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Table 4 Themes of moderating factors and selected interview quotations on experiences and perceptions of respondents in implementing SPEC model

From: Implementation fidelity of the Systems for Person-Centered Elder Care (SPEC): a process evaluation study



Representative quotation from interviews

Participant responsiveness

Boosting CGA

“The CGA tool was very useful to see the images of the old adults at a glance and grasp the needs comprehensively.”

Facilitating communication

“Communication between care teams was enhanced with the SPEC ICT system.”

“At the case conference, care teams gathered and communicated about the patient, making it easier to understand the patient and get help from other teams to implement interventions for patients.”

Providing tailored care plan

“The care plans are based on the list of problems derived from the needs assessment and therefore, enable us to promote individual approach and to provide tailored care plan for each patient.”

Duplication of using SPEC system

“I consider it a duplication using both the SPEC ICT system and the system currently in use.”

Lack of staffing level and time

“I know the SPEC model is good, but we don’t have human resources and time to use it. There is no time to feed the result of needs assessments and care plans into the SPEC model during working hours. If I want to use the SPEC model, I may have to work overtime.”

Intervention complexity

Comprehensiveness of intervention description

“The detailed manuals and materials for interventions were helpful, so I can handle the tasks even though the interventions were complex.

Complexity of interventions

“The SPEC model has so many steps. If we make an individual care plan, we should complete CGA, prioritize the problem lists and choose interventions for each problem from intervention checklists and get consent for the care plan from patients or their family.”, “Needs assessment items are too long and hard to understand.”

Difficulty of using ICT system

“The method of inputting into the SPEC ICT system is too complicated because most of the staff using the ICT system are not familiar with the computer.”

Facilitating strategies

Provision of immediate feedback

“The SPEC consultant and help desk provide immediate answers for any question asked through phone call and KakaoTalk, and it is very helpful.”

Tailored consulting and extra education

“I had no clue when I had to organize a case conference for the first time, but it was very helpful of the SPEC consultant to participate in the case meeting, giving us feedback and providing us with advice on planning the intervention.”

Quality of delivery

Well-prepared training and manuals

“The training was well prepared overall, and after the theoretical training, it was good to have a practical training with the care team to evaluate the needs of real patients in the NH and set up care plans for the residents.”

Provision of individual/institutional report

“The most valuable advantage is that the individual problem list is automatically derived from the needs assessment of each patient by algorithm, which is not included in any existing evaluation system.” “It was good to me that I can check the execution rate of intervention immediately through the SPEC ICT system.” “An institutional report on the list of problems and the number of drug use for a NH are very helpful.”

Reflection of preferences of participants

“When I set up a patient’ care plan, I need to get consent about the care plan and therefore, ask the patient what he/she wants.” “In particular, if the patient is selected as a candidate for a case conference, we try to identify what interventions are particularly preferred by the patient and reflect them in the patient’s care plan.”

Needs for practical system for Korean NHs

“It seems that some items in the CGA tool for the old adults do not fit with Korean NHs.” “When I am trying to make a care plan for an old adult, I don’t have enough contents to choose from in the care plan checklists of the SPEC ICT system. It would be better to have a more realistic and practical list of care plans for Korean NHs.”


Recruiting a proactive NH head

“We expect the SPEC model to be used systematically to evaluate needs and establish care plans.” “Even if it’s difficult, I think we should use the SPEC model to improve the quality of care of NHs.”

Presentation for key care team for participation

“I cannot decide whether or not to use the SPEC model solely by myself even though I am a NH head, so I would ask the research team to visit my NH and explain it to the care team.” “My staff worried about new tasks adding burden on the participant, uncertainty about the effectiveness of interventions, and the potential to receive complaints from patients and their families due to participation in the study.”

Difficulty of maintaining participation due to workload

“I don’t have enough time to use the SPEC ICT system. Some employees say that they would quit their job if I keep asking them to use the SPEC ICT system.”


Supportive or individualistic organizational culture

“Multidisciplinary care team work together when we evaluate patient’s needs and set up care plans, making it easy to use the SPEC ICT system. For example, nurses, social workers, and physical therapists each take care of certain items given in the assessment tool.” “The nursing team does not want to get involved in using SPEC ICT system at all and does not cooperate, either.”

Supportive leadership

“The staff seems to be working hard in using the SPEC ICT system because at the weekly meetings held each Monday, the NH head emphasizes the need for the SPEC model and the quality improvement, and also checks the execution rate of the intervention checklist.”

Current events (Evaluation of National Health Insurance Services, resignation of key person etc.)

“I hope to delay the use of SPEC ICT system to after the institutional evaluation of the National Health Insurance Services.” “It is difficult to make an individualized care plan for each patient when the staff, who is in charge of setting up care plans with the SPEC model, quits the NH.”