Managing, Measuring and Spreading Improvements in Long Term Care Workshop

February 10-11, 2015
Vancouver, British Columbia

See photos from this event

This workshop was part of CFHI’s Innovation Summit in Vancouver, British Columbia, which brought together more than 200 healthcare leaders from across Canada to advance 45 CFHI-supported projects that are improving healthcare for patients, and spreading innovations and improvements nationwide. It involved a series of short working sessions led by lead and guest faculty.


Learning Objectives

The learning objectives of the workshop included:

  • How to spread and sustain improvements;
  • How to use data and results to inform care planning and create the change imperative to leadership;
  • Strategies for improving culture and creating physician partnerships.


Workshop participants included:

  • Forty-six team representatives with diverse experiences in healthcare improvement and long term care. Project teams included physicians, nurses, pharmacists, healthcare managers and executives from seven provinces and one territory.
  • The six core faculty members of CFHI’s Reducing Antipsychotic Medication Use in Long Term Care collaborative—Terry Sullivan, Dennis Cleaver, Mollie Cole, Cynthia Sinclair, Lori Mitchell, and Joe Puchniak
  • Ten special guest faculty/invited speakers.

Session Descriptions

Team Interviews: Project teams leading similar implementation and spread efforts interviewed each other about the key components of implementation and spread approaches, challenges and successes. Commonly cited challenges included: finding time to use specific behaviour monitoring tools that support the new person-centred approaches; physician engagement; and leadership change. Commonly cited successes included: reductions in the numbers of residents inappropriately prescribed antipsychotics (with some teams already surpassing their improvement goals related to reductions in prescribing); improvements in resident functioning and staff engagement with residents; teamwork/staff engagement; and development of creative strategies that support improvements in resident functioning without medications (e.g., recreational programs).

World Cafés: Project teams shared their insights and challenges with regard to a wide variety of topics, including: spreading large scale improvements; managing spontaneous spread; effective methods for training; leadership; alternatives to the antipsychotic medications; understanding regulatory environments; physician engagement; and polypharmacy. 

Spread and Scale Up: Participants learned how to support and measure the spread of improvements, through, for example: ensuring team members at successful pilot sites serve as advisors to project teams at new implementation sites; creating and implementing a ‘playbook’ or set of tools that sites conducting spread could use and adapt; creating a spread plan that contains clear goals and timelines; and, when measuring spread, considering the speed of improvement, coverage and completeness of spread (how many sites and how well), as well as the reliability of the implementation.

Managing Implementation and Sustaining the Change/Improvement: This session included: demonstrations of tools that can aid in planning and management (e.g., driver diagrams); review of steps and strategies to support sustainability of the improvement (which begins during initial planning and implementation), including the need to test the improvement under a variety of conditions (e.g., different shifts, new staff, different types of patients); and review of strategies to build reliability (e.g., through activities that create visibility, such as whiteboards, huddles, auto-reminders built into software).

Moving from Spread to Scale Up: This panel session featured leaders of provincial improvement initiatives dedicated to improving patient care and appropriate prescribing of antipsychotic medications in long term care (LTC). Strategies in place to support implementation, spread and scale up included attaching smaller projects to larger initiatives (e.g., provincial efforts to reduce polypharmacy), advocacy, and implementation and review of mandatory quality improvement plans from LTC facilities.

Partnering with Physicians in Long Term Care: Participants were given the opportunity to ask a panel consisting of two physicians and an experienced LTC nurse manager specializing in geriatrics, questions about their challenges in motivating physicians to become champions in the appropriate medications prescribing initiatives. Panel members described education options that may increase physician engagement, successful and unsuccessful strategies that they have used, as well as strategies to maintain improvement initiatives in the absence of physician cooperation. Improving Organizational Culture: Following a review of evidence-informed strategies that support culture change in organizations, panelists answered participants’ specific questions regarding how they could support culture change in their organizations.

Telling your Improvement Story Using Performance Measurement: Demonstrations using data that all teams had submitted to date (i.e. baseline data) provided teams with a sense of where they stood relative to other teams in terms of prescribing antipsychotic medications and other quality indicators related to the healthcare of the long term care residents within their facilities. In addition, the use of facility-level interRAI data to communicate improvement data to leadership and staff to sustain the imperative for change/improvement (e.g., through benchmarking) was also demonstrated.