Organizational factors associated with readiness for change in residential aged care settings

The relationship between emotional intelligence and readiness for organizational change among nurses

Organizational change is a complex process that often faces high failure rates due to challenges in managing transition issues. The role of emotional intelligence in fostering readiness for organizational change among nurses remains understudied, especially in the context of Jordan. The study aimed to investigate the relationship between emotional intelligence and readiness for organizational change among Jordanian nurses working in governmental hospitals. A descriptive cross sectional correlational design was used. A convenient sampling method was used to enroll Jordanian nurses from different governmental hospitals, with a resulting final sample of 250 nurses. Self-reported questionnaires were used to collect data. Data analysis was run using descriptive and inferential analysis. The findings revealed that the participants had moderate levels of emotional intelligence with a mean score of (M = 87.96, SD = 26.59). The participants demonstrated strengths in understanding their own emotions, perceiving others' emotions, and setting goals. They also showed good control of their emotions and a positive self-perception. Regarding readiness for organizational change, the mean score was (M = 39.58, SD = 11.16), suggesting a moderate level of readiness. The participants exhibited commitment, motivation, and confidence in handling challenges associated with change. A strong positive relationship between emotional intelligence and readiness for change commitment (r = .942, P < .01), change efficacy (r = .935, P < .01), and total readiness for change (r = .951, P < .01) were exist. Moreover, age and years of experience were negatively correlated with readiness for change. There was a strong and significant positive relationship between emotional intelligence and readiness for change. This emphasizes the importance of developing emotional intelligence abilities among nurses to facilitate successful change processes in healthcare organizations.

Organizational Innovation in Long Term Care Enabled by Collaboration Between Government Agencies: A Critical Realist Case Study

Long term care for older people is a highly regulated sector providing accommodation, health, and social care to vulnerable older adults. Older adults in New Zealand are among the highest users of long term care services globally. Traditionally those requiring specialist care for dementia are housed apart from other residents. In an example of organizational innovation, 1 provider relocated residents to a secure village where residents requiring specialist dementia care would be desegregated. We utilized a critical realist case study to explain the role of intersectoral collaboration among government agencies in supporting the transition while managing risk and ensuring regulatory compliance.

Factors contributing to innovation readiness in health care organizations: a scoping review

Background

Increasing innovation readiness of healthcare organizations is necessary to meet upcoming challenges, including population aging, staff shortages and reduced funding. Health care organizations differ in the extent to which they are innovation ready. This review aims to clarify the concept of innovation readiness and identify which factors contribute to innovation readiness in health care organizations.

Methods

A scoping review was conducted based on the framework from Arksey and O’Malley. PubMed/MEDLINE, CINAHL and Web of Science were searched for studies that (a) aimed to contribute to scientific knowledge about innovation readiness of health care organizations, (b) were peer-reviewed, (c) reported empirical data and (d) were written in English, Dutch or German. Factors researched in the included studies were bundled into 4 overarching main factors and 10 sub-factors.

Results

Of the 6,208 studies identified, 44 were included. The majority (n = 36) of the studies had been conducted since 2011 and almost half of the studies (n = 19) were performed in hospitals. Of the 44 studies, 21 researched factors contributing to innovation readiness in the implementation stage of the innovation process. The authors used a variety of words and descriptions addressing innovation readiness, with hardly any theoretical frameworks for innovation readiness presented. Four main factors and 10 sub-factors contributing to the innovation readiness of health care organizations were summarized: strategic course for innovation, climate for innovation, leadership for innovation and commitment to innovation. Climate for innovation (n = 16) was studied the most and individual commitment to innovation (n = 6) was the least studied.

Conclusion

Our study identified four main factors contributing to the innovation readiness of health care organizations. Research into innovation readiness of health care organizations is a rather new field. Future research could be directed towards defining the concept of innovation readiness and the development of a framework for innovation readiness. More understanding of the interplay of factors contributing to innovation readiness in all stages of the innovation process and in diverse health care settings can support health care managers to structurally embed innovation. This review contributes to the first stage of theory building on factors contributing to innovation readiness of health care organizations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08185-x.

