Organizational readiness to implement the Serious Illness Care Program in hospital settings in Sweden

Abstract

Background The Serious Illness Care Program (SICP) is a model developed for structured communication, identifying patients, and training physicians to use a structured guide for conversations with patients and family members. However, there is a lack of knowledge regarding the sustainable implementation of this conversation model. Therefore, the aim of this study was to identify barriers and enablers during the implementation of the SICP in hospital settings. Methods The SICP was implemented at 20 units in two hospitals in Sweden. During the implementation process, seven individual interviews and two group interviews were conducted with seven facilitators (five physicians, one behavioral therapist, and one administrator). Data were analyzed using qualitative content analysis, first inductively, and then deductively using the organizational readiness for change as a theoretical framework. Result The analysis resulted in three factors acting as enablers and eight factors acting as enablers and/or barriers during the implementation of the SICP. The three factors considered as enablers were preliminaries, identifying patients, and facilitator’s role. The eight factors considered as enablers and/or barriers were broad implementation, leadership, time, confidence, building foundation, motivation to work change, motivation for training in serious illness conversations, and attitudes. Conclusion This study indicates limited readiness to implement the SICP in hospital settings due to considerable variation in organizational contextual factors, change efficacy, and change commitment. The identified enablers and barriers for implementation of the SICP could guide and support future implementations to be sustainable over time.

Physicians’ perceptions of the implementation of the serious illness care program: a qualitative study

“…For instance, having SIC can interfere with beliefs that the physician’s professional role is to “treat”, not to talk about values and goals [ 16 ]. Physicians’ attitudes and their own capabilities in SIC have been described as both an enabler and a barrier [ 17 ]. However, altering mindsets and creating culture shifts regarding attitudes and norms around SIC can occur alongside the implementation process [ 18 ].…”

Impact of Training in Serious Illness Communication and Work Life Balance on Physicians’ Self-Efficacy, Clinical Practice and Perception of Roles

“…The physicians’ confidence in their ability to find time to conduct ACP conversations remained low, and constitutes an organizational barrier, as described by Andersson and Sandgren in their recent study of organizational readiness to change. 20 The high level of burnout among physicians in hemato-oncology calls for institutional interventions in addition to training. A work organization allocating time to conduct goals of care conversations could be one the means.…”

Perils and payoffs for patients in serious illness conversations as described by physicians: a qualitative study

“…15 16 A study describing organisational factors related to implementing the SICP found that clinicians' confidence, motivation and attitudes to enacting serious illness conversations could act as barriers as well as facilitators to the implementation. 17…”