Date Published: April 3, 2019
Publisher: Public Library of Science
Author(s): Ying-Ling Kuo, I-Ju Chen, Sandra C. Buttigieg.
The ageing population is a powerful and transformative demographic force. The World Health Organization (WHO) has encouraged the development of an age-friendly hospital (AFH) network. However, no specific implementation strategies or best practices of AFH standards have been produced. This study sought to apply Kotter’s change model to the elements included in a successful AFH certification process and to evaluate the changes in employees’ knowledge of ageing and their attitudes toward the elderly. This was an observational study that utilized a pre- and posttest design, before and after an age-friendly hospital certification process was implemented. Participants were 163 hospital employees in Taiwan, who completed both pre- and postquestionnaires. The self-administered online questionnaire consisted of three sections: The Facts on Ageing Quiz, the Geriatric Attitudes Scale, and a demographic questionnaire. Following introduction of the intervention, the change process began, and later Kotter’s model was brought in as a descriptive framework. The results showed that Kotter’s eight-step framework is a good choice for thinking about how to change practice and make healthcare more age-friendly. Employee knowledge of ageing and their attitudes toward the elderly improved after this certification process. Appointing a chief executive officer, forming a steering committee, obtaining interdepartmental and interdisciplinary cooperation, and “soliciting support” for new policies from all employees, were identified as key factors influencing the success of age-friendly hospital (AFH) certification. This is the first study to apply Kotter’s eight-step framework of organizational change to an AFH certification process.
The ageing population is a powerful and transformative demographic force. In 2015, the number of elderly individuals (over 65 years) worldwide was 901 million, comprising 12.3% of the total population . By March 2018, the proportion of elderly population in Taiwan reached 14.05%, officially entering the “Aged Society.” The World Health Organization (WHO) has advocated the importance of developing age-friendly environments by introducing the principles of proactive age-friendly healthcare . In particular, the WHO World Report on Ageing and Health provides a framework to guide countries in taking concrete actions toward improving the lives of the elderly worldwide . The International Network of Health Promoting Hospitals and Health Services supports the development of “Age-friendly Health Care”  to address the specific needs and capabilities of different patient groups for health promotion in hospitals and health services. Specific standards and self-assessment tools for particular target groups have been developed—for “Health Promotion for Children & Adolescents in and by Hospitals,” for “Age-friendly Health Care” , and for “Migrant-friendly and Culturally Competent Healthcare.” The WHO has also encouraged the development of an Age-Friendly Hospital (AFH) care network [6,7], defined as a system that can accommodate the elderly by providing barrier-free mobility and enhancing active ageing [6,7]. Providing an appropriate, pleasant, supportive, respectful, and accessible AFH for elderly patients is a critical component of the age-friendly environment . Therefore, the mission of an AFH should be to provide a comprehensive and appropriate care environment for elderly [8,9]. However, no specific implementation policies or best practices of AFH standards have been produced.
The effect of the change intervention was actually demonstrated within six months of implementation of the intervention. The Guiding Coalition becomes a critical force in identifying significant improvements that can happen between 6 and 18 months . Most people will not stay on board for the long term unless they see compelling evidence in 12 to 24 months that the journey is producing the expected results. Without short-term wins, too many people give up or join the ranks of those who resist change. For example, the new program was adopted about six months into the effort because it met multiple criteria . The change usually takes 6 to 24 months [11,35], and our study was effective within 6 months of the intervention.
This study applied John Kotter’s change model to describe the AFH certification process and strategies. Kotter identified leadership (appointing a chief executive officer), forming a steering committee, obtaining interdepartmental and interdisciplinary cooperation, and “soliciting support” for new policies from all employees as key factors influencing the success of an organizational change plan . The staff’s current level of understanding and attitudes and the impact of training experiences are important factors to consider when planning curricular changes to accomplish these objectives . Because AFH certification was not completed the previous year, we interviewed our leaders to determine that these were the important factors. Further, results from the study indicated that forming a promotion committee, employing a nurse manager as the CEO, enacting interdepartmental and interdisciplinary cooperation, and soliciting support from all employees for new policies and decision-making strategies were key factors influencing the success of age-friendly care. Employee knowledge of ageing and their attitudes toward elderly improved after this certification process.