Developing sustainable workplace through leadership: Perspectives of transformational leadership and of organizational citizenship behavior

The objective of this study was to investigate the leadership style of the supervisor to develop the organization's sustainable workplace of and the extra-role behavior of employees (i.e., OCB). An organizational context of the immigration officer is explored by using the data collected from a survey of 453 immigration officers from 26 immigration officer teams in Taiwan. This study has verified the transformational leadership and organizational commitment that they have positive effect on organizational citizenship behavior (OCB) of the immigration officers. Moreover, it showed that the organizational climate has a context effect on organizational commitment and OCB. Furthermore, the results of this study have shown that an aggregated transformational leadership has cross-level interactions on OCB. This study also found that the transformational leadership has strong effect on organizational commitment and OCB. This study adopts a cross-level study taking organizational environmental factors and cross-level interactions as research considerations. Because of the focus on group-level impact, the research methodology can apply the supervisor's leadership style and the organizational climate to measure whether the immigration officers have a high degree of organizational commitment and influence their OCB performance across levels. The organizational commitment of the immigration officers and their individual OCB performance could be improved by converging the organizational context effect of aggregated transformational leadership and organizational climate. This study found that the application of the transformational leadership is extremely helpful for an organization to develop sustainable workplace and extra-role behavior of employees.

Issues and Implications of Readiness to Change

In light of readiness to change, organizational readiness has received little attention with the extensive assessment of individual readiness to change. (1) Background: Therefore, this conceptual paper aims to address the need for change at the organizational level through the lenses of Lewin theory, organizational change theory, and social exchange theory. It will identify issues and implications in readiness to change at the organizational level; (2) Methods: The primary method used in the study was mainly a literature review to add neglected factors driving change such as contextual factors and technology. (3) Results: The paper shows how various players and other determinants of successful change implementation can derail the organization’s readiness to embrace change. (4) Conclusions: The paper adds to the available knowledge on how technology is likely to affect organizational willingness to change. The study suggests various solutions that seek to address the issues on organizational readiness to change. Hence, this study may provide organizational managers with takeaway implications on change management for policymakers and practitioners to improve an organization’s preparedness towards change implementation.

Burnout and intention to leave among care workers in residential care homes in Hong Kong: Technology acceptance as a moderator

Care workers in residential care settings for older adults often experience job burnout, resulting in a high turnover rate. Previous studies offered contradictory findings on technology use in the workplace and its relationship with burnout. This study aimed to explore the moderator role technology acceptance plays in the relationship between burnout and intention to leave among care workers in residential care settings in Hong Kong. The study was based on a multicenter, cross-sectional questionnaire survey. The acceptance of general, and three specific, technologies (i.e., tablets, social robots and video gaming) was measured based on the scale of the Technology Acceptance Model. Two dimensions of burnout (exhaustion and disengagement) were measured using the Oldenburg Burnout Inventory scale. Intention to leave was measured using a self-reported item. Data collection took place from July to December 2018. We analysed data from 370 care workers from seven non-private residential care homes for older people in Hong Kong. A hierarchical multiple regression approach was used for moderator analysis. The results revealed that two measures of burnout (exhaustion and disengagement) were significantly and positively associated with intention to leave. The four measures of technology acceptance were negatively associated with intention to leave. The interaction of video-gaming acceptance and exhaustion was predictive of intention to leave (standardized beta = -0.20, p = .011). Acceptance of video gaming changed the strength of the relationship between exhaustion and intention to leave among participants. No significant moderating effects were observed in the relationship between disengagement and intention to leave. We highlight the importance of integrating technology variables, especially subjective appraisal of technology, in the issues of burnout and intention to leave. These findings shed new light on policies and practices that consider implement technology in routine care in residential care settings without unanticipated negative impacts for care staff.

