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What, Why, and How Care Protocols are Implemented in Ontario Nursing Homes*

Published online by Cambridge University Press:  18 March 2013

Whitney Berta ,
Liane Ginsburg ,
Erin Gilbart ,
Louise Lemieux-Charles  and
Dave Davis
Whitney Berta*
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto
Liane Ginsburg
Affiliation:
School of Health Policy and Management, York University
Erin Gilbart
Affiliation:
2by2 Strategies
Louise Lemieux-Charles
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto
Dave Davis
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto Division of Medical Education, American Association of Medical Colleges
*
†Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à:Whitney Berta, Ph.D. Institute of Health Policy, Management, and Evaluation University of Toronto 155 College Street – Suite 425 Toronto, ON M5T 3M6 (whit.berta@utoronto.ca)
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Abstract

The aim of this study was to better understand care protocol implementation, including the influence of organizational-contextual factors on implementation approaches, in long-term care homes operating in Ontario. We surveyed directors of care employed in all 547 Ontario LTC homes, and combined survey data with secondary organizational data on rural/urban location, nursing home size, chain membership, type of ownership, and accreditation status. Motivations for the use/selection of care protocols in nursing homes primarily derived from beliefs in continuous improvement and in evidence-based care. Protocol selection was largely participative, involving management and staff. External information sources were important for protocol implementation, and in-service education was the chief means of training and educating staff. Significant differences in approaches to implementation were evident in association with differences in ownership. Three key success factors for implementation were identified: contextualizing the practice change, adequately resourcing for implementation, and demonstrating connections between practice change and outcomes.

Résumé

Le but de cette étude était de mieux comprendre la mise en oeuvre de protocoles des soins, y compris l’influence des facteurs organisationnels et contextuels sur les approches de mise en oeuvre dans les maisons de soins de longue durée (MSLD) en Ontario. Nous avons sondé les directeurs de soins employés dans tous les 547 maisons de soins de longue durée (MSLD) en Ontario, et avons combiné les données d’enquête avec des données sécondaires concernant l’emplacement rural ou urbain, les dimensions de la maison de soins infirmiers, l’appartenance à une chaîne, le type de propriété, et le status d’accréditation. Les motivations pour l’utilisation ou la sélection de protocoles des soins dans les maisons de soins infirmiers dérivent principalement des croyances en amélioration continue et des soins fondés sur des preuves. Le choix des protocoles a été largement participative, impliquant la gestion et le personnel. Les sources d’informations externes sont importants pour la mise en oeuvre des protocoles, et l’éducation permanente était le principal moyen de l’éducation et la formation du personnel. Des différences significatives dans les méthodes de mise en oeuvre sont devenue évidentes dans le cadre des différences de la propriété. On a identifié trois facteurs essentiels de la réussite dans la mise en oeuvre: la contextualisation d’un changement dans la pratique; le ressourcement pour la mise en oeuvre; et la démonstration du rapport entre les changements dans les pratiques et les résultats.

Keywords

vieillissmentvieillissementapplication des connaissancestransfert des connaissancesprotocoles de soinssoins de longue duréeagingcare protocolsknowledge translationknowledge applicationlong-term carepractice standards
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 32 , Issue 1 , March 2013 , pp. 73 - 85
Copyright
Copyright © Canadian Association on Gerontology 2013

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Footnotes

*

We owe thanks to Raisa Deber for valuable feedback on earlier versions of our proposal, and to M-THAC (From Medicare to Home and Community) and CIHR for providing seed funding through the Research Opportunities Fund. We acknowledge the valuable work of Gary Teare in earlier phases of this research and on prior related publications (Teare et al., 2001). We thank members of our advisory committee for generously sharing their insights and experience: Diane Buchanan, Mindy Ginsler, Larry Chambers, Nancy Cooper, Lois Cormack, Jane Brenneman Gibson, David Harvey, Robert Rich, Paul Tuttle, Philippa Welch, Evelyn Williams, and Jack Williams. The Ontario Long Term Care Association (OLTCA), the Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS), and the Registered Nurses Association of Ontario (RNAO) have been wonderful in promoting our research to their members. We are indebted to Ava John-Baptiste and Lina Fung for their assistance with data coding and analysis. This research was funded in large part by the Canadian Institutes of Health Research (CIHR), Knowledge Translation Strategies for Health Research Program, and through the Faculty of Medicine Dean’s Fund, University of Toronto.

