Table 5 Summary of findings based on CFIR domains and constructs
Theme | Summary of data extracted | Facilitator / Barrier | Domain | Construct | Possible strategies to help with planning the PDSA cycle? |
|---|---|---|---|---|---|
1 | The robot could support: • Residents’ needs during the pandemic • Families’ geographical needs | Facilitator | Outer Setting | Patient needs and resources | Plan – stress these perceived residents’ needs to increase staff buy-in |
The robot did not match the residents’ readiness to use the intervention | Barrier | Plan – access residents’ needs and whether the intervention match or possibilities to adapt to these needs Study – evaluate whether the intervention is helpful for residents Act – whether the intervention can be adapted | |||
The robot allowed private conversations compared to other devices | Facilitator | Intervention characteristics | Relative advantage | Plan – stress these relative advantages | |
The use of robots aligned with: • Staff personal philosophy of care • Organizational mission | Facilitator | Inner setting | Compatibility | Plan – evaluate staff and organizational values; emphasize these values when introducing the technology; engage those staff who have similar values; promotes the benefits to leadership teams and gain their support | |
The use of robots did not align with the staff’s personal values | Barrier | ||||
The use of robots could promote own organization’s goals | Facilitator | Leadership engagement | |||
2 | Staff buy-in drove leaders/ organizational purchasing decision | Facilitator | Inner setting | Leadership engagement | Do – collect staff successful stories/ positive comments Study – communicate positive comments to leadership teams Act – tailor planning with staff to promote ownership of the project |
There were guidelines to prevent privacy invasion | Facilitator | Available resources | Plan – prepare the guidelines requested by the staff Study – evaluate the usefulness of the guidelines and whether improvements needed | ||
There was a limited number of telepresence robots for use | Barrier | Plan – co-create with staff the strategies of the sharing use of robots in the settings, e.g., scheduling of calls Do – observe and documents failures or successes of the strategies Study – analyze the data Act – adjust strategies in the subsequent cycle | |||
There was a dedicated time to debrief and reflect | Facilitator | Process | Reflecting and evaluating | Plan – plan constant check-ins with staff during the cycle to listen to their concerns; build relationships with staff at the beginning and let them know that there is a safe space to talk Do – dedicate time and listen to staff concerns and feedback Study – analyze feedback and assess the acceptability of the robots Act – co-create improvement plans with staff for the next PDSA cycle | |
There was an open space to share concerns | Facilitator | Reflecting and evaluating | |||
During the implementation process, there was a successful engagement of: • Supportive staff • Implementation leaders from different groups | Facilitator | Engaging | Plan – co-create engagement plans with staff champion and leadership teams who are familiar with the working cultures; learn about who the opinion leaders are in different groups in the LTC; start with engaging the supportive staff Do – engage stakeholders early; observe engagement processes to document which strategies work and which do not Study – evaluate the engagement plan with data collected; communicate what has been learnt | ||
Unsupportive individuals did not have buy-in for the intervention | Barrier | ||||
3 | There was easily accessible training | Facilitator | Inner setting | Access to knowledge and information | Plan – learn about staff’s preferred training style and time; prepare preferred training materials; offer more training sessions if needed Do – documents comments on training materials and training processes Study – analyze the effectiveness of training materials and procedures Act – adjust training sessions and materials |
• There was incompatible training time and length • There were limited chances to try using the robots | Barrier | ||||
Staff perceived that the intervention was complex | Barrier | Intervention characteristics | Complexity | Plan – provide training; identify staff who need extra help Do – document and acknowledge staff concerns Study – find out what works for them and what do not Act – focus on training strategies that work for them in the subsequent cycles | |
Staff had an increased level of confidence in using the robots | Facilitator | Characteristics of individuals | Self-efficacy |