6th UK and Ireland Implementation Science Research Conference 2023
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PRESENter
Yvonne Kelly
presenter biography
Yvonne is a general nurse and a PhD student in the Health Information and Quality Authority. She is a PhD scholar on the Structured Population health, Policy and Health-services Research Education (SPHeRE) programme, University College Cork. Her research interests include implementation science, quality improvement and adult nursing. Yvonne’s PhD is focusing on the implementation of health and social care standards in health and social care services. Currently, she is developing an evidence- and theory-informed process and digital platform, to guide research teams in identifying implementation strategies and then selecting tailored support tools and support actions. Yvonne has a Masters in Nursing and Healthcare Quality Improvement.
background
Health and social care standards are complex interventions that describe safe, high-quality care. They require multiple collective actions from multiple stakeholders across diverse services in health systems [1]. Standards are typically enforced or encouraged through statutory requirements or quality improvement initiatives. Limited evidence exists on appropriate implementation strategies to enhance their implementation [2,3]. We aimed to explore experiences of implementing nationally endorsed standards from stakeholders working at multiple levels in the health system, and to identify enablers and barriers to effective implementation. This exploration will inform implementation strategies that can optimise standards implementation.
MEthod
Using a descriptive qualitative design, six focus groups and eight individual interviews were conducted with stakeholders at individual-level (n=10), organisational-level (n=14) and system-level (n=14). Discussions were audio-recorded with consent, transcribed verbatim and analysed using Braun & Clarke’s reflexive thematic analysis [4]. Interpretation of data was underpinned by social constructionism [5]. Collective reflexivity and Lincoln & Guba’s criteria of trustworthiness was used to enhance rigour [6].
results
Six themes were generated from patterns of shared meanings across participants’ stories. Participants reported that implementation should incorporate: a “top-down, bottom-up approach”, accessible “bite-size” support tools, “meaningful” language, and “leaders at every single level.” An enabler to implementing standards was collegial support from the regulatory body that included reassurance that services were “doing the right thing.” A barrier was a “tired, worn out” workforce.
Conclusion
Themes generated described intervention and organisational characteristics that are reflected in existing implementation determinant frameworks. A novel finding was how an external organisation such as a regulatory body can influence implementation of standards. Few determinant frameworks address external organisational influences [7]. Adopting organisational theory may help to better understand these external influences on implementation in health and social care services. Findings from this exploration can be used by researchers to inform implementation strategies that can optimise safe, high-quality care delivery.
References
1. Kelly Y, O’Rourke N, Flynn R, Hegarty J, O’Connor L. Definitions of health and social care standards used internationally: A narrative review. Int J Health Plann Manage. 2023;38(1):40-52.
2. Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci. 2013;8(1):139.
3. Powell BJ, Beidas RS, Lewis CC, Aarons GA, McMillen JC, Proctor EK, et al. Methods to Improve the Selection and Tailoring of Implementation Strategies. J Behav Health Serv Res. 2017;44(2):177-94.
4. Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qual. Res. Psychol. 2021;18(3):328-52.
5. Burr V. An Introduction to Social Constructionism. Routledge; 1995.
6. Lincoln Y, Guba E. Naturalistic inquiry. Beverly Hills: Sage Publications. 1985.
7. Nilsen P, Bernhardsson S. Context matters in implementation science: a scoping review of determinant frameworks that describe contextual determinants for implementation outcomes. BMC Health Serv. Res. 2019;19(1):189-99.
Acknowledgements
This work was conducted as part of the Structured Population health, Policy and Health-services Research Education (SPHeRE) programme (Grant No. SPHeRE/2019/1). Yvonne Kelly has conducted this work as part of a PhD studentship that is funded by the Health Information and Quality Authority (HIQA).