Stakeholder Participation, Key Intervention Components, and Reinforcement Processes for the Intervention

Stakeholders' Participation for the Intervention
Theoretical Models	Owners	Nursing leaders and facility administrators	Direct-care staff of the facilities	Project staff
	Key Components of the Intervention
Intervention Model
Consistent nursing and administrative leadership	Agree to provide consistent nursing and administrative leadership; adopt the elements of change (EC) into their management practices	Agree to actively provide consistent leadership; adopt EC into their management practices		Reinforce with owners and staff that consistent leadership is essential as is continuous adaptive change
Team/group focus	Actively support the use of team and group processes for decisions affecting resident care; actively use EC in management practices	Actively use team and group processes for decisions affecting resident care; actively use EC in management practices	Actively participate in team and group processes for decisions affecting resident care; actively use EC	Teach use of team, group, and change processes to administrative and direct-care staff. Reinforce benefits of using team, group, and change process.
Active quality- improvement (QI) program	Actively support the use of a quality- improvement program	Actively use a quality- improvement program and involve direct-care staff in the QI activities	Actively participate in the quality- improvement activities (problem identification, data collection, interpretation, and planned changes)	Teach quality- improvement techniques. Assist with designing quality-improvement activities. Reinforce benefits of QI. Reinforce the use of change process
Systems to support the basics of care	Actively support and encourage staff to focus on performing care basics (ambulation, nutrition and hydration, toileting and bowel regularity, preventing skin breakdown, and managing pain).	Actively support and encourage direct-care staff to focus on performing care basics; reinforce the use of systems of care that promote performing care basics	Adopt systems of care that help them focus on performing care basics and consistently use the systems of care to perform care basics	Teach about the systems of care to perform care basics. Help the staff implement the systems of care. Reinforce use of systems of care to perform care basics. Reinforce use of change process and anchoring changes in systems of care
	Reinforcement Processes for the Intervention
Elements of Change (EC) Model
Establish a sense of urgency Create the guiding coalition Develop a vision and strategy Communicate the change vision	Actively support all staff to participate in educational program about QI, EC, and basics of care processes	Participate in and actively support all staff to participate in baseline educational program about QI, EC, teams, and basics of care processes	Participate in baseline educational program about QI, EC, teams, and basics of care processes	Conduct baseline educational program about QI, EC, teams, and basics of care processes
Create the guiding coalition Communicate the change vision Empower broad- based action	Actively support staff participation in the on-site monthly QI consultations; provide feedback on progress	Actively support staff to participate in on- site monthly QI consultations tailored to each site and the projects they decide to do; use EC to support and encourage using team process	Participate in on- site monthly QI consultations tailored to each site and the projects they decide to do, learn to use QI, team process and EC	Provide on-site monthly QI consultations tailored to each site and the projects they decide to do; assist staff to learn team process for decision-making and how to use EC effectively; provide feedback on progress
Generate short- term wins Consolidate gains and produce more change Anchor new approaches in the culture	Encourage staff to focus on the basics of care; provide feedback on progress	Actively support staff to devote time to build the systems of care for getting the basics of care accomplished; use EC to support and encourage team process	Implement the systems of care to support getting the basics of care accomplished	Assist staff to learn how to implement systems of care to get the basics of care accomplished; provide feedback on progress
Establish a sense of urgency Develop a vision and strategy	Participate in and encourage administrative staff to participate in monthly telephone support; provide feedback on progress	Discuss progress regarding the quality- improvement program, use of group process and EC, and the focus on basics of care		Make monthly telephone calls to owners and administrative staff to provide feedback about progress with QI, EC, and focus on the basics of care; provide feedback about baseline organizational measure (CVF) and how to use results; answer questions