Sustainable care improvement programs supported by undergraduate health care education

Background: The Care for Better Region program was developed to achieve sustainable care improvement focusing on fall prevention. Key ingredients involved improvement teams developing and implementing a falls reduction plan, Practice Development; facilitation of improvement teams by lecturers and undergraduate health care students; an implementation phase. This study evaluates the impact of this program on: (1) the number of falls incidents, and (2) the sustainability of care improvement practice. Methods: A realist evaluation design was used. Nine improvement teams participated in the Care for Better Region program. Staff members registered falls incidents in two measurement cycles in the participating teams (N = 143 older adults) and in a control group (N = 93). Data collection on improvement sustainability involved participative observations, interviews, logs of students and lecturer coaches, minutes and evaluations. Results: The falls incidents on the participating wards decreased over 12 months from 13.3% to 1.4%. At the control wards they stabilized. Sustainability of improvement practice: (1) Involvement of improvement teams was enhanced by measurements of falls incidents. However, involvement of ward staff was difficult to accomplish; (2) Students, lecturer coaches and project leaders of the improvement teams learned how to involve stakeholders, implement project management, and how to prevent falls incidents; (3) Network facilitation was promoted by the central meetings. The project leaders’ meetings continued after the project; (4) Students facilitated the improvement teams. The change of students after six and twelve months inspired the teams to renew their focus. Conclusions: This exploratory realist evaluation study shows how the Care for Better Region program improved sustainability of falls incidents reduction. The program also had a positive impact on the sustainability of improvement practice. Nursing education should focus on the development of innovation and facilitation skills in students. Nursing practice may improve by interdisciplinary collaboration with undergraduate health care education in care improvement programs.