• Alistair Hewison, Frances Badger, Collette Clifford, and Keri Thomas.
• School of Health Sciences, University of Birmingham, Birmingham, UK.
• J Clin Nurs. 2009 Jun 1;18(12):1756-65.

AimThis paper reports findings from a study which investigated the introduction of the Gold Standards Framework for improving end-of-life care into care homes in England.BackgroundThe Gold Standards Framework was developed in primary care to improve the care provided for people at the end-of-life. Following its successful introduction to this setting it was adapted and implemented in care homes.DesignA case study approach was appropriate for this study of a care programme into a 'real life' setting.MethodFourteen managers participated in an initial telephone interview. Ten of these homes participated in the case study phase and 61 staff participated in individual or group interviews. Seven residents and three relatives participated in face to face interviews. Qualitative data were analysed in line with the template approach. Survey data were also analysed and a validated Teamworking Questionnaire was used.ResultsIt was found that teamwork is central to the successful introduction of the Gold Standards Framework in Care Homes. Good staffing levels and management support were also perceived to be key factors in homes where the Framework became established.ConclusionEffective teamwork was necessary for changes in end-of-life care to be achieved in the care homes. If end-of-life care and other improvements in practice are to continue, teamwork will need to be supported and developed.Relevance To Clinical PracticeEffective teamwork appears to be a pre-requisite for successful implementation of new programmes of care. Organisations wishing to implement such programmes should assess the quality of teamwork and may need to address this first.

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