Implementation through translation: a qualitative case study of translation processes in the implementation of quality improvement collaboratives
Abstract Background Quality improvement collaboratives (QICs) are used extensively to implement quality improvement in healthcare, and current research is demonstrating positive yet varying evidence. To interpret the effectiveness results, it is necessary to illuminate the dynamics of QIC implementa...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-03-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-09201-4 |
| _version_ | 1797865189507334144 |
|---|---|
| author | Kathrine Carstensen Anne Mette Kjeldsen Stina Lou Camilla Palmhøj Nielsen |
| author_facet | Kathrine Carstensen Anne Mette Kjeldsen Stina Lou Camilla Palmhøj Nielsen |
| author_sort | Kathrine Carstensen |
| collection | DOAJ |
| description | Abstract Background Quality improvement collaboratives (QICs) are used extensively to implement quality improvement in healthcare, and current research is demonstrating positive yet varying evidence. To interpret the effectiveness results, it is necessary to illuminate the dynamics of QIC implementation in specific contexts. Using Scandinavian institutionalist translation theory as a theoretical framework, this study aims to make two contributions. First, we provide insights into the dynamics of the translation processes inherent in QIC implementation. Second, we discuss the implications of the translation processes as experienced by participating actors. Methods We used empirical data from a qualitative case study investigating the implementation of QICs as an approach to quality improvement within a national Danish healthcare quality program. We included two diverse QICs to allow for exploration of the significance of organizational complexity for the translation processes. Data comprised qualitative interviews, participant observation and documentary material. Results Translation was an inherent part of QIC implementation. Key actors at different organizational levels engaged in translation of their implementation roles, and the QIC content and methodology. They drew on different translation strategies and practices that mainly materialized as kinds of modification. The translations were motivated by deliberate, strategic, and pragmatic rationales, contingent on combinations of features of the actors’ organizational contexts, and the transformability and organizational complexity of the QICs. The findings point to a transformative power of translation, as different translations led to various regional and local QIC versions. Furthermore, the findings indicate that translation affects the outcomes of the implementation process and the QIC intervention. Translation may positively affect the institutionalization of the QICs and the creation of professional engagement and negatively influence the QIC effects. Conclusion The findings extends the current research concerning the understanding of the dynamics of the translation processes embedded in the local implementation of QICs, and thus constitute a valuable contribution to a more sustainable and effective implementation of QICs in healthcare improvement. For researchers and practitioners, this highlights translation as an embedded part of the QIC implementation process, and encourages detailed attention to the implications of translation for both organizational institutionalization and realisation of the expected intervention outcomes. |
| first_indexed | 2024-04-09T23:05:09Z |
| format | Article |
| id | doaj.art-559b9afc99ba4e7983052bb83e52d982 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-09T23:05:09Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-559b9afc99ba4e7983052bb83e52d9822023-03-22T10:46:41ZengBMCBMC Health Services Research1472-69632023-03-0123111610.1186/s12913-023-09201-4Implementation through translation: a qualitative case study of translation processes in the implementation of quality improvement collaborativesKathrine Carstensen0Anne Mette Kjeldsen1Stina Lou2Camilla Palmhøj Nielsen3Public Health Research, Central Denmark Region, Department of Public Health, DEFACTUM, Aarhus UniversityDepartment of Political Science, Aarhus UniversityPublic Health Research, Central Denmark Region, Department of Clinical Medicine, DEFACTUM, Aarhus UniversityPublic Health Research, Central Denmark Region, Department of Public Health, DEFACTUM, Aarhus UniversityAbstract Background Quality improvement collaboratives (QICs) are used extensively to implement quality improvement in healthcare, and current research is demonstrating positive yet varying evidence. To interpret the effectiveness results, it is necessary to illuminate the dynamics of QIC implementation in specific contexts. Using Scandinavian institutionalist translation theory as a theoretical framework, this study aims to make two contributions. First, we provide insights into the dynamics of the translation processes inherent in QIC implementation. Second, we discuss the implications of the translation processes as experienced by participating actors. Methods We used empirical data from a qualitative case study investigating the implementation of QICs as an approach to quality improvement within a national Danish healthcare quality program. We included two diverse QICs to allow for exploration of the significance of organizational complexity for the translation processes. Data comprised qualitative interviews, participant observation and documentary material. Results Translation was an inherent part of QIC implementation. Key actors at different organizational levels engaged in translation of their implementation roles, and the QIC content and methodology. They drew on different translation strategies and practices that mainly materialized as kinds of modification. The translations were motivated by deliberate, strategic, and pragmatic rationales, contingent on combinations of features of the actors’ organizational contexts, and the transformability and organizational complexity of the QICs. The findings point to a transformative power of translation, as different translations led to various regional and local QIC versions. Furthermore, the findings indicate that translation affects the outcomes of the implementation process and the QIC intervention. Translation may positively affect the institutionalization of the QICs and the creation of professional engagement and negatively influence the QIC effects. Conclusion The findings extends the current research concerning the understanding of the dynamics of the translation processes embedded in the local implementation of QICs, and thus constitute a valuable contribution to a more sustainable and effective implementation of QICs in healthcare improvement. For researchers and practitioners, this highlights translation as an embedded part of the QIC implementation process, and encourages detailed attention to the implications of translation for both organizational institutionalization and realisation of the expected intervention outcomes.https://doi.org/10.1186/s12913-023-09201-4Quality improvement collaborativesImplementationTranslationHealth Care |
| spellingShingle | Kathrine Carstensen Anne Mette Kjeldsen Stina Lou Camilla Palmhøj Nielsen Implementation through translation: a qualitative case study of translation processes in the implementation of quality improvement collaboratives BMC Health Services Research Quality improvement collaboratives Implementation Translation Health Care |
| title | Implementation through translation: a qualitative case study of translation processes in the implementation of quality improvement collaboratives |
| title_full | Implementation through translation: a qualitative case study of translation processes in the implementation of quality improvement collaboratives |
| title_fullStr | Implementation through translation: a qualitative case study of translation processes in the implementation of quality improvement collaboratives |
| title_full_unstemmed | Implementation through translation: a qualitative case study of translation processes in the implementation of quality improvement collaboratives |
| title_short | Implementation through translation: a qualitative case study of translation processes in the implementation of quality improvement collaboratives |
| title_sort | implementation through translation a qualitative case study of translation processes in the implementation of quality improvement collaboratives |
| topic | Quality improvement collaboratives Implementation Translation Health Care |
| url | https://doi.org/10.1186/s12913-023-09201-4 |
| work_keys_str_mv | AT kathrinecarstensen implementationthroughtranslationaqualitativecasestudyoftranslationprocessesintheimplementationofqualityimprovementcollaboratives AT annemettekjeldsen implementationthroughtranslationaqualitativecasestudyoftranslationprocessesintheimplementationofqualityimprovementcollaboratives AT stinalou implementationthroughtranslationaqualitativecasestudyoftranslationprocessesintheimplementationofqualityimprovementcollaboratives AT camillapalmhøjnielsen implementationthroughtranslationaqualitativecasestudyoftranslationprocessesintheimplementationofqualityimprovementcollaboratives |