Table 6.

Learnings and Improvements to the CHOICE Program

Findings	Learnings	Planned Improvements to Program
New Appreciation for Mealtimes: “It’s not about us; it’s about them.”	• CHOICE provided dedicated time for care staff and management to reflect and reconsider the meaning of mealtimes within their home area. • Care staff took advantage of this opportunity to share insights, learnings, and revelations amongst care teams as another way to reinforce the importance of what they are undertaking. • Staff huddles and meetings serve as a great opportunity to engage in self-reflection.	• Staff huddles and meetings proved to be more beneficial to staff to communicate with one another than using Huddle Diaries. The use of diaries ceased, which left additional time for staff to consider what aspect of mealtimes were improving, and what needed more attention. • Self-reflection based on checklists of relationship-centred care practices at mealtimes. • Adapting training on CHOICE Principles to video to allow for individual review and goal setting.
Knowing context and culture	• Additional time is needed prior to implementation to tailor the intervention components to each home area, support communication across all stakeholders and build consensus on what needs to be improved. • Changes to both the physical and social environment can improve the mealtime experience. Taking time to reflect on both environments and how they interact with one another is important. • Spending time with staff discussing how each CHOICE Principle would be enacted during their mealtimes and collectively identifying specific approaches to make change as opposed to offering vague recommendations that are not relevant to their context.	• Program extended to 52 weeks to allow for a preparatory phase where a CHOICE Dining Team is developed and trained on change management techniques. • Engagement of the residents, family and greater team with baseline findings and what areas need to be improved and identification of priority areas for change based on the perspectives of all stakeholders • Self-assessment checklist for mealtime practices as well as physical aspects of dining. • CHOICE Dining Team takes priority areas identified by family, residents and the greater care team and develops concrete action plans that are negotiated and communicated with all stakeholders in the area.
Getting everyone on board	• Additional time spent at the early stages of implementation to ensure that everyone understands what changes need to be made is critical to buy-in from care staff and management. • The development of a dining team that includes members from home management would assist in tailoring implementation components that were acceptable and feasible for a specific home area • Basic change management principles should become part of educational component for Mealtime Champions (and a dining team) so that home areas can utilize implementation methods and tools that work best for their home area.	• Greater team engagement and self-reflection checklists mentioned above to bring awareness as to what aspects of mealtimes could be improved. • CHOICE Dining Team to include residents, family, care team champions, management and CHOICE Coach; ownership and leadership transferred from Coach to home members over the course of the implementation. • Training components for the CHOICE Dining Team on change management; mentorship by Coach on change management principles.
Keeping communication lines open	• More frequent communication was needed between the CHOICE Coach, the Mealtime Champions, and the home area for guidance and support in determining what aspects of mealtimes to target and how to go about it. • Once implementation is underway, clear and consistent methods of communication are needed to understand how the intervention is progressing and what support is needed in the home area.	• Establish communication processes with Choice Dining Team and greater team, including residents and family. • Use a variety of communication formats to reach diverse audiences and once established use consistently.
Sharing responsibilities and accountability	• The CHOICE Program gave the home areas the opportunity and space to reflect on how mealtimes could be improved and what their roles were to make changes. • Mealtime Champions expressed additional pressure associated with the responsibility of leading the change efforts in their home areas. • The development of a Dining Team would assist in sharing some of the change management tasks that were originally given to the Mealtime Champions.	• Development of a CHOICE Dining Team to share responsibility and promote accountability. • Use of informal audit of new practices to promote accountability and embedding.
Empowering and supporting creativity	• From the outset of implementation, care staff and management need to collaborate to identify feasible mealtime improvements and change management strategies that work best for their home area. • Care staff have creative ideas and solutions to improve the mealtime experience for residents, however, they require time, resources, and support to make them a reality.	• CHOICE Dining Team needs to include a management representative to facilitate some changes considered a priority. • To ensure that care staff do not feel overwhelmed with change efforts, 1–2 CHOICE Principles could be prioritized. • Provide opportunities for engaging staff in identifying solutions; potentially post review of evaluation data to stimulate priority setting and motivation for change.