Barriers and facilitators to adopting functional maintenance initiatives for acutely hospitalised older adults.

Purpose: To determine perceived barriers and facilitators to adopting and sustaining functional maintenance initiatives for acutely hospitalised older adults.

Methods

A qualitative descriptive study using semi-structured interviews and initiative observations was conducted at five international and four Victorian acute hospitals. Purposive snowball sampling was used to recruit clinical, research, managerial, and volunteer staff who were involved in implementing and/or sustaining the initiatives. Emergent themes from audio-recorded interviews were developed and categorised as staff-perceived barriers or facilitators to adopting and sustaining initiatives using inductive thematic analysis.

Results

Twenty-seven medical, nursing, allied health, and volunteer staff participated in interviews. Staff resistance and turnover, especially the loss of staff considered to be change drivers, were commonly reported barriers. A lack of professional autonomy was perceived to threaten longevity in allied health assistant led initiatives. Facilitators included support from change drivers, use of collaborative approaches and opinion leaders, integration of initiatives into usual care, alignment with institutional priorities, use of "internal" evidence to justify ongoing institutional investment, and use of an accompanying training and evaluation strategy.

Conclusions

Successful adoption and sustainability of functional maintenance initiatives for acutely hospitalised older adults are influenced by a range of "non-clinical" factors, such as the ongoing effectiveness of change drivers. These factors should be considered when deciding upon future innovations to address functional decline and its associated economic impact.IMPLICATIONS FOR REHABILITATIONConsidering barriers and facilitators to successful adoption of functional maintenance initiatives is important for implementing evidence-based practice targeting the prevention of functional decline in acutely hospitalised older adults.Change drivers who remain actively involved are core facilitators of successful functional maintenance initiative adoption.Credible "internal" evaluation data are essential for ongoing sustainability of functional maintenance initiatives.Continual staff training is a key feature of successful functional maintenance initiatives.Perceived financial barriers to adopting functional maintenance initiatives can be overcome by other facilitating influences.