Beyond Plan-Do-Study-Act cycle – staff perceptions on facilitators and barriers to the implementation of telepresence robots in long-term care

Abstract

Background Quality improvement (QI) programs with technology implementations have been introduced to long-term care (LTC) to improve residents’ quality of life. Plan-Do-Study-Act (PDSA) cycle is commonly adopted in QI projects. There should be an appropriate investment of resources to enhance learning from iterative PDSA cycles. Recently, scholars explored possibilities of implementation science (IS) with QI methods to increase QI projects’ generalisability and make them more widely applicable in other healthcare contexts. To date, scant examples demonstrate the complementary use of the two methods in QI projects involving technology implementation. This qualitative study explores staff and leadership teams’ perspectives on facilitators and barriers of a QI project to implement telepresence robots in LTC guided by the Consolidated Framework for Implementation Research (CFIR). Methods We employed purposive and snowballing methods to recruit 22 participants from two LTC in British Columbia, Canada: operational and unit leaders and interdisciplinary staff, including nursing staff, care aides, and allied health practitioners. CFIR was used to guide data collection and analysis. Semi-structured interviews and focus groups were conducted through in-person and virtual meetings. Thematic analysis was employed to generate insights into participants’ perspectives. Results Our analysis identified three themes: (a) The essential needs for family-resident connections, (b) Meaningful engagement builds partnership, and (c) Training and timely support gives confidence. Based on the findings and CFIR guidance, we demonstrate how to plan strategies in upcoming PDSA cycles and offer an easy-to-use tool ‘START’ to encourage the practical application of evidence-based strategies in technology implementation: Share benefits and failures; Tailor planning with staff partners; Acknowledge staff concerns; Recruit opinion leaders early; and Target residents’ needs. Conclusions Our study offers pragmatic insights into the complementary application of CFIR with PDSA methods in QI projects on implementing technologies in LTC. Healthcare leaders should consider evidence-based strategies in implementing innovations beyond PDSA cycles.

Working with a robot in hospital and long-term care homes: staff experience

“…We argue that to achieve long-term or larger-scale implementation of telerobots, training and technical support needs to be sustainably available to staff. We also call for continuous acknowledgement and promotion of their successful experiences in technology usage, which was in line with an argument made by Wong et al [ 30 ]. Future research could explore strategies concerning staff training, staff engagement, and the provision of support tools, as well as evaluate the effect of such strategies in the identified problem contexts.…”

A Robotics Experimental Design Method Based on PDCA: A Case Study of Wall-Following Robots

“…DMAIC (Define–Measure–Analyze–Improve–Control) [ 26 , 27 ] is a data-oriented problem-solving method suitable for larger-scale projects. PDSA (Plan–Do–Study–Act) [ 28 , 29 , 30 ] is a modification of the original PDCA, which changes Check in the third step to Study (Study Assessment), which is suitable for longer-term projects. Compared with DMAIC and PDSA, the cycle design concept of PDCA is more suitable for the student-learning-outcome-oriented design of the robotics experimental course in this study.…”