Interprofessional Team Collaboration Research Articles

IMPLEMENTATION OF INTERPROFESSIONAL COLLABORATIVE PRACTICE IN TYPE B TEACHING GENERAL HOSPITALS: A MIXED METHODS STUDY

Background: The concept of patient centered health services encourages interprofessional collaboration practice (IPCP), including teaching hospitals. IPCP in teaching hospitals expected to be implemented properly as a role model for students. Students in academic stage are expected to understand the concept of interprofessional education (IPE) and apply IPCP concept during clinical practice. This study aimed to determine the implementation of IPCP and various factors related to IPCP in teaching hospitals.Methods: This study used a mixed methods-sequential explanatory design with the subjects of healthcare professionals at RSUD R Syamsudin SH recruited using systematic random sampling. The research began with collecting quantitative data to measure the implementation of IPCP using the Indonesian version of the Assessment of Interprofessional Team Collaboration Scale-II (AITCS-II), continued with collecting qualitative data with in-depth interviews to explored IPCP and various factors associated with its implementation.Results: A total of 320 respondents filled out the AITCS-II questionnaire and 11 participants were interviewed deeply. More than 66% of respondents had a good collaboration in each domain; 73,8% of respondents had a good collaboration in IPCP; profession background significantly contributed IPCP (p <0.05). Qualitative analysis was carried out with a semantic theme and obtained 3 themes: not ideal IPCP implementation, perception of IPCP domains by healthcare professionals and barriers in implementing IPCP. Conclusion: The perception of IPCP that well implemented may resulted from improper understanding of IPCP. We still found barrier in implementing IPCP related to stereotypes, hierarchical culture, interprofessional communication and regulation.

The Importance of Interprofessional Practice in Family Medicine Residency Education.

The practice of family medicine is undergoing rapid transformation, with increasing recognition that family physicians can most effectively meet the needs of individual patients and populations within the context of highly effective interprofessional teams. A substantive evidence base exists to support effective workplace learning by practicing health care teams and learners, much of which has been developed in primary care teaching practices. A strong national consensus now emphasizes the importance of the interprofessional clinical learning environment, including in graduate medical education. Evidence for the impact of improved team function on quadruple aim outcomes is increasingly robust. The World Health Organization, Interprofessional Education Consortium, National Collaborative for Improving the Clinical Learning Environment, and National Center for Interprofessional Practice and Education have developed evidence-based approaches and tools for improving interprofessional collaboration to improve important health outcomes in the clinical learning environment. Embracing the practice as the curriculum and preparing our residency graduates to work within high-functioning interprofessional collaborative practice teams, family medicine has the opportunity to lead the way in demonstrating the value of effective interprofessional practice across health care settings, including virtual teaming, to improve the health of the communities we serve, and across the nation.

Nurse Educators Teaching Medical Interns: Impact of Interprofessional Collaboration.

This quantitative educational intervention was conducted to determine the effectiveness of a 1-day internal medicine orientation for new interns, led by nurse educators instead of medical doctors. Scheduled within the orientation week curriculum, this project had a purposeful convenience sample of 14 students comprising the entire intern class. An afternoon of 1:1 clinical skills with nursing guidance followed a morning of didactic lecture on medical knowledge and skills transfer. Students completed a pre/postmedical education test (MET) to evaluate knowledge and skills acquired. Interns reported increased confidence with clinical competencies to both nurse educators and the chief resident. Outcome questionnaires revealed statistically significant increases in knowledge about clinical skills after the intervention. Interns witnessed interprofessional teamwork. Nurse educators teaching medical interns facilitates interprofessional team collaboration, communication, and mutual respect. This simulation pedagogy focusing on principles of deliberate practice can have a positive impact on academic and clinical performance.

Impact of a sleep promotion protocol on off-pump coronary artery bypass graft patients.

