Table 6 A tool ‘START’ for the technology implementation in LTC based on empirical findings and literature

S - Share benefits and failures

Share benefits of interventions that align with the values of staff, have team reflections on successful stories and experiences of residents and staff, and communicate failures to avoid them from happening in the subsequent cycle

- “The robot turns on and off itself [as call ends] …no need to be ‘set up’… Residents don’t need to ‘work’ the robot like they have to ‘work’ the tablet, which many do not know how to… and staff don’t have to help residents use the robot like how they would have to help with the tablet.” (Lily)

- “If we enjoy using the technology, we will encourage other staff to use it.” (Vera)

- “Staff are having ‘consultation fatigue’. They are consulted on various things. It is sometimes difficult to engage them.” (Cindy)

A study demonstrated the positive changes in nursing staff’s perceptions towards a robotic seal, and staff started incorporating the robot into their routines after observing the therapeutic effects of the robot with the residents in LTC [46].

T - Tailor planning with staff partners

Tailor various plans on engagement, training, technical support and debriefing schedules

- “I am a visual learner. I need to practice and practice a few more times before I get familiarized with how to do it. Practice is critical besides verbal or written education.” (Sophie)

- “If there are technical issues, staff can contact someone. It will increase the feeling of confidence of staff to use it.” (Britney)

- “Certain boundaries and guidelines will be needed to prevent invasion of privacy.” (Sophie)

Yuan et al. [39] emphasized the diversity of care staff skills and motivations when introducing social robots to staff in LTC.

A - Acknowledge staff concerns

Dedicate time to acknowledge and address staff concerns and offer a psychologically safe space

- “Create open spaces to ask about staff concerns and validate them… the closer you are physically to staff, the more engaged and grounded approaches that you use, the more responses that you will get.” (Mandy)

- “If we need to assist and give cues to those residents who are not good at interacting in the conversation, it will take us much time and create burdens. We still need to care about other residents.” (Rocky)

Koh et al. [45] demonstrated how joint discussions with colleagues allowed staff to express their concerns and empower each other with skills to manage the negative reactions of residents towards the pet robots.

R – Recruit opinion leaders early

Recruit opinion leaders and staff champions who support the interventions early in the implementation

- “Engaging those who are interested and see the potential benefits of using the robots… Sometimes you just cannot get the buy-ins from certain staff.” (Johnny)

- “Get support from different levels of leadership and leaders representing different groups, for example, leaders of the family council, residents’ council, and operational leaders. They can be helpful to generate engagement.” (Janet)

Getson and Nejat [40] suggested that all stakeholders should be considered in technology implementation. Identifying champions among staff members was an enabling factor for the successful implementation of technology in LTC homes.

T - Target residents’ needs

Implementation of interventions should target and match residents’ needs. The implementation team needs to evaluate the impact of the intervention and adjust interventions or implementation strategies accordingly.

- “Robots can create private spaces for family and residents for their conversations. They can share intimate information without staff assisting and staying in the room.” (Mandy)

- “For a person who speaks a different language, staying connected with somebody who understands them [through the robot] would be really good.” (Amy)

- “The robots are now more urgently needed when in-person visits are not allowed.” (Katherine)

The perceived benefits of addressing residents’ needs will become an internal drive and motivation for staff to adopt using the robots in their routines [39].