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Stakeholder engagement for successful practice change in long‐term care: Evaluating the Feasible and Sustainable Culture Change Initiative (FASCCI) model
Author(s) -
Caspar Sienna
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.036917
Subject(s) - psychological intervention , fidelity , stakeholder , stakeholder engagement , intervention (counseling) , long term care , psychology , behaviour change , culture change , qualitative property , nursing , theory of change , medicine , applied psychology , public relations , computer science , political science , telecommunications , social science , machine learning , sociology , management , economics
Background and Objectives Interventions aimed at increasing the provision of relational and person‐centred care in long‐term care (LTC) homes that do not address contextual and system issues most often fail. Promoting positive change in LTC homes requires a multilevel, systems approach. The objective of this study was to evaluate the feasibility and effectiveness of the Feasible and Sustainable Culture Change Initiative (FASCCI) model for change for improving the provision of person‐centred mealtime practices in a LTC home. Methods A single‐group, time series design was used to assess the impact of the FASCCI model for change on outcome measures across four time periods (pre‐intervention, 2‐month, 4‐month and 6‐month follow‐up). Mealtime observations (n=38) using the Mealtime Scan (MTS+) were completed over the course of six‐months in a single dining room. Interviews (n=21) were also conducted to examine treatment fidelity and to ascertain the study participants’ perceptions of the process for making improvements using the FASCCI model. Results We observed increases in care staffs’ capacity to consistently provide relational and person‐centred care during mealtimes. Mealtime environment scores started increasing immediately following the intervention, with statistically significant improvements noted in all mealtime environment scales by six‐months, including the: physical environment (z=‐3.43, p=0.004); social environment (z=‐4.17, p<0.001); relationship‐centred care (z= ‐4.121, p<0.001); and overall quality of dining environment (z= ‐4.08, p<0.001). Analysis of data from qualitative interviews demonstrated that use of the FASCCI model resulted in improved team leadership, communication, and collaborative decision‐making. Conclusions This study offers evidence that the FASCCI model provides a promising approach for improving the provision of relationship‐centred mealtime practices in LTC homes. Our findings reinforce the importance of cultivating and implementing workforce practices that increase staff empowerment and enable and encourage collaborative decision‐making. We found these practices to be essential to the outcomes associated with the improved relationship‐centred care practices that occurred during this study. This is consistent with the small but growing body of evidence demonstrating that staff empowerment has a significant effect on overall quality of resident care.