Proceedings of the 6th UK and Ireland implementation science research conference

Abstract

Background: this paper presents findings from a novel theoretically informed agency-structure study involving implementation of a Compassionate Care Initiative (CCI) in a NHS mental health setting during Covid-19 in the UK. We argue that implementation during Covid-19, not only compounded existing barriers to implementation identified in earlier studies reporting on implementation of CCI in acute hospital settings, such as staffing levels and working practices [1,2,3], but presented an unprecedented implementation landscape of uncertainty operating at micro, meso and macro levels with key implications for conceptualising sustainability.

Method: the study adopted a longitudinal case study design [4] in one NHS mental health setting in the UK involving semi-structured interviews with staff involved in the implementation of CCI (managers, facilitators and frontline care staff including registered nurses), alongside documentary analysis of key documents. A theoretically informed approach, involving a combination of structuration theory (ST) and Normalisation Process Theory (NPT) informed analysis [5,6,7,8].

Results: findings demonstrate that the implementation of CCI during Covid-19 presented an unprecedented landscape for implementation, requiring staff navigation of complex and shifting micro, meso and macro dynamics and uncertainties. Tensions between the opportunity of CCI related activities to afford mechanisms of support to staff were counteracted with concerns over involvement through potential risks of contracting Covid-19 and wider infection control policies. Understanding staff perceptions and experiences of the complexities of implementation are pivotal to affording insight into this uncertainty.

Conclusion: navigating uncertainty in the implementation of CCI during Covid-19 provides invaluable insight into the often contradictory dynamics of implementation in highly adaptive circumstances. It prioritises the importance of understanding the perceptions and experiences of those at the forefront of this agency and structure interface, conceptualising sustainability as a fluid and dynamic space to be continually revisited in accordance with these dynamics.

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Identifiers

ORCID for Cindy Brooks: orcid.org/0000-0002-0022-2100

ORCID for Jackie Bridges: orcid.org/0000-0001-6776-736X

ORCID for Jane Frankland: orcid.org/0000-0002-3813-8879

ORCID for Michelle Myall: orcid.org/0000-0001-8733-7412

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