As to broader implications, sustainable business models are needed to ensure that evidence-based DMHIs are maintained and deployed. PROSPERO CRD42021282871; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282871.

The hypothetical assumptions and evaluation weather HR systems and the agro-tourism industry aligned and ready for each other?

The aim of this study is to examine the preparedness and implementation of Human Resource (HR) systems in the agro-tourism sector and their implications for the processes of recruiting the workforce, organizing their work, and training, and Staff engagement. For sustainable development and to optimize the working of related agro-tourism sectors, it is important for integrated agro-tourism to develop bridges between agriculture and structured human resources functions.The research focuses on the opportunities of the management of HR systems to cope with the particular nature of employment in the field of agro-tourism, including seasonal employment, recruitment in rural areas, and the establishment of homogeneous quality of service. Through analyzing the available and presently unexplored tools and approaches of the HRM it is possible defining various possibilities of the recruitment enhancement, improvement of the employee training, as well as the positive work environment creation in the sphere of agro-tourism.Qualitative interviews with agro-tourism operators and human resource management specialists are conducted, as well as a case-study of a successful agro-tourism business. This research work will offer the desired understanding of the current practice in the HR management of agro-tourism with special reference to the best practices as well as areas of improvement.The research insights would hopefully assist the agro-tourism operations with recommendations of how to selectively implement appropriate HR systems for the enhancement of its employees’ management and the subsequent organizational performances to enhance sustainable development of the agro-tourism industry. This work fills a gap in the existing literature on the HR function and its future in emerging industries and presents the following operational HRM strategies for developing a strategic fit between HR systems and the agro-tourism business.

Patient safety improvement in the ear, nose, and throat (ENT) speciality: A scoping review of improvement initiatives and involvement of frontline staff

Abstract Background The success of patient safety improvement initiatives depends on frontline staff engaging with improvement efforts. However, in the ear, nose, and throat (ENT) speciality, there is less patient safety research compared to other healthcare specialities, and limited evidence on staff perspectives regarding safety improvement and the factors influencing their engagement. Objectives To map the literature on safety improvement efforts in the ENT speciality in UK settings, and to explore staff involvement and engagement with initiatives to improve patient safety in ENT. Methods A literature search was conducted using the PubMed, Ovid MEDLINE, and SCOPUS databases to retrieve studies reporting the implementation of patient safety initiatives in ENT departments in the UK, and studies exploring frontline staff perspectives on improving safety in ENT. The selected studies were peer-reviewed, written in English and published between 2013 and 2023. Data were extracted and synthesized in accordance with the predefined research questions. Results A total of 1661 studies were screened and 10 met the selection criteria. Findings demonstrated evidence of staff initiating, designing, and implementing safety improvement initiatives. Frontline staff engagement and senior staff/managerial involvement were identified as key contributors to successful implementation. Only one study addressed frontline staff priorities for safety improvement, in the context of improving tracheostomy, with the author stating that results indicated that frontline staff are unwilling to implement low priority interventions. Conclusion Further research is needed to explore the factors influencing staff perspectives on how patient safety can be improved in ENT and the factors influencing their engagement. This could lead to recommendations for the development of successful and sustainable initiatives. The authors of this review recommend establishing the following as standard practice: (i) appointing staff as quality/safety champions, and (ii) involving frontline staff and senior managers in co-developing improvement strategies.

Facilitators and barriers to adopting a multifaceted chlamydia management intervention in general practice: qualitative findings from Management of Chlamydia Cases in Australia (MoCCA)

Background Chlamydia is one of the most common sexually transmissible infections globally and can lead to reproductive complications, including pelvic inflammatory disease and infertility. Interventions to reduce disease burden, including retesting for reinfection, partner management, and early detection of complications, are the focus of the Management of Chlamydia Cases in Australia (MoCCA) study, an implementation and feasibility trial aiming to strengthen chlamydia management in Australian general practice. This study aimed to identify factors influencing participation in and adoption of a multifaceted chlamydia management intervention within the general practice setting. Methods We conducted semi-structured interviews with general practice staff (n = 13) from clinics (n = 9) participating in the MoCCA study. Data were analysed using inductive content analysis to identify facilitators and barriers to study participation and intervention adoption. Results Participants felt that practice champions, motivated staff and interventions that improved workflow efficiency, integrated with existing processes and improved patient interactions, facilitated participation in, and adoption of, study interventions. A perceived lack of staff engagement related to time constraints, competing priorities, staff retention issues and interventions that were less convenient to use or had reduced patient uptake were identified as barriers to participation. Conclusions Identifying perceived facilitators and barriers to successful implementation of a multifaceted chlamydia intervention enables public health practitioners to better support general practice in the ongoing uptake and use of evidence-based chlamydia management strategies, ultimately aiming to reduce the burden of chlamydia and its complications in Australia.

