Abstract
Leadership has been shown to have a positive influence on the sustainability of programs and innovations in long-term care (LTC) homes. This research focused on the relationship between leadership and the sustainability of a dementia-specific behavioural training program (Gentle Persuasive Approaches Program or GPA) for staff in LTC homes. Four focus groups with nursing aides (NAs) and 17 semi-structured interviews were completed with Directors of Care, Administrators, Registered Nurses, GPA Coaches, and a Clinical Nurse Leader were completed in a retrospective study in five rural LTC homes. Document reviews, direct observations, and 15 semi-structured interviews were completed with staff from all departments in two rural LTC homes prospectively over 15 months. Leadership was influential in the sustainability of the GPA program in the seven LTC homes. In low sustainability homes, GPA was not regarded as a priority by the formal leaders. They did not attend the training and it was viewed as “just another program” to complete. Staff were afraid of retribution by co-workers and leaders if they practiced GPA. In the medium sustainability homes, leaders verbally supported the GPA program and attended the training but the home’s culture was institutional. Leaders were seldom on the floor to role model or coach staff in using the GPA skills. Leaders in the high sustainability homes created a culture that was person-centred and where practice change was a top priority. Formal leaders in these homes displayed more advanced facilitation and leadership skills than leaders in the medium and low sustainability homes.