Table 3 Three interlinked programme theories

Motivation: Mandates and incentives for MDS completion combined with MDS training and clinician involvement for care home staff motivates staff to complete MDS for residents and use this as the basis for discussion and care planning to identify residents’ needs and review care.

Frontline staff monitoring: Completion of the MDS is built into the working practices, monitoring, and record systems of all staff (including visiting clinicians) involved in residents’ care, with junior staff contributing to data entry. This creates an accessible comprehensive account of residents’ needs, supports continuity of care, especially in instances of residents who cannot respond verbally because of cognition, language, or cultural background.

Embedded recording systems: When staff MDS recording systems are embedded as part of the care home approach to collecting resident data and staff are skilled in using digitally based systems to record residents’ needs as part of a person-centred care process the accuracy and relevance of data will reflect residents’ experiences and be used as the basis for care planning and review and reduce time away from providing care