The Person, Interactions and Environment Programme to improve care of people with dementia in hospital: a multisite study

• DOI: 10.3310/hsdr06230
• Publication Date: 2018-07-02T09:16:08Z
• Authors: Mary Godfrey; John Young; Rosemary Shannon; Ann Skingley; Rosemary Woolley; Frank Arrojo; Dawn Brooker; Kim Manley; Claire Surr
• Keywords: Medicine (General); comparative case study; RT; improvement programme; 3. Good health; 03 medical and health sciences; R5-920; 0302 clinical medicine; person-centred care; acute care; Public aspects of medicine; RA1-1270; dementia

Background Improving the care of people with dementia on acute hospital wards is a policy priority. Person-centred marker quality; delivering such goal service improvement. Objectives The Person, Interactions and Environment (PIE) Programme comprises an observation tool systematic approach to implement embed person-centred in routine for hospitalised patients dementia. study aims were evaluate PIE as method improve older wards, develop insight into what might look like practice this setting. Methods We performed longitudinal comparative case design 10 purposively selected five trusts three English regions, alongside embedded process evaluation. Data collected from multiple sources: staff, patients, relatives, organisational aggregate information documents. Mixed methods employed: ethnographic observation; interviews questionnaires; patient studies (patient conversations ‘in moment’, relatives records); ward data. synthesised create individual implementation outcomes context structure, organisation, profile delivery. A cross-case comparison facilitated descriptive explanatory account context, pattern variation, shaped it consequences flowing it. Quantitative data analysed using simple statistics. qualitative analysis employed grounded theory methods. Results furthered understanding dimensions quality environmental, cultural factors that Only two fully implemented PIE, sustaining embedding change over 18 months. remaining either did not install (‘non-implementers’) or ‘partial implementers’. interaction between micro-level contextual [aspects leadership (drivers, facilitators, team, networks), fit strategic initiatives salience valued goals] meso- macro-level main barriers adoption. Evidence suggests programme, where implemented, directly affected improvements practice, positive impact experiences caregivers, although heterogeneity need severity impairment meant some more visible changes affect everyone equally. Limitations Although has potential when findings are indicative only: clinical systematically collected, was adopted most wards. Research implications Further research required identify precisely skill mix resources necessary provide person-focused dementia, across spectrum need, including those moderate severe impairment. Implementing innovations practices complex organisations requires in-depth have capacity absorb new practices. Funding National Institute Health Services Delivery programme.