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Promote and Sustain/Expand Value

Investment and opportunities do not stop once the Living Classroom is up and running. Rather, the focus of the work shifts from development and implementation to promoting the LC, sustaining momentum, and building on that base for continuous innovation and quality improvement.

This building block describes four strategies to promote and maintain the momentum of the Living Classroom:

  • promote the LC and develop strong connections with community organizations;
  • monitor success of the LC and leverage shared learning opportunities to understand how to build on strengths;
  • examine potential to grow; and
  • expand the LC concept to other programs.

Each of these strategies is described below using examples from our own experience.

“Forecasters predict there won’t be enough staff to meet the health care needs of our growing aging population. From our experience, Living Classrooms are a successful workforce development strategy to address this upcoming challenge. We are experiencing increasing student interest for the Living Classroom programs and have more graduates seeking employment in LTC. I’m optimistic that Living Classrooms are heading us in the right direction.”

— Mary-Lou van der Horst, Director, Schlegel Centre for Learning, Research and Innovation in Long-Term Care

Strategy 1: Promote the Living Classroom and Develop Strong Connections with Community Organizations

Strategy 1: Promote the Living Classroom and Develop Strong Connections with Community Organizations

Promoting the LC within the community is an important strategy to inform others about this unique learning opportunity, especially towards increasing student enrollment, expanding student placements and enhancing staff team recruitment for LTC as well as community care. Promotion of the LC is important to:

  • inform prospective students of innovative learning opportunities;
  • create opportunities to build new relationships;
  • provide workforce development strategies for the LTC sector;
  • enhance the reputation of the LTC and the PSE; and
  • differentiate the LTC home and the PSE from others.

When considering an active promotion strategy for the LC, a few steps might be helpful:

Step 1: Determine the importance and benefits of promotion of the LC.
Step 2: Identify the target audience (i.e. high school graduates, residents and families, LTC homes, PSWs, etc.). Each group will require a different approach.
Step 3: Articulate the messages to be shared with the target audience.
Step 4: Determine the timing of the promotion.
Step 5: Identify the communication/media channels you would like to use to promote your LC. In our experience, we have used several communication strategies:

  • the PSE course calendar;
  • the PSE and LTC website;
  • PSE/LTC recruitment fairs;
  • Facebook, Twitter, Instagram, and YouTube;
  • physical bulletin boards and signage along busy intersections and on the LTC site;
  • brochures and newsletters;
  • through PSE and LTC professional organizations;
  • by attending conferences (i.e., presentations, booths);
  • radio advertisements;
  • fundraising; and through
  • online webinars.

Step 6: Evaluate and monitor the effectiveness of the promotional strategies.

Once the above steps have been discussed within your collaboration, a promotion plan needs to be developed. A promotion plan is a tool used to document and track all promotional activities and successes. Several excellent resources and tools are available to help you develop a promotion plan.

Developing a Promotion Plan – Resource List

Developing networks with community organizations is critical to ensure shared values and sustaining the LC.

  • Our Canadian health care system depends on inter-agency cooperation, communication and collaboration. Community connections within the LC are essential to promote these relationships and collaborations and ensure that the LC is a community resource.
  • On a practical level, effective relationships with community organizations are critical to manage student placements during infectious outbreaks in LTC homes, since an outbreak in one setting impacts the students learning and travel across sites and at the LC. Community connections can be developed through outreach by the LC Coordinator as well as by holding open houses and events at the LC.

Presenting LC experiences at conferences is another opportunity to share experiences. For example, on November 9th, 2015, we presented at the Ontario Centres for Learning, Research and Innovation (CLRI) conference in Ottawa, Ontario. The presentation discussed the design of the LC, the curricular programs in the LC, and the evaluation. This is one example of promotion, where other LTC and PSE organizations interested in the LC can receive information and engage in discussion about the LC concept and its implementation.

Strategy 2: Monitor Success of the Living Classroom and Leverage Shared Learning Opportunities

Strategy 2: Monitor Success of the Living Classroom and Leverage Shared Learning Opportunities

Monitoring success and evaluation are important components of every educational program and delivery approach as this identifies the program’s strengths and opportunities for growth. Structured evaluation measures the impact of the LC on its students, stakeholders, the community, the faculty, LTC team members, residents and families. An evaluation plan supports the collaborating organizations to monitor the progress towards the organizational goals and identify areas for improvement. An evaluation plan can also provide a framework for communication to inform the various stakeholders of the values of the LC, justify the need for further funding and support, and empower all to continue working towards the organization’s desired goals and outcomes.