Professionals' Expectations and Preparedness to Implement Knowledge-Based Palliative Care at Nursing Homes before an Educational Intervention: A Focus Group Interview Study

The provision of knowledge-based palliative care is rare in nursing homes. There are obstacles to practically performing this because it can be difficult to identify when the final stage of life begins for older persons. Educational interventions in palliative care in nursing homes are a challenge, and joint efforts are needed in an organisation, including preparedness. The aim was to explore professionals' expectations and preparedness to implement knowledge-based palliative care in nursing homes before an educational intervention. This study has a qualitative focus group design, and a total of 48 professionals working in nursing homes were interviewed with a semi-structured interview guide. Qualitative content analysis with an inductive approach was used for the analysis. One major theme was identified: professionals were hopeful yet doubtful about the organisation's readiness. The main categories of increased knowledge, consensus in the team, and a vision for the future illustrate the hopefulness, while insufficient resources and prioritisation illustrate the doubts about the organisation's readiness. This study contributes valuable knowledge about professionals' expectations and preparedness, which are essential for researchers to consider in the planning phase of an implementation study. The successful implementation of changes needs to involve strategies that circumvent the identified obstacles to organisations' readiness.

Organizational readiness to change as a leverage point for improving safety: a national nursing home survey

Background

A stronger safety climate in nursing homes may reduce avoidable adverse events. Yet efforts to strengthen safety climate may fail if nursing homes are not ready to change. To inform improvement efforts, we examined the link between organizational readiness to change and safety climate.

Methods

Seven safety climate domains and organizational readiness to change were measured with validated Community Living Center/CLC Employee Survey of Attitudes about Resident Safety and Organizational Readiness to Change Assessment. Safety climate domains comprised of safety priorities, supervisor commitment to safety, senior management commitment to safety, safety attitudes, environmental safety, coworker interactions around safety, and global rating of CLC. We specified models with and without readiness to change to explain CLC- and person-level variance in safety climate domains.

Results

One thousand three hundred ninety seven workers (frontline staff and managers) responded from 56 US Veterans Health Administration CLCs located throughout the US. Adding readiness to change reduced baseline CLC-level variance of outcomes (2.3–9.3%) by > 70% for interpersonal domains (co-workers, supervisors, and senior management). Readiness to change explained person-level variance of every safety climate domain (P < 0.05), especially for interpersonal domains.

Conclusions

Organizational readiness to change predicted safety climate. Safety climate initiatives that address readiness to change among frontline staff and managers may be more likely to succeed and eventually increase resident safety.

Cold wind of change: Associations between organizational change, turnover intention, overcommitment and quality of care in Spanish and Swedish eldercare organizations

Aim

To examine the association between organizational change, turnover intentions, overcommitment and perceptions of quality of care among nurses and nursing assistants employed in eldercare organizations.

Design

A longitudinal survey (baseline, 12-month follow-up) was used.

Methods

A panel sample of 226 eldercare employees in Spain and Sweden responded to survey questions concerning organizational change, turnover intentions, overcommitment and perceptions of quality of care. The data were analysed using structural equational modelling.

Results

We found a statistically significant positive relationship between organizational change, employees' turnover intention and overcommitment. We also found a statistically significant negative relationship between organizational change and perceived quality of care.

"Are you ready?" Validation of the Hospital Change Readiness (HCR) Questionnaire

OBJECTIVE

Organisational change in hospitals is a frequent, seemingly inevitable occurrence. A critical precursor to successful organisational change is change readiness. This paper presents the adaptation of a self-report measure of change readiness for hospital staff, examines its reliability and validity, and evaluates the relationship between hospital change readiness (HCR) and staff well-being.

