What is INFORM?

The INFORM (Improving Nursing Home Care Through Feedback On PerfoRMance Data) model supports long term care managers to make change and improve performance by working on modifiable elements within their care units. It is also adaptable to other improvement targets. 

In the original INFORM intervention study, we used different intensities of facilitated workshops. In the workshops, researchers and trained facilitators worked with care managers on goal setting, action plans, measurement, and other ongoing change activities in their facilities.

INFORM Intervention

We successfully completed the original study—a pragmatic randomized controlled trial of INFORM—including a comprehensive process evaluation. In that study the main outcome worked on was the engagement of care aides in decision-making. The INFORM trial focused on the goal of improving communication by coaching care managers to increase care aides’ involvement in the planning process (formal interactions) around resident care, for instance through care aides’ participation in care conferences. 

The trial was successful: the intervention improved the engagement of care aides in decision making. The lower intensity approach (virtual) worked as well as the higher intensity approach. Our follow-up findings two years later show sustainability of the improved outcome and early signs of spread. The elements of success included:

• Greater care aide involvement around resident care 
• The work culture becoming more supportive 
• An increase in feedback activities 

In 2022-20223, TREC worked with Michael Smith Health Research BC to adapt INFORM for operational use and implement it more widely in a cohort of 26 homes across British Columbia, focusing again on care managers. Managers and their teams worked on one of three areas prioritized by managers, with teams having the an opportunity to meet and network through workshops, strengthening peer to peer connections. Regional Practice Leads (RPLs) - one in each of BC's five Health Authorities - were oriented to the approach and facilitated each home's use of INFORM. The implementation was evaluated by TREC, supported by Michael Smith Health Research BC and Healthcare Excellence Canada. 

Currently, INFORM is being used in Phase 2 of TREC's Manager Resilience project. Once again, the implementation is being formally evaluated, with initial results expected by early 2027.

Key Findings

• The INFORM model can facilitate long lasting improvement in care units 
• A lower intensity approach (more virtual contact) works as well as a higher intensity approach (more face to face contact)
• Units differed in their implementation of INFORM activities due to factors such as resources (e.g., time and staff) and staff buy-in
• Care mangers’ attendance at workshops was integral to success. It also fostered networking and the sharing of strategies with care mangers in other facilities
• Care aides’ involvement in formal communications had a positive impact on residents, care aides, and care teams
• Care managers thought INFORM was feasible 
• Care mangers reported that the skills learned during their INFORM experience were transferable to other settings and problems

Publications and Presentations

Saeidzadeh, S., Minion, J.T., Bryan, S., Norton, P.G., & Estabrooks, C. A (2024). Evaluating real-world implementation of INFORM (Improving Nursing Home Care through Feedback on Performance Data): an improvement initiative in Canadian nursing homes. Joint Commission Journal on Quality and Patient Safety, 50(8):579-590.

Hoben, M., Ginsburg, L.R., Norton, P.G., Doupe, B.D., Berta, W.B, Dearing, J.W., Keefe, J.M & Estabrooks, C.A. (2021). Sustained effects of the INFORM cluster randomized trial: an observational post-intervention study. Implementation Science, 16(83), 1-14. 

Ginsburg, L. R., Hoben, M., Easterbrook, A., Anderson, R. A., Estabrooks, C. A., & Norton, P. G. (2021). Fidelity is not easy! Challenges and guidelines for assessing fidelity in complex interventions. Trials, 22(1), 1-13.

Hoben, M., Ginsburg, L. R., Easterbrook, A., Norton, P. G., Anderson, R. A., Andersen, E. A., Boström, A., Cranley, L., Lanham, H.J., Weeks, L.E.,  Cummings, G., Holroyd-Leduc, J.M., Squires, J.E., Wagg, A.S. & Estabrooks, C. A. (2020). Comparing effects of two higher intensity feedback interventions with simple feedback on improving staff communication in nursing homes—the INFORM cluster-randomized controlled trial. Implementation Science, 15(1), 1-16.

Ginsburg, L. R., Hoben, M., Easterbrook, A., Andersen, E., Anderson, R. A., Cranley, L.,  Lanham, H.J., Norton, P.G., Weeks, L.E. & Estabrooks, C. A. (2020). Examining fidelity in the INFORM trial: a complex team-based behavioral intervention. Implementation Science, 15(1), 1-11.

Hoben M, Norton PG, Ginsburg LR, Anderson RA, Cummings GG, Lanham HJ, Squires JE, Taylor D, Wagg AS, Estabrooks CA. (2017). Improving Nursing Home Care through Feedback On PerfoRMance Data (INFORM): Protocol for a cluster-randomized trial. Trials, 18:9.

Hoben, M., Ginsburg, L., Berta, W., Dearing, J., Norton, P., Doupe, M., Keefe, J., & Estabrooks, C.A. (2021, May). Sustainability of INFORM (Improving Nursing Home Care Through Feedback On performance data): A complex team-based improvement intervention. Oral presentation at the Canadian Association of Health Services and Policy Research (CAHSPR) Annual Conference: Virtual.