Affiliation:
1. Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System , Boston, Massachusetts , USA
2. Center of Innovation in Long-Term Services and Supports (LTSS COIN), VA Providence Healthcare System , Providence, Rhode Island , USA
3. Department of Health Services, Policy and Practice, Brown University School of Public Health , Providence, Rhode Island , USA
4. VA Center for Integrated Health (CIH), VA Western New York Healthcare System , Buffalo, New York , USA
5. VA Center for Integrated Health (CIH), VA Western New York Healthcare System , Batavia, New York , USA
Abstract
Abstract
Background and Objectives
Sustained implementation of new programs in complex care systems like nursing homes is challenging. This prospective qualitative evaluation examined factors affecting the sustainability of the Staff Training in Assisted Living Residences in Veterans Health Administration (STAR-VA) program in Veterans Health Administration (VA) Community Living Centers (CLC, i.e., nursing homes). STAR-VA is an evidence-based interdisciplinary, resident-centered, behavioral approach for managing distress behaviors in dementia.
Evaluation Design and Methods
In 2019, we conducted 39 semistructured phone interviews with STAR-VA key informants across 20 CLCs. We identified a priori themes based on the Organizational Memory Framework, which includes 7 Knowledge Reservoirs (KRs): people, routines, artifacts, relationships, organizational information space, culture, and structure. We conducted content-directed analysis of transcripts to identify factors to program sustainment.
Results
We identified 9 sustainment facilitators across KRs: engaged site leaders and champions, regular meetings and trainings, written documentation and resources, regular and open communication, available educational tools (e.g., handouts and posters), adequate spaces, leadership support on many levels, staff buy-in across disciplines, and staff competencies and recognition. Ten barriers across KRs included: staffing concerns, inconsistent/inefficient routines, inconsistent documentation, lack of written policies, communication gaps, nonstandardized use of tools, constraints with meeting spaces and regulations on posting information, limited leadership support, division among staff, and missing performance expectations.
Discussion and Implications
Findings inform tailored strategies for optimizing STAR-VA program sustainment in CLCs, including the development of a sustained implementation guide, implementation resources, regional communities of practice, and STAR-VA integration into national CLC quality improvement routines for team communication and problem-solving.
Funder
Quality Enhancement Research Initiative
Publisher
Oxford University Press (OUP)
Subject
Geriatrics and Gerontology,Gerontology,General Medicine
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