A qualitative Exploration of Contextual Factors Within Schools Impacting the Introduction of the New Statutory ‘Framework on Embedding a Whole School Approach to Emotional and Mental Wellbeing’ in Wales

AbstractIn 2021, the Welsh Government introduced new statutory guidance for schools titled ‘Framework Guidance on Embedding a Whole School Approach to Emotional and Mental Wellbeing’. This document outlined new responsibilities for educational settings to work towards incorporating a whole school approach, with regard to the Framework in action planning, service delivery and policy in relation to the mental and emotional wellbeing of learners and staff. While there is growing evidence to suggest that whole school approaches can be beneficial to social and emotional wellbeing for pupils, evidence on effective implementation is limited. This paper reports on findings from qualitative group interviews with staff in schools in Wales, conducted as part of a wider, mixed-methods evaluation of the Framework. It focuses on factors in the school context which impacted initial implementation. A number of school level factors were identified as barriers to implementation and staff engagement with the Framework. School staff reported higher levels of pupil mental health challenges stemming from the COVID-19 pandemic and an absence of capacity in in-house and external support services to address this. Poor staff wellbeing and significant workload pressures were also reported, driven in part by concurrent implementation of the new Curriculum For Wales. This led staff to feel ill-prepared for the more complex issues being faced, exacerbated by a lack of access to relevant training to be able to support pupil and colleague mental health. This paper concludes with recommendations for policy-makers to support Framework implementation.

Exploring the Negative Impact of Social Media Platforms on Work Efficiency

People use social media sites like Facebook, Twitter, and LinkedIn all the time to talk to each other and share information these days. However, their effect on productivity at work is being closely looked into. This study looks into the bad effects of social media on job performance, especially how these sites cause interruptions at work, less focus, and less work getting done. A study found that workers who spend a lot of time on social media at work are less productive and more easily distracted. These results are supported by talks with managers, who say that staff engagement and productivity have dropped significantly. The study shows that while social media can help with networking and contact, using it without limits can make work much less efficient. Some suggestions for lowering lost output are making it clear when you can and can’t use social media and encouraging good management of online interactions.

“New Normal:” Opportunities and Challenges Faced by Syringe Service Programs Following the Effects of the COVID-19 Pandemic

Background Syringe services programs (SSPs) provide critical evidence-based public health services that decrease harms from drug use for people who use drugs (PWUD). Many SSPs have experienced significant and evolving COVID-19-related disruptions. We aimed to characterize the impacts of COVID-19 on SSP operations in the United States approximately two years into the pandemic. Methods Participating sites, selected from a national sample of SSPs, completed a semi-structured interview via teleconference and brief electronic survey evaluating the impacts of COVID-19 on program operations. Data collection explored program financing, service delivery approaches, and perspectives on staff morale two years into the pandemic. Interview data were analyzed qualitatively using Rapid Assessment Process. Survey data were analyzed using descriptive statistics and triangulated with qualitative findings. Results Twenty-five SSPs completed the interview and survey between April – June 2022. Triangulation of qualitative and quantitative data characterized the dynamic ways that demand for SSP services has evolved throughout the pandemic, and how approaches to care delivery have increased in flexibility and participant-centeredness. However, SSPs expressed worry about longer-term barriers to program participant and staff engagement, and a mismatch between available programmatic resources and the “new normal” of service delivery needs. Conclusion The COVID-19 pandemic has had lasting impacts on multiple facets of syringe service delivery. While SSPs consistently meet barriers with ingenuity, greater programmatic and staff support is needed to ensure SSPs can continue to meet the changing public health needs for PWUD.

ED Nurse-Led Code Sepsis to Reduce Time to Antibiotics.

