Exploring readiness for implementing goal-oriented care in primary care using normalization process theory

Huybrechts, Ine; Boeykens, Dagje; Grudniewicz, Agnes; Gray, Carolyn Steele; Sutter, An De; Pype, Peter; Velde, Dominique Van de; Boeckxstaens, Pauline; Anthierens, Sibyl

doi:10.1017/s1463423622000767

Cited by 4 publications

(1 citation statement)

References 32 publications

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“…Huybrechts and colleagues similarly found a positive tendency for coherence and cognitive participation when exploring readiness for implementing goal-oriented care in primary care. 32 In our study, we focused our implementation intervention mainly toward subconstructs within collective action, which led to successful implementation of the cranial surgery ERP.…”

Section: Discussionmentioning

confidence: 99%

Theory-based implementation of an enhanced recovery protocol for cranial surgery

Jamjoom,

Sluijters,

Yeung

et al. 2023

Neurosurgical Focus

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OBJECTIVE There is growing evidence for the use of enhanced recovery protocols (ERPs) in cranial surgery. As they become widespread, successful implementation of these complex interventions will become a challenge for neurosurgical teams owing to the need for multidisciplinary engagement. Here, the authors describe the novel use of an implementation framework (normalization process theory [NPT]) to promote the incorporation of a cranial surgery ERP into routine neuro-oncology practice. METHODS A baseline audit was conducted to determine the degree of implementation of the ERP into practice. The Normalization MeAsure Development (NoMAD) questionnaire was circulated among 6 groups of stakeholders (neurosurgeons, anesthetists, intensivists, recovery nurses, preoperative assessment nurses, and neurosurgery ward staff) to examine barriers to implementation. Based on these findings, a theory-guided implementation intervention was delivered. A repeat audit and NoMAD questionnaire were conducted to assess the impact of the intervention on the uptake of the ERP. RESULTS The baseline audit (n = 24) demonstrated limited delivery of the ERP elements. The NoMAD questionnaire (n = 32) identified 4 subconstructs of the NPT as barriers to implementation: communal specification, contextual integration, skill set workability, and relational integration. These guided an implementation intervention that included the following: 1) teamwork-focused training; 2) ERP promotion; and 3) procedure simplification. The reaudit (n = 21) demonstrated significant increases in the delivery of 5 protocol elements: scalp block (12.5% of patients before intervention vs 76.2% of patients after intervention, p < 0.00001), recommended analgesia (25.0% vs 100.0%, p < 0.00001) and antiemetics (12.5% vs 100.0%, p < 0.00001), trial without catheter (13.6% vs 88.9%, p < 0.00001), and mobilization on the 1st postoperative day (45.5% vs 94.4%, p < 0.00001). There was a significant reduction in the mean hospital length of stay from 6.3 ± 3.4 to 4.2 ± 1.7 days (p = 0.022). Two months after implementation, a repeat NoMAD survey demonstrated significant improvement in communal specification. CONCLUSIONS Here, the authors have demonstrated the successful implementation of a cranial surgery ERP by using a systematic theory-based approach.

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Section: Discussionmentioning

confidence: 99%

Theory-based implementation of an enhanced recovery protocol for cranial surgery

Jamjoom,

Sluijters,

Yeung

et al. 2023

Neurosurgical Focus

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Opportunities and challenges of promoting integrated care through digitalisation–Learning lessons from large-scale national programmes in England

Cresswell,

Anderson,

Elizondo

et al. 2024

Health Policy and Technology

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Strengths-based practice in adult social care: Understanding implementation

Mahesh,

Bharatan,

Miller

2024

NIHR Open Res

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Background There has been increasing emphasis towards adopting strengths-based practice (SBP) within adult social care in England. Whilst there is agreement that SBP is the right approach to discharge adult social care duties, there is limited evidence regarding the implementation of SBP. This paper presents findings from the evaluation of the implementation of SBP in fourteen local authorities in one region in England. Methods We employed a mixed methods research design, drawing on data from a scoping review, 36 interviews with practice leaders and two surveys, one with wider adult social care staff and the other, with external organisations like independent care providers and community and voluntary organisations. Our data collection and analysis were guided by two well established implementation theories: the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT). Interviews were analysed deductively, and surveys were analysed descriptively. Results Local authorities are at different stages in their implementation journey. The Care Act 2014 and support for SBP demonstrated by key professional groups were seen as major drivers for implementing SBP. Whilst SBP resonated with the professional principles of social workers and occupational therapists, staff did not always have the confidence and skills to adapt to SBP. Changing paperwork and recording systems, providing training opportunities to develop staff competencies, establishing new care pathways, genuine co-production, and senior management buy-in were key enablers supporting implementation. Conclusions To successfully implement SBP, a whole system approach that meaningfully collaborates with key professionals across sectors is essential. When implemented well, SBP has the potential to empower individuals by focusing on what matters to them.

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Exploring readiness for implementing goal-oriented care in primary care using normalization process theory

Cited by 4 publications

References 32 publications

Theory-based implementation of an enhanced recovery protocol for cranial surgery

Theory-based implementation of an enhanced recovery protocol for cranial surgery

Opportunities and challenges of promoting integrated care through digitalisation–Learning lessons from large-scale national programmes in England

Strengths-based practice in adult social care: Understanding implementation

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