Complexity and involvement as implementation challenges: results from a process analysis.
Guideline adherence
Implementation
Multifaceted approach
Patient safety
Perioperative care
Stepped-wedge design
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
23 Oct 2021
23 Oct 2021
Historique:
received:
08
02
2021
accepted:
21
09
2021
entrez:
24
10
2021
pubmed:
25
10
2021
medline:
27
10
2021
Statut:
epublish
Résumé
The study objective was to analyse the implementation challenges experienced in carrying out the IMPROVE programme. This programme was designed to implement checklist-related improvement initiatives based on the national perioperative guidelines using a stepped-wedge trial design. A process analysis was carried out to investigate the involvement in the implementation activities. An involvement rating measure was developed to express the extent to which the implementation programme was carried out in the hospitals. This measure reflects the number of IMPROVE-implementation activities executed and the estimated participation in these activities in all nine participating hospitals. These data were compared with prospectively collected field notes. Considerable variation between the hospitals was found with involvement ratings ranging from 0 to 6 (mean per measurement = 1.83 on a scale of 0-11). Major implementation challenges were respectively the study design (fixed design, time planning, long duration, repeated measurements, and data availability); the selection process of hospitals, departments and key contact person(s) (inadequately covering the entire perioperative team and stand-alone surgeons); the implementation programme (programme size and scope, tailoring, multicentre, lack of mandate, co-interventions by the Inspectorate, local intervention initiatives, intervention fatigue); and competitive events such as hospital mergers or the introduction of new IT systems, all reducing involvement. The process analysis approach helped to explain the limited and delayed execution of the IMPROVE-implementation programme. This turned out to be very heterogeneous between hospitals, with variation in the number and content of implementation activities carried out. The identified implementation challenges reflect a high complexity with regard to the implementation programme, study design and setting. The involvement of the target professionals was put under pressure by many factors. We mostly encountered challenges, but at the same time we provide solutions for addressing them. A less complex implementation programme, a less fixed study design, a better thought-out selection of contact persons, as well as more commitment of the hospital management and surgeons would likely have contributed to better implementation results. Dutch Trial Registry: NTR3568 , retrospectively registered on 2 August 2012.
Sections du résumé
BACKGROUND
BACKGROUND
The study objective was to analyse the implementation challenges experienced in carrying out the IMPROVE programme. This programme was designed to implement checklist-related improvement initiatives based on the national perioperative guidelines using a stepped-wedge trial design. A process analysis was carried out to investigate the involvement in the implementation activities.
METHODS
METHODS
An involvement rating measure was developed to express the extent to which the implementation programme was carried out in the hospitals. This measure reflects the number of IMPROVE-implementation activities executed and the estimated participation in these activities in all nine participating hospitals. These data were compared with prospectively collected field notes.
RESULTS
RESULTS
Considerable variation between the hospitals was found with involvement ratings ranging from 0 to 6 (mean per measurement = 1.83 on a scale of 0-11). Major implementation challenges were respectively the study design (fixed design, time planning, long duration, repeated measurements, and data availability); the selection process of hospitals, departments and key contact person(s) (inadequately covering the entire perioperative team and stand-alone surgeons); the implementation programme (programme size and scope, tailoring, multicentre, lack of mandate, co-interventions by the Inspectorate, local intervention initiatives, intervention fatigue); and competitive events such as hospital mergers or the introduction of new IT systems, all reducing involvement.
CONCLUSIONS
CONCLUSIONS
The process analysis approach helped to explain the limited and delayed execution of the IMPROVE-implementation programme. This turned out to be very heterogeneous between hospitals, with variation in the number and content of implementation activities carried out. The identified implementation challenges reflect a high complexity with regard to the implementation programme, study design and setting. The involvement of the target professionals was put under pressure by many factors. We mostly encountered challenges, but at the same time we provide solutions for addressing them. A less complex implementation programme, a less fixed study design, a better thought-out selection of contact persons, as well as more commitment of the hospital management and surgeons would likely have contributed to better implementation results.
