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Research and Projects

AHSN/PenCLAHRC Project - Analysing implementation in Acute Stroke and Patient Initiated Clinics (ASPIC)

Who is involved?

Theme: Evidence for Policy and Practice
Status: Live


It is difficult to generalise what approach to take when implementing improvements and new practice in healthcare due to differences in service context, meaning what works to change practice in one place may work partially or not at all in another. These differences may relate to personnel, organisational culture or structure, financial considerations, physical constraints and styles or absence of leadership, for example, or some combination of these. We do not need to reinvent the implementation wheel every time we work with a new organisation or team.  Although each setting is unique there are similarities across settings that allow established approaches to be employed, if we are able to understand the contextual differences and how to approach them.

The aim of this project is to help understand differences in context across two AHSN/PenCLAHRC supported interventions. Each intervention has been piloted and has already been shown to be effective and acceptable, these are:

1. Emergency treatment of acute ischaemic stroke

Work has been carried out at a single site and is ready to be implemented across the region. An ethnographic study of the processes involved in implementing the stroke project will be conducted,  which will involve interviews with individuals involved in delivery of the project and service provision  (i.e. clinicians, managers, administrative staff and researchers), observation of formal and informal meetings and analysis of documents.

2. Patient-initiated clinics (PICs)

PICs have been implemented in rheumatology and will now be applied in other clinics across the same site. Additional support will be provided to the existing ethnographic evaluation and implementation that forms part of the PICs project, by joint working with the qualitative researcher, reading and analysis of data, as well as conducting additional purposeful interviews.

By analysing the data collected in this way the research team will gain a better understanding of the implementation process, including barriers and facilitators to desired changes in practice.  A comparative analysis of implementation will enable synthesising of insights across both projects.

Project aims and objectives

To help us understand differences in context and generate in-depth insights into the implementation processes of two SW AHSN/CLAHRC supported projects to increase the uptake of changes in healthcare practice. In particular, to provide in-depth insights into the barriers and facilitators to desired changes in practice across the different implementation contexts.

The two different projects will be explored to answer the following research questions:

  • What can be learnt about the implementation processes?
  • What constrains and facilitates implementation?
  • How are obstacles and barriers overcome during implementation?
  • How is implementation tailored and adapted?
  • What are the critical factors enabling and disabling implementation and improvement?

Project activity

A researcher with knowledge of implementation science will undertake an ethnographic study across the two contexts. Often implementation and improvement studies rely on retrospective approaches or participants’ reports of experience rather than direct observation. Our strategy will be to combine a retrospective analysis with a prospective one. 

Once the appropriate ethical approvals and access has been obtained, our approach will include undertaking semi-structured interviews with individuals involved in project delivery and service provision (clinicians, managers, analysts, administrative staff, researchers, operational modellers and those involved in improvement support and project management aspects of the implementation); observation of selected formal and informal meetings and events, along with shadowing of the work of selected project team members; as well as analysis of relevant project, policy, guidance and procedural documents.

Insights from both projects will be synthesised so common and contrasting barriers and facilitators to implementation of change in practice can be considered.

Anticipated outputs

  • Improve understanding within both the SW AHSN and PenCLAHRC of methods of effective improvement and implementation.
  • Develop tools (e.g. guidance, checklists) to facilitate future implementation.
  • Deliver a seminar/workshop to share and discuss insights and recommendations. 
  • Report on the implementation of the two projects with details of what has worked and what has not in relation to the differences in context found at each site.
  • Article(s) written for peer-reviewed academic publications.
  • Present at national forums on how we have improved our success in implementing change in applied healthcare settings.

Related projects

Others Involved

Bettina Kluettgens - Director of Quality Improvement SW AHSN


  • Case study example of the value of NIHR CLAHRC funding - PDF