The process of implementing culture change across a city-operated long-term care home and the importance of stakeholder engagement.

This article describes the Quality Improvement (QI) initiative of a culture change model, CareTO. CareTO is a made-in-Toronto, resident-driven, person-centred approach to care that was implemented across all units of a City of Toronto-operated Long-Term Care (LTC) home during the COVID-19 pandemic. The City of Toronto's Seniors Services and Long-Term Care (SSLTC) Division partnered with an external QI team to support the implementation of CareTO at the pilot site. This team employed a multi-method approach (fact-gathering conversations, stakeholder survey, and meeting) to understand how residents, families, and professionals defined CareTO, and identified implementation facilitators, barriers, and priorities. Emerging findings were shared with SSLTC to inform the delivery of CareTO in real time. Results suggested that stakeholder engagement, and collaborations between external partners and municipal governments are an effective means of mobilizing implementation initiatives by encouraging reflection, developing a shared understanding, and refining objectives.