When making decisions about promoting and sustaining the LC, it is important to understand what processes are contributing to the program’s success, and how these processes could be improved in order to promote additional positive outcomes. This is done through the use of formative evaluation (i.e., process evaluation). A summative evaluation (i.e., outcome evaluation) is used to demonstrate the long-term outcomes of the LC. These types of evaluation are described below.

Formative Evaluation

Formative evaluation explores how the LC is making progress towards its goals in terms of its inputs and short-term outcomes by asking “what is working, what is not working, and what can be improved?” (Preskill and Mack, 2013). There are many ways to carry out a formative evaluation, including:

Knowledge, Attitudes and Practices surveys (KAPs) are used to reveal misconceptions or misunderstandings that could become obstacles to successful implementation of the LC. These surveys can be distributed over the course of a year (i.e. fall semester, winter semester, and spring semester) in any kind of LC program. KAP surveys may be used to identify needs, problems and barriers in program delivery, as well as solutions for improving quality and accessibility of services. All Ontario PSE programs employ the Key Performance Indicator Survey. Information from this survey can be easily used to evaluate student’s perceptions of the LC program.

Classroom Assessment Technique (CAT) is a form of ungraded formative evaluation used by faculty to monitor student learning before and between summative exams or assignments. CATs can be used when seeking just-in-time feedback about the learning process in the LC, to provide information about student learning outside of traditional assignments (i.e., tests, paper, etc.) or help students to become better monitors of their own learning. Results from CATs can guide faculty and LTC team members in fine-tuning their teaching strategies to better meet student needs.

Satisfaction surveys give stakeholders (students, faculty, LTC team, residents, families, employers, etc.) an opportunity to rate their level of satisfaction with the LC. These surveys can be analysed to determine where there are gaps or areas for improvement in the LC. Satisfaction surveys can be handed out weekly, monthly, or yearly, depending on how much information you are looking to attain and if you are looking for a certain trend.

Reflection journals can be used to provide feedback about a program or personal experience in the LC. Students, LTC team members, and resident and families can write these journals at any point in time. Evaluators can review these journals and carry out a thematic analysis to determine common responses or phrases people use to describe their experiences in the LC.

Interviews are a great way for individuals to freely talk about their LC experiences. Interviews can be used to inform decision making, strategic planning and resource allocation.

Post-graduate tracking involves collaborating with the Alumni Office of the PSE to follow graduates from the LC. This method can reveal valuable information to improve the LC, such as:

  • In which settings or sectors are LC graduates employed?
  • In which geographic areas did LC graduates find employment?
  • How soon did LC graduates gain employment?
  • Do LC graduates hold full-time, part-time, or casual employment?
  • Are employers willing to provide feedback on career preparedness of their new hires?
Example of Formative Evaluation from the Schlegel Village-Conestoga College Living Classroom Experience

Dr. Veronique Boscart and her colleagues used several formative evaluation techniques to monitor the impact of the LC and to identify areas for improvement. Some of these techniques included focus groups, semi-structured interviews, student knowledge tests, employment surveys, LTC team, residents, and families’ satisfaction surveys, and Visual Analogue Scales to measure relationships. This data gathering has supported the identification of what’s working well, and changes needed to improve satisfaction and overall experience of the LC.

Summative Evaluation

Summative evaluation measures if the intended outcomes have been achieved to “judge it all worthwhile” (Preskill and Mack, 2013). There are many ways to carry out a summative evaluation, including an analysis of an annual Return on Investment, reviewing Key Performance Indicators, and reviewing student marks on final exams. Some formative evaluation techniques can also be used for summative evaluation.

Example of Summative Evaluation from the Schlegel Village-Conestoga College Living Classroom Experience

Dr. Veronique Boscart and colleagues completed a study called Enhancing Care of Seniors in Long-Term Care: Impact of a Living Classroom on the Education of Personal Support Workers. Using both formative and summative evaluation methods, Dr. Boscart and her colleagues have been able to demonstrate that the LC has had a positive impact.

For more information on Dr. Boscart’s evaluation study, please contact her through the Conestoga College directory.

In addition to learning from the above evaluations, the LC offers a great opportunity to close the gap between PSEs’ understanding and knowledge of LTC practice.