METHODS

The questionnaire was piloted among 153 staff from a large metropolitan, public hospital in Sydney, Australia. The hospital was undergoing a major change involving a multimillion-dollar development project that included a new building and new models of care. Construct validity was evaluated by confirmatory factor analysis (CFA) and reliability was assessed by internal consistency. Differences between professional groups were examined using regression analyses and structural equation modelling (SEM) was used to test the relationship between change readiness and staff well-being (job satisfaction and burnout).

RESULTS

The HCR Questionnaire was found to reflect theoretically derived and empirically observed domains and have high internal reliability. CFA identified that a two-factor structure demonstrated excellent fit. Cronbach's alpha for the two subscales (appropriateness and change efficacy) was 0.85 and 0.75, respectively. No statistically significant differences of HCR were identified between professional groups. SEM revealed that perceiving change as appropriate was significantly positively related to job satisfaction (0.33) and significantly negatively related to burnout (-0.30), and feeling capable in implementing the change was significantly negatively related to burnout (-0.40).

CONCLUSIONS

The HCR Questionnaire provides reliable information on how prepared hospital staff felt for organisational change and showed significant relationships with staff well-being. This questionnaire is validated for the Australian hospital context, particularly in the case of hospital redevelopment. It can be used to help manage times of hospital organisational change with minimal disruption to the quality and safety of patient care.

Nursing staff's evaluation of facilitators and barriers during implementation of wireless nurse call systems in residential care facilities. A cross-sectional study

Background

Traditional nurse call systems used in residential care facilities rely on patients to summon assistance for routine or emergency needs. Wireless nurse call systems (WNCS) offer new affordances for persons unable to actively or consciously engage with the system, allowing detection of hazardous situations, prevention and timely treatment, as well as enhanced nurse workflows. This study aimed to explore facilitators and barriers of implementation of WNCSs in residential care facilities.

Methods

The study had a cross-sectional descriptive design. We collected data from care providers (n = 98) based on the Measurement Instrument for Determinants of Innovation (MIDI) framework in five Norwegian residential care facilities during the first year of WNCS implementation. The self-reporting MIDI questionnaire was adapted to the contexts. Descriptive statistics were used to explore participant characteristics and MIDI item and determinant scores. MIDI items to which ≥20% of participants disagreed/totally disagreed were regarded as barriers and items to which ≥80% of participants agreed/totally agreed were regarded as facilitators for implementation.

Results

More facilitators (n = 22) than barriers (n = 6) were identified. The greatest facilitators, reported by 98% of the care providers, were the expected outcomes: the importance and probability of achieving prompt call responses and increased safety, and the normative belief of unit managers. During the implementation process, 87% became familiar with the systems, and 86 and 90%, respectively regarded themselves and their colleagues as competent users of the WNCS. The most salient barriers, reported by 37%, were their lack of prior knowledge and that they found the WNCS difficult to learn. No features of the technology were identified as barriers.

Conclusions

Overall, the care providers gave a positive evaluation of the WNCS implementation. The barriers to implementation were addressed by training and practicing technological skills, facilitated by the influence and support by the manager and the colleagues within the residential care unit. WNCSs offer a range of advanced applications and services, and further research is needed as more WNCS functionalities are implemented into residential care services.

Outcomes of health information technology utilization in nursing homes: Do implementation processes matter?

We examined several outcomes of health information technology utilization in nursing homes and how the processes used to implement health information technology affected these outcomes. We hypothesized that one type of health information technology, electronic medical records, will improve efficiency and quality-related outcomes, and that the use of effective implementation processes and change leadership strategies will improve these outcomes. We tested these hypotheses by creating an original survey based on the case study literature, which we sent to the top executives of nursing homes in seven US states. The administrators reported that electronic medical record adoption led to moderately positive efficiency and quality outcomes, but its adoption was unrelated to objective quality indicators obtained from regulatory agencies. Improved electronic medical record implementation processes, however, were positively related to administrator-reported efficiency and quality outcomes and to decreased deficiency citations at the next regulatory visit to the nursing home. Change leadership processes did not matter as much as technological implementation processes.

