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Barriers and enablers for externally and internally driven implementation processes in healthcare: a qualitative cross-case study

BMC health services research, 2024-04, Vol.24 (1), p.528-528 [Peer Reviewed Journal]

2024. The Author(s). ;COPYRIGHT 2024 BioMed Central Ltd. ;2024. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;ISSN: 1472-6963 ;EISSN: 1472-6963 ;DOI: 10.1186/s12913-024-10985-2 ;PMID: 38664668

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  • Title:
    Barriers and enablers for externally and internally driven implementation processes in healthcare: a qualitative cross-case study
  • Author: Lyng, Hilda Bø ; Ree, Eline ; Strømme, Torunn ; Johannessen, Terese ; Aase, Ingunn ; Ullebust, Berit ; Thomsen, Line Hurup ; Holen-Rabbersvik, Elisabeth ; Schibevaag, Lene ; Bates, David W ; Wiig, Siri
  • Subjects: Case studies ; Data collection ; Home care services ; Home Care Services - organization & administration ; Home care services industry ; Home health care ; Homework ; Humans ; Implementation ; Implementation barriers ; Implementation enablers ; Intervention ; Interviews ; Leadership ; Medical care ; Norway ; Nursing homes ; Nursing Homes - organization & administration ; Nursing Homes - standards ; Patient safety ; Primary care ; Primary Health Care - organization & administration ; Professional development ; Qualitative Research ; Quality improvement ; Quality Improvement - organization & administration ; Quality management ; Service enhancement ; Workshops
  • Is Part Of: BMC health services research, 2024-04, Vol.24 (1), p.528-528
  • Description: Quality in healthcare is a subject in need of continuous attention. Quality improvement (QI) programmes with the purpose of increasing service quality are therefore of priority for healthcare leaders and governments. This study explores the implementation process of two different QI programmes, one externally driven implementation and one internally driven, in Norwegian nursing homes and home care services. The aim for the study was to identify enablers and barriers for externally and internally driven implementation processes in nursing homes and homecare services, and furthermore to explore if identified enablers and barriers are different or similar across the different implementation processes. This study is based on an exploratory qualitative methodology. The empirical data was collected through the 'Improving Quality and Safety in Primary Care - Implementing a Leadership Intervention in Nursing Homes and Homecare' (SAFE-LEAD) project. The SAFE-LEAD project is a multiple case study of two different QI programmes in primary care in Norway. A large externally driven implementation process was supplemented with a tracer project involving an internally driven implementation process to identify differences and similarities. The empirical data was inductively analysed in accordance with grounded theory. Enablers for both external and internal implementation processes were found to be technology and tools, dedication, and ownership. Other more implementation process specific enablers entailed continuous learning, simulation training, knowledge sharing, perceived relevance, dedication, ownership, technology and tools, a systematic approach and coordination. Only workload was identified as coincident barriers across both externally and internally implementation processes. Implementation process specific barriers included turnover, coping with given responsibilities, staff variety, challenges in coordination, technology and tools, standardizations not aligned with work, extensive documentation, lack of knowledge sharing. This study provides understanding that some enablers and barriers are present in both externally and internally driven implementation processes, while other are more implementation process specific. Dedication, engagement, technology and tools are coinciding enablers which can be drawn upon in different implementation processes, while workload acted as the main barrier in both externally and internally driven implementation processes. This means that some enablers and barriers can be expected in implementation of QI programmes in nursing homes and home care services, while others require contextual understanding of their setting and work.
  • Publisher: England: BioMed Central Ltd
  • Language: English
  • Identifier: ISSN: 1472-6963
    EISSN: 1472-6963
    DOI: 10.1186/s12913-024-10985-2
    PMID: 38664668
  • Source: PubMed (Medline)
    Geneva Foundation Free Medical Journals at publisher websites
    AUTh Library subscriptions: ProQuest Central
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    SpringerOpen website
    ROAD: Directory of Open Access Scholarly Resources
    DOAJ Directory of Open Access Journals
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