Dr. Sienna Caspar, Associate Professor and Program Coordinator in the Therapeutic Recreation program at the University of Lethbridge, worked as a recreation therapist in health care for close to 20 years before she decided to go back to school because she had a burning question. She wanted to know why person-centred care, or care that is delivered based on individual needs and preferences, was so hard to implement. And she knew she needed to learn more about organizational behaviour and organizational change to find answers.
Since completing her PhD, Caspar has focused her research on understanding the challenges of implementing person-centred care and finding ways to make it easier for continuing-care homes to adopt this type of care. While many continuing care homes profess to provide person-centred care, the reality is that many struggle to consistently achieve this laudable goal.
Caspar focused her research on finding the key factors at play in changing practices and cultures at care homes. She found four: educational interventions are largely ineffective in changing practice, yet this remains our primary means by which to elicit change, the quality of relationships in the workplace has a direct and meaningful impact on care aides’ ability to provide person-centred care, the presence of leaders who demonstrate respect, appreciation and show recognition and respond to the needs of the care team is foundational to the success of any change initiative and finally, care teams that are empowered by leadership, teamwork and collaborative decision making are able to make real and lasting changes in care practices.
“Then I took my clinical experience, research and knowledge and developed a model for change,” says Caspar.
She tested the model, called the Feasible and Sustainable Culture Change Initiative (FASCCI), in residential care settings in Alberta and found that it led to more positive change than Caspar imagined possible. Residents became more involved in activities such as mealtime and staff felt more empowered and socialized with residents more often.
“Some of the things they did were amazing,” she says. “We hired a statistician to run the stats on the outcomes and when he ran the first analysis, he wrote back to us and said ‘I don’t know what you’re doing but you need to keep on doing it because I’ve never seen these kinds of outcomes before.”
The model went on to win an Innovative Research on Aging award from the Mather Institute.
Knowing the model works and because continuing-care homes have limited resources when implementing change initiatives, Caspar made the program available online for free. She expected that would lead to increased adoption of the model, but that hasn’t been the case.
“What I’ve experienced is this almost Catch-22 situation,” says Caspar. “Long-term care is not a resource-rich industry. They don’t have thousands of dollars to spend on bringing in change agents. I put time and energy into creating these resources to make them available for free. And what I’ve found is that, because they are free, managers and administrators tend to not be invested in them — literally and figuratively. That’s a serious problem because, without administrative support, no change initiative can be successful.”
To ensure the FASCCI model gets adopted, Caspar recognizes she will need to continue to invest time in promoting and presenting the model and guiding care homes in its adoption.
Caspar’s experiences have revealed that knowledge translation and mobilization are key to making sure research knowledge becomes part of best real-world practices, and academic institutions have an important role to play in ensuring this is supported.
The COVID-19 pandemic revealed many gaps in long-term care, with vulnerable people needing care in a situation where resources were stretched too far. Caspar’s research can assist care teams in making residential care homes better for residents, their families and staff and she knows it’s worth the investment.