References

Almeida, P., & Kogut, B. (1999). Localization of knowledge and the mobility of engineers in regional networks. Management Science, 45(7), 905–917.Google Scholar
Argote, L. (1999). Organizational learning: Creating, retaining and transferring knowledge. Norwell, MA: Kluwer Academic Publishers.Google Scholar
Barnsley, J., Lemieux-Charles, L., & McKinney, M.M. (1998). Integrating learning into integrated delivery systems. Health Care Management Review, 23(1), 18–28.Google Scholar
Berta, W., Teare, G., Gilbart, E., Ginsburg, L., Lemieux-Charles, L., Davis, D., et al. . (2010). Spanning the know-do gap: Knowledge application in Ontario’s long term care homes. Social Science & Medicine, 70, 1326–1337.CrossRefGoogle ScholarPubMed
Bierly, P.E., Damanpour, F., & Santoro, M.D. (2009). The application of external knowledge: Organizational conditions for exploration and exploitation. Journal of Management Studies, 46(3), 481–509.Google Scholar
Burns, L.R., & Wholey, D.R. (1993). Adoption and abandonment of Matrix Management Programs: Effects of organizational characteristics and interorganizational networks. Academy of Management Journal, 36, 106–138.CrossRefGoogle ScholarPubMed
Caccia-Bava, M., Guimaraes, T., & Harrington, S. (2006). Hospital organization culture, capacity to innovate and success in technology adoption. Journal of Health Organization and Management, 20, 194–217.CrossRefGoogle ScholarPubMed
Cherry, B.J., Ford, E.W., & Peterson, L.T. (2011). Experiences with electronic health records: Early adopters in long-term care facilities. Health Care Management Review, 36(3), 265–274.CrossRefGoogle ScholarPubMed
Cohen, W.M., & Levinthal, D.A. (1990). Absorptive-Capacity: A new perspective on learning and innovation. Administrative Science Quarterly, 35(1), 128–152.Google Scholar
Damanpour, F., (1991). Organizational innovation: A meta-analysis of effects of determinants and moderators. Academy of Management Journal, 34, 555–590.CrossRefGoogle Scholar
Damanpour, F., (1992). Organizational size and innovation. Organization Studies, 13, 375–402.CrossRefGoogle Scholar
Damanpour, F. (1996). Organizational complexity and innovation: Developing and testing multiple contingency models. Management Science, 42, 693–716.Google Scholar
Damanpour, F., & Schneider, M. (2006). Phases of the adoption of innovation in organizations: Effects of environment, organization and top managers. British Journal of Management, 17, 215–236.Google Scholar
Dijkstra, R., Wensing, M., Thomas, R., Akkermans, R., Braspenning, J., Grimshaw, J., et al. . (2006). The relationship between organizational characteristics and the effects of clinical guidelines on medical performance in hospitals, a meta-analysis. BMC Health Services Research, 6, 53.Google Scholar
Dillman, D.A. (1978). Mail and telephone surveys: The total design method. New York, NY: John Wiley & Sons.Google Scholar
Dobbins, M., Ciliska, D., Cockerill, R., Barnsley, J., & DiCenso, A. (2002). A framework for the dissemination and utilization of research for health-care policy and practice. The Online Journal of Knowledge Synthesis for Nursing, 9(7). Retrieved October 27, 2009 fromhttp://health-evidence.ca/downloads/A_framework_for_dissemination_(2002).pdf.Google Scholar
Eaton, S.C. (2000). Beyond ‘unloving care’: Linking human resource management and patient care quality in nursing homes. International Journal of Human Resource Management, 11(3), 591–616.Google Scholar
Emmons, K.M., Weiner, B., Fernandez, M.E., & Tu, S. (2012). Systems antecedents for dissemination and implementation: A review and analysis of measures. Health Education & Behavior, 39(1), 87–105.CrossRefGoogle ScholarPubMed
Estabrooks, C.A., Midodzi, W.K., Cummings, G.G., & Wallin, L. (2007). Predicting research use in nursing organizations. Nursing Research, 56(4S), S7–S23.Google Scholar
Estabrooks, C.A., Winther, C., & Derksen, L. (2004). Mapping the field: A bibliometric analysis of the research utilization literature in nursing. Nursing Research, 53, 293–303.Google Scholar
