Challenges of implementing and embedding a programme to improve care for older people with dementia on hospital wards.

The authors took part in a national research project that evaluated an intervention to enhance person-centred care for people with dementia in hospital. The Person, Interactions, Environment (PIE) programme involves staff observing care on a ward, focusing on these three areas. Findings from observations form the basis for introducing changes to ward practices. Implementing PIE led to improvements in practice but proved challenging in the context of the NHS. Sustaining the programme after the research required important features to be in place, in particular the presence of a 'driver' to maintain momentum, the support of the ward manager to encourage ward staff to take part and a degree of flexibility and persistence in the implementation of the programme. Staff expressed satisfaction from taking part in PIE, which continues to be used to improve care in this area of practice.