Nurses' views of organizational readiness for change

BACKGROUND

"Organizational readiness for change" is critical to successfully managing change in healthcare organizations. Yet healthcare and nursing studies about this relatively new concept are few and lack clear criteria on what comprises "organizational readiness for change."

PURPOSE

This study assessed organizational (hospital) readiness for change, as perceived by registered nurses in two types of hospital in Jordan.

METHODS

Using a quantitative research design, the researcher collected data from a convenience sample of 153 nurses from one major government hospital and one major private hospital. The response rate was 64%.

RESULTS

The lowest means, indicating unreadiness for change, were reported for the following items: having developed plans for expanding ambulatory care or enhancing continuity of care, including nurses on all committees, and involving them in policy development and strategic planning efforts. The only difference between the types of hospitals in terms of readiness for change was the use of "collaboration and multidisciplinary work": the governmental hospital was more ready than the private hospital in this regard.

IMPLICATIONS FOR PRACTICE AND NURSE LEADERS

To prepare for change, nurse leaders should initiate interventions to enhance organizational readiness and facilitate the integration of change, such as continuing education courses for staff and focus on teamwork, open communication, total quality management, strategic planning, advanced nursing practice and participatory management, especially shared decision-making and policy development. Successful leaders support employees' creative ideas, focus on the timing of the change, and provide training on change management.

Latent Classes of Principals' Transformational Leadership and the Organizational Climate of Kindergartens

Background

Organizational climate refers to an individual’s perception and experience of the climate of the work environment, and it is the most important environmental variable that affects individuals’ work performance. This study aims to classify characteristics of transformational leadership among kindergarten principals and examine their relationship to organizational climate.

Methods

Convenience sampling yielded 498 kindergarten principals who completed the “Questionnaire on the Principal’s Transformational Leadership Behavior” and “Questionnaire on Organizational Climate.” Ethics approval was obtained from the Academic Ethics Committee of the College of Psychology of Northeast Normal University prior to starting the study.

Results

Three latent classes were identified, including the high-level (68.8%), care-virtues (35.7%), and virtues groups (5.3%). There were significant differences in support, directive, restrictive, colleague, intimate, and disengaged behavior scores between groups. In terms of support, colleague, and intimate behavior, the high-level group had the highest scores, followed by the care-virtues group and virtues group, respectively. Regarding restrictive and disengaged behaviors, the highest scores were received by the virtues group, followed by the care-virtues and high-level group, respectively.

Conclusion

The study suggested that principals’ transformational leadership could be classified into three latent classes that are related to organizational climate.

Organizational Readiness to Implement System Changes in an Alaskan Tribal Dental Care Organization

INTRODUCTION

Tribal health care systems are striving to implement internal changes to improve dental care access and delivery and reduce health inequities for American Indian and Alaska Native children. Within similar systems, organizational readiness to implement change has been associated with adoption of system-level changes and affected by organizational factors, including culture, resources, and structure.

OBJECTIVES

The objectives of this study were to assess organizational readiness to implement changes related to delivery of evidence-based dental care within a tribal health care organization and determine workforce- and perceived work environment-related factors associated with readiness.

METHODS

A 92-item questionnaire was completed online by 78 employees, including dental providers, dental assistants, and support staff (88% response rate). The questionnaire queried readiness for implementation (Organizational Readiness for Implementing Change), organizational context and resources, workforce issues, organizational functioning, and demographics.

RESULTS

Average scores for the change commitment and change efficacy domains (readiness for implementation) were 3.93 (SD = .75) and 3.85 (SD = .80), respectively, where the maximum best score was 5. Perceived quality of management, a facet of organizational functioning, was the only significant predictor of readiness to implement change (B = .727, SE = .181, P < .0002) when all other variables were accounted for.

