AMDA Foundation - Learned Flexibility

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Vol XI, Nov `05

Learned Flexibility

Vol XI, Nov `05

While the project follows a randomized control trial design, it is, at heart, a demonstration project and has required project staff to react to barriers in real-time and adjust the project's strategies accordingly. The AMDA Foundation's Director of Research, Barbara Calabrese, described the intervention components and explained when and why project staff incorporated flexibility. One example is that training was shortened to allow: (1) key nursing home leadership to attend half-day sessions and (2) training by phone.

Flexibility was also key to recruitment. Research Projects Coordinator Erin Blume discussed multiple barriers encountered during recruitment, including hurricanes, minimal local support, and delays. For example, waiting for 8-10 nursing homes in each state to enroll before scheduling that state's training meant that interested homes sometimes had to wait months to start the project. To overcome this barrier, the project team implemented "rolling recruitment," whereby homes were quickly trained in small groups.

Ms. Blume also discussed the changing role of state nurse coordinators, reminding participants that the nurses were originally hired to train and mentor nursing home staff. In practice, however, the numerous recruitment barriers translated to hours and hours spent on recruitment.

As a result, Ms. Blume took over recruitment. Once recruitment was centralized, efficiency increased and the nurse coordinators were able to return to their original roles. (Figure 1, at right, illustrates the dramatic increase in the number of nursing homes trained after centralized and rolling recruitment were both implemented.)