Gambassi, G., Lapane, K., Sgadari, A., Landi, F., Carbonin, P., Hume, A., et al. . (1998). Prevalence, clinical correlates, and treatment of hypertension in elderly nursing home residents. Archives of Internal Medicine, 158(21), 2377–2385.Google Scholar
Graham, I.D., Harrison, M.B., Brouwers, M. (2003). Evaluating and adapting practice guidelines for local use: A conceptual framework. In Pickering, S., & Thompson, J. (Eds.), Clinical Governance in Practice (pp. 213–229). London: Harcourt.Google Scholar
Graham, I.D., Harrison, M.B., Lorimer, K., Piercianowski, T., Friedberg, E., Buchanan, M., et al. ., (2005). Adapting national and international leg ulcer practice guidelines for local use: The Ontario Leg Ulcer Community Care Protocol. Advances in Skin Wound Care, 18(6), 307–318.Google Scholar
Graham, I., & Tetroe, J. (2007). Whither knowledge translation. Nursing Research, 56(4S), S86–S88.Google Scholar
Greenhalgh, T., Robert, G., MacFarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581–629.Google Scholar
Greve, H., & Baum, J.A.C. (2001). Intoduction: A multiunit, multimarket world. In Baum, J.A.C. & Greve, H.R. (Eds.), Multiunit Organization and Multimarket Strategy (Advances in Strategic Management, Volume 18) (pp. 1–28). Oxford, UK: JAI/Elsevier.Google Scholar
Grimshaw, J.M., Eccles, M., & Tetroe, J. (2004a). Implementing clinical guidelines: Current evidence and future implications. The Journal of Continuing Education in the Health Professions, 24, S31–S37.Google Scholar
Grimshaw, J.M., Thomas, R.E., MacLennan, G., Fraser, C., Ramsay, C.R., Vale, L., et al. . (2004b). Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment, 8(6), iii–iv, 1–72.Google Scholar
Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: Effective implementation of change in patients’ care. The Lancet, 362, 1317–1322.Google Scholar
Grunier, A., & Mor, V. (2008). Nursing home safety: Current issues and barriers to improvement. Annual Review of Public Health, 29, 369–382.Google Scholar
Gurwitz, J.H., Monette, J., Rochon, P., Eckler, M., & Avorn, J. (1997). A trial fibrillation and stroke prevention with warfarin in the long-term care setting. Archives of Internal Medicine, 157(9), 978–984.Google Scholar
Hollander, M.J. (1994). The costs, and cost-effectiveness, of continuing-care services in Canada. Kingston, ON: Queen’s University of Ottawa Economic Projects, 94–10.Google Scholar
Kastner, M., Estey, E., Perrier, L., Graham, I.D., Grimshaw, J., Straus, S.E., et al. . (2011). Understanding the relationship between the perceived characteristics of clinical practice guidelines and their uptake: Protocol for a realist review. Implementation Science, 6, 69.Google Scholar
Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence based practice: A conceptual framework. Quality in Health Care, 7, 149–158.Google Scholar
Kotter, J.P. (1996). Leading change. Boston MA: Harvard Business School Press.Google Scholar
Levine, J.M., & Totolos, E. (1994). A quality-oriented approach to pressure ulcer management in a nursing facility. The Gerontologist, 34(3), 413–417.Google Scholar
Lewin, A.Y., Massini, S., & Peeters, C. (2011). Microfoundations of internal and external absorptive capacity routines. Organization Science, 22(1), 81–98.Google Scholar
March, J.G. (1991). Exploration and exploitation in organizational learning. Organization Science, 2, 71–87.Google Scholar
Niessen, L.W., Grijseels, E.W.M., & Rutten, F.F.H. (2000). The evidence-based approach in health policy and health care delivery. Social Science & Medicine, 51, 859–869.CrossRefGoogle ScholarPubMed
Nonaka, I. (1994). A dynamic theory of organizational knowledge creation. Organizational Science, 5(1), 14–37.Google Scholar
O’Neill, C., Harringon, C., Kitchener, M., & Saliba, D. (2003). Quality of care in nursing homes: An analysis of relationships among profit, quality and ownership. Medical Care, 41(12), 1318–1330.Google Scholar
