Addressing the How of Implementation: A Hermeneutic Exploration of Implementing Virtual Kidney Care in a Remote, Rural Health Region.
Rationale: Implementing evidence‐informed healthcare services is typically approached as a structured, time‐limited project, focused largely on what to do. Less well understood is how implementation actually unfolds in practice: the ways in which those involved navigate change and generate solutions...
| Publicado en: | Journal of Evaluation in Clinical Practice Vol. 32; no. 5; pp. 1 - 11 |
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| Autores principales: | , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Aug2026
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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=196542782&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 196542782 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 13561294 EV1 jtl: Journal of Evaluation in Clinical Practice issn: 13561294 maglogo: Y pubinfo: dt: Aug2026 vid: 32 iid: 5 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 196542782 196542782 196542782 10.1111/jep.70524 196542782 ppf: 1 ppct: 10 formats: tig: atl: Addressing the How of Implementation: A Hermeneutic Exploration of Implementing Virtual Kidney Care in a Remote, Rural Health Region. aug: au: Macleod, Martha L. P. Singh, Anurag Barker, Erin Jónatansdóttir, Steinunn Snadden, David McCaffrey, Graham Zimmer, Lela V. Zimmer, Peter Ulrich, Cathy Graham, Ian D. affil: School of Nursing, University of Northern British Columbia, Prince George British Columbia,, Canada sug: subj: Rural Health Services British Columbia Telemedicine Implementation Science Attitude of Health Personnel Patient Attitudes Kidney Diseases Therapy Health Care Delivery Human Qualitative Studies Exploratory Research Phenomenological Research Female Male Interviews British Columbia COVID-19 Pandemic Organizational Change Funding Source Nephrologists Nurses Dietitians Pharmacists Clerical Personnel Female Male ab: Rationale: Implementing evidence‐informed healthcare services is typically approached as a structured, time‐limited project, focused largely on what to do. Less well understood is how implementation actually unfolds in practice: the ways in which those involved navigate change and generate solutions in diverse community settings. Without understanding how implementation happens in unique contexts, implementation failure may remain poorly understood. Aim: The aim was to understand what it means for kidney care team providers, information technology staff, and patients to engage in implementing an evolving virtual kidney care service in a large, sparsely populated rural and remote region. Method: We interviewed eight kidney care service providers, two information technology specialists, and 17 patients in northern British Columbia, Canada, for their experiences in implementing, delivering, and receiving virtual kidney care and how their practices changed with COVID‐19. Through an inductive, reflexive process of analysis and hermeneutic interpretation, we identified patterns in how virtual kidney care was implemented. Results: The analysis showed six hermeneutic principles of implementation at work in the everyday practices of the kidney care and information technology teams: acknowledging central concerns, creating new common understandings, collectively acting, surfacing tensions, being responsive to context, and engaging in ongoing dialogue. Rather than discrete, technical, and time‐limited, we found implementation to be an ongoing, evolving, relational, generative, and iterative process that is inextricably connected to its context, and that never fully ends. Conclusion: Attending to the how revealed dimensions of implementation practice that are seldom visible in conventional implementation research. A hermeneutic sensibility, marked by openness, humility, and dialogue, with a commitment to understanding, responsiveness, and relationship‐building, is key to implementation, especially in the ever‐changing contexts of rural and remote areas. The findings point to the value of a hermeneutic approach in implementing, sustaining, and researching innovations in dynamic healthcare systems and rural settings. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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