Sleep abnormalities frequently occur in intensive care unit (ICU) patients, and the consequences of sleep abnormalities in patients who undergo off-pump coronary artery bypass graft (OPCABG) surgery are particularly significant. Although many interventions have been reported to improve sleep, few sleep promotion protocols have been designed specifically for patients in cardiac ICUs. This study aimed to explore the effects of an evidence-based sleep promotion protocol on patients who underwent OPCABG in a cardiac ICU. A quasi-experimental study was conducted in a comprehensive hospital in Shandong province of China. Overall, 67 participants were recruited (37 in the control group and 30 in the intervention group). An evidence-based sleep promotion protocol was developed by a 10-member interprofessional collaborative team and then applied. Sound levels, light intensity, and the number of nocturnal interventions were compared between groups. The Chinese version of the Richards-Campbell Sleep Questionnaire (RCSQ) was used to compare intergroup sleep status on two consecutive postoperative nights. No significant differences were found for demographics or disease severity between the groups. In the intervention group, sound levels and light intensity were significantly lower at various times, and nocturnal interventions were significantly less frequent over the two consecutive nights. RCSQ scores were significantly higher in the intervention group for both nights. The sleep promotion protocol reduced sound levels, night-time light intensity, the number of nocturnal interventions, and improved sleep among OPCABG patients in a cardiac ICU. Evidence-based practice can help to promote good quality of care, improve patient outcomes, and advance nursing in clinical settings.

Cognitive load theory in simulations to facilitate critical thinking in radiography students

Background. Problem solving and critical thinking are top future skills. High-fidelity simulations improve critical thinking, but also increase students’ cognitive load, possibly limiting their learning. Educators should therefore consider learning outcomes, problems that require critical thinking, the relationship between working and long-term memory, and intrinsic and extraneous cognitive loads when developing simulation scenarios. Objective. To report on the application of cognitive load theory (CLT) and students’ responses in terms of problem solving and new insights during and after a simulation experience. Methods. A high-fidelity simulation, targeting multilevel communication, teamwork and prioritisation of learning outcomes, was designed according to CLT. Eighty students participated in presimulation knowledge, skills and attitudes acquisition and 10 participated in the simulation. A qualitative descriptive design was followed and data were collected through video/audio recordings of the simulation and reflection session, supported by educator and critical observer notes. Qualitative content analysis allowed comprehensive summarisation of students’ problem-solving abilities and emerging new insights. Results. Eighty second-year radiography students formed the target population, with 10 simulation participants comprising the sample. Communication with health professionals was good, but lacking towards patients. Intraprofessional team collaboration was suboptimal, but interprofessional team collaboration was good. Students were mostly unfamiliar with the prioritisation responsibility. Upon reflection, students came to new insights regarding teamwork and prioritisation. Conclusion. After application of CLT, critical thinking to facilitate problem solving during simulation was suggested and post-simulation reflection facilitated new insights. The exposure of large groups to the benefits of simulation validates further investigation.

Analysis of the Surgeons-Anaesthetists Communicative and Collaborative Relationship in the Operating Rooms (An Inside Perspective)

Introduction: Effective collaboration and communication among health care professionals are essential for efficient patient-care; however, collaboration can be challenging in a highly demanding, Operating Room (OR) environment, where different team members have a shared responsibility for a single patient. The surgeon and anaesthetist are two physicians in charge of one patient, however with different focus and aspects of care, and thus their communication is importance to ensure patient safety, reduce medical errors and achieve the best outcome. Purpose: The purpose of this research study was to understand the current collaborative relationship between surgeons and anaesthetists at a tertiary hospital, discussing different factors that might have contributed to this relationship and how that might impact, patients, practice, and healthcare trainees. Design, setting and participants: The Study was conducted at a tertiary center university-based hospital on the east coast of Saudi Arabia, using a quantitative descriptive, cross-sectional survey design. The inclusion criteria included any anaesthetist or surgeon who had spent at least six months in the institution. The instrument used was “The Assessment of Inter-professional Team Collaboration Scale II” (AITCS II) in its online version. Results: A total of 85 participants data were considered for analysis, the data analysis indicated a positive collaborative relationship. Surgeons overall collaboration means were higher than the anaesthetists, but the difference was statistically insignificant between disciplines. Also the overall collaboration scores were higher among females but again statistically insignificant. Conclusion: The survey demonstrated a positive Inter Professional Collaborative (IPC) relationship among surgeons and anaesthetists in the institution, with stronger collaboration seen amongst senior staff which alludes to the importance of the reinforcement of collaboration through role modelling and training especially in academic institutions, high lightening the need of involving program directors, educators, and policy makers, in the process towards a collaborative patient-centred care.

