Target multiple levels when implementing complex health technology in a specific context
Guidance
When implementing Advance care planning (ACP) as a complex health technology in a complex setting such as a nursing home, multiple levels should be targeted, including management, nurses, care staff, volunteers, visiting or residing physicians, families, cleaning or other staff.
Explanation
The implementation process will have a higher chance of succeeding when multiple levels are targeted within the nursing home. Colleagues in the nursing home can help each other to implement the intervention, creating a positive and open environment to learn and develop new skills and deliver the best care possible. In this way the intervention can produce a shift in working culture and attitudes and deliver sustainable change.
Example
The ACP+ intervention targeted not only the (head) nurses, but also other care staff and cleaning, kitchen and maintenance staff. Also, engagement of the management was required for participation in the trial. A few highly motivated people were extensively trained in conducting ACP conversations and this knowledge was past onwards to colleagues via internal training sessions. In this way the whole nursing home was involved in the intervention, leading to greater participation of all nursing home employees.
Themes
Complex health care technology Complex intervention Implementation
Target groups
Care organizations & professionals ResearchersType of evidence
Annelien van Dael (INDUCT ESR12)
Development of advance care planning intervention (based on review, theory of change workshops and feasibility testing)
References
Gilissen, J., Pivodic, L., Wendrich-van Dael, A., Gastmans, C., Vander Stichele, R., Van Humbeeck, L., Deliens, L., & Van den Block, L. (2019). Implementing advance care planning in routine nursing home care: The development of the theory-based ACP+ program.PloS one, 14(10), e0223586. https://doi.org/10.1371/journal.pone.0223586
Wendrich-van Dael, A., Gilissen, J., Van Humbeeck, L., Deliens, L., Vander Stichele, R., Gastmans, C., Pivodic, L., & Van den Block, L. (2021). Advance care planning in nursing homes: new conversation and documentation tools. BMJ supportive & palliative care, 11(3), 312–317. https://doi.org/10.1136/bmjspcare-2021-003008