10 research outputs found
The barriers and facilitators influencing the sustainability of hospital-based interventions: a systematic review
Acknowledgements University of Stirling for providing financial support for open access costs Funding This review was funded by the Chief Scientist Office, grant number GCA/17/26. JC, PC and EAD are employed by the Nursing, Midwifery and Allied Health Professions Research Unit, which is funded by the Chief Scientist Office in Scotland.Peer reviewedPublisher PD
Exploring factors that influence the spread and sustainability of a dysphagia innovation: an instrumental case study
Background: Swallowing difficulties challenge patient safety due to the increased risk of malnutrition, dehydration
and aspiration pneumonia. A theoretically driven study was undertaken to examine the spread and sustainability of
a locally developed innovation that involved using the Inter-Professional Dysphagia Framework to structure
education for the workforce. A conceptual framework with 3 spread strategies (hierarchical control, participatory
adaptation and facilitated evolution) was blended with a processual approach to sustaining organisational change.
The aim was to understand the processes, mechanism and outcomes associated with the spread and sustainability
of this safety initiative.
Methods: An instrumental case study, prospectively tracked a dysphagia innovation for 34 months (April 2011
to January 2014) in a large health care organisation in England. A train-the-trainer intervention (as participatory
adaptation) was deployed on care pathways for stroke and fractured neck of femur. Data were collected at the
organisational and clinical level through interviews (n = 30) and document review. The coding frame combined
the processual approach with the spread mechanisms. Pre-determined outcomes included the number of staff
trained about dysphagia and impact related to changes in practice.
Results: The features and processes associated with hierarchical control and participatory adaptation were
identified. Leadership, critical junctures, temporality and making the innovation routine were aspects of hierarchical
control. Participatory adaptation was evident on the care pathways through stakeholder responses, workload and
resource pressures. Six of the 25 ward based trainers cascaded the dysphagia training. The expected outcomes
were achieved when the top-down mandate (hierarchical control) was supplemented by local engagement and
support (participatory adaptation).
Conclusions: Frameworks for spread and sustainability were combined to create a ‘small theory’ that described
the interventions, the processes and desired outcomes a priori. This novel methodological approach confirmed
what is known about spread and sustainability, highlighted the particularity of change and offered new insights
into the factors associated with hierarchical control and participatory adaptation. The findings illustrate the dualities
of organisational change as universal and context specific; as particular and amendable to theoretical generalisation.
Appreciating these dualities may contribute to understanding why many innovations fail to become routine