Background Implementation of organisational change is recognised to be challenging. This is particularly true in a care home where organisational, financial and care barriers are known to exist. Early research demonstrated that education in palliative care alone did not achieve organisational change. Recently, ‘high facilitation’ of end-of-life care programmes, alongside a multi-layered approach to learning, has been identified as a research-based model to support organisational change in this setting. With growing numbers of people dying in care homes providing care to meet this need is now essential.

Methods A Care Home Project Team (CHPT) was commissioned to deliver an end-of-life care programme within nursing care homes (NCHs) in 2008. The CHPT provides ‘face to face’ high facilitation to NCHs to implement and then sustain the programme in practice. Both implementation and sustainability is based on facilitating individual learning (a single person), organisational learning (the NCH staff and external professionals) and appreciative learning systems (learning across NCHs).

Results All 74 NCHs and all commissioners have remained engaged with the programme. Currently 27 NCHs are implementing and 45 sustaining an end-of-life care programme (the remaining two NCHs have closed). Monthly audit data show clear improvement with 75% residents dying in the 74 NCHs in 2015/2016 compared to 57% in the 19 NCHs at the outset in 2007/8. Over time the delivery of this initiative has varied; from a practice development model, to one incorporating clinical care: vocational qualifications and more recently piloting the use of information technology. What has remained core within the sustainability initiative is the multi-layered approach to learning regardless of its format.

Conclusion Within a NCH the on-going provision of multi-layered learning offers the potential to develop and sustain the delivery of high quality end-of-life care that is now required within this care setting.