“I was surprised at just how variable the implementation of DCM was, and how difficult many of the homes found it, particularly given it is an interevention already in use in care homes. We knew we would see some turnover of staff but there was much more managerial turnover than we expected and the impacts of this were greater on the intervention than we anticipated.”Study Author Rachel Kelley,
Dementia Researcher, Leeds Beckett University
An NIHR- funded study looked at why implementation of the dementia care mapping has failed to lead to improvements in some care homes. The authors of the study found that implementation is patchy and vulnerable to issues such as staff and manager turnover, their confidence or skills to lead changes in practice, and inadequate staffing and funds.
Previous studies (not in the UK) reported that that DCM had mixed results across care homes. Where DCM was led by the researchers, there were some benefits for residents and staff. However, where DCM was led by care home staff, no benefits were found and there were problems implementing the tool.
This study explored the barriers and facilitators in introducing a complex tool like DCM, including the influence of care home managers. It interviewed almost 50 care home managers who were also participants in the intervention arms of a related trial.
Study Author Rachel Kelley said, “overall the findings show just how important support for care homes and their managers and staff is when we are trying to implement new interventions and practices. It is important to say there were definitely examples of care homes that implemented DCM well and where the staff thought it was beneficial. Other homes wanted to implement it, but were unable to for a variety of reasons, as our study showed.” (Source: NIHR)
Read the full NIHR article Dementia Care Mapping: Care home managers and staff need more support to improve care
The primary paper is available from BMC Geriatrics Kelley R, and others. The influence of care home managers on the implementation of a complex intervention: findings from the process evaluation of a randomised controlled trial of dementia care mapping. BMC Geriatrics. 2020;20:303