Centre for Dementia Research, Leeds Beckett University, Leeds, LS1 3HE, UK.
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
BMC Geriatr. 2020 Aug 25;20(1):303. doi: 10.1186/s12877-020-01706-5.
Many people with dementia live in care homes, where staff can struggle to meet their complex needs. Successful practice improvement interventions in these settings require strong managerial support, but little is known about how managers can support implementation in practice, or what factors support or hinder care home managers in providing this support. Using Dementia Care Mapping™ (DCM) as an example, this study explored how care home managers can support the implementation of complex interventions, and identified factors affecting their ability to provide this support.
We undertook interviews with 48 staff members (managers and intervention leads) from care homes participating in the intervention arm of the DCM EPIC trial of DCM implementation.
Managerial support played a key role in facilitating the implementation of a complex intervention in care home settings. Managers could provide practical and financial support in many forms. However, managerial support and leadership approaches towards implementation were highly variable in practice, and implementation was easily de-stabilised by management changes or competing managerial priorities. How well managers understood, valued and engaged with the intervention, alongside the leadership style they adopted to support implementation, were key influences on implementation success.
For care home managers to effectively support interventions they must fully understand the proposed intervention and its potential value. This is especially important during times of managerial or practice changes, when managers lack the skills required to effectively support implementation, or when the intervention is complex. It may be unfeasible to successfully implement new interventions during times of managerial or practice instability.
Current Controlled Trials ISRCTN82288852 , registered 16/01/2014.
许多患有痴呆症的人居住在养老院中，而养老院的工作人员可能难以满足他们复杂的需求。在这些环境中成功实施实践改进干预措施需要强有力的管理支持，但对于管理者如何在实践中支持实施，或哪些因素支持或阻碍养老院管理者提供这种支持，知之甚少。本研究以痴呆症护理映射（DCM）为例，探讨了养老院管理者如何支持复杂干预措施的实施，并确定了影响他们提供这种支持能力的因素。
我们对参与 DCM 实施 EPIC 试验干预组的养老院工作人员（管理者和干预负责人）进行了 48 次访谈。
管理支持在养老院环境中促进复杂干预措施的实施中起着关键作用。管理者可以以多种形式提供实际和财务支持。然而，管理支持和实施的领导方法在实践中存在很大差异，管理变更或竞争管理优先级很容易使实施失去稳定性。管理者对干预措施的理解、重视和参与程度，以及他们采用的支持实施的领导风格，是影响实施成功的关键因素。
为了有效地支持干预措施，养老院管理者必须充分了解拟议的干预措施及其潜在价值。这在管理或实践变更期间尤其重要，因为管理者缺乏有效支持实施所需的技能，或者干预措施很复杂。在管理或实践不稳定期间，可能无法成功实施新的干预措施。
当前对照试验 ISRCTN82288852，于 2014 年 1 月 16 日注册。