TRIAL REGISTRATION
BACKGROUND
Dutch Trial Registry: NTR3568 , retrospectively registered on 2 August 2012.
Identifiants
pubmed: 34688287
doi: 10.1186/s12913-021-07090-z
pii: 10.1186/s12913-021-07090-z
pmc: PMC8542304
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1149Informations de copyright
© 2021. The Author(s).
Références
Ann Surg. 2015 Jan;261(1):81-91
pubmed: 25072435
Adm Policy Ment Health. 2008 Mar;35(1-2):11-20
pubmed: 17990096
Jt Comm J Qual Patient Saf. 2006 Jun;32(6):324-36
pubmed: 16776387
Implement Sci Commun. 2020 May 27;1:49
pubmed: 32885205
Jt Comm J Qual Improv. 2001 Dec;27(12):639-50
pubmed: 11765381
BMJ Qual Saf. 2013 Mar;22(3):233-41
pubmed: 23362504
Health Technol Assess. 2004 Feb;8(6):iii-iv, 1-72
pubmed: 14960256
AORN J. 2010 May;91(5):576-82
pubmed: 20450999
J Contin Educ Health Prof. 2004 Fall;24 Suppl 1:S31-7
pubmed: 15712775
Implement Sci. 2013 Jun 14;8:67
pubmed: 23767696
Health Serv Res. 1997 Oct;32(4):491-510
pubmed: 9327815
Harv Bus Rev. 2013 Jul-Aug;91(7-8):62-8, 132
pubmed: 24730170
Med J Aust. 2004 Mar 15;180(S6):S57-60
pubmed: 15012583
Ann Surg. 2012 Jan;255(1):44-9
pubmed: 22123159
BMJ. 2006 Feb 18;332(7538):413-6
pubmed: 16484270
Med Care Res Rev. 2007 Jun;64(3):279-303
pubmed: 17507459
Implement Sci Commun. 2020 Oct 23;1:92
pubmed: 33111063
Am J Manag Care. 2002 Jul;8(7):622-30
pubmed: 12125802
PLoS One. 2012;7(9):e44599
pubmed: 22962619
AORN J. 2014 Jul;100(1):8-26, 27-9
pubmed: 24973182
BMJ. 2015 Mar 19;350:h1258
pubmed: 25791983
Implement Sci. 2018 Nov 13;13(1):142
pubmed: 30424818
J Am Coll Surg. 2014 Sep;219(3):390-8
pubmed: 25067803
Contemp Clin Trials. 2007 Feb;28(2):182-91
pubmed: 16829207
Soc Sci Med. 2001 Sep;53(6):745-57
pubmed: 11511050
JAMA. 1999 Oct 20;282(15):1458-65
pubmed: 10535437
J Eval Clin Pract. 2007 Apr;13(2):161-8
pubmed: 17378860
Int J Qual Health Care. 1994 Jun;6(2):115-32
pubmed: 7953212
J Clin Epidemiol. 2012 Dec;65(12):1249-52
pubmed: 22964070
BMC Health Serv Res. 2006 Apr 28;6:53
pubmed: 16646968
Qual Saf Health Care. 2009 Oct;18(5):385-92
pubmed: 19812102
Psychiatr Serv. 2006 Aug;57(8):1162-9
pubmed: 16870968
Implement Sci. 2015 Jan 08;10:3
pubmed: 25567584
JPEN J Parenter Enteral Nutr. 2010 Nov-Dec;34(6):616-24
pubmed: 21097762
Br J Anaesth. 2012 Jul;109(1):47-54
pubmed: 22649183
Lancet. 2003 Oct 11;362(9391):1225-30
pubmed: 14568747
Qual Saf Health Care. 2005 Oct;14(5):340-6
pubmed: 16195567
Cochrane Database Syst Rev. 2010 Mar 17;(3):CD005470
pubmed: 20238340
Implement Sci. 2019 Dec 11;14(1):104
pubmed: 31829252
N Engl J Med. 2014 Mar 13;370(11):1063-4
pubmed: 24620871