Since 2019, long-term care facilities (LTCFs) in Switzerland have been required by the Federal Insurance Law (KVG, Art. 59a) to report data for the calculation and public reporting of medical quality indicators (MQIs) in four clinical domains: polypharmacy, pain, malnutrition, and physical restraints. This data serves both for monitoring care quality at the national level through public reporting and for internal quality development. Contextual analysis showed that various quality development methods are already known and used in Swiss LTCFs. However, significant challenges remain: limited resources, time constraints, and restricted access to MQI data hinder effective use. Facilities reported a greater need for support in using MQI data. They also expressed interest in peer networking, structured support for applying quality methods (such as Plan Do Check Act cycles (PDCA)), and practical tools such as training, best-practice examples, and additional resources. Residents and relatives also expressed a strong interest in being more involved in decision-making and care quality discussions.

The overall aim of the current study is to test a quality development training programme that supports LTCFs in using MQI data for continuous data-driven care quality development.

The study is structured into three thematic areas:

1. MQI Results Literacy - Supporting LTCFs in interpreting MQI reports and benchmarks.
2. Impactful Actions - Supporting LTCFs to translate MQI results into concrete quality development actions using PDCA cycles.
3. Sparking Culture - Integrating data-driven quality development into everyday practice and fostering a culture of continuous development, with a strong emphasis on strengthening the involvement of residents, relatives, and leadership.

The study follows a train-the-trainer strategy. Trainers instructed by the NIP-Q-UPGRADE research team provide structured training and coaching to Quality Leaders and management representatives of LTCFs. Quality Leaders then support their co-workers in quality development. The training programme consists of online and in-person trainings, training materials, practical tools, a website, guided tasks for facilities, and an email helpdesk for ongoing support.

Study outcomes: This sub-study of the NIP-Q-UPGRADE programme aims to assess the acceptability, feasibility, fidelity, and costs related to the training programme, both at the facility level and at the trainer level.

A one-group experimental study is performed including a multiple methods evaluation.

Participants were recruited at two levels:

• the trainers responsible for delivering the training to the Quality Leaders and the Managers from the long-term care facilities,
• LTCF who test the training programme, select the Quality Leaders and Managers to participate in the training and who will elaborate and test a data-driven quality development project based on one MQI with the PDCA cycle within their facility.

The external training providers have experience in training staff in long-term care facilities. They have been instructed by the research team (February 2025) on how to conduct the developed training for facility Quality Leaders and managers. The trainings are conducted in three languages all regions of Switzerland. The research team informs the training participants about the study and the data collection.

At facility level, six to twelve LTCFs per Swiss language region (German, French and Italian speaking) were recruited between November and December 2024 (25 facilities in total over all language regions). At least two persons per facility will be trained between March and June 2025 to act as a Quality Leader or a Manager and perform tasks (1 full day in-person training and one peer-to-peer online meeting (2h) for managers; 2 full day in-person training onsite, two online workshops (3-4h), and two peer-to-peer online meetings (2x2h) for quality leaders.

In LTCFs the investigators aim to collect data from the quality leaders, the managers, the direct care staff, the broader staff and the residents and relatives. All individual participants will be asked written consent for data collection. This study examines the tested "training and support programme" during a 3-months interval, from end of March until June 2025. Data will be collected between March 2025 and August 2025.

At the training provider level

Quantitative data:

Activity logs: The costs of organizing and delivering the trainings will be assessed by using activity logbooks filled in continuously by the staff organizing and conducting the training (March to June 2025)

Qualitative data:

Group discussion: Acceptability, feasibility, fidelity, and adaptations to the training and support material, and barriers and facilitators to the implementation of the training will be assessed through group discussions with the staff involved after each of the training sessions (March to June 2025, in total 21 interviews or group discussions, 7 per language region).

At the long-term care facility level Staff level

Quantitative data:

Online survey: Acceptability, feasibility and fidelity will be assessed via surveys of involved staff at different levels in March 2025 (quality leaders and managers) and in June 2025 (quality leaders, managers, care staff and broader staff). The surveys will also ask for background information on the facilities and participants. Survey data will be collected in a secure online electronic data collection platform (REDCap).

Activity logbooks: Costs associated with the implementation will be assessed by using activity logbooks filled in by the quality leaders and managers and salary categories.

Qualitative data:

Focus groups: Acceptability, feasibility, fidelity, and adaptations to the toolkit, and barriers and facilitators to implementation will be assessed through focus group per language region per staff group mixing facilities:

1. 1 focus groups with quality leaders (June 2025, 1 per language region)
2. 1 focus groups with nurses and care staff exposed to the training and support program (June 2025, 1 per language region) Residents and relatives' level

Qualitative data:

Focus groups or interviews: Experiences, perceptions, expectations regarding their involvement in quality development during the pilot.

Inclusion criteria:

1. Trainers:

   1. with competence in training staff of LTCFs
   2. with knowledge. on the current MQIs and PDCA cycle.

2. Long-term care facilities:

   1. with a cantonal recognition as a residential long-term care facility
   2. willing to implement the training and support program
   3. which can nominate at least one quality leader and one management representative

3. Quality leaders:

   1. Long-term care facility employees motivated to take up the role
   2. having sufficient knowledge of the residents, infrastructure and care processes in the facility.
   3. Ideally with experience in leadership, coordination, experience in care, datas, e.g., nurse, nurse expert, quality manager, clinical nurse specialist.

4. Management representative:

   1. any level of management staff in long-term care facility e.g., Members of the direction, health, director, nursing managers, ward leaders, facility or department managers.
   2. directly involved in supporting the implementation of the toolkit or exposed to its content

5. Nursing and care staff:

   1. Any level of nursing or care staff e.g., registered nurses, licensed practical nurses, nurse aids, care and community health assistant, providing direct care on all the MQI themes and are in direct dialogue with residents and relatives
   2. exposed to the content of the toolkit (i.e., participation in an interprofessional meeting, as a key person to co-elaborate the quality development project, participating in the testing phase of the quality development project).

6. Broader staff:

   1. Any level of broader staff e.g., non-clinical staff (e.g. sociocultural, catering, hotel service, occupational therapist, chaplaincy, stewardship, administration, technical department, dietician, medical doctors, socio-cultural team, ...), who are involved in quality goals.
   2. exposed to the content of the toolkit (i.e., participation in an interprofessional meeting, as a key person to co-elaborate the quality development project, participating in the testing phase of the quality development project).

7. Residents and relatives:

   1. All residents and relatives of the participating facilities who are exposed to the content of the toolkit (i.e., brochure, participating in the workshop for residents and relatives).

Exclusion criteria:

1. LTCFs that are participants of the study "Data Quality and National Quality Indicators in Long-term Care Facilities: a Validation Study and Evaluation Study"