Project Title: Learning Capacity in Ontario's Long-Term Care Facilities: A Study of Factors that Affect the Adoption, Transfer, Adaptation and Retention of Clinical Practice Guidelines

Research Team:
Berta, W..
Davis, D.
Gilbart, E.
Lemieux-Charles, L
Rappolt, S.
Soberman-Ginsburg, L.
Teare, G.

This research builds on theory and research in the organization and management sciences in the area of organizational learning, and set out to identify the key factors that affect the adoption (interorganizational transfer), replication (intra-organizational transfer), adaptation (contextualization) and retention or rejection of knowledge that is conveyed in clinical practice guidelines (CPGs) relevant to long-term care institutions in Ontario, Canada. The overarching research question driving the proposal is: What factors operating at the environmental, organizational, individual and transfer-target (knowledge-specific) levels -- influence the capability of long-term care (LTC) organizations to learn through knowledge translation and exchange?

Clinical practice guidelines are accepted syntheses of current best practices and so seemingly offer long-term care organizations a ready, accessible, and inexpensive source of knowledge around particular aspects of care and acceptable levels of quality. Translating evidence-based information for use in LTC facilities has great potential for streamlining workload and improving patient care: some researchers contend that CPGs that are evidence-based, clinically relevant, and implemented appropriately can lead to improved patient outcomes and reduced costs to the health system. At the very least, CPGs in long-term care represent a source of standardized care routines that improve the consistency and quality of care and reduce "unnecessary variation" in the provision of care. Despite the potential that CPGs hold to resolve some of the existing issues around quality of care in long-term care settings, the results-to-date of their applications has been mixed. Our research will increase understanding of the factors that enhance, and limit, the application of CPGs in long-term care settings.

In order to enrich our study of the influence of knowledge-specific characteristics, we have elected to focus on two CPGs with differing degrees of complexity and tacitness. The proposed focal clinical issues are: pressure ulcers; incontinence; behaviour management, and antimicrobial resistance. We employed a mixed methods (quantitative, qualitative) approach. A series of hypotheses have been developed to test relationships between CPG adoption and factors at the transfer-target, individual, organizational and environmental levels.

This project was awarded seed funding in the M-THAC Research Opportunities Competition. Subsequently, the project successfully competed for a 3-year operating grant from the CIHR Knowledge Translation Strategies initiative.

Publications:

• Berta, W., Teare, G., Gilbart, E., Ginsburg, L., Lemieux-Charles, L., Davis, D. and Rappolt, S.  "The Contingencies of Organizational Learning in Long-Term Care: Factors that Affect Innovation Adoption".  Health Care Management Review, 30(4): 1-11, 2005. The definitive version can be found at Healthcare Management Review, http://www.hcmrjournal.com