Encouraging Best Practice in Residential Aged Care Program: Final Evaluation Report

4.5 - Impact on facilities

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Table 16 summarises the impact of the EBPRAC projects on facilities. The summary aims to capture the more general impacts across facilities, rather than the impact in every single facility. The impacts on facilities were generally about improvements in structures, systems and processes.

Table 16 Summary of impact on facilities

Project title	Impacts on facilities
NARI pain	Improvements in compliance with best practice pain management standards by all facilities. Equipment purchased (heat packs and TENS machines). All facilities appointed a pain management team. Pain protocols changed to include more regular assessment. Documentation of pain improved.
UN nutrition	Elevated the importance of nutrition and hydration as essential components of care. Systems developed for weighing residents; recording weights and monitoring change; menu planning and assessing residents’ preferences; processing and providing meals; and staff rosters. Changes to the dining room environment. Purchase of equipment for weighing residents and for preparing and heating food.
NARI falls	Statistically significant improvement in 14 out of 52 items in a safety culture survey between baseline and follow-up. 71% of staff reported resident safety to be either better or much better. Environmental modifications and equipment purchase improved the environment, with changes to signage, use of height adjustable chairs, sensors and hip protectors. Increased access to allied health support.
SA dental	Use of oral health assessments and oral care plans. Provision of on-site dental care.
DATIS meds	Some introduction of new policies and assessment tools.
QUT wounds	Improvement in positive attitudes and culture towards implementing changes in wound management practices. Staff reported improved communication between levels of staff. Improved capacity to access expertise with establishment of wound care networks and contact with outside experts.
PW inf control	Different changes in each facility, including changes to waste management, cleaning and hand hygiene. No reduction in infections.
MGPN pall care	Introduction of palliative care minimum data set. Introduction of end-of-life care pathways and promotion of advance care plans. No change in the frequency of case conferencing.
NEVDGP pall care	Some decoration and equipment purchases. Improvements in medication supply chain. Introduction and use of end-of-life care pathway in 43% of instances where it could have been used, with use highly variable between facilities.
UQ pall care	Introduction of end-of-life care pathways. Introduction and use of palliative care case conferences. Little change in services available for palliative care (based on self-assessment by facilities). Improved documentation of advanced care planning and end-of-life care.
UTS behav	Changes to physical environment, including improved signage. Changes to facility-wide policies and processes in some facilities. Improvement in five out of seven units in the organisational domain of the Person-centred Care Assessment Tool. Increased safety scores in five out of seven units.
HC behav	Changes to physical environment. Increase in quality of the physical environment.
MU behav	Improvements to the physical environment e.g. improved lighting, improvements to outdoor facilities. Five facilities made noticeable differences in mealtimes making them a more leisurely event (as perceived by families). Needs-based problem solving standard practice in several facilities and used regularly in other facilities.

There were indications of changes in some elements of culture in four projects. According to Schein, culture is layered, with observable patterns of behaviour being classified as Level 1, beliefs and values as Level 2 and assumptions as Level 3 (Schein 1992). Change may take place at Level 1 whereas deeper beliefs and assumptions (levels 2 and 3) remain unchanged. Until new behaviours become embedded and part of daily routine, they may not necessarily influence deeper levels of culture (Mannion, Davies et al. 2005), reverting over time to behaviours consistent with underlying (and unchanged) assumptions and values. It is unlikely that a time-limited project focusing on one aspect of care, even a relatively broad ranging area such as behaviour management, would result in cultural change at levels 2 and 3 and even if it did the key issue is whether that change is maintained.
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