Stakeholder engagement for successful practice change in long‐term care: Evaluating the Feasible and Sustainable Culture Change Initiative (FASCCI) model
Bibliographic record
Abstract
Abstract Background and Objectives Interventions aimed at increasing the provision of relational and person‐centred care in long‐term care (LTC) homes that do not address contextual and system issues most often fail. Promoting positive change in LTC homes requires a multilevel, systems approach. The objective of this study was to evaluate the feasibility and effectiveness of the Feasible and Sustainable Culture Change Initiative (FASCCI) model for change for improving the provision of person‐centred mealtime practices in a LTC home. Methods A single‐group, time series design was used to assess the impact of the FASCCI model for change on outcome measures across four time periods (pre‐intervention, 2‐month, 4‐month and 6‐month follow‐up). Mealtime observations (n=38) using the Mealtime Scan (MTS+) were completed over the course of six‐months in a single dining room. Interviews (n=21) were also conducted to examine treatment fidelity and to ascertain the study participants’ perceptions of the process for making improvements using the FASCCI model. Results We observed increases in care staffs’ capacity to consistently provide relational and person‐centred care during mealtimes. Mealtime environment scores started increasing immediately following the intervention, with statistically significant improvements noted in all mealtime environment scales by six‐months, including the: physical environment (z=‐3.43, p=0.004); social environment (z=‐4.17, p<0.001); relationship‐centred care (z= ‐4.121, p<0.001); and overall quality of dining environment (z= ‐4.08, p<0.001). Analysis of data from qualitative interviews demonstrated that use of the FASCCI model resulted in improved team leadership, communication, and collaborative decision‐making. Conclusions This study offers evidence that the FASCCI model provides a promising approach for improving the provision of relationship‐centred mealtime practices in LTC homes. Our findings reinforce the importance of cultivating and implementing workforce practices that increase staff empowerment and enable and encourage collaborative decision‐making. We found these practices to be essential to the outcomes associated with the improved relationship‐centred care practices that occurred during this study. This is consistent with the small but growing body of evidence demonstrating that staff empowerment has a significant effect on overall quality of resident care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.088 | 0.084 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.006 |
| Scholarly communication | 0.005 | 0.004 |
| Open science | 0.003 | 0.010 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".