  • The Academic Team from the LC has information regarding current LTC practices to share with their colleagues at the main campus.
  • Simulated learning scenarios developed in the LC can be added to the curriculum of the program delivered at the main campus or can be integrated in the curriculum for other programs. In this way, new LTC care practices are mobilized into overall health care curriculum. This initiative is currently underway at the Village of Riverside Glen where a knowledge mobilization initiative is incorporating leading practices in culture change in LTC into the PSW curriculum of the LC. These experiences are shared with the overall PSW program at the end of each semester. The next opportunity to share the full cycle of learning, application and translation and influence provincial PSW curriculum will take place at provincial coordinators meetings.
  • The learning environment created in the LTC home hosting the LC is a welcoming environment for PSE faculty to collaborate on projects with LTC team members.

As a result of the LC relationships, team members in LTC homes can gain from their PSE by:

  • Enhancing adult education strategies and receiving in-service education curriculum; and
  • Collaborating on applied research projects, enhancing knowledge and skills to undertake projects to improve practice and create evidence-informed protocols for continual quality improvement.

Taken together, these strategies for mutual learning are one of the most important sustainability engines for a LC since needs and opportunities for new learning are endless. In addition, the rewards of mutual learning are significant to promote improved practices in LTC, create an environment of creativity and inquiry, and respect for each other’s expertise.

Strategy 3: Examine Potential to Grow

Strategy 3: Examine Potential to Grow

From our experience, the LC tends to start out small. However, once the LC picks up momentum and gains a reputation, increasing numbers of students may want to enroll into this program and other programs that are available in the LTC home. As well, additional alliances or community members (i.e. colleges, research organizations, and home care companies) might want to become part of the LC initiative. Yet, these exciting opportunities do require some strategic planning.

Depending on how fast the LC grows, there may be a point in time when the LC has reached its maximum capacity. At that time, the organizations have to decide to maintain the LC as is, expand the LC within the same setting, or relocate the LC to a new and larger location.

In 2009, the Schlegel Village-Conestoga College LC started with a PSW program based on the LTC sector workforce needs. In addition, the PSW program is a rather short (2 semesters) and straightforward program to deliver. This program also provides endless opportunities for intentionally integrated learning activities. The Schlegel Village-Conestoga College LC was expanded to include a PN program in 2012. The second LC at the Village at University Gates delivers both PSW and PN programming. The PN program at University Gates was a result of transferring the PN program from Riverside Glen. The PN program requires a range of learning resources that are not available in a typical LC. The LC has additional simulation resources which support the PN program, as well as planned continuing education initiatives at this site.

Some questions to consider in contemplating growth of the LC are listed below.

Assessing the Geographic Area and Target Audience

  • Does your community have more than one PSE (college/university) in your geographic area?
  • How many LTC homes, hospitals, community-based services, and home care organizations are in this geographic area?
  • How many students are attending college/university in this geographic area? (i.e., is your target market within your geographic area?)
  • How many older adults live in this geographic area? How many reside in LTC homes?
  • Where are the health care shortages in this geographic area (i.e. LTC homes, community health settings, home care)?
  • What municipal zoning by-laws must you be aware of, if locating the LC to a new location?
  • Will municipal zoning by-laws support the expansion of the LC?

Expanding or Extending your PSE Programs

  • What are the popular or in-demand programs for students?
  • What are the most needed PSE programs that the LC could offer in your area? (i.e., PSW, PN, other).
  • What professional development certifications can be offered in the LC (i.e., Gentle Persuasiveness Approaches in Dementia Care/GPA, Physical, Intellectual, Emotional, Capabilities, Environment, and Social/P.I.E.C.E.S)?
  • Will you increase LC programs per academic year or will you increase class sizes per program intake?
  • What program resources/materials will be needed?

Understanding LTC Needs

  • What skills do LTC homes expect new hires to come with? How can these be included into the LC programs?
  • Is LTC experiencing human resource issues? Is there an oversupply or undersupply of job applicants to certain positions?
  • Are there plans for LTC home construction or expansion?
  • Is there a shift in the LTC sector towards recognizing LCs as a best practice approach to educating the LTC workforce?

Hiring More PSE Faculty and Training LTC Teams

  • Will you need to hire more PSE faculty once the LC has been expanded?
  • Will you need to train more LTC team members?
  • What credentials/certification must they possess?

Financial and Legal Liabilities

  • Will financial plans need to be changed or updated to meet the new operating costs of the expanded LC (i.e. who will pay for what)?
  • What policies and SOPs will be adjusted or redefined (i.e. infection control, safety and security)?
  • Will you need to update the formal agreements once the LC has been expanded?
  • Will additional liability and insurance be needed?

