Table 4 Description of non-spread site

Barriers to spread

The findings of the non-spread site confirmed the importance of the facilitators identified in the spread model, largely by their absence. Participants at the non-spread site stated that the organization was committed to falls prevention strategies and initiatives. However, they were not actively implementing and spreading the specific falls prevention tool under study. Frontline staff recalled having a presentation related to the tool at a staff meeting, but they commonly stated they were not using the tool: “I haven’t actually used it…it’s kind of obvious that a lot of us are not using it” (04-01). They described that they were not clear if the tool was to be used with all clients or only with selected clients. Common responses to questions about the development, piloting, and spread of the tool included: “I couldn’t tell you, I don’t know” (04-02).

One of the key barriers to spread at this site was identified as the lack of a project lead, steering committee, and champions related to the initiative. At this site, the project leader left the organization shortly after the introduction of the falls tool and was not replaced, leaving a critical gap in leadership: “We’re in a transition time right now because we just lost our clinical educator…so I know that she was working on it first…and I'm not sure where that is going right now… because I don't think there is anyone else involved in that” (04-01). When participants were asked if they were aware of any working group or champions to assist with the roll out of the tool, they responded with: “No, not that I’m aware of” (04-06). Participants were also uncertain about the benefits of using this tool, or any audit and feedback mechanisms related to the use of the tool: “I couldn’t answer that…I would assume they are checking these things in the chart audits…I don’t know” (04-04).

Barriers to sustainability

At the second interview, participants referred to issues that prevented sustained emphasis on the new tool, including manager turnover, new priorities, and lack of ongoing education: “We’ve had a lot of changeover in our management so there’s other priorities…We haven’t really had any education on it since a year and a half ago” (04-01).

Advice for future spread processes

The advice of frontline staff in relation to future spread projects directly addressed many of the limitations experienced in their own spread process: “It goes back to resources, you have to have champions…have your core group that figure out what’s in it for them, how it can make their life better or their client's life better…you need the leadership resources to get that going” (04-09). Participants also identified the need for involvement of frontline staff in the change process, information about the benefits of using the tool, and ongoing feedback: `Bring in the staff and ask for their feedback and also present the whole picture to them. Don't just say `here's a guideline we've been told to implement', give them some information: `We have found that this guideline has led to this much decrease in falls, it hasn't increased workers hours by any length of time, it's actually…made their day more efficient or clients are happier’…Give them some real feedback on how things have worked. And for sure I would ask them first how do you feel about it?’ (04-04).