Commitment to Care for the Community and COVID-19: teaching-learning approach to medical education in primary health care in Brazil

The major challenge of the COVID-19 pandemic to all countries has been to their healthcare systems and how to face it with excellence. Medical education can contribute in a short period so that the health system responds effectively to the current challenges imposed by the pandemic. Political implications identification and action are important to show that they can convert ideas into realities. In the middle of the COVID-19 pandemic, literacy in individual, community, and population health is more important than ever. As knowledge about COVID-19 grows rapidly, so does the opportunity to shape more effective interprofessional educational practices. During this pandemic, interprofessional collaborative teams are more crucial than ever in health promotion, mainly at the Primary Health Care.

Preparing Pharmacy Students for Practice to Support Underserved Older Persons

Interprofessional collaboration is needed to ensure high quality care. Effective programs teaching necessary team-based care skills are under investigation. This study evaluated the Aging in Place program, an interprofessional practice experience (IPE), in preparing pharmacy students for practice with underserved older persons. The Assessment of Interprofessional Team Collaboration Scale (AITCS) and Team Decision Making Questionnaire (TCMQ) were administered to students before and after their experience. The number of disciplines represented, campuses involved, resident sessions, resident interactions, and health screenings performed were documented. Overall, AITCS and TDMQ scores improved after participation in the program. Since the program’s inception, there have been 7 disciplines represented, 2 campuses involved, 125 student participants, 2 housing buildings, 90 resident sessions, and 370 health screenings performed. The Aging in Place program has grown and shown that an IPE program is feasible to better prepare pharmacy students for collaborative care with older residents of affordable housing buildings.

Interprofessional versus monoprofessional case-based learning in childhood cancer and the effect on healthcare professionals\u2019 knowledge and attitudes: study protocol for a randomised trial

BackgroundInterprofessional education in childhood cancer is a multifaceted field involving multiple healthcare professionals with general and specialised knowledge and skills. Complex treatment, care and rehabilitation require continuous professional development and maintenance of healthcare professionals’ competencies in their field of expertise. However, limited knowledge exists in comparing interprofessional and monoprofessional education. Only a few randomised studies have evaluated the effectiveness and efficiency of interprofessional education.The objective of this single-centre, investigator-initiated cluster randomised trial is to study the effect of interprofessional versus monoprofessional case-based learning on healthcare professionals’ knowledge of gastrointestinal side effects and attitudes towards team collaboration.MethodsThis study will randomise healthcare professionals to participate in either the experimental interprofessional group or the control monoprofessional group of case-based learning. The topic of the case-based intervention will be gastrointestinal side effects, one of six categories identified in a three-round Scandinavian Delphi study as relevant for interprofessional education in childhood cancer.The primary outcome is the self-reported questionnaire Assessment of Interprofessional Team Collaboration Scale. Secondary outcomes are measured by the self-reported questionnaires Readiness for Interprofessional Learning Scale Questionnaire, Safety Attitudes Questionnaire, and knowledge will be evaluated using a multiple-choice quiz.Participants will receive the self-reported questionnaires about 2 weeks before and 1 month after the intervention. On the day of the intervention, participants will answer a multiple-choice quiz before and after the case-based learning.Linear mixed models will be used to compare differences between the two groups in mean scores postintervention, adjusting for preintervention scores.DiscussionThis study will provide insight into the differences between interprofessional and monoprofessional case-based learning and how it affects healthcare professionals’ knowledge of gastrointestinal side effects and attitudes towards team collaboration.Trial registrationThe intervention was registered at Clinical Trials.gov: NCT04204109 on December 102,019 and with the National Committee on Health Research Ethics: H-19087506 December 112,019 and the Danish Data Protection Agency: P-2019-637 October 152,019.

Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective.

As the demand for telepsychiatry increases during the COVID-19 pandemic, the strengths and challenges of telepsychiatry implementation must be articulated to improve clinical practices in the long term. Currently, observations within US contexts are lacking; therefore, we report on the rapid implementation of telepsychiatry and workflow experiences in a psychiatric practice based within a large health care system in southeast Texas with a national catchment area. We discuss the logistics of the implementation, including modes of communication, scheduling, coordination, and capacity; the psychological effects of web-based services, including both the loss of the physical therapeutic environment and the unique interpersonal dynamics experienced in the virtual environment; and postadoption patterns of engagement with our services and with other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed web-based program (eg, patients were receptive and well-engaged, and they appreciated the continuity of accessible service) as well as the challenges (eg, the need for backup plans and technological fallbacks, managing interruptions and telecommunication learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients’ home spaces). We conclude from our experience that the overall strengths of telepsychiatry include receptive and well-engaged responses from patients as well as the expansion of boundaries, which provides a directly contextualized view into patients’ home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high-risk patients; maintaining professional boundaries in the newly informal virtual setting; designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist; allowing for delays and interruptions (including an initial acclimation session); and preserving interprofessional care team collaboration when the physical locations that normally facilitate such encounters are not accessible. We believe that careful observations of the strengths and challenges of telepsychiatry during this pandemic will better inform practices that are considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter.

