Complexity and involvement as implementation challenges: results from a process analysis
Abstract 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...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-10-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-021-07090-z |
| _version_ | 1818575135734497280 |
|---|---|
| author | Yvette Emond André Wolff Gerrit Bloo Johan Damen Gert Westert Hub Wollersheim Hiske Calsbeek |
| author_facet | Yvette Emond André Wolff Gerrit Bloo Johan Damen Gert Westert Hub Wollersheim Hiske Calsbeek |
| author_sort | Yvette Emond |
| collection | DOAJ |
| description | Abstract 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 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 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 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 Dutch Trial Registry: NTR3568 , retrospectively registered on 2 August 2012. |
| first_indexed | 2024-12-15T00:36:14Z |
| format | Article |
| id | doaj.art-c05d6fd650fa4007934924e5712efed5 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-15T00:36:14Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-c05d6fd650fa4007934924e5712efed52022-12-21T22:41:47ZengBMCBMC Health Services Research1472-69632021-10-0121111610.1186/s12913-021-07090-zComplexity and involvement as implementation challenges: results from a process analysisYvette Emond0André Wolff1Gerrit Bloo2Johan Damen3Gert Westert4Hub Wollersheim5Hiske Calsbeek6Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud university medical centerDepartment of Anesthesiology, Pain Center, University of Groningen, University Medical Center GroningenScientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud university medical centerDepartment of Anesthesiology, Pain and Palliative Care, Radboud university medical centerScientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud university medical centerScientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud university medical centerScientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud university medical centerAbstract 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 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 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 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 Dutch Trial Registry: NTR3568 , retrospectively registered on 2 August 2012.https://doi.org/10.1186/s12913-021-07090-zGuideline adherenceImplementationMultifaceted approachPatient safetyPerioperative careStepped-wedge design |
| spellingShingle | Yvette Emond André Wolff Gerrit Bloo Johan Damen Gert Westert Hub Wollersheim Hiske Calsbeek Complexity and involvement as implementation challenges: results from a process analysis BMC Health Services Research Guideline adherence Implementation Multifaceted approach Patient safety Perioperative care Stepped-wedge design |
| title | Complexity and involvement as implementation challenges: results from a process analysis |
| title_full | Complexity and involvement as implementation challenges: results from a process analysis |
| title_fullStr | Complexity and involvement as implementation challenges: results from a process analysis |
| title_full_unstemmed | Complexity and involvement as implementation challenges: results from a process analysis |
| title_short | Complexity and involvement as implementation challenges: results from a process analysis |
| title_sort | complexity and involvement as implementation challenges results from a process analysis |
| topic | Guideline adherence Implementation Multifaceted approach Patient safety Perioperative care Stepped-wedge design |
| url | https://doi.org/10.1186/s12913-021-07090-z |
| work_keys_str_mv | AT yvetteemond complexityandinvolvementasimplementationchallengesresultsfromaprocessanalysis AT andrewolff complexityandinvolvementasimplementationchallengesresultsfromaprocessanalysis AT gerritbloo complexityandinvolvementasimplementationchallengesresultsfromaprocessanalysis AT johandamen complexityandinvolvementasimplementationchallengesresultsfromaprocessanalysis AT gertwestert complexityandinvolvementasimplementationchallengesresultsfromaprocessanalysis AT hubwollersheim complexityandinvolvementasimplementationchallengesresultsfromaprocessanalysis AT hiskecalsbeek complexityandinvolvementasimplementationchallengesresultsfromaprocessanalysis |