Abstract
PurposeImplementing change in healthcare is difficult to accomplish due to the unpredictability associated with challenging the status quo. Adapting the intervention/practice/program being implemented to better fit the complex context is an important aspect of implementation success. Despite the acknowledged influence of context, the concept continues to receive insufficient attention at the team-level within implementation research. Using two heterogeneous multidisciplinary healthcare teams as implementation case studies, this study evaluates the interplay between context and implementation and highlights the ways in which context influences the introduction of a collective leadership intervention in routine practice.Design/methodology/approachThe multiple case study design adopted, employed a triangulation of qualitative research methods which involved observation (Case A = 16 h, Case B = 15 h) and interview data (Case A = 13 participants, Case B = 12 participants). Using an inductive approach, an in-depth thematic analysis of the data outlined the relationship between team-level contextual factors and implementation success.FindingsThemes are presented under the headings: (1) adapting to the everyday realities, a key determinant for implementation success and (2) implementation stimulating change in context. The findings demonstrate a dynamic relationship between context and implementation. The challenges of engaging busy healthcare professionals emphasised that mapping the contextual complexity of a site and adapting implementation accordingly is essential to enhance the likelihood of successful implementation. However, implementation also altered the surrounding context, stimulating changes within both teams.Originality/valueBy exposing the reciprocal relationship between team-level contextual factors and implementation, this research supports the improved design of implementation strategies through better understanding the interplay and mutual evolution of evidence-based healthcare interventions within different contexts.
Highlights
Study background This paper examined the active role of context during the implementation of a team-based collective leadership intervention
The key themes emerging from the data demonstrate the nature of the relationship between team-level contextual factors and implementation success
Using a multiple case study design and a triangulation of qualitative research methods, this study evaluated the relationship between context and implementation and identified the ways in which team-level contextual factors influence change in healthcare practice
Summary
The extant literature suggests that two-thirds of change projects fail (Beer and Nohria, 2000; Burnes, 2004) and that only 50–60% of care in the past decade aligned with the best available evidence (Braithwaite, 2018). A “one size fits all” approach to implementing change has been associated with this failure, as the priorities of staff and the unique characteristics of settings are overlooked (Dopson and Fitzgerald, 2005; Bauer et al, 2015; Braithwaite et al, 2018). While best practices are intended to apply to all healthcare organisations, accounting for the everyday contextual realities of each setting is necessary to enable the adaptions required to optimise the uptake of change in routine practice (Berta and Baker, 2004)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
