Dataset Information

Complexity and involvement as implementation challenges: results from a process analysis.

ABSTRACT:

Background

The study objective was to analyse the implementation challenges experienced in carrying out the IMPROVE programme. This programme was designed to implement checklist-related improvement initiatives based on the national perioperative guidelines using a stepped-wedge trial design. A process analysis was carried out to investigate the involvement in the implementation activities.

Methods

An involvement rating measure was developed to express the extent to which the implementation programme was carried out in the hospitals. This measure reflects the number of IMPROVE-implementation activities executed and the estimated participation in these activities in all nine participating hospitals. These data were compared with prospectively collected field notes.

Results

Considerable variation between the hospitals was found with involvement ratings ranging from 0 to 6 (mean per measurement = 1.83 on a scale of 0-11). Major implementation challenges were respectively the study design (fixed design, time planning, long duration, repeated measurements, and data availability); the selection process of hospitals, departments and key contact person(s) (inadequately covering the entire perioperative team and stand-alone surgeons); the implementation programme (programme size and scope, tailoring, multicentre, lack of mandate, co-interventions by the Inspectorate, local intervention initiatives, intervention fatigue); and competitive events such as hospital mergers or the introduction of new IT systems, all reducing involvement.

Conclusions

The process analysis approach helped to explain the limited and delayed execution of the IMPROVE-implementation programme. This turned out to be very heterogeneous between hospitals, with variation in the number and content of implementation activities carried out. The identified implementation challenges reflect a high complexity with regard to the implementation programme, study design and setting. The involvement of the target professionals was put under pressure by many factors. We mostly encountered challenges, but at the same time we provide solutions for addressing them. A less complex implementation programme, a less fixed study design, a better thought-out selection of contact persons, as well as more commitment of the hospital management and surgeons would likely have contributed to better implementation results.

Trial registration

Dutch Trial Registry: NTR3568 , retrospectively registered on 2 August 2012.

SUBMITTER: Emond Y

PROVIDER: S-EPMC8542304 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Complexity and involvement as implementation challenges: results from a process analysis.

Emond Yvette Y Wolff André A Bloo Gerrit G Damen Johan J Westert Gert G Wollersheim Hub H Calsbeek Hiske H

BMC health services research 20211023 1

<h4>Background</h4>The study objective was to analyse the implementation challenges experienced in carrying out the IMPROVE programme. This programme was designed to implement checklist-related improvement initiatives based on the national perioperative guidelines using a stepped-wedge trial design. A process analysis was carried out to investigate the involvement in the implementation activities.<h4>Methods</h4>An involvement rating measure was developed to express the extent to which the imple ...[more]

PMID: 34688287

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Dataset Information

Complexity and involvement as implementation challenges: results from a process analysis.

Background

Methods

Results

Conclusions

Trial registration

Publications

Complexity and involvement as implementation challenges: results from a process analysis.

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