Physical Changes

  • Will additional parking spaces be needed for more students attending the LC?
  • What design changes will be needed to make the LC an interprofessional working environment?
  • Will additional lockers be needed?
  • Is additional storage space needed to accommodate all program materials in the LC?
  • Will the LTC home need to implement a centralized student coordination service (i.e., to schedule classroom usage and lab space)?

The majority of these questions were raised when we decided to expand our LC in the Village of Riverside Glen, and when we decided to build a second LC at the Village at University Gates. It took approximately two years for our collaboration to develop plans for the second LC. Although this process was extensive and required further commitments to be made by both organizations, we believe that our shared values, resource commitments, annual planning, mechanisms for coordination, and win-win strategies made the promotion and sustaining of two successful LCs possible.

Strategy 4: Expand the Living Classroom Concept to other Programs

Strategy 4: Expand the Living Classroom Concept to other Programs

A last discussion point in the strategy of promoting and sustaining the LC is related to expanding the LC to include other programs beyond the PSW and PN programs currently offered. Our experiences suggest that full implementation of the LC concept is most successful with programs that do not need a range of specialized resources. Certificate programs such as PSW or specialty certificates like Gentle Persuasive Approaches can be delivered with the resources that are typically provided in a LC. It is more difficult to garner the necessary resources for more complex programs such as the PN program. We are able to offer the PN program in a LC format at the Village at University Gates in Waterloo because the Village is supported by specialty resources that are linked to the Schlegel Center of Excellence for Innovation in Aging. Here, the on-site resources support the PN program and a future vision of growth in continuing and specialty education.

At the same time, the LC philosophy and demonstrated benefits of high engagement between a PSE program and a LTC home have value in creating enhanced experiential learning opportunities for a broad range of PSE programs.

Figure 4 portrays many PSE programs which could benefit from enhanced practice-learning experiences in a LTC home. For example, the Paramedic Program, currently delivered as an on-campus program, could benefit from a couple of weeks of immersive learning. Older adults are the highest users of paramedicine services in Ontario (Stall, Cummings and Sullivan, 2013). Students in the Paramedic Program would benefit from experiential learning as it would allow for exposure to older adults in LTC settings, including those living with dementia. Paramedic students would also have the opportunity to engage with other health care professionals, which promotes team work and interprofessional communication in the health care workforce.

We have proposed a range of PSE programs that could benefit from exposure to a LC or a LTC home, varying from a brief exposure, to a couple of weeks to an entire program. The examples presented in Figure 4 are not meant to be inclusive, nor will this be necessarily appropriate in every LTC home. Some programs may require short interfacing periods with LTC, while other programs may consist of small groups of students with on-site mentors or preceptors.

Diagram of expansion opportunities for the Living Classroom
Figure 4: Expanding to Other Programs in the Living Classroom

The LTC Home can engage a variety of different PSE programs. Incorporating these programs within a LC creates an open atmosphere for interprofessional workforce preparation. Students, faculty, community members, and LTC team members (from different disciplines) are able to learn from one another and interact with each other, promoting workforce enhancement. The LC or LTC home can become a community resource centre with services that support community-based care and service delivery. And so, the LC becomes a place of knowledge mobilization for all.


Closing Remarks

From the initial discussions to a fully operational LC, we have asked ourselves if our work in developing, implementing, evaluating and sustaining the LC was worth it. The resounding answer is yes.

The LC has brought tremendous value to many stakeholders including the students, LTC team members, faculty, and most importantly, the residents and families. Students, faculty, and LTC team members have told us that the LC has had a substantial impact on their personal learning, and desire to work in LTC. Many of the graduates from the LC have gone on to careers working in LTC, demonstrating the capabilities that are directly relevant to the work environment of LTC. Some organizations, including Schlegel Villages, are refining their staffing models to align better with a learning culture that benefits both students and those working and living in LTC. The gerontology content in all of Conestoga’s programs has been enhanced substantially, with lessons learned in the LC initiative. Not only is Conestoga College producing graduates that have a stronger interest and are better prepared for careers working with older adults, but the college has also established strong professional development and continuing education programs to enhance the skills of those already working with older adults.

We truly believe that the Living Classroom has the potential to create a system-wide impact in not only seniors’ health care, but all education of future health care professionals working with a rapidly aging population. It’s our hope that this guide inspires others to embark on a future Living Classroom endeavor.

“Together We Learn, Together We Change”