Model for Change (Text Description)

TeamSTEPPS Long-Term Care Instructor Guide

The Long-Term Care version of TeamSTEPPS adapts the core concepts of the TeamSTEPPS program to reflect the environment of nursing homes and other other long-term care settings such as assisted living and continuing care retirement communities. The examples, discussions, and exercises below are tailored to the long-term care environment.

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The Model for Change is a flowchart that begins with Transformational Change Factors. Change factors are divided into three levels and two columns, A and B. On the organizational level are a) safety culture and transparency/trust and b) systems-efficacy and learning environment. On the leadership level are a) lead the way; establish the sense of urgency; create a vision or gain—plan and prepare; develop a coalition—assess environment and b) communication process; enable change to last; empower others to act; short term wins; and sustain/improvement. On the individual level are a) pre-training experience and b) self efficacy and training motivation.

Column A of Transformational Change Factors flows down to pre-training measurement, which includes knowledge, skills, and attitudes. There is a bidirectional flow from Column B of Transformational Change Factors to post-training measurement, which includes knowledge, skills, and attitudes, and to training transfer.

An area labeled Interventions is below Transformational Change Factor, between column A and B. A third arrow flows down from Transformational Change Factors to Intervention.

Pre-training measurement flows through level 2 evaluation to the Intervention section of the chart. Intervention includes tools and methods (linked with a bidirectional arrow) which both flow to training. Training includes training objectives: competencies— knowledge, skills, and attitudes. Competencies are at level 1 evaluation.

Interventions flow toward post-training measurement (level 2 evaluation) and to training transfer (level 3 evaluation).

Transformational Change Factors and the Intervention section both flow toward outcomes: (illegible) patient outcomes, improved staff and patient satisfaction, improved processes, staff retention and decreased claims. Outcomes include level 4 evaluations and sentinel event. An arrow leads from outcomes, through report card, back to Transformational Change Factors. An arrow leads from outcomes back to training in the interventions section.

Additional bidirectional arrows connect report card to sentinel event, and connect interventions to report card, level 2 evaluation, and level 3 evaluation.

Sources: Salas E and Cannon-Bowers JA. Training and retraining: A handbook for business, industry, government, and the military. Tobias S and Fletcher JD (editors), McMilan: NY, 2000: 312-335.

Kirkpatric, D. Model for summative evaluation. 1976.

Kotter JP. Leading change. Boston, MA: Harvard Business School Press. 1996.

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Page last reviewed October 2014
Page originally created October 2012
Internet Citation: Model for Change (Text Description). Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD.