Barriers and facilitators to adopting functional maintenance initiatives for acutely hospitalised older adults

Abstract

Purpose: To determine perceived barriers and facilitators to adopting and sustaining functional maintenance initiatives for acutely hospitalised older adults.

Methods: A qualitative descriptive study using semi-structured interviews and initiative observations was conducted at five international and four Victorian acute hospitals. Purposive snowball sampling was used to recruit clinical, research, managerial, and volunteer staff who were involved in implementing and/or sustaining the initiatives. Emergent themes from audio-recorded interviews were developed and categorised as staff-perceived barriers or facilitators to adopting and sustaining initiatives using inductive thematic analysis.

Results: Twenty-seven medical, nursing, allied health, and volunteer staff participated in interviews. Staff resistance and turnover, especially the loss of staff considered to be change drivers, were commonly reported barriers. A lack of professional autonomy was perceived to threaten longevity in allied health assistant led initiatives. Facilitators included support from change drivers, use of collaborative approaches and opinion leaders, integration of initiatives into usual care, alignment with institutional priorities, use of “internal” evidence to justify ongoing institutional investment, and use of an accompanying training and evaluation strategy.

Conclusions: Successful adoption and sustainability of functional maintenance initiatives for acutely hospitalised older adults are influenced by a range of “non-clinical” factors, such as the ongoing effectiveness of change drivers. These factors should be considered when deciding upon future innovations to address functional decline and its associated economic impact.

IMPLICATIONS FOR REHABILITATION

• Considering barriers and facilitators to successful adoption of functional maintenance initiatives is important for implementing evidence-based practice targeting the prevention of functional decline in acutely hospitalised older adults.

• Change drivers who remain actively involved are core facilitators of successful functional maintenance initiative adoption.

• Credible “internal” evaluation data are essential for ongoing sustainability of functional maintenance initiatives.

• Continual staff training is a key feature of successful functional maintenance initiatives.

• Perceived financial barriers to adopting functional maintenance initiatives can be overcome by other facilitating influences.

Keywords:

• Functional decline
• rehabilitation
• geriatrics
• aged
• inpatient
• hospitalisation
• health care delivery
• implementation research

Acknowledgements

The researchers would like to thank all participants and FMI personnel who supported centre observations.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

Centre visitations and clinical backfill of the lead researcher (AK) to collect data were supported by the VCF Felice Rosemary Lloyd Scholarship (CT21857) and Monash Health Emerging Researcher Fellowship (2015). Dr. Osadnik was supported by the Lung Foundation Australia/Boehringer-Ingelheim COPD Research Fellowship (2016/2017). Funding organisations had no role in the design or conduct of the study, or review or approval of the manuscript.