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Table 3 Key LTC staff insights about sustainability and potential approaches suggested by focus group participants, CONNECT study experience, or implementation science literature

From: Sustaining complex interventions in long-term care: a qualitative study of direct care staff and managers

Key participant insights Potential approaches
Intervention features
• Must be perceived to be beneficial and promote organizational aims
• Must balance complexity and simplicity
• Include regular outcome measurement with participant feedback
• Reinforce impact on resident outcomes
• Pilot content with full range of target staff
• Group sessions allow mutual instruction, increase confidence, give “permission” to bring up problems, and strengthen relationships
• Individual sessions allow assessment of understanding and customization
• Trainers should balance clarity and excess repetition
• Reinforcement and practice of new skills is needed
• Consider combination of group and individual sessions for interventions requiring staff coordination
• Use role-play, storytelling, and other means to promote interaction
• Use mentored practice sessions with feedback
• Sessions should accommodate clinical demands, include all shifts, and be customized to fit each facility’s schedule • Build flexibility into intervention testing, e.g., allow staff to choose when/where instruction occurs, number of sessions (multiple short vs. single long), number of participants per session
• Test number of “booster sessions” needed to sustain desired level of change
• Intervention materials should consider diversity of staff; make learning objectives pertinent regardless of role, experience, education level, language
• Materials should be visually appealing and in different formats
• Use range of authentic case scenarios of interdisciplinary interest when possible
• Use graphics, stories that are understandable to diverse target audience
• Consider range of print, online, video
Contextual features
• Direct care staff want to observe active leadership support and engagement in the program
• Lack of trust and gaps in communication frequently exists between direct care staff and managers
• Avoid always separating managers and staff for training
• Consider whether manager/direct care staff communication issues can be addressed as part of the intervention (e.g., promote discussion, include team building approaches)
• “Accountability” to change behavior is expected by staff
• Desired behavior should be an expected part of the culture
• Avoid mandatory training sessions
• Avoid rule-based, “shame and blame” approach, but instead articulate shared goals, vision to be accomplished by sustaining program, particularly impact on residents
External supports
 Processes and procedures
• Formalizing changes through changing work routines promotes continuation
• New staff orientation is a key target for continuing training
• “Refresher” sessions are needed
• Use approaches such as “train the trainer,” facility champions to promote continuation
• Make explicit changes to meeting schedules, documentation templates, work rounds, etc.
• Facilitate changes to orientation schedule
• Incorporate champion training midway into intervention
• Visual aids and reminders scattered throughout work environment are helpful
• Address training for those unable to attend in-person sessions
• Creative uses of information technology are now feasible in LTC
• Develop posters, bulletin boards, bookmarks, calendars, pens, etc.
• Develop orientation package
• Consider use of DVDs, video clips, web-based training sessions followed by individual/small group discussions
• Reminders within electronic medical record, online training resources