Integrating the complexity of healthcare improvement with implementation science: a longitudinal qualitative case study.
Background: Implementation science seeks to enable change, underpinned by theories and frameworks such as the Consolidated Framework for Implementation Research (CFIR). Yet academia and frontline healthcare improvement remain largely siloed, with limited integration of implementation science methods...
| Publicado en: | BMC Health Services Research Vol. 22; no. 1; pp. 1 - 13 |
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| Autores principales: | , , , , |
| Formato: | Journal Article |
| Publicado: |
BioMed Central
2/19/2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=155338314&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 155338314 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14726963 1CHS jtl: BMC Health Services Research issn: 14726963 maglogo: N pubinfo: dt: 2/19/2022 vid: 22 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 155338314 155338314 NLM35183164 10.1186/s12913-022-07505-5 NLM35183164 155338314 ppf: 1 ppct: 12 formats: tig: atl: Integrating the complexity of healthcare improvement with implementation science: a longitudinal qualitative case study. aug: au: Melder, Angela Robinson, Tracy Mcloughlin, Ian Iedema, Rick Teede, Helena affil: Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Gve, 3168, Clayton, Victoria, Australia sug: subj: Health Care Delivery Methods Qualitative Studies Prospective Studies Leadership Clinical Assessment Tools ab: Background: Implementation science seeks to enable change, underpinned by theories and frameworks such as the Consolidated Framework for Implementation Research (CFIR). Yet academia and frontline healthcare improvement remain largely siloed, with limited integration of implementation science methods into frontline improvement where the drivers include pragmatic, rapid change. Using the CIFR lens, we aimed to explore how pragmatic and complex healthcare improvement and implementation science can be integrated.Methods: Our research involved the investigation of a case study that was undertaking the implementation of an improvement intervention at a large public health service. Our research involved qualitative data collection methods of semi-structured interviews and non-participant observations of the implementation team delivering the intervention. Thematic analysis identified key themes from the qualitative data. We examined our themes through the lens of CFIR to gain in-depth understanding of how the CFIR components operated in a 'real-world' context.Results: The key themes emerging from our research outlined that leadership, context and process are the key components that dominate and affect the implementation process. Leadership which cultivates connections with front line clinicians, fosters engagement and trust. Navigating context was facilitated by 'bottom-up' governance. Multi-disciplinary and cross-sector capability were key processes that supported pragmatic and agile responses in a changing complex environment. Process reflected the theoretically-informed, and iterative implementation approach. Mapping CFIR domains and constructs, with these themes demonstrated close alignment with the CFIR. The findings bring further depth to CFIR. Our research demonstrates that leadership which has a focus on patient need as a key motivator to engage clinicians, which applies and ensures iterative processes which leverage contextual factors can achieve successful, sustained implementation and healthcare improvement outcomes.Conclusions: Our longitudinal study highlights insights that strengthen alignment between implementation science and pragmatic frontline healthcare improvement. We identify opportunities to enhance the relevance of CFIR in the 'real-world' setting through the interconnected nature of our themes. Our study demonstrates actionable knowledge to enhance the integration of implementation science in healthcare improvement. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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