A Systematic Mapping Review and Consensus Process
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In England, there are almost three times as many care home places as there are beds in the acute hospital sector, and one in six people aged 85 or over are living permanently in a care home. Care home residents have complex healthcare needs due to multiple comorbidities (including dementia) yet do not always have access to the healthcare services that they would have if they were living in their own home. In the UK, most care homes do not have registered nursing staff on site.
There is a growing recognition of the need for care home specific evidence that informs and improves healthcare of older people in these settings. How improvements to healthcare for residents in care homes are implemented depends on a range of factors, including institutional and sectoral priorities, leadership styles, communication patterns, staff interest, and the quality of pre-existing relationships between staff and visiting healthcare professionals. Understanding from the outset how the organisational context and culture of a care home influences readiness to participate in change is important. It has the potential to shape how healthcare professionals and care home staff plan their work together and explain the variability of uptake of new initiatives across the sector.
Implementation science recognises that differences in context influence innovation and implementation. Context is a broad concept, and multiple implementation frameworks have operationalised the individual, organisational, and environmental factors involved. Despite the rapid growth in implementation science in the healthcare sector in general, there is limited knowledge regarding how context affects innovation and implementation in care homes. This is especially relevant when implementation involves practitioners from different types of organisations (public and private, health, and social care), with overlapping but distinct priorities, beliefs, and values.
A Canadian programme of work (Alberta Context Tool© (ACT)) has linked assessment of the organisational context of care with a care home’s capacity to embed new ways of working and caring into its everyday practice. This has been done by studying different elements of organisational context, such as leadership styles and communication patterns and their impact on implementation of innovative models of care. The aim of our study was to draw on this work to explore in more detail how the organisational context of the care home, and its constituent elements, might shape care home capacity and readiness to engage alongside health services in innovative approaches to care delivery. We aimed to identify the extent to which researchers have considered organisational contextual factors when planning and reporting the implementation of healthcare interventions in care homes. Organisations involved in innovation in care homes might then use these results to measure and better understand their local care home organisational contexts before attempting to implement changes