Facilitation of the Gold Standards Framework Programme for End-of-Life Care in Care Homes : A Mixed Methods Study.

Kinley, Julie (2014) Facilitation of the Gold Standards Framework Programme for End-of-Life Care in Care Homes : A Mixed Methods Study. PhD thesis, Lancaster University.

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Abstract

The implementation of end-of-life care interventions is promoted within English healthcare policy to improve care delivery within different settings. How these interventions are best implemented is less clearly promoted. The role of facilitation in the implementation of one end-of-life care initiative, recommended by the English Department of Health, the Gold Standards Framework in Care Homes (GSFCH) programme is considered in this study. It has been noted that a low number of care homes complete the programme which has raised questions about the implementation process. Whilst an early evaluation reported that it was easier to implement the GSFCH programme when a care home was supported by an external facilitator, this report and subsequent evaluations failed to clearly identify the role or competencies that they needed. This mixed methods study was undertaken within 38 nursing care homes undertaking the GSFCH programme in England. Qualitative and quantitative data were collected from staff employed within (nursing care home managers and GSFCH coordinators) or associated with (external facilitators) these nursing care homes and included interviews, surveys, Facilitator Activity Logs and a researcher's diary. Following separate quantitative and qualitative data analysis the data sets were integrated by 'following a thread'. Utilisation of a system-based-framework enabled the wider context of the participating nursing care homes to be considered. Three approaches of facilitation were provided to nursing care home staff when implementing the GSFCH programme: 'fitting it in' facilitation; 'as requested' facilitation; and, 'being present' facilitation. Completion of the GSFCH programme, through to accreditation, was influenced by the approach of facilitation that was provided. Implementation of the programme required an external facilitator who could mediate multi-layered learning at an appreciative system level, an organisational level and at an individual level. Multi-layered learning was required in order to achieve the cultural change necessary to complete the GSFCH programme.