Implementation of a Complex Improvement Program in Aged Care
Efficient implementation of care improvement programs is increasingly important, since care organizations are expected to work in accordance with the latest evidence-based methods. This chapter presents findings from an evaluation of the implementation of a care continuum model for frail older people living in their own homes. The Conceptual Framework for Implementation Fidelity was used to guide the evaluation. A longitudinal case study design using both quantitative and qualitative methods was applied. In general, the intervention was implemented with high fidelity, that is, in accordance with the original program description. However, the findings also illustrate the difficult balance for staff to both implement the intervention in accordance with the program model, and take into consideration organizational circumstances and other factors such as older people’s preferences. This chapter also suggests ways in which practitioners and managers could improve future implementation processes. We propose that future research should focus on investigating how different types of adaptations to a program or evidence-based method are made and what the immediate and long-term impact of these are on participants’ health and well-being. We also emphasize the importance of investigating the interrelationships between different factors affecting implementation fidelity. It would also be important to examine the relative impact of these factors on each other and on fidelity. Methodological recommendations are also given, including the use of direct observations when analyzing implementation processes.
KeywordsCase Manager Program Logic Implementation Process High Fidelity Implementation Fidelity
The authors would like to thank all the interview respondents. The Vårdal Institute financed the development and evaluation of the intervention “Continuum of care for frail elderly persons, from the emergency ward to living at home intervention.” In addition, the project received funding from the Vinnvård research program. The involvement of the first author was funded by ERA-AGE2, Future Leaders of Ageing Research in Europe (FLARE)/Swedish Council for Working Life and Social Research. Special thanks go to Ulrica von Thiele Schwarz, Associate professor, Karolinska Insitutet, for reviewing this chapter.
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