Abstract

This study responds to calls for work that informs the development of strategies to improve the uptake of care practice standards and guidelines. The aim of our study was to better understand care protocol implementation in long term care (LTC) homes operating in Ontario, and the influence of organizational-contextual factors on implementation approaches.

We surveyed Directors of Care (DOCs) employed in all 547 Ontario LTC homes, and combined survey data with secondary data on organizational-contextual characteristics including rural/urban location, nursing home size, chain ownership, mission, and accreditation status. The motivation for the use/selection of care protocols primarily derived from a belief in continuous improvement and in evidence-based care. Protocol selection was participative, involving management and staff. External information sources were important for protocol implementation, and in-services were the chief means of training and educating staff.

Of the five organizational-contextual characteristics we examined, the only significant differences we detected in approaches to implementation arose as a consequence of differences in organizational mission relating to motivations for care protocol implementation and philosophies on staff preparation for implementation. Key success factors identified by respondents included contextualizing of the practice change; resourcing against implementation; and demonstrating connections between practice change and outcomes.

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