Implementation of person-centred care: management perspective

Abstract

Objective: In this study the implementation of a care model was examined in a public hospital in Sweden. The aim was to identify, from the management perspective, barriers and facilitators with respect to the implementation. A further aim was to study the explanatory power of a theoretical framework, normalization process theory (NPT). Method: Semi-structured interviews were conducted with all of the members of a hospital departments’ managerial group. Interview transcripts were analysed by means of directed deductive content analysis, applying NPT as theoretical frame work. Results: The respondents identified factors, which were perceived as facilitating or obstructing the implementation process. These factors were; organizational culture, distribution of power, patient characteristics, resistance to change, teamwork, efficiency, time and speed of implementation. The theoretical framework, NPT, was partly supported by the data. There was however an absence of collective action and reflexive monitoring constructs. Conclusion: The implementation process, according to NPT, was incomplete and there was a risk that it could regress to the previous work routines. However, implementation theories, including NPT, do not have a timeframe for the implementation process. Even though theories are able of describing in detail the steps for successfully embedding and sustaining an innovation, they do not describe or identify factors influencing the speed of the implementation. A possible reason might be that time is a subjective factor.

The process of implementing a new working method - a project towards change in a Swedish psychiatric clinic

“…With some restrictions suggested by May et al, NPT could be used to predict the outcome of implementation processes [25] . Alharbi et al mean that NPT has a weakness in the sense that the theory does not take into account the time dimension of implementation processes [38] , a notion that is also supported by the present results. Participants on some of the studied wards suggested that more time is required in relation to the implementation process.…”

“…Even if a previous study on these wards [42] did not show that they were dominated by change resistant cultures, the present results of this present study suggest that there are indeed additional inhibiting factors that affected the outcomes of implementation of the DLDA tool [15,61] . Besides cultural characteristics, resistance to change and its impact on implementation processes [14,15,34,62] as well as time constraints and co-workers defending the old system [18,33,38,56] , the present study reveals a number of other factors that may have affected the implementation processes: time pressure; heavy workload; stress; lack of routines in using the new tool; lack of nursing staff as well as lack of time. Lack of time is also consistent with the findings of Grol and Wensing, who mean that time-consuming, complex interventions may affect the implementation process in nursing [63] .…”

“…Reflexive monitoring concerns how this new way of working or new method is assessed and understood by the participants. Implementation can be summarized as a process containing four steps, starting with coherence, cognitive participation, collective action and, if the implementation is fully successful, ending with reflexive monitoring [23][24][25]38] . Because NPT has been developed for the healthcare industry and has been used to analyse implementation processes in hospital contexts, it is thought to be a useful conceptual tool for use in the present study and for understanding the implementation, embedding and integration of the DLDA tool in a psychiatric nursing context [38] .…”

Collaboration Exercises—The Lack of Collaborative Benefits

“…If the participating organizations can balance contrasting characteristics such as flexibility and firmness, then learning can be more than an individualistic and repetitive behavior (drill). New integrative strategies can be developed and implemented (collaboration exercises) (Johansson et al 2013;Alharbi et al 2014).…”

“…This stresses the need to support flexibility and trust, as well as stability, planning, and repetitive behavior. Alharbi et al (2014) suggest that organizations that can balance opposing characteristics seem to have the best chance to successfully implement necessary change and sustain it. This is in accordance with Quinn (1988), who asserts that effective organizations present contradictory characteristics.…”