Delays in sepsis recognition contribute to delays in antibiotic administration, which lead to increased morbidity and mortality in patients with sepsis. Our objective was to create an Emergency Department (ED) Code Sepsis Nurse-led team to reduce the time to antibiotics and mortality in patients with sepsis. This initiative was implemented at a community hospital in Southern California in response to previous undesirable sepsis outcomes. In fiscal year 2021, the ED Sepsis Nursing Team was launched with the goal of improving sepsis-related outcomes. The following interventions were implemented: First, a group of dedicated Sepsis Nurses with training specific to sepsis recognition was created, and an electronic ED-sepsis screening tool was developed and implemented. Next, the dedicated sepsis nurses designed and educated to a "Code Sepsis" activation process. The code triggered a multidisciplinary response and implementation of standing orders for blood cultures, lactate, complete blood count, complete metabolic panel, and chest x-ray or urinalysis if indicated. Finally, the Sepsis Team Registered Nurse (RN) Captain led house-wide monthly Sepsis Task Force meetings to improve unit-level engagement and to allow the team to have ownership over sharing wins and losses. By Quarter 4 (Q4) of Fiscal Year 2021, door-to-antibiotic time for sepsis patients dropped from 196.7min (Q1) to 144.7 (Q4). Additionally, mortality dropped below the health system average (10.4% vs. 13.5%), and Fiscal Year 2021 surpassed the readmissions benchmark of<1.0 at a rate of 0.5. An RN-led, interprofessional response to accepted sepsis identification criteria enhanced staff and physician engagement and improved sepsis outcomes for patient mortality and hospital reporting outcomes. The process was adopted with very few obstacles that were easily overcome as the understanding of the role and its significance was realized.

Healthcare Providers' Experiences With and Perspective on Delivering the Enhanced Recovery After Elective Caesarean Birth Pathway With Next-Day Discharge: Qualitative Analysis.

To understand the perspectives and experiences of healthcare providers who have experience working with an enhanced recovery care after elective caesarean birth pathway with next-day discharge and home midwifery. This study applies a qualitative study design with a pragmatic realist approach. The realist framework was used while also taking a post-positivist philosophy. The work was conducted in South Australia, Australia between May and October 2019. Twenty-three semi-structured interviews were completed with 5 doctors and 18 midwives who had occupational experience working with the pathway. Interviews were analysed using following the six-phase qualitative thematic analysis process outlined by Braun and Clarke. COREQ guidelines were followed. Four main themes and 11 sub-themes were identified. Main themes identified were as follows: The pathway is more than just early discharge; experiences with the process; staff engagement with the pathway; and the impact of the pathway within the health system. Healthcare providers generally accepted the pathway and found enhanced recovery care to be a positive and beneficial model of care. Staff identified five main challenges with implementing the pathway: early discharge; eligible women's automatic inclusion on the pathway; engaging women; change for staff and organisational constraints and procedures. Elements that support integration include the following: education for women; reassurance and communication with women and families; prepared care and supports including home midwifery; staff education and communication of the evidence; clear guidelines and protocols; defined staff roles; enough clinical time and clinical flexibility. Knowledge from staff in this study would be useful for other health services to consider when looking to deliver similar models of care. The health service and health providers were involved with the initiation and development of the research aims and design.

Factors influencing community intensive care unit research participation: a qualitative descriptive study.

Community hospitals account for 90% of hospitals in Canada, but clinical research is mainly conducted in academic hospitals. Increasing community hospital research participation can improve generalizability of study results, while alsoaccelerating study recruitment and increasing staff engagement. We aimed to identify and describe the factors that influence community intensive care unit (ICU) research participation and the development, implementation, and sustainability of a community ICU research program. We conducted a qualitative descriptive study using semistructured interviews. Between April 2022 and May 2023, we interviewed a purposeful sample of individuals interested or involved in community hospital research in Canadian community ICUs. We analyzed qualitative data using both conventional content analysis and rapid qualitative analysis. Findings were deductively mapped out using the Ecological Model of Health Behavior. Quantitative survey data were analyzed using descriptive statistics. Participants included 23 health care workers, ten research staff, and five hospital administrators (n = 38) from 20 community hospitals across six provinces in Canada. The main factors associated with community ICU research participation were 1) infrastructure, 2) personnel characteristics, 3) key relationships and connections, and 4) the COVID-19 pandemic. In this qualitative descriptive study, participants identified the physical resources, skills, and relationships required to start and sustain a clinical research program in a Canadian community ICU. Our findings suggest that all levels of the Canadian health care system need to invest in strengthening community hospital research capacity to increase research participation.

