Table 3 Key LTC staff insights about sustainability and potential approaches suggested by focus group participants, CONNECT study experience, or implementation science literature
Key participant insights | Potential approaches |
|---|---|
Intervention features | |
Content | |
• 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 |
Delivery | |
• 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 |
Customizability/flexibility | |
• 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 |
Materials | |
• 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 | |
Leadership | |
• 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) |
Incentives | |
• “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 |
Tools | |
• 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 |