Behavioral and Systems Change in Nursing Homes with an Integrated Training Intervention

Training of healthcare professionals in nursing homes (NH) is fundamental to improve quality and safety. This project (funding by 2 resolutions) is carried out at a sample of 7 NHs of Tuscany Region (Italy), for evaluate a participatory approach to reduce preventable incidents and implement good practices, through behavioral and systems change. The inclusion criteria were defined to represent the different areas of the Region. The method for training sessions is based on what emerged in the literature, according to the principles of andragogy and management of human factors. It is based on interactive class, that follow action research method, with bottom-up approach to multidisciplinary groups. Each session lead by a nurse and a psychologist takes 8 h. Participants’ experience of a good or a bad day of practice is elicited to let the tacit knowledge on strengths and weaknesses emerge, to help the group envision a joint commitment to improve on the more relevant themes for patient safety. Evaluation included participant reactions, learning and change in practice. Staff who attended responded very well. In the majority they appreciated training but above all the intention to change and improve their job. Follow-up (up to 2 months) was carried out in all NHs through field observations and a second meeting. In some cases, we were able to observe changes in care and organizational practices, in other no changes emerged. In all NHs we have found the need for supported in working practices, the request to continue to be followed over time.