Role of Occupational Therapy in Primary Care.

The American Occupational Therapy Association (AOTA) affirms that occupational therapy practitioners1 are well prepared to contribute to interprofessional collaborative care teams addressing the primary care needs of individuals across the life course. Because of an increased focus on preventive population health and social determinants of health by health care organizations, synergy between primary care and occupational therapy is growing, with support for client-centered,2 comprehensive whole-person care, health promotion and prevention, disease self-management, and quality of life (Halle et al., 2018). Occupational therapy practitioners' distinct knowledge of the significant impact that roles, habits, and routines have on health and wellness makes their contribution to primary care valuable (AOTA, 2020b). Occupational therapy's focus on meaningful engagement in occupations is relevant and vital to participation in individual, family, and community life (AOTA, 2020c). In addition, occupational therapy practitioners' holistic and population perspectives allow them to be effective both as interprofessional health care team members and as direct care providers to support client, family, and community needs in primary care delivery models (Leland et al., 2017). The purposes of this position paper are to define primary care and to describe occupational therapy's evolving and advancing role in primary care, including expansion of services into specialty primary care areas such as pediatric primary care and obstetrics and gynecology (AOTA, 2018).

Impact of an interprofessional training ward on interprofessional competencies – a quantitative longitudinal study

ABSTRACT Complex learning strategies, like interprofessional training wards in which students work autonomously in interprofessional collaboration, can support the development of interprofessional competencies in terms of knowledge, abilities and attitudes. To assess the short-term and long-term effects of a three to five weeks placement on such an interprofessional training ward on nursing and medical undergraduates, a study with pre-post-follow-up design was conducted from April 2017 until February 2019. Outcome measures were the University of the West of England Interprofessional Questionnaire (UWE-IP), the Interprofessional Socialization and Valuing Scale (ISVS), and the Assessment of Interprofessional Team Collaboration Scale (AITCS) measuring interprofessional competencies, including teamwork, communication, interprofessional learning, collaboration, and socialization. 60 medical and 63 nursing undergraduates of the first 16 interprofessional student teams that were placed on the Heidelberg interprofessional training ward (HIPSTA) between April 2017 and November 2018 were included in the study. Data was analyzed using the linear mixed model analysis for longitudinal comparisons of scores before, directly after and three months after the placement on the interprofessional training ward. Statistically significant positive short-term effects in interprofessional competencies were found in all three questionnaires, with effect sizes up to d = 1.05. Statistically significant positive long-term effects with effect sizes up to d = 0.60 were found in the ISVS and the AITCS concerning socialization and collaboration. These results indicate that interprofessional education in a clinical setting positively influences the participants’ perception of interprofessional socialization and teamwork. This may possibly lead to improved interprofessional collaboration in their further career. Strategies to yield a sustainable improvement of attitudes toward interprofessional interaction are still needed.

Penn State College of Medicine.

Penn State College of Medicine.

How interprofessional teams of students mobilized collaborative practice competencies and the patient partnership approach in a hybrid IPE course

ABSTRACT To develop collaborative competencies of future health and social services professionals, the Université de Montréal (UdeM) offers interprofessional education (IPE) in partnership with patients. To meet the challenges of IPE, UdeM turned to digital tools to enable interprofessional teams of students to collaborate online and face-to-face. The collaborative flipped classroom for IPE with patient partnership is the conceptual framework for the pedagogical method used for this study. It is based on: 1) a competency framework and 2) collaborative learning concept and dimensions. The study aimed to: 1) demonstrate how interprofessional teams of students mobilize framework competencies and care approaches during online and face-to-face collaborative learning activities; and 2) analyze how students collaborate during a hybrid IPE course using a patient partnership approach. Using a qualitative methodology, the contents of the online collaborative journals (OCJs) of 12 interprofessional student teams were analyzed, along with the individual comments (n = 994) of IPE course learners collected through the Interprofessional Team Collaboration questionnaire (n = 321). The results suggest that the course under study enabled teams to collaborate online and face-to-face throughout the term, and indicate that students were better prepared to adopt a patient partnership approach.

