Deliberate and emergent strategies for implementing person-centred care: a qualitative interview study with researchers, professionals and patients

Öncel Naldemirci,Doris Lydahl,Mark Elam,Lucy Moore,Nicky Britten,Axel Wolf

doi:10.1186/s12913-017-2470-2

Öncel Naldemirci, Doris Lydahl + Show 4 more

Open Access

https://doi.org/10.1186/s12913-017-2470-2

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Abstract

BackgroundThe introduction of innovative models of healthcare does not necessarily mean that they become embedded in everyday clinical practice. This study has two aims: first, to analyse deliberate and emergent strategies adopted by healthcare professionals to overcome barriers to normalization of a specific framework of person-centred care (PCC); and secondly, to explore how the recipients of PCC understand these strategies.MethodsThis paper is based on a qualitative study of the implementation of PCC in a Swedish context. It draws on semi-structured interviews with 18 researchers and 17 practitioners who adopted a model of PCC on four different wards and 20 patients who were cared for in one of these wards. Data from these interviews were first coded inductively and emerging themes are analysed in relation to normalization process theory (NPT).ResultsIn addition to deliberate strategies, we identify emergent strategies to normalize PCC by (i) creating and sustaining coherence in small but continuously communicating groups (ii) interpreting PCC flexibly when it meets specific local situations and (iii) enforcing teamwork between professional groups. These strategies resulted in patients perceiving PCC as bringing about (i) a sense of ease (ii) appreciation of inter-professional congruity (ii) non-hierarchical communication.ConclusionNPT is useful to identify and analyse deliberate and emergent strategies relating to mechanisms of normalization. Emergent strategies should be interpreted not as trivial solutions to problems in implementation, but as a possible repertoire of tools, practices and skills developed in situ. As professionals and patients may have different understandings of implementation, it is also crucial to include patients’ perceptions to evaluate outcomes.

Highlights

The introduction of innovative models of healthcare does not necessarily mean that they become embedded in everyday clinical practice
We want to draw upon deliberate and emergent strategies as they were conceptualised by Mintzberg and Water [10] not to add to the taxonomy of types of strategies, but rather to highlight the nature of implementation strategies
The second group (n = 17) were healthcare practitioners who worked in hospital wards enrolled in a larger person-centred care (PCC) implementation project at a university hospital in Sweden, or in other healthcare settings used as study sites for Gothenburg Centre for Person-Centred Care (GPCC) interventions

Summary

Introduction

The introduction of innovative models of healthcare does not necessarily mean that they become embedded in everyday clinical practice. Deliberate strategies appear prior to the initiation of a novel type of collective action and offer prescriptions and itineraries based on evidence and intuition (see [5]), whereas emergent strategies imply “learning what works–taking one action at a time in search for that viable pattern or consistency” ([10], p.271). By employing this classification, we want to emphasise that challenges to implementing a complex intervention are collectively and creatively interpreted and handled in practice [11]. It is crucial to see how a set of practices are locally interpreted and modified in practice [12], which is often possible due to emergent strategies

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