Programme theory and linked intervention strategy for large-scale change to improve hospital care in a low and middle-income country - A Study Pre-Protocol.

In low and middle-income countries (LMIC) general hospitals are important for delivering some key acute care services. Neonatal care is emblematic of these acute services as averting deaths requires skilled care over many days from multiple professionals with at least basic equipment. However, hospital care is often of poor quality and large-scale change is needed to improve outcomes. However, achieving large scale change in health systems remains challenging. To set the scene we first characterise the problems of hospital newborn units (NBU) in Kenya. We then combine our understanding of theory and context with reflection on our own position as an embedded research group with no formal authority to help us propose a feasible intervention strategy linked to in initial programme theory. We explain this programme theory and suggest how within a multi-level clinical professional network leaders at the ward or mid-level of hospital hierarchies are key potential change agents. In support of our programme theory we briefly outline and seek to integrate key ideas drawn from a wider set of theories. We propose how an intervention might be developed and employed in a phased approach to create the ownership, relationships and momentum that will be needed to achieve change at scale. Finally, we discuss the implications of such a strategy for our research design that is based on a prospective, in-depth case study that includes quantitative and qualitative data collection linked to specific sub-studies. We suggest using Realistic Evaluation to integrate our findings and develop an updated programme theory that should inform future large-scale change efforts before briefly discussing some of the challenges of evaluating a network as an intervention.

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Copyright: © 2020 English M et al.

Déclaration de conflit d'intérêts

Competing interests: All authors are supported by research funding for work in fields related to the topic of this manuscript, have been involved in early phases of developing the Kenyan Clinical Information Network or are members of organisations referred to in this report such as the Kenya Paediatric Association and the Kenya research team undertaking ongoing work on neonatal care.