Table 2.

Main steps taken towards implementation of the interRAI instruments in the seven countries.

IMPLEMENTATION STEPS	BELGIUM	SWITZERLAND	FRANCE	IRELAND	ICELAND	FINLAND	NEW ZEALAND
1	Translation into national languages (Dutch, French and German). Adaptation of the instruments and manuals to the Belgian social care and health care settings.	Evaluation of the existing use of assessment instruments in general and interRAI in particular. Exploration of the context (clinical, political). Mapping of the stakeholders (roles – agendas).	Translation into the French language.	Selection of interRAI- system of Assessments and Customisation/locatisation of instruments, associated manuals, and CAPs for use in the Irish context.	Translation into Icelandic	Translation into Finnish and Swedish languages	Transparent process to select interRAI (Tools Review). Business cases approved Project management infrastructure established. Active communication with the sector.
2	Comparison between the instruments to make them compatible across settings.	Developing a roadmap to introduce the newest generation interRAI Suite with focus on clinical use. Organisation of a conference to introduce the public health program to the field.	Participation in comparative studies with interRAI LTCF and HC instruments	Development of IT platform (Testing/Training and live applications) and associated eLearning System	Establishment of interRAI Iceland committee which worked within the MOH and later within the Medical Director General.	Back translation of the Finnish version. A version of Swedish translation received from Sweden, and modified according the language used in Finland.	Acceptance from Māori for the items and assessment process. Customisation of demographic items and New Zealand English terms.
3	Creation of an IT platform allowing professional caregivers from several disciplines to fill out the instruments in a multidisciplinary way (physicians, nurses, physiotherapists, occupational therapists, social assistants, etc.).	Creation of a legal framework (a decree) enhancing electronic health records and a common language between health settings to reinforce coordination and continuity of care. Strong political signal for policy support.	Creation of a non-profit organisation InterRAI France to promote the implementation.	Development of Training Programme tailored to user groups (Assessors, Decision Makers, etc.)	IT platform developed in Icelandic and compatible for all assessment forms.	Creation of Educational model how to assess the needs, and understand the scales (Chydenius Institute) Building up a commercial feasible software for data collection and creation of individual care plan (RAIsoft.ltd) Creation of first version of benchmarking the outcomes of care including: 1) safe digital transference of the person level data (STAKES/THL) Creation of unit/organization organisation/national level feed-back reports Creation of different types of seminars according the needs of participants	Single software platform developed. National training service developed. Contract with international software vendor. Contract with international e-learning system vendor.
4	Adaptation of some CAPs to the Belgian care setting, with evidence-based guidelines.	Defining, designing small-scale pilots. Guaranteeing the conditions: software, training, local support, project managers, budget, academic participation.	Implementation of integrated care model with intensive case management	Programme of User Acceptance Testing and Live Testing of IT system and associated processes/workflows.	Small supportive group for training and supervision from within the Medical Directorate of Iceland.	Collecting data of unit-level costs of care. Due to scattered way of governance, it turned out impossible to find or calculate information on costs, in compatible ways. In 2000 there were more than 400 independent regional jurisdictions, with non-compatible ways of calculating costs, in the country, and in 2022 still over 300.	A (4 year) – national implementation project that encouraged ownership and autonomy at the local level as long as national project parameters were met. Change management techniques for clinicians and managers. Data services strategy developed. Demonstrations of the aggregated data and potential use to inform planning.
5	Creation of an online manual for easy access while filling out the instruments – the BelRAI wiki website.	Translation and adaptations to local context of multiple instruments with special attention to coherence between languages and between instruments.	A top-down decision by the French national agency the “Caisse Nationale Solidarité Autonomie” (CNSA) to implement the interRAI HC for the case managers.	11-month pilot in 3 sites nationally	Caregiver groups and organisations have established working groups around implementation and to work with quality indicators.	Improving benchmarking reports Improving education Training experts -e-learning Improving contents of the seminars	Strong sector engagement through meetings, conferences and successful pilots and projects. Focus on the value of interRAI assessment for the person’s role, their client’s welfare and their organisational efficiency.
6	Organisation of training for professional caregivers and train-the-trainer to diffuse the knowledge in a more rapidly way.	Multiple pilots of various interRAI instruments in diverse populations, diverse settings, with varying length in time and size.	Development of a training program based on a dynamic software, making the links between the comprehensive assessment, the CAPS and the scales	Development of implementation framework for roll out of interRAI implementation in CHO regions.	Implementation evaluated by KPMG (MDS 2.0 and HC)	Gaining mandatory implementation	interRAI New Zealand established with ongoing funding from Ministry of Health for: Governance Board, Education and Support Service, Software Service, Data Services, Website and newsletters
7	Development of e-learning.	Regular free-of-charge conferences on evidence-based care and various forms of interRAI applications locally and internationally. Create a community of users and future users. Preparing upscaling from pilot to integration in routine use: train-the-trainer, e-learnings, funding, licensing, support	Training the interRAI trainers of the case managers	Development of IT equipping and support processes in conjunction with National HSE IT department.			Establishment of an iterative process for introducing new interRAI assessment versions building on sector support for example introducing the Palliative Care assessment to the sector Building relationships with researchers and developing an interRAI research community
8	Designing several pilot projects.	Policy considerations. Preparation and rollout of the switch from MDS-version to Suite. Train-the-trainer, licensing software vendors, updates manuals, progress evaluation.		Re-procurement exercise for alternative software provider following conclusion of initial contract.			Undertaking and responding to independent reviews Implementation requirements (2005) The LTCF Implementation (2018) Review of Service Design (2020)