Hospital Associated Deconditioning: A System-Thinking Solution to Promoting Incidental Patient Movement

Abstract

Hospital associated deconditioning is a syndrome predicted by inactivity, sedentary behaviour, and maladaptive sleep and dietary behaviours. There have been a range of interventions and programmes which have attempted to modify the behaviours predicting deconditioning, with weak to moderate effectiveness. This to some extent may be due to researchers, policymakers, stakeholders, and clinicians neglecting the system in which deconditioning occurs. Systems-thinking methodologies may have the capacity to understand the complexity underpinning deconditioning and explain where ‘change’ can be acceptably, feasibly, and effectively leveraged. In addressing this challenge, the study which this protocol represents will use secondary data to understand the system through a sequential process and identify leverage points for change. These processes will be validated through an expert group of academics, stakeholders, and a representation of the clinical multi-disciplinary team. More specifically, building on previous research outside a clinical domain, the present study will follow five sequential steps. These include conducting a PRISMA scoping review of peer-reviewed and grey evidence (Phase 1), using these data to construct AcciMap and ActorMap (Phase 2) and a systems map (Phase 3), identifying leverage points (Phase 4), and verifying our systems-science findings with subject experts (Phase 5). Findings will be published within academic periodicals, presented within conferences, and disseminated to policymakers through reports and outreach events.