Poster Presentations


P-11: Strategies for sustaining and spreading nutrition care changes in acute care: A thematic analysis from the More-2-Eat Study

Ms. Celia Laur

Celia Laur*,
Heather Keller,
Renata Valaitis,
Sumantra Ray,
Jack Bell

University of Waterloo
School of Public Health and Health Systems

Topic: Health Services, Knowledge Translation

Background
Successful change needs to be sustained and spread to have maximum benefit. The rationale for embedding sustainability from the beginning of implementation is well recognized; however, specific strategies used to sustain and spread successful changes are less clearly described. When improving nutrition care in Canadian hospitals, including improved identification, monitoring, and treatment of malnourished patients, strategies to sustain and spread successful changes are needed.

Objective
To identify strategies used by hospital staff and management to sustain and spread successful nutrition care improvements.

Methods
The More-2-Eat (M2E) project used participatory action research to work with hospital staff and management to improve their nutrition care practices. Five hospital units in four Canadian provinces had one year to improve the detection, treatment, and monitoring of malnourished patients. Each hospital had a champion and interdisciplinary site implementation team to drive the change. After the year (2016) of implementing changes, 2-day sites visits were completed at each M2E hospital to conduct interviews (n=45), small group discussions (4 groups; n=10), and focus groups (FG) (11 FG; n=68) (total n=123), with staff and management. A year after project completion (early 2018), another round of interviews (n=12) were conducted to see if and how the changes had been sustained and/or spread to other units or hospitals. Verbatim transcription was completed for all interviews. Thematic analysis of interview transcripts, FG notes, and context memos was completed.  

Results
After implementation of nutrition care improvements, initial success led to changes being sustained and spread, beginning an overall culture change. Strategies to sustain changes included: maintaining the routine through reminders and continuing to engage with staff; building intrinsic motivation; continuing to collect data (audits) and report back to the team; and engaging new staff and management due to high hospital staff turnover. Strategies to spread changes to other units or hospitals included: being responsive to opportunities, such as interest from other units; considering local context and readiness to spread the change to a new location; and making it easier to spread, such as by supplying resources created from a pilot or explaining which barriers were faced and how they were overcome. For successful spread, each change in practice required going through the implementation process in the new hospital area. Strategies for both sustaining and spreading included: being and staying visible; and maintaining roles and supporting new champions such that the current champions would remain in their role, while others were encouraged to champion initiatives in new units/hospitals. M2E units saw a slow shift towards an embedded culture of nutrition that supports sustaining of practice; this process required patience, flexibility and persistence.

Conclusion
After initial success with implementation, a variety of strategies can be used to spread and sustain successful changes. These changes build toward a culture of nutrition care that encourages lasting positive impact on patient safety and care.