Discussion
EVENTS, EVENT
The study results revealed that organizational budgets, and underpinning contractual and financial requirements, influenced whether managers and/or physical therapists considered it was possible to embed a falls prevention exercise program as standard practice in LTC after the cessation of the research program. Identifying these factors highlights to designers of future falls prevention initiatives that on-going funding, as an aspect of delivery and maintenance, must be considered. This evidence also illustrates to policy makers that service specifications are used as drivers of care delivery and that identifying and addressing key health issues such as falls prevention should be considered in the wording of contractual documents.Healthcare can be considered a complex adaptive system, as it comprises different components that are dynamically inter-related, changing in response to events. In this study facilities, organizations and the Government are system components however, each is also its own system. With this in mind, a complex adaptive systems view was taken and SUp considered as an event occurring in the complex adaptive system of the NZ health system [In NZ, means testing is used to determine the amount of government subsidy paid to a LTC facility for a person’s residency. Most residents receive a form of subsidy [Considering the financial environment, growing care demands from increasingly frail residents and the drive for fiscal responsibility, if physical therapy is not understood and valued, it is likely that management either will seek cheaper methods of delivering SUp or not continue it at all. Delivering SUp without increasing costs saw participants adapting the intervention for their context [The research funding allowed the delivery SUp to be prioritised; that the program ceased when funding ended was not surprising. When an intervention (SUp) is introduced to a complex system (LTC), the system realigns to accommodate the new event, often at the expense of another component within the system. In the LTC facilities that ran exercise programs prior to SUp, they were typically only 30 minutes long. For the SUp classes to be accommodated, these class times were gradually increased. In facilities that had not run classes prior, the SUp classes were additional as the extra staff time was paid for and the physical therapist’s usual case load was not affected. When funding was stopped status quo returned to the system (LTC), with physical therapist applying some elements of SUp to their work but not delivering SUp as designed. The sustainability of falls prevention programs beyond external funding is an ongoing problem [