A Protocol to Examine Surgical Team Communication in a Large Military Medical Center.

Preventable clinician communication errors are the most frequent root cause of surgical adverse events. Effective communication among surgical team members is an important overall indicator of clinical nursing excellence and is crucial to promote patient safety and reduce healthcare risk. The purpose of this publication is to describe our research protocol, which will comprehensively investigate surgical team communication and surgical team structure. There are two overall study objectives: (a) to characterize the network factors that influence perioperative clinician communication and (b) to identify how team structure shapes communication effectiveness. Specifically, we will study the association among clinician relationships, surgical team familiarity, surgical team size, and communication effectiveness. We will use an exploratory, prospective, cross-sectional, network-centric approach using social network analysis to determine how interdependent clinician relationships influence surgical communication patterns. Targeting an 80% response rate, we will use total population sampling to recruit all clinicians (nurses, surgeons, anesthetists, surgical technologists, students, residents) who directly provide surgical care in the operating room at a large military medical center. We will administer an electronic survey to surgical teams at the end of the surgical day to elicit clinician communication assessments and relational preferences. From the survey questions, we will develop six relational networks (interaction, close working relationship, socialization, advice seeking, advice giving, speaking up/voice) and three models that represent communication effectiveness for each participant and team. We will use various statistical methods to characterize the network factors that shape operating room clinician communication and identify how team structure shapes communication effectiveness. This study will start enrolling participants in 2020. We are among the first to comprehensively investigate operating room communication using social network analysis. The results of this study will provide valuable insight into nurse collaboration and communication in interprofessional teams, enable a thoughtful analysis of surgical staffing and perioperative team building, and inform future-targeted interventions to improve operating room communication weaknesses.

A Call for North Carolina to Surround the Seriously Ill and Caregivers with Interprofessional Collaborative Teams

As the population ages, the number of people living with serious illness is increasing and the demand for quality, timely, person-centered palliative care is growing. We need specialized, trained health professionals working in collaborative teams to answer this call. It is upon health care leaders and policymakers to jointly design, build, and sustain a workforce to ensure all North Carolinians have access to care during a serious illness or end of life.

Factors influencing interprofessional team collaboration when delivering care to community-dwelling seniors: A metasynthesis of Canadian interventions

ABSTRACT The rapid growth in the proportion of adults over the age of 65 translates into greater need of complex, highly specialized care. Hence, coupled with other factors, healthcare expenditures in Canada have grown exponentially, creating tension for a high-quality care while managing costs. Interventions with community-based interprofessional teams have been piloted across Canada as a means to provide efficient specialized care. These teams must, however, work collaboratively for a more comprehensive and patient-centered care. This metasynthesis aimed to identify common factors or characteristics found to be essential for a collaborative practice among members of an interdisciplinary team delivering coordinated care to community-dwelling seniors in both rural and urban centers in Canada. Six databases (Medline, CINAHL, Sage, JSTOR, ProQuest, Web of Science) were searched for qualitative peer‐reviewed articles on community-based interventions with interprofessional teams in Canada and published between 2005–2018. Six articles were included and appraised using the COREQ guidelines for quality, followed by a thematic analysis for common themes related to team collaboration. Overarching themes related to practices of interprofessional collaboration were trust and respect, communication, and shared vision. Sub-themes included trust in the relationship between health care professional, professional identity and role clarity, interprofessional communication, communication with the client or family, and common goals. Interprofessional teams work collaboratively when trust and respect, communication, and shared vision are valued and present. Agencies coordinating interprofessional teams for community-based care could be pivotal in ensuring an environment conducive to collaboration, such as learning and team building opportunities.

The nurse practitioner as a bridge to interprofessional research team collaboration in rural community clinics.

Clinical health outcomes and health disparities can be improved through interprofessional collaborations among multidisciplinary clinicians, health care services researchers, and patients. Bridging gaps between community clinics and urban academic centers allows added valuable perspectives that can lead to improved care and extend clinical research. Nurse practitioners (NPs) who serve as primary care providers in many rural community clinics can facilitate access to clinical trials for patients who are rarely included in health care services research as well as coordinate interprofessional research team collaboration. A NP working in a rural clinic can assist academic-based research teams in designing feasible strategies to address disparities and improve health care of underserved populations. The purpose of this article was to provide an example of a rural provider/urban academic research team collaborating to conduct a health literacy-directed randomized controlled trial to improve colorectal cancer screening in isolated rural community clinics.