CONCLUSION

Results suggest that when staff members (including dentists, dental therapists, hygienists, assistants, and support staff) from a tribal health care organization perceive management to be high quality, they are more supportive of organizational changes that promote evidence-based practices. Readiness-for-change scores indicate an organization capable of institutional adoption of new policies and procedures. In this case, use of more effective management strategies may be one of the changes most critical for enhancing institutional behaviors to improve population health and reduce health inequities.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by clinicians and other leaders implementing changes within dental care organizations. To promote organizational readiness for change and, ultimately, more expedient and efficient adoption of system-level changes by stakeholders, consideration should be given to organizational functioning generally and quality of management practices specifically.

Towards successful digital transformation through co-creation: a longitudinal study of a four-year implementation of digital monitoring technology in residential care for persons with dementia

Background

Implementation of digital monitoring technology systems is considered beneficial for increasing the safety and quality of care for residents in nursing homes and simultaneously improving care providers’ workflow. Co-creation is a suitable approach for developing and implementing digital technologies and transforming the service accordingly. This study aimed to identify the facilitators and barriers for implementation of digital monitoring technology in residential care for persons with dementia and wandering behaviour, and explore co-creation as an implementation strategy and practice.

Methods

In this longitudinal case study, we observed and elicited the experiences of care providers and healthcare managers in eight nursing homes, in addition to those of the information technology (IT) support services and technology vendors, during a four-year implementation process. We were guided by theories on innovation, implementation and learning, as well as co-creation and design. The data were analysed deductively using a determinants of innovation framework, followed by an inductive content analysis of interview and observation data.

Results

The implementation represented radical innovation and required far more resources than the incremental changes anticipated by the participants. Five categories of facilitators and barriers were identified, including several subcategories for each category: 1) Pre-implementation preparations; 2) Implementation strategy; 3) Technology stability and usability; 4) Building competence and organisational learning; and 5) Service transformation and quality management. The combination of IT infrastructure instability and the reluctance of the IT support service to contribute in co-creating value with the healthcare services was the most persistent barrier. Overall, the co-creation methodology was the most prominent facilitator, resulting in a safer night monitoring service.

Conclusion

Successful implementation of novel digital monitoring technologies in the care service is a complex and time-consuming process and even more so when the technology allows care providers to radically transform clinical practices at the point of care, which offers new affordances in the co-creation of value with their residents. From a long-term perspective, the digital transformation of municipal healthcare services requires more advanced IT competence to be integrated directly into the management and provision of healthcare and value co-creation with service users and their relatives.

The role of organizational attractiveness in an internal market-oriented culture (IMOC): a study of hospital frontline employees

Background

Hospitals need to understand how to reduce their frontline employees’ turnover rate as well as how to positively engage them and improve their service. Central to these issues, we find, is the employees’ perception of their organization’s attractiveness. This objective of this paper is to clarify how the role of organizational attractiveness relates to frontline employees’ perception of their internal market-oriented culture as well as their turnover rate, engagement, and service quality. To our knowledge, no previous research has explored the role of organizational attractiveness from a frontline employee perspective in health-service organizations.

Methods

The conceptual framework we developed was tested in a quantitative study. We sent a questionnaire to nurses in several public hospitals in Norway. We then analyzed the data with confirmatory factor analysis and structural equation modeling in Stata. Further, we performed multi-group comparisons to test heterogeneity in personal characteristics. The indirect effects were tested by mediator analyses.

Results

We made three main findings. First, organizational attractiveness has a significant positive effect on frontline employees’ engagement (β = 0.833) as well as on the service quality they provide to hospital patients (β = 0.472). Additionally, it significantly lowers their turnover rate (β = − 0.729). Second, the ‘internal market-oriented culture’ (IMOC) has a significantly positive effect on organizational attractiveness (β = 0.587) and explains a total of 35% of the variance in organizational attractiveness. Third, organizational attractiveness fully mediates the relationship between “internal market-oriented culture” (IMOC) and frontline employees’ engagement and the service quality they provide to patients, and it partially mediates the relationship with the turnover rate.