Orsted, H., & Attrell, E. (1999). Making clinical practice guidelines work: The experience of one home healthcare agency. Ostomy/Wound Management, 45(9), 48–56.Google Scholar
Richardson, J., Moreland, J., & Fox, P. (2001). The state of evidence-based care in long-term care institutions: A provincial survey. Canadian Journal on Aging, 20(3), 357–372.CrossRefGoogle Scholar
Robinson, J.C. (2001). Organizational economics and health care markets. Health Services Research, 36(1–2), 177–189.Google Scholar
Rogers, E. (1995). Diffusion of Innovations (4th ed). New York: Free Press.Google Scholar
Rycroft-Malone, J. (2007). Theory and knowledge translation. Nursing Research, 56(4S), S78–S85.Google Scholar
Rycroft-Malone, J., Kitson, A., Harvey, G., McCormack, B., Seers, K., Titcen, A., et al. . (2002). Ingredients for change: Revisiting a conceptual framework. Quality & Safety in Health Care, 11, 174–180.Google Scholar
Rycroft-Malone, J., Seers, K., Titchen, A., Harvey, G., Kitson, Al., & McCormack, B. (2004). What counts as evidence in evidence-based practice? Journal of Advanced Nursing, 47(1), 81–90.Google Scholar
Schnelle, J.F., Ouslander, J.G., Cruise, P.A. (1997). Policy without technology: A barrier to improving nursing home care. The Gerontologist, 37(4), 527–532.CrossRefGoogle ScholarPubMed
Scott, I. (2007). The evolving science of translating research evidence into clinical practice. Evidence Based Medicine, 12, 4–7.CrossRefGoogle ScholarPubMed
Sekimoto, M., Imanaka, Y., Kitano, N., Ishizaki, T., & Takahashi, O. (2006). Why are physicians not persuaded by scientific evidence? A grounded theory interview study. BMC Health Services Research, 6, 92.Google Scholar
Shaw, B., Cheater, F., Baker, R., Gillies, C., Hearnshaw, H., Flottorp, S., et al. . (2006). Tailored interventions to overcome identified barriers to change: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews, 3, CD005470.Google Scholar
Solberg, L.I., Brekke, M.L., Fazio, C.J., Fowles, J., Jacobsen, D.N., Kottke, T.E., et al. . (2000). Lessons from experienced guideline implementers: attend to many factors and use multiple strategies. Journal of Quality Improvement, 26(4), 171–188. Retrieved October 27, 2009, fromhttp://www.jcrinc.com/docviewer.aspx.Google Scholar
Stirman, W., Kimberly, J., Cook, N., Calloway, A., Castro, F., & Charns, M. (2012). The sustainability of new programs and innovations: A review of the empirical literature and recommendations for future research. Implementation Science, 7, 17.Google Scholar
Straus, S., Tetroe, J.M., & Graham, I.D. (2011). Knowledge translation is the use of knowledge in health care decision making. Journal of Clinical Epidemiology, 64(1), 6–10.Google Scholar
Szulanski, G. (1996). Exploring internal stickiness: Impediments to the transfer of best practice within the firm. Strategic Management Journal, 17, 27–43.CrossRefGoogle Scholar
Szulanski, G. (2000). The process of knowledge transfer: A diachronic analysis of stickiness. Organizational Behavior and Human Decision Processes, 82(1), 9–27.Google Scholar
Teare, G.F., Baker, G.R., Daniel, I., Hirdes, J.P., Markel, F., McKillop, I., et al. . (2001). Hospital Report 2001: Complex Continuing Care. Joint Initiative of the Ontario Hospital Association and the Government of Ontario. Toronto: Hospital Report Research Collaborative, University of Toronto.Google Scholar
Wright, J., Warren, E., Reeves, J., Bibby, J., Harrison, S., Dowswell, G., et al. . (2003). Effectiveness of multifaceted implementation of guidelines in primary care. Journal of Health Services Research and Policy, 8(3), 142–148.Google Scholar
Xakellis, G.C., Frantz, R.A., Lewis, A., & Harvey, P. (1998). Cost-effectiveness of an intensive pressure ulcer prevention protocol in long-term care. Advances in Wound Care, 11(1), 22–29.Google Scholar
Zahra, S.A., & George, G. (2002). Absorptive capacity: A review, reconceptualization, and extension. Academy of Management Review, 27, 185–203.Google Scholar
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