A Multimethod International Mapping Exercise of Arts Interventions in Renal Units: The PAINT Project

Introduction: Due to the chronic nature of kidney disease, the challenges of symptom burden, and reduced mortality and comorbidity, individuals living with the condition experience substantial anxiety and depression. Incorporating the arts into clinical practice is encouraged to promote and support mental health and well-being. The aim of the PAINT project was to undertake an international mapping exercise to identify the current provision of arts programmes in kidney centres for people living with kidney disease. Methods: A multimethod approach was employed, involving a cross-sectional online survey and semi-structured qualitative interviews, which employed qualitative description research design. Healthcare staff working in kidney centres or organisations providing arts activities to individuals living with kidney disease were recruited into the study. Results: One hundred and nineteen participants from 29 countries responded to the survey, with 39 of the respondents reporting arts activities in their renal unit. There was a wide range of respondents in terms of role, and the types of arts activities included visual arts activities, music, literature/creative writing, film, movement/dance, and craft. Individuals with chronic kidney disease who had taken part in arts activities were mostly adults (64%), and most were undergoing haemodialysis (82%). Sixteen respondents participated in the semi-structured interviews and encouraged the adoption of arts activities for people living with kidney disease. Three themes were identified: enhanced well-being and positive outcomes for individuals living with kidney disease; staff engagement and enthusiasm; and barriers to participation. Conclusions: This overview of arts activities being offered globally to people living with kidney disease and experiences of renal healthcare staff who provide activities in their units are encouraging in terms of arts in healthcare. These practitioners have observed the benefits of this person-centred arts approach in action, predominantly in terms of the positive impact on the well-being of individuals with kidney disease and improved relationships with staff in dialysis units. Further attention and funding should be focused on arts activities within renal centres.

The Influence of Online Tax Services on Service Delivery at Kenya Revenue Authority – Nakuru Station

Purpose: This study examined the influence of Online Tax Services on service delivery at the Kenya Revenue Authority (KRA) Nakuru Station. Methods: Utilizing a descriptive case study research design, the study targeted a population of 504 staff and customers at the station. A sample size of 287 was derived using Yamane’s (1967) formula. Results: The findings reveal a moderate positive correlation (Pearson correlation coefficient of 0.538) between Online Tax Services and service delivery, indicating that improvements in the availability and functionality of these services are associated with better service delivery outcomes. Regression analysis further confirms that Online Tax Services significantly impact service delivery, with an unstandardized coefficient of 0.317 and a standardized coefficient of 0.271. This suggests that enhancing these services results in a moderate improvement in service delivery. Respondents also noted the benefits of reduced processing times, increased accuracy of tax assessments, and improved taxpayer compliance. However, concerns about staff training and readiness indicate a need for further capacity-building efforts to fully optimize the benefits of digitization. Conclusion: The study concludes that while Online Tax Services positively influence service delivery, additional focus on staff engagement and system reliability is essential for sustained improvements.

Factors Impacting the Adoption and Potential Reimbursement of a Virtual Reality Tool for Pain Management in Switzerland: Qualitative Case Study.

Pain and its adequate treatment are an issue in hospitals and emergency departments (EDs). A virtual reality (VR) tool to manage pain could act as a valuable complement to common pharmaceutical analgesics. While efficacy could be shown in previous studies, this does not assure clinical adoption in EDs. The main aim of this study was to investigate which factors affect the adoption and potential reimbursement of a VR tool for pain management in the ED of a Swiss university hospital. Key informant interviews were conducted using in-depth semistructured interviews with 11 participants reflecting the perspectives of all the relevant stakeholder groups, including physicians, nurses, patients, health technology providers, and health insurance and reimbursement experts. The interviews were recorded and transcribed, and the extracted data were systematically analyzed using a thematic analysis and narrative synthesis of emergent themes. A consolidated framework for eHealth adoption was used to enable a systematic investigation of the topic and help determine which adoption factors are considered as facilitators or barriers or as not particularly relevant for the tool subject of this study. According to the participants, the three key facilitators are (1) organizational environment; (2) tension for change, ease of use, and demonstrability; and (3) employee engagement. Further, the three key barriers to adoption are (1) workload, (2) changes in clinical workflow and habit, and (3) reimbursement. This study concludes that the adoption of a VR tool for pain management in the ED of the hospital subject of this study, although benefiting from a high tension for change in pain and workload management, is highly dependent on the respective organizational environment, engagement of the clinical staff, and reimbursement considerations. While tailored incentive structures and ambassador roles could benefit initial adoption, a change in the reimbursement landscape and further investigation of the positive effects on workflow effectiveness are required to drive long-term adoption.

