Tracking, naming, specifying, and comparing implementation strategies for person-centred care in a real-world setting: a case study with seven embedded units

Abstract

Background The implementation of person-centred care (PCC) is advocated worldwide. Stakeholders in charge of implementing PCC as a broad-scale change across the health care sector face two intertwined and complex challenges. First, making sense of PCC as an intervention with complex innovation characteristics and second, staging implementation of PCC by choosing appropriate implementation strategies. We aimed to explore one of these challenges by tracking, naming, specifying, and comparing which strategies and how strategies were enacted to support the implementation of more PCC in a real-world setting represented by one health care region in Sweden. Methods A case study with seven embedded units at two organisational levels within a health care region was conducted from 2016 to 2019. Data were collected from three sources: activity logs, interviews, and written documents. Strategies were identified from all sources and triangulated deductively by name, definition, and cluster in line with the taxonomy Expert Recommendations for Implementing Change (ERIC) and specified according to recommendations by Proctor and colleagues as actor, action, action target, temporality, dose, outcome, and justification. Results Four hundred thirteen activities were reported in logs, representing 43 discrete strategies identified in ERIC (n = 38), elsewhere (n = 1), or as emerging strategies (n = 4). The highest reported frequencies of discrete strategies were identified as belonging to two clusters: Train and educate stakeholders (40%) and Develop stakeholder interrelationships (38%). We identified a limited number of strategies belonging to the cluster Use evaluative and iterative strategies (4.6%) and an even smaller number of strategies targeting information to patients about the change initiative (0.8%). Most of the total dose of 11,076 person-hours in the 7 units was spent on strategies targeting health care professionals who provide PCC (81.5%) while the dose of strategies targeting support functions was 18.5%. Conclusions Our findings show both challenges and merits when strategies for implementation of PCC are conducted in a real-world setting. The results can be used to support and guide both scientists and practitioners in future implementation initiatives.

How is tailored implementation undertaken using a self-guided toolkit? Qualitative study of the ItFits-toolkit in the ImpleMentAll project

“…In relation to implementation strategies themselves, differences in how these are conceptualised and operationalised 'on the ground' are likely. In our study, some teams created custom strategies that were not seen to be represented in the list derived from ERIC, which has also been found in other studies of use of implementation strategies in real world settings where 'new' strategies not included in ERIC have been proposed [28,29]. In real world implementation, further understanding of how strategies employed change over time from initial planning, to executing, and maintaining service innovations is needed [26].…”

Analysis on personnel costs and working time for implementing a more person-centred care approach: a case study with embedded units in a Swedish region

“…This study thus reports on the resources used for implementing a more PCC approach in one Swedish region, using data from a case study with seven embedded units ( study protocol available as Supporting information ). Previous publications from the IMPROVE project have investigated how patients’ perception of PCC can be measured, 19 how the concept of PCC was perceived by healthcare staff, 20 how the concept of PCC was operationalised by the units, 21 the used implementation strategies 22 and congruence of managers’ perceptions and understanding of PCC across organisational levels. 23 …”

“…There was no joint implementation support programme other than the learning seminars, but the DD could provide support on-demand. The implementation strategies used have previously been described to mainly fall in two clusters, that is, train and educate stakeholder, as well as Develop stakeholder interrelationships 22…”

“…The implementation strategies used have previously been described to mainly fall in two clusters, that is, train and educate stakeholder, as well as Develop stakeholder interrelationships. 22 …”

“…The implementation strategies used have previously been described to mainly fall in two clusters, that is, train and educate stakeholder, as well as Develop stakeholder interrelationships. 22 The process evaluation Interventions or programmes directed to changing healthcare provision, such as the implementation of PCC, are often described as complex interventions. 30 Complex interventions are interventions that contain several interacting components.…”