When Dr. Sienna Caspar, a Professor in the Therapeutic Recreation (TR) program at the University of Lethbridge, developed the Feasible and Sustainable Culture Change Initiative (FASCCI), she wanted to create a resource for staff at continuing care residences that was easily implemented on a limited budget. The FASCCI model, available for free on the Relational Care Knowledge Hub website, is designed to help continuing care settings be successful in their goal of improving the quality of life for their residents.
The FASCCI model empowers staff to work as a team to implement person-centred care that leads to meaningful relationships between caregivers and residents and provides positive resident outcomes. For example, one continuing care facility used the model to change mealtime routines to give residents more choices and enable staff to sit down and socialize with residents when they are assisting them during meals.
Katelyn Scott (BTR’ 19), an instructor in the TR program and a master’s student studying under Caspar, wanted to try the FASCCI model in a therapeutic recreation context for her thesis project.
Scott and Caspar partnered with Kaitlyn Edwards, a recreation therapist who works in a continuing care setting with 128 residents in Alberta. In her practice, she uses a tool called a Tovertafel. The Tovertafel is an interactive gaming system with an overhead device that projects games and activities, such as soccer, popping bubbles or making music, onto a tabletop. The Tovertafel has many benefits, including increased social interaction and physical activity, reduced agitated behaviours and better relationships between staff and residents. Recreation therapists like Edwards would like to see the Tovertafel used more broadly by nursing and care staff, volunteers and family members after recreation staff have gone home for the day.
“What we’re finding is that people aren’t using it,” says Scott. “Changing the habits and routines in care settings is hard.”
In a continuing care setting, engaging in fun activities is typically seen as something only recreation staff get to do, so other staff may be reluctant to participate or feel they don’t have time.
“It challenges this idea of what is work, even when the culture in continuing care settings says that the relationships staff have with the residents and their quality of life is the most important aspect of their work,” says Caspar.
Scott and Caspar planned a study using the FASCCI training to see if it would lead to increased use of the Tovertafel by a variety of staff. Months before the study began, Edwards provided an in-service to staff on how to use the Tovertafel and the benefits it could provide. Administrators supported the idea as part of their quality-of-life initiative.
“We went in thinking we already had staff buy-in,” says Scott. “When we went to officially recruit on-site, I spoke to a room of people looking down at their phones and avoiding eye contact. Nobody wanted to listen. I walked away with zero participants that day. That speaks volumes about the systems they’re working in and the challenges they face every day with time pressure.”
They changed their recruitment strategy and, in addition to one-to-one conversations between staff and the recreation therapist, staff were told they’d get a free lunch if they attended the FASCCI training day, that they wouldn’t lose any pay and could drop out after the training. Eventually, they had nine participants from across the organization, including nurses, a spiritual care director, health care aides, volunteers and recreation therapy staff.
“It only took about an hour after they started engaging in the FASCCI training modules and the interactive breakout activities that they were literally on the edge of their seats, listening and connecting with one another and cultivating these relationships that go beyond their roles,” says Scott. “Once we got further into the modules and they understood why they were participating, it didn’t take long before the loudest naysayers were the most invested in this change.”
Following the FASCCI training day, the team met regularly to complete a PDSA (Plan-Do-Study-Act) cycle plan, where they looked at the changes they wanted to make and discussed their progress. After about two weeks, they realized that no change was happening. The team decided to solve the problem by putting up posters as visual reminders and creating a competition to earn points by using the Tovertafel.
“That’s really when we started to see the hours go up,” says Scott. “It was because the staff were giving themselves permission to try this and teach other staff, volunteers and family members how to use it.”
On the floor where staff participated in the FASCCI training, time using the Tovertafel went from seven minutes a day to 42.9 minutes a day by the end of the study. The Tovertafel was then moved to a floor where staff hadn’t taken the training. On that floor, use of the Tovertafel went from 7.1 minutes per day to 48.1 minutes a day.
“It was being used even more than on the original floor with the staff who participated in the training, which spoke to their ability to educate one another and work together to use the strategies provided in the FASCCI training to make this change happen and spread it across the organization,” says Scott.
“It’s clear that it wasn’t just an increase in the use of the Tovertafel; there was a transformation of the culture,” says Caspar. “In all of my other research studies where we used the FASCCI model to create changes, the same thing happened where the change gets pulled by other floors, other units and teams. Part of that is that people want to feel like they are a part of something, and they all want positive workplace relationships. FASCCI helps facilitate that and upends the power dynamics. It can be used for any change initiative and with any configuration of team. But there must be active support from the people with the greatest true power in the organization — administration. Without it, it won’t succeed.”