Encouraging Best Practice in Residential Aged Care Program: Final Evaluation Report
3.10 - Key success factors - perceptions of lead organisations and facility staff
Table of contents
- Key Messages
- Executive Summary
- About This Report
1 - Introduction- 2 - Evidence, Changes in Practice and the EBPRAC Program
3 - Program Delivery/Implementation- 3.1 - Introduction
- 3.2 - Implementation delays
- 3.3 - Model of change/implementation
- 3.4 - The nature of the changes in practice
- 3.5 - Context for change
- 3.6 - Demonstrable benefit
- 3.7 - Adequate resources
- 3.8 - Systems and use of data to support the use of evidence
- 3.9 - Stakeholder engagement, participation and commitment
- 3.10 - Key success factors - perceptions of lead organisations and facility staff
- 3.11 - Summary - incentives and barriers to sustained implementation
- 4 - Program Impact
- 5 - Capacity Building
- 6 - Generalisability
- 7 - Sustainability
- 8 - Dissemination
- 9 - Appropriateness
- 10 - Cost Implications for Government and Aged Care Providers
- 11 - Perceptions of High-Level Stakeholders
- 12 - Discussion and Conclusions
- 13 - Recommendations
- References
- Appendices 1 to 6
- Appendices 7 to 12
- Appendices 13 to 17
3.10.1 Lead organisations - essential ingredients for success
The progress report submitted on a six-monthly basis by each project included the question ‘are there any essential ingredients for success (the ‘must have’ or ‘must do’) of the project?’ In answering this question projects built on what had been reported in previous progress reports, rather than identifying a completely new set of ‘must haves’ or ‘must dos’ with each progress report. Appendix 14 includes a summary of all the responses from all the projects over the two years of each project. Table 12 maps the responses to the key success factors underpinning the evaluation framework. Based on these responses some factors such as having a receptive context for change, leadership, certain aspects of the model of change (particularly local facilitators) and stakeholder engagement are mentioned more frequently than some of the other key success factors.Table 12 Essential ingredients for success as reported by lead organisations
Key success factor | Essential ingredients for success |
|---|---|
| Receptive context for change | Trust and good communication between key staff. Support from management that is evident to staff. Managers of facilities have volunteered to be involved. The goodwill and commitment of the residents. Effective communication and team work. Commitment to providing evidence-based practice and care. Ensure all staff are ready for change. |
| Leadership | Key drivers to engage project participants, maintain momentum and lead change. Dedicated driver within the organisation to implement best practice. Clear directive identifying tasks and responsibilities for others in the organisation to support the champion. A committed and enthusiastic senior member of staff. Committed leadership within facilities. Recruit a supportive team with leadership and change management skills. Support by credible, known local leaders. |
| Model of change | Regular, clear lines of communication between all project partners. Collaboration with the facilities at early inception of the project and as the project is conducted. Funded champion position. The champion position must be supplemented by assistants as a risk management strategy in larger facilities. An enthusiastic and dedicated resource nurse. Appointment and training of link nurses to be the key change agents and drivers. Enough link nurses to cover all shifts/days of the week including holiday relief. Ensure delivery of information, presentations, feedback and training appropriate for target audiences. Simple and user friendly messages using a minimum of terminology. Assist facility staff to identify areas of need and opportunities for practice involvement |
| Staff with the necessary skills | Understand the health literacy of the workforce and the environment in which they work. |
| Stakeholder engagement, participation and commitment | Time for development of collaborative, trusting and collegial working relationships. Time for development of understanding of what each partner wants and needs. Ability to engage interested people with a variety of skills (multidisciplinary team) who have trust and willingness to work together. High level of communication and engagement with direct care staff and management. Engagement of the aged care sector and all consortium partners. Engage all levels of facility staff, residents and carers. Engagement with key stakeholders both within the organisation and those external. |
| Adequate resources | Adequate time and resources. Sufficient funding to help cover the increased workload associated with implementation. Remuneration to the facilities needs to be more generous. Provide resources and avenues for facilities to act on areas of need. |
| Demonstrable benefits | Reporting back successes to all levels of staff. Clarity on how implementing evidence based practice will benefit residents and families. |
| The nature of the change in practice | Identify evidence-based processes and tools that are readily available, user-friendly and have intuitive logic in their application (i.e. find and use the best bet that provides the best fit). |
| Systems in place to support the use of evidence | Provide continuous feedback on planning and progress towards goals. |
3.10.2 Perspectives of facility staff
At two of the EBPRAC national workshops, in March 2009 (Round 1) and February 2010 (Round 2), sessions were held with a total of 95 staff attending from facilities involved in the program to get their perspectives on what factors influence the implementation of evidence-based practice. In the first of these sessions participants were asked ‘what factors influence the implementation of evidenced-based practice in residential aged care based on your experience with the EBPRAC project and any similar projects or attempts to change practice that you have been involved?’ In the second session a different approach was taken – participants were asked the same question but then requested to apply a ranking to the eight factors identified in the literature review plus one other factor (leadership). In the framework for the evaluation leadership was incorporated as one component of a receptive context for change but because leadership had arisen repeatedly as an issue in the program it was decided to separate it out as a factor in its own right to gauge its importance.In both sessions a receptive context for change (including leadership) and the availability of adequate resources were identified as important. The implication of the results from the second session is that leadership is the most important component of a receptive context. The main difference between the two sessions was the importance placed on ‘demonstrable benefits’ by the second group. Of the eight factors from the initial literature review three were identified as relatively unimportant by both groups – the nature of the change in practice, model for change/implementation and systems in place to support the use of evidence. Further details of the results from both sessions are included in Appendix 15.
Top of page