Conclusions

This study proves that organizational attractiveness is vital for hospital managers to focus on, as it affects employees’ perception of whether the organizations is a great place to work. It reveals the need for those same managers to develop an internal market-oriented culture (IMOC) directed toward hospital frontline employees, as it has both a direct effect on organizational attractiveness and an indirect effect on employees’ engagement, turnover intention, and service quality.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4144-8) contains supplementary material, which is available to authorized users.

Key considerations prior to nasal high flow deployment in a Peruvian PICU from providers' perspectives

AIM

Implementation of healthcare interventions in resource-limited settings remains challenging. This exploratory qualitative study describes social and institutional factors to consider prior to nasal high flow deployment in a middle-income country.

METHODS

Researchers conducted eight nursing focus groups and four semi-structured physician interviews at Instituto Nacional de Salud del Niño in Lima, Peru. Participants were identified via purposive sampling. Data were transcribed, translated and coded using a rigorous and iterative process. Pertinent themes were identified using thematic analysis with Dedoose software.

RESULTS

Thirty-nine nurses and four physicians participated in focus groups and interviews, respectively. Participants identified five major factors: (i) Adequate training, (ii) Clinician buy-in, (iii) Resource-limited setting, (iv) Local social context and (v) Organizational change management. To create buy-in, physicians and nurses emphasised the need to recognise benefit of the intervention and agree with clinical practice standardization. Physicians and nurses described barriers specific to resource-limited settings, including unreliable supply chain, whereas nurses shared concerns about increasing workload and physician-nurse social hierarchy. Participants recognised the importance of team commitment and ongoing interdisciplinary communication for sustainability.

CONCLUSION

While some factors to consider prior to deployment of healthcare technology are universal, resource-limited settings have unique implementation barriers.

A randomized controlled trial to evaluate the effectiveness of a staff training program to implement consumer directed care on resident quality of life in residential aged care

BACKGROUND

Residential Aged Care Facilities (RACFs) are moving towards a Consumer Directed Care (CDC) model of care. There are limited examples of CDC in ageing research, and no evaluation of a comprehensive CDC intervention in residential care was located. This study will implement and evaluate a staff training program, Resident at the Center of Care (RCC), designed to facilitate and drive CDC in residential care.

METHODS

The study will adopt a cluster randomized controlled design with 39 facilities randomly allocated to one of three conditions: delivery of the RCC program plus additional organizational support, delivery of the program without additional support, and care as usual. A total of 834 staff (22 in each facility, half senior, half general staff) as well as 744 residents (20 in each facility) will be recruited to participate in the study. The RCC program comprises five sessions spread over nine weeks: Session 1 clarifies CDC principles; Sessions 2 to 5 focus on skills to build and maintain working relationships with residents, as well as identifying organizational barriers and facilitators regarding the implementation of CDC. The primary outcome measure is resident quality of life. Secondary outcome measures are resident measures of choice and control, the working relationship between resident and staff; staff reports of transformational leadership, job satisfaction, intention to quit, experience of CDC, work role stress, organizational climate, and organizational readiness for change. All measures will be completed at four time points: pre-intervention, 3-months, 6-months, and 12-month follow-up. Primary analyses will be conducted on an intention to treat basis. Outcomes for the three conditions will be compared with multilevel linear regression modelling.

DISCUSSION

The RCC program is designed to improve the knowledge and skills of staff and encourage transformational leadership and organizational change that supports implementation of CDC. The overarching goal is to improve the quality of life and care of older people living in residential care.

TRIAL REGISTRATION

ACTRN12618000779279; Registered 9 May 2018 with the Australian and New Zealand Clinical Trials Registry (ANZCTR; http://www.anzctr.org.au/ ).