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Theme: Evidence for Policy and Practice
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, because 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.
We seek to help understand differences in context across two SW 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 the project, observations 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 support that forms part of the PICs project by joint working with the qualitative researcher and some additional purposeful interviews.
A comparative analysis of implementation will enable a synthesising of insights across both projects. This will inform the identification of lessons learnt from these two efforts to spread improvements and implement changes in healthcare.
The project aim is to understand differences in context and generate in-depth insights into the implementation processes of these two SW AHSN- and CLAHRC-supported projects to increase the uptake of changes in health care practice.
An ethnographic study of the two projects, guided by an implementation science framework: the Consolidated Framework for Implementation Research. Often implementation and improvement studies rely on retrospective approaches or participants’ reports of experience rather than direct observation. Our strategy combines a retrospective analysis with a prospective one.
With the appropriate ethical approvals and access our approach included undertaking:
Insights from both projects will be synthesised so common and contrasting barriers and facilitators to implementation of change in practice can be considered.
The team have also written an article for the Implementation Science Team's blog: Understanding the Rollercoaster of contextual influences on the spread of practices.
Bettina Kluettgens - Director of Patient Safety, SW AHSN & Jo Gajtkowska - Programme Manager Improvement, SW AHSN