Implementing INTERACT in Veterans Health Administration Community Living Centers: A pragmatic randomized trial.

Hospital transfers from VA Community Living Centers (CLCs) are common. The objective of this study was to evaluate the effect of introducing the Intervention to Reduce Acute Care Transfers (INTERACT) program into VA CLCs. Cluster randomized trial involving 16 pair-matched VA CLCs. Intervention CLC nursing staff were trained in the use of INTERACT tools designed to identify early signs of a clinical change in condition and improve communication and documentation. One tool was embedded into the VA Electronic Medical Record. Intervention staff were supported by bi-weekly calls over 18 months to reinforce INTERACT tool use. The primary outcome for intent-to-treat analyses was the rate of all-cause hospitalizations per 1000 person days. Secondary outcomes, assessed through structured record reviews and algorithms, were intervention CLCs change in 1) potentially inappropriate transfer decisions and 2) potentially preventable transfers. CLC staff implementation and engagement in INTERACT were documented. Only five of the eight intervention CLCs substantially engaged in the intervention. Using a negative-binomial regression with random effects, adjusting for month, intervention, and the interaction of time and the intervention, we observed no statistically significant difference between intervention and control facilities in all-cause hospitalizations. This was confirmed with matched resident-level, as-treated, analyses among residents in the five engaged CLCs and their matched controls. Structured implicit review of intervention CLC's medical records revealed low rates of inappropriate transfer decisions both before and after the intervention. Introducing INTERACT into volunteer VA CLCs did not reduce the rates of all-cause hospitalizations. In both the pre- and post-intervention periods, all-cause hospitalization rates were relatively higher, and inappropriate transfers lower in VA CLCs than commonly observed in community NHs. Low rates of potentially inappropriate transfers and higher nurse and physician staffing in CLCs may explain why INTERACT was not implemented as fully as planned.

Preparing a global workforce for implementation of evidence‐based dementia care: facilitators and barriers

AbstractDementia is a global public health challenge, impacting &gt; 55 million individuals worldwide. However, widespread dissemination of efficacious non‐pharmacologic interventions remains limited. A key implementation barrier is workforce preparation and support for healthcare professionals (HPs) and administrators when being trained in, implementing, and sustaining programs. Normalization Process Theory (NPT) is a useful framework for understanding how complex interventions are perceived by frontline staff and integrated into daily work routines. NPT consists of four constructs: coherence (describing the process), cognitive participation (level of engagement of staff in the program), collective action (operational work), and reflective monitoring (perceived value of the program). Using NPT, we examined training and implementation barriers and facilitators for HPs and administrators from different countries embedding two evidence‐based programs (Tailored Activity Program (TAP) or Care of Older People in the Environment (COPE) in their settings.Twenty‐nine participants (15 HP and 14 administrators) from the United States, Australia, Scotland, Italy, Chile, and Poland, were trained in either TAP or COPE, consisting of self‐paced online modules (10 hours for TAP; 16 hours for COPE), and accompanied by virtual meetings and personalized coaching. After training, participants used TAP/COPE with families in their respective countries and health systems. Seven focus groups (2‐4 participants per group) and eight individual interviews were conducted, using semi‐structured interview techniques, and qualitatively analyzed through directed content analysis to examine their experiences with these programs.Applying NPT, we found general consensus that TAP/COPE were well received and perceived as beneficial to patients/clients (NPT = reflective monitoring). Nevertheless, additional resources for training and implementation were identified as important for effective implementation and sustainability: 1) strategies/checklists for getting started (NPT = coherence and cognitive participation), 2) support (webinars with seasoned implementers/trainers; NPT = cognitive participation and collective action), 3) and for the USA, billing information for reimbursement (NPT = collective action).NPT provides a useful framework for understanding implementation and workforce preparatory challenges. We found that it is possible to effectively train and prepare a workforce using online, self‐paced approaches followed by live coaching opportunities. However, additional supports are needed for effective implementation/sustainability. A need for packaging evidence‐based programs in ways that facilitate implementation and sustainability is needed.