Table 3.

Key LTC staff insights about sustainability and potential approaches suggested by focus group participants, CONNECT study experience, or implementation science literature

Key participant insights	Potential approaches
Intervention features
Content
• Must be perceived to be beneficial and promote organizational aims • Must balance complexity and simplicity	• Include regular outcome measurement with participant feedback • Reinforce impact on resident outcomes • Pilot content with full range of target staff
Delivery
• Group sessions allow mutual instruction, increase confidence, give “permission” to bring up problems, and strengthen relationships • Individual sessions allow assessment of understanding and customization • Trainers should balance clarity and excess repetition • Reinforcement and practice of new skills is needed	• Consider combination of group and individual sessions for interventions requiring staff coordination • Use role-play, storytelling, and other means to promote interaction • Use mentored practice sessions with feedback
Customizability/flexibility
• Sessions should accommodate clinical demands, include all shifts, and be customized to fit each facility’s schedule	• Build flexibility into intervention testing, e.g., allow staff to choose when/where instruction occurs, number of sessions (multiple short vs. single long), number of participants per session • Test number of “booster sessions” needed to sustain desired level of change
Materials
• Intervention materials should consider diversity of staff; make learning objectives pertinent regardless of role, experience, education level, language • Materials should be visually appealing and in different formats	• Use range of authentic case scenarios of interdisciplinary interest when possible • Use graphics, stories that are understandable to diverse target audience • Consider range of print, online, video
Contextual features
Leadership
• Direct care staff want to observe active leadership support and engagement in the program • Lack of trust and gaps in communication frequently exists between direct care staff and managers	• Avoid always separating managers and staff for training • Consider whether manager/direct care staff communication issues can be addressed as part of the intervention (e.g., promote discussion, include team building approaches)
Incentives
• “Accountability” to change behavior is expected by staff • Desired behavior should be an expected part of the culture	• Avoid mandatory training sessions • Avoid rule-based, “shame and blame” approach, but instead articulate shared goals, vision to be accomplished by sustaining program, particularly impact on residents
External supports
Processes and procedures
• Formalizing changes through changing work routines promotes continuation • New staff orientation is a key target for continuing training • “Refresher” sessions are needed • Use approaches such as “train the trainer,” facility champions to promote continuation	• Make explicit changes to meeting schedules, documentation templates, work rounds, etc. • Facilitate changes to orientation schedule • Incorporate champion training midway into intervention
Tools
• Visual aids and reminders scattered throughout work environment are helpful • Address training for those unable to attend in-person sessions • Creative uses of information technology are now feasible in LTC	• Develop posters, bulletin boards, bookmarks, calendars, pens, etc. • Develop orientation package • Consider use of DVDs, video clips, web-based training sessions followed by individual/small group discussions • Reminders within electronic medical record, online training resources