Abstract
The purpose of this paper is to explore what happens when changes to clinical practice are proposed and introduced in healthcare organisations. The authors use the implementation of Treatment Escalation Plans to explore the dynamics shaping the translational journey of a complex intervention from research into the everyday context of real-world healthcare settings. A qualitative instrumental collective case study design was used. Data were gathered using qualitative interviews (n=36) and observations (n=46) in three English acute hospital trusts. Normalisation process theory provided the theoretical lens and informed data collection and analysis. While each organisation faced the same translational problem, there was variation between settings regarding adoption and implementation. Successful change was dependent on participants' ability to manage and shape contexts and the work this involved was reliant on individual capacity to create a new, receptive context for change. Managing contexts to facilitate the move from research into clinical practice was a complex interactive and iterative process. The paper advocates a move away from contextual factors influencing change and adoption, to contextual patterns and processes that accommodate different elements of whole systems and the work required to manage and shape them. The paper addresses important and timely issues of change in healthcare, particularly for new regulatory and service-oriented processes and practices. Insights and explanations of variations in implementation are revealed which could contribute to conceptual generalisation of context and implementation.
Highlights
This paper focusses on a long-standing problem for healthcare: that of changing clinical practice (Davidoff and Batalden, 2005)
This paper explores how changing clinical practice in three English acute hospital trusts, through the proposed introduction of a newly developed complex clinical decision-making intervention, a Treatment Escalation Plan (TEP), necessitated interactions between the participants attempting to make changes and multiple contexts which influenced and shaped the process within the organisation
What is the role of a treatment escalation plan? In the UK TEPs have been in use since 2006 (Mercer, 2009) and internationally since the 1990s (Schmidt et al, 2014; Thomas et al, 2014; Godfrey et al, 2012)
Summary
This paper focusses on a long-standing problem for healthcare: that of changing clinical practice (Davidoff and Batalden, 2005). Altering established behaviour of any kind is difficult It is challenging in healthcare because of the complex relationships between professionals, patients and carers and the interplay with contexts in which change is to be operationalised. TEPs situate the DNACPR decision within an overall plan for treatment, offering a process for supporting clinical decision-making that take into account the treatment preferences of patients and their families, and define the scope and limits that can be applied to care (Fritz et al, 2013, 2017; Mockford et al, 2015; Jesus et al, 2014; Schmidt et al, 2014)
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.
