Evaluation of the Encouraging Better Practice in Aged Care (ebpac) Initiative Final Report

6.3National roll-out projects

The focus of these two projects was to actively disseminate evidence-based resources about palliative care and wound care throughout residential aged care i.e. they are both exercises in promoting generalisability. The two issues regarding generalisability which arise from these projects are about their capacity to be implemented. Although there was widespread dissemination of the resources and processes by each project, it is not clear that these have been integrated into practice. For example, a recurring theme in the CSI stakeholder interviews is concern about the potential cost of best practice wound care products that may be a barrier to ongoing implementation. Data in the RC1 final report shows that while some processes appear to have been implemented (increased number of Advance Care Plans), the system level impacts have not changed, in terms of transfers to hospital, place of death and ACFI claims.

The Guidelines for a palliative approach in residential aged care provided the foundation for the RC1 project. We are aware that both the Guidelines for residential aged care and those for community care services are currently being updated. Once these have been completed, the Palliative Approach Toolkit will need to be updated. It is not clear that a similar ‘roll-out’ of the updated guidelines will change behaviour, or whether some other mechanism should be employed to assist/encourage aged care organisations to embed the palliative approach in practice.

The Champions for Skin Integrity Guide and Resource Pack has likewise been disseminated throughout residential aged care and early indications suggest that many aged care services have reframed their processes and practices accordingly. There are some elements of overlap in terms of content of RC2 and CC1, which targeted community care clients and services. The evidence base of the RC2 covers a broader and wider spectrum of wound management issues than the CC1 project and therefore may provide ready transferability to community care services. Any consideration of improving skin integrity and wound care within the community care sector would need to consider the potential for integration of resources, tools and processes between the two projects.

7SUSTAINABILITY

It is widely agreed that sustainability of an innovative project encompasses three important elements:

Maintaining the benefits of the project for consumers and other stakeholders;

Continuing some activities of the project, consistent with its original goals and objectives;

Building capacity in the system or the community to continue the project.

This broad definition of sustainability is based on two major reviews of the literature.^{34 35} Sustainability is more than simply what remains after program funding ends. Instead, it is generally seen as an ongoing process that needs to be integrated into project planning and throughout implementation.³⁶ Implementation processes such as stakeholder engagement, staff participation, adaptation of project activities to meet organisational needs and dissemination of materials all contribute to sustainability. Activities specific to sustainability include the use of policies and rules to standardise project activities and integrate them into ‘business as usual’, and obtaining and maintaining resources such as staff, equipment and training materials.³⁷

In this section of the report, we consider the sustainability of the 11 EBPAC projects using the definition above as a framework. That is, to what extent will the projects’ benefits and activities continue, and what capacity has been established to support sustainability? We draw on projects’ final and progress reports and the key stakeholder interviews conducted by the national evaluation team. In addition, Evaluation Tool 4 included an item asking respondents to ‘identify any issues that may challenge the future sustainability of the training materials’.

7.1Factors that promote sustainability

In measuring sustainability, it is important to decide which aspects of the innovation are expected to be sustained, and in what form.³⁸ Furthermore, it is vital to consider characteristics of the innovation itself, including evidence of effectiveness,³⁹ and whether it meets the needs of intended users and is compatible with their philosophies and agendas.⁴⁰ Each of the EBPAC projects was informed by evidence such as clinical guidelines, literature reviews etc. (see Table ). Local contextual factors, such as client needs, staff attitudes, and organisational strategic directions were explored through engagement and consultation with key informants, which in turn provided an indication of the extent to which the project would meet a receptive context. These two foundational elements – evidence and context – when well facilitated, are widely understood as leading to successful implementation of research into practice.⁴¹

Whether implementation is sustained is further influenced by a number of other factors, including:

Organisational factors, such as culture, leadership and policies:

New programs are more likely to thrive and survive if implemented by organisations that are stable, mature and have a clear purpose, and by leaders who have a good understanding of program theory and are able to enlist community support.⁴² Policies that formally establish the innovation as part of (new) usual practice have been shown to support the sustainability of project activities and benefits.^{43 44}

Capacity, including funding, champions, staff skills and stakeholder investment:

Capacity to sustain innovation is enhanced by the presence of multiple ‘champions’ at various levels of the organisation.⁴⁵ Another major contributor to capacity is a skilled, highly motivated and stable workforce. ⁴⁶

Processes, such as shared decision making, training and partnerships:⁴⁷

Ongoing support and collaboration among stakeholders has also been shown to influence the likelihood of sustainability,⁴⁸ along with formal linkages and established partnerships between organisations.⁴⁹ A supportive social and political climate is also likely to contribute to sustainability.⁵⁰

In the next parts of this section, we consider the extent to which these three factors to promote sustainability were present in the EBPAC projects. As will become apparent, the leadership and change projects focussed on sector development initiatives and therefore are not included within discussions about sustainability at the organisational, staff and client levels.