Adjognon Omonyêlé L, Sullivan Jennifer L, Pendergast Jacquelyn, Wray Laura O, Curyto Kimberly
Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA.
Center of Innovation in Long-Term Services and Supports (LTSS COIN), VA Providence Healthcare System, Providence, Rhode Island, USA.
Gerontologist. 2023 Mar 21;63(3):577-588. doi: 10.1093/geront/gnac090.
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.
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.
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.
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.
在诸如养老院这样复杂的护理系统中持续实施新计划具有挑战性。这项前瞻性定性评估研究了影响退伍军人健康管理局（VA）社区生活中心（CLC，即养老院）中退伍军人辅助生活住所员工培训（STAR-VA）计划可持续性的因素。STAR-VA是一种基于证据的跨学科、以居民为中心的行为方法，用于管理痴呆症患者的困扰行为。
2019年，我们对20个CLC的STAR-VA关键信息提供者进行了39次半结构化电话访谈。我们基于组织记忆框架确定了先验主题，该框架包括7个知识储备库（KRs）：人员、常规、人工制品、关系、组织信息空间、文化和结构。我们对访谈记录进行了内容导向分析，以确定影响计划可持续性的因素。
我们在各个KRs中确定了9个可持续性促进因素：积极参与的现场领导和倡导者、定期会议和培训、书面文件和资源、定期且开放的沟通、可用的教育工具（如手册和海报）、充足的空间、多层次的领导支持、跨学科的员工认可、员工能力和认可。各个KRs中的10个障碍包括：人员配备问题、不一致/低效的常规、不一致的文件记录、缺乏书面政策、沟通差距、工具使用不规范、会议空间限制和信息张贴规定、有限的领导支持、员工之间的分歧以及缺失的绩效期望。
研究结果为优化CLC中STAR-VA计划可持续性的定制策略提供了信息，包括制定持续实施指南、实施资源、区域实践社区，以及将STAR-VA纳入国家CLC质量改进常规，以促进团队沟通和解决问题。
