Identifying barriers to Implementation of New Care Models, a Multi-Stakeholder Engagement Study

Abstract

Introduction: In 2010, the National Clinical Programmes in Ireland were established with the aim of Nationalising best practice to improve quality, access and cost for patients. The aim of this study was to gain insight into the barriers key stakeholders faced in terms of implementing these new models of care. Method: A Multi-Stakeholder Engagement Process was conducted with 59 key stakeholders involved in the Clinical Programmes including clinicians, managers, academics and patients. An inductive approach using qualitative thematic analysis of the outputs was used to determine themes.  Descriptive statistics were computed to assess the frequency of barriers and perceived challenges. Results: The most common barriers to implementation identified were;  lack of business alignment and engagement, unclear governance, challenges with allocation of resources (in particular HR, Finance and ICT, including data management), recurrent restructuring and poor communications. Poor engagement by General Practitioners was also identified as a barrier as well as the need to have a consistent systematic programme management approach to implementation. Discussion: This participatory approach was an effective way to engage multiple diverse stakeholders to collaborate in identifying barriers to implementation to inform the next phase of the Clinical Programmes. Conclusion: Having a clear vision, a prescribed methodology and clinician buy in and involvement in the design of new models of care is not sufficient to ensure implementation. A whole system approach to the design and implementation of new models of care must be supported by essential enablers such as policy, financial and HR models and knowledge management systems. The second phase of the programmes will seek to overcome the barriers identified in this study and work with operations and policy makers to improve outcomes for patients by implementing person centred evidence based models of care