Creating pre-conditions for change in clinical practice: the influence of interactions between multiple contexts and human agency
Creating pre-conditions for change in clinical practice: the influence of interactions between multiple contexts and human agency
Purpose: The purpose of this paper is to explore what happens when changes to clinical practice are proposed and introduced in healthcare organisations. The authors use the implementation of Treatment Escalation Plans to explore the dynamics shaping the translational journey of a complex intervention from research into the everyday context of real-world healthcare settings. Design/methodology/approach: A qualitative instrumental collective case study design was used. Data were gathered using qualitative interviews (n = 36) and observations (n = 46) in three English acute hospital trusts. Normalisation process theory provided the theoretical lens and informed data collection and analysis. Findings: While each organisation faced the same translational problem, there was variation between settings regarding adoption and implementation. Successful change was dependent on participants' ability to manage and shape contexts and the work this involved was reliant on individual capacity to create a new, receptive context for change. Managing contexts to facilitate the move from research into clinical practice was a complex interactive and iterative process. Practical implications: The paper advocates a move away from contextual factors influencing change and adoption, to contextual patterns and processes that accommodate different elements of whole systems and the work required to manage and shape them. Originality/value: The paper addresses important and timely issues of change in healthcare, particularly for new regulatory and service-oriented processes and practices. Insights and explanations of variations in implementation are revealed which could contribute to conceptual generalisation of context and implementation.
Agency, Case study, Context, England, Implementation, National Health Service, Normalisation process theory, Organisational change, Treatment Escalation Plan
Myall, Michelle
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May, Carl
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Richardson, Alison
3db30680-aa47-43a5-b54d-62d10ece17b7
Bogle, Sarah
edae2c50-f030-419e-b71d-71f73a7cc75b
Campling, Natasha
0e0410b0-a9cd-486d-a51f-20d80df04791
Dace, Sally
617290ee-3839-45e1-81ef-35c3220920c7
Lund, Susi
239a4d54-13e1-4d69-8e3f-08475c20af47
Myall, Michelle
0604ba0f-75c2-4783-9afe-aa54bf81513f
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Richardson, Alison
3db30680-aa47-43a5-b54d-62d10ece17b7
Bogle, Sarah
edae2c50-f030-419e-b71d-71f73a7cc75b
Campling, Natasha
0e0410b0-a9cd-486d-a51f-20d80df04791
Dace, Sally
617290ee-3839-45e1-81ef-35c3220920c7
Lund, Susi
239a4d54-13e1-4d69-8e3f-08475c20af47
Myall, Michelle, May, Carl, Richardson, Alison, Bogle, Sarah, Campling, Natasha, Dace, Sally and Lund, Susi
(2020)
Creating pre-conditions for change in clinical practice: the influence of interactions between multiple contexts and human agency.
Journal of Health Organization and Management.
(doi:10.1108/JHOM-06-2020-0240).
Abstract
Purpose: The purpose of this paper is to explore what happens when changes to clinical practice are proposed and introduced in healthcare organisations. The authors use the implementation of Treatment Escalation Plans to explore the dynamics shaping the translational journey of a complex intervention from research into the everyday context of real-world healthcare settings. Design/methodology/approach: A qualitative instrumental collective case study design was used. Data were gathered using qualitative interviews (n = 36) and observations (n = 46) in three English acute hospital trusts. Normalisation process theory provided the theoretical lens and informed data collection and analysis. Findings: While each organisation faced the same translational problem, there was variation between settings regarding adoption and implementation. Successful change was dependent on participants' ability to manage and shape contexts and the work this involved was reliant on individual capacity to create a new, receptive context for change. Managing contexts to facilitate the move from research into clinical practice was a complex interactive and iterative process. Practical implications: The paper advocates a move away from contextual factors influencing change and adoption, to contextual patterns and processes that accommodate different elements of whole systems and the work required to manage and shape them. Originality/value: The paper addresses important and timely issues of change in healthcare, particularly for new regulatory and service-oriented processes and practices. Insights and explanations of variations in implementation are revealed which could contribute to conceptual generalisation of context and implementation.
Text
Creating pre-conditions for change in clinical practice the influence of interactions between multiple contexts and human agency
- Accepted Manuscript
More information
Accepted/In Press date: 25 August 2020
e-pub ahead of print date: 27 October 2020
Additional Information:
Publisher Copyright:
© 2020, Michelle Myall, Carl May, Alison Richardson, Sarah Bogle, Natasha Campling, Sally Dace and Susi Lund.
Keywords:
Agency, Case study, Context, England, Implementation, National Health Service, Normalisation process theory, Organisational change, Treatment Escalation Plan
Identifiers
Local EPrints ID: 443743
URI: http://eprints.soton.ac.uk/id/eprint/443743
ISSN: 1477-7266
PURE UUID: bd797a48-59a0-49c8-8fc2-b62cd26f09cd
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Date deposited: 10 Sep 2020 16:47
Last modified: 17 Mar 2024 05:53
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Contributors
Author:
Carl May
Author:
Sarah Bogle
Author:
Sally Dace
Author:
Susi Lund
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