Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program
Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program
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DOI：
10.1097/hcm.0000000000000168
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发表时间：
2017-07-01
影响因子：
--
通讯作者：
Ouslander, Joseph G.
中科院分区：
文献类型：
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作者：
Tappen, Ruth M.;Wolf, David G.;Ouslander, Joseph G.
主要组织变革举措的实施对长期护理领导提出了挑战。INTERACT（减少急症护理转移的干预措施）质量改进计划的实施，旨在改善对急症状况变化的管理，减少疗养院居民不必要的急诊就诊和住院，作为一个例子，说明了长期护理发生重大变化的促进因素和障碍。作为对INTERACT (R)对急诊科就诊率和住院率影响的更大规模研究的一部分，71家养老院的工作人员每月被要求跟进其进展情况，并讨论成功的促进战略以及他们在为期一年的实施期间遇到的任何挑战和障碍。确定了与障碍和促进因素有关的主题。确定了实施的六个主要障碍：变化的规模和复杂性（35%），设施领导的不稳定性（27%），竞争需求（40%），利益相关者抵制（49%），稀缺资源（86%）和技术问题（31%）。此外，还报告了六种促进策略：组织范围内的参与（68%）、领导支持（41%）、使用行政权力（14%）、充分的培训（66%）、倡导者的坚持和监督（73%）以及展现积极成果（14%）。在长期护理机构中成功引入诸如INTERACT (R)质量改进计划之类的复杂变革，需要关注本报告中前线人员确定的促进因素和障碍。
Implementation of major organizational change initiatives presents a challenge for long-term care leadership. Implementation of the INTERACT (R) (Interventions to Reduce Acute Care Transfers) quality improvement program, designed to improve the management of acute changes in condition and reduce unnecessary emergency department visits and hospitalizations of nursing home residents, serves as an example to illustrate the facilitators and barriers to major change in long-term care. As part of a larger study of the impact of INTERACT (R) on rates of emergency department visits and hospitalizations, staff of 71 nursing homes were called monthly to follow-up on their progress and discuss successful facilitating strategies and any challenges and barriers they encountered during the yearlong implementation period. Themes related to barriers and facilitators were identified. Six major barriers to implementation were identified: the magnitude and complexity of the change (35%), instability of facility leadership (27%), competing demands (40%), stakeholder resistance (49%), scarce resources (86%), and technical problems (31%). Six facilitating strategies were also reported: organization-wide involvement (68%), leadership support (41%), use of administrative authority (14%), adequate training (66%), persistence and oversight on the part of the champion (73%), and unfolding positive results (14%). Successful introduction of a complex change such as the INTERACT (R) quality improvement program in a long-term care facility requires attention to the facilitators and barriers identified in this report from those at the frontline.