The barriers and facilitators to the implementation of National Clinical Programmes in Ireland: using the MRC framework for process evaluations
Abstract Background A major healthcare reform agenda in Ireland is underway which underpins the establishment of a series of National Clinical Programmes (NCPs), which aim to take an evidence based approach to improve quality, access and value. The current study aimed to determine the enablers and b...
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| Format: | Article |
| Language: | English |
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BMC
2018-09-01
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| Series: | BMC Health Services Research |
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| Online Access: | http://link.springer.com/article/10.1186/s12913-018-3543-6 |
| _version_ | 1818481648716480512 |
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| author | Catherine D. Darker Gail H. Nicolson Aine Carroll Joe M. Barry |
| author_facet | Catherine D. Darker Gail H. Nicolson Aine Carroll Joe M. Barry |
| author_sort | Catherine D. Darker |
| collection | DOAJ |
| description | Abstract Background A major healthcare reform agenda in Ireland is underway which underpins the establishment of a series of National Clinical Programmes (NCPs), which aim to take an evidence based approach to improve quality, access and value. The current study aimed to determine the enablers and barriers to implementation of the NCPs. Methods A qualitative methodology advocated by the Medical Research Council (MRC) framework on conducting process evaluations of complex interventions guided this research. Purposive sampling techniques were used to recruit participants from seven NCPs across both acute and chronic healthcare domains, comprised of orthopaedics, rheumatology, elective surgery, emergency medicine, paediatrics, diabetes and chronic obstructive pulmonary disease. A total of 33 participants were interviewed using a semi-structured interview guide. Participants included current and previous Clinical Leads, Programme Managers, Health Service Executive management, hospital Chief Executive Officers, representatives of General Practice, and a Nursing and a Patient representative. Thematic analyses was conducted. Results A range of factors of different combinations and co-occurrence were highlighted across a total of six themes, including (i) positive leadership, governance and clinical networks of the NCPs, (ii) the political and social context in which the NCPs operate, (iii) constraints on resources, (iv) a passive attitudinal resistance to change borne from poor consultation and communication, (v) lack of data and information technology, (vi) forces outside of the NCPs such as the general practitioner contract thwarting change of the model of care. Conclusions The MRC framework proved a useful tool to conduct this process evaluation. Results from this research provide real world experiences and insight from the people charged with implementing large-scale health system improvement initiatives. The findings highlight the need for measured responses that acknowledge both direct and non-direct challenges and opportunities for successful change. Combined, it is recommended that these elements be considered in the planning and implementation of large-scale initiatives across healthcare delivery systems, both in Ireland and internationally. |
| first_indexed | 2024-12-10T11:37:44Z |
| format | Article |
| id | doaj.art-a92da80a575d48958a4819416dda9189 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-10T11:37:44Z |
| publishDate | 2018-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-a92da80a575d48958a4819416dda91892022-12-22T01:50:23ZengBMCBMC Health Services Research1472-69632018-09-0118111010.1186/s12913-018-3543-6The barriers and facilitators to the implementation of National Clinical Programmes in Ireland: using the MRC framework for process evaluationsCatherine D. Darker0Gail H. Nicolson1Aine Carroll2Joe M. Barry3Department of Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College DublinDepartment of Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College DublinClinical Strategy and Programmes Division, Health Service Executive, Dr Steevens’ HospitalDepartment of Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College DublinAbstract Background A major healthcare reform agenda in Ireland is underway which underpins the establishment of a series of National Clinical Programmes (NCPs), which aim to take an evidence based approach to improve quality, access and value. The current study aimed to determine the enablers and barriers to implementation of the NCPs. Methods A qualitative methodology advocated by the Medical Research Council (MRC) framework on conducting process evaluations of complex interventions guided this research. Purposive sampling techniques were used to recruit participants from seven NCPs across both acute and chronic healthcare domains, comprised of orthopaedics, rheumatology, elective surgery, emergency medicine, paediatrics, diabetes and chronic obstructive pulmonary disease. A total of 33 participants were interviewed using a semi-structured interview guide. Participants included current and previous Clinical Leads, Programme Managers, Health Service Executive management, hospital Chief Executive Officers, representatives of General Practice, and a Nursing and a Patient representative. Thematic analyses was conducted. Results A range of factors of different combinations and co-occurrence were highlighted across a total of six themes, including (i) positive leadership, governance and clinical networks of the NCPs, (ii) the political and social context in which the NCPs operate, (iii) constraints on resources, (iv) a passive attitudinal resistance to change borne from poor consultation and communication, (v) lack of data and information technology, (vi) forces outside of the NCPs such as the general practitioner contract thwarting change of the model of care. Conclusions The MRC framework proved a useful tool to conduct this process evaluation. Results from this research provide real world experiences and insight from the people charged with implementing large-scale health system improvement initiatives. The findings highlight the need for measured responses that acknowledge both direct and non-direct challenges and opportunities for successful change. Combined, it is recommended that these elements be considered in the planning and implementation of large-scale initiatives across healthcare delivery systems, both in Ireland and internationally.http://link.springer.com/article/10.1186/s12913-018-3543-6HealthcareImplementationProcess evaluationMRC frameworkQualitative |
| spellingShingle | Catherine D. Darker Gail H. Nicolson Aine Carroll Joe M. Barry The barriers and facilitators to the implementation of National Clinical Programmes in Ireland: using the MRC framework for process evaluations BMC Health Services Research Healthcare Implementation Process evaluation MRC framework Qualitative |
| title | The barriers and facilitators to the implementation of National Clinical Programmes in Ireland: using the MRC framework for process evaluations |
| title_full | The barriers and facilitators to the implementation of National Clinical Programmes in Ireland: using the MRC framework for process evaluations |
| title_fullStr | The barriers and facilitators to the implementation of National Clinical Programmes in Ireland: using the MRC framework for process evaluations |
| title_full_unstemmed | The barriers and facilitators to the implementation of National Clinical Programmes in Ireland: using the MRC framework for process evaluations |
| title_short | The barriers and facilitators to the implementation of National Clinical Programmes in Ireland: using the MRC framework for process evaluations |
| title_sort | barriers and facilitators to the implementation of national clinical programmes in ireland using the mrc framework for process evaluations |
| topic | Healthcare Implementation Process evaluation MRC framework Qualitative |
| url | http://link.springer.com/article/10.1186/s12913-018-3543-6 |
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