The influence of organisational context on staff attitudes to the implementation of the Carer Support Needs Assessment Tool (CSNAT) intervention in end of life care

Background: The Carer Support Needs Assessment Tool (CSNAT) intervention facilitates family carer support during end of life care. It involves a change in practice from a practitioner-led to more carer-led assessment process. An important precursor for practice change is the attitude to the new, evidence based practice (EBP), e.g. whether its benefits are perceived to outweigh the costs in terms of time and effort. Aspects of the organisational context, such as leadership strength and how facilitative the culture is to change, may influence staff attitudes to the EBP implementation.
Aim: To examine the relationship between the context of the service and staff attitudes to the CSNAT intervention prior to implementation.
Methods: The implementation of the CSNAT was investigated in 36 palliative/end of life care services within the UK. Survey packs were administered to practitioners at each service and included: (i) The Alberta Context Tool (ACT) to assess the overall context e.g. supportiveness of the culture, influence of leadership, satisfaction with staffing levels, and (ii) a survey to assess practitioner attitudes to the CSNAT. Correlations between the ACT concepts and practitioner attitudes were analysed.
Results: 163 surveys from a range of professionals across 31 services were returned. A more positive organisational ‘culture’ which is supportive of staff development and balances best practice and productivity was associated with higher ratings of the appropriateness and acceptability of using the CSNAT approach. A more positive rating of ‘staffing’ e.g. sufficient staff levels to deliver the care required, was also associated positively with ratings of appropriateness.
Conclusion: Within palliative care it is important to assess the organisational context into which new, evidence-based practice is introduced, in particular those elements which are amenable to change. Modifications to these contextual elements during the process of implementation have the potential to enhance practitioner readiness and motivation for change.