Relationships between work conditions, job satisfaction and burnout in Israeli Ministry of Education art therapists

ABSTRACT Background: Art therapists in the education system work within a framework that is not therapeutic in orientation, a fact which has implications for their work environment. Aims: This study examined the relationships between working conditions and between job satisfaction and burnout of art therapists employed by the education system in Israel. Method: Forty-nine therapists completed a set of self-report questionnaires at the beginning, middle and end of the academic year. Results: Several significant correlations between the therapists' perceptions of their working conditions and between burnout and job satisfaction were found. The better the therapists' perception of inter-professional team collaboration, the greater their sense of professional efficacy. More satisfactory perceptions of the working conditions in the therapy room were associated with a lesser sense of exhaustion. Most of the correlations between the variables emerged at Time 2, midyear. Conclusions: Midyear is characterized by more consecutive workdays, which allows for more staff meetings than in the first and last trimesters of the school year and is considered the main period for therapeutic work to take place. The findings, which partially support the hypotheses, also illustrate the moderating role of inter-professional team collaboration on the relationship between the number of clients and the exhaustion dimension of burnout. Plain-language summary Art therapists in the education system work within a framework that is not therapeutic in orientation and has highly specific working conditions. This study examined whether there is a relationship between working conditions; the suitability of the therapy room, the quality of the interprofessional team collaboration, and the number of clients, and between job satisfaction and burnout in 49 art therapists employed by the education system in Israel. The therapists were sent an online link from the researchers to complete self-report questionnaires at the beginning, middle and end of the academic year. We found several significant correlations between the therapists’ perceptions of their working conditions and between burnout and job satisfaction. The better the perception of inter-professional team collaboration, the more job satisfaction was reported at Time 2. The better the therapists’ perception of inter-professional team collaboration in the school system, the greater their sense of professional efficacy at Times 1 and 2 and the less their sense of exhaustion at Time 2. More satisfactory perceptions of the working conditions in the therapy room were associated with a lesser sense of exhaustion at Times 1 and 2. Most of the correlations between the variables emerged at Time 2, midyear. This period is characterised by more consecutive work days, which allows for more staff meetings than in the first and last trimesters of the school year, and is considered the main period for therapeutic work to take place. The findings also show that inter-professional team collaboration affects the relationship between the number of clients and burnout from exhaustion.

Neighbourhood Team Development to promote resident centred approaches in nursing homes: a protocol for a multi component intervention

BackgroundAs the demand for nursing home (NH) services increases, older adults and their families expect exceptional services. Neighbourhood Team Development (NTD) is a multi-component intervention designed to train team members (staff) in the implementation of resident-centered care in NH settings. A neighbourhood is a 32-resident home area within a NH. This paper presents the protocol used to implement and evaluate NTD. The evaluation aimed to 1) examine fidelity with which the NTD was implemented across NHs; 2) explore contextual factors associated with implementation and outcomes of the NTD; and 3) examine effects of NTD on residents, team members, family, and organizational outcomes, and the association between level of implementation fidelity and outcomes.MethodsThe study employed a repeated measure, mixed method design. NTD consisted of a 30-month standardised training and implementation plan to modify the physical environment, organize delivery and services and align staff members to promote inter-professional team collaboration and enhanced resident centeredness. Training was centred in each 32-resident neighbourhood or home area. Quantitative and qualitative data were collected with reliable and valid measures over the course of 3 years from residents (clinical outcomes, quality of life, satisfaction with care, perception of person centeredness, opportunities for social engagement), families (satisfaction with care for relative, person centeredness, relationship opportunities), team members (satisfaction with job, ability to provide person centered care, team relationships) and organizations (retention, turnover, staffing, events) in 6 NHs. Mixed models were used for the analysis.DiscussionThe advantages and limitations of the NTD intervention are described. The challenges in implementing and evaluating this multi-component intervention are discussed as related to the complexity of the NH environment.Trial registrationClinicalTrials.gov ID: NCT03415217 (January 30, 2018 – Retrospectively registered).