Exploring implementation and sustainability of models of care: can theory help?
Exploring implementation and sustainability of models of care: can theory help?
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DOI：
10.1186/1471-2458-11-s5-s8
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发表时间：
2011-11-25
影响因子：
4.5
通讯作者：
Willis, Karen
中科院分区：
文献类型：
--
作者：
Forster, Della A.;Newton, Michelle;Willis, Karen
目的：关于提供保健服务的新的护理模式的研究是复杂的，这种模式的引入和嵌入也是复杂的，积极的研究结果只是决定是否实施新的护理模式的一个因素。为了理解为什么会出现这种情况，研究设计不仅要考虑临床遇到的拟议变化，而且要考虑必须维持和规范任何变化的实践的组织背景。我们使用了两个案例研究，通过随机对照试验（RCT）实施和评估了新的孕产妇护理模式，以讨论如何（或是否）使用理论可能会告知实施和可持续发展战略。正常化过程模型提出了一个合适的理论框架，并使用两个案例研究的比较-一个理论框架被使用，其他的地方，它不是。上下文和方法：在产妇部门有相当大的辩论，哪种模式的护理提供最好的结果为妇女，同时可持续的组织设置。我们探讨了为什么一个模式的产妇护理-助产士团队（妇女有一小群助产士提供他们的照顾）-这是实施和测试的随机对照试验后，随机对照试验的结论没有继续，尽管显示相同或更好的结果，为妇女在干预组相比，妇女分配到常规护理。然后，我们讨论的概念和理由，导致使用的'规范化过程模型'，作为一种援助，探索方面的实施情况下的助产模式（为妇女分配一名初级助产士进行护理），最近由随机对照试验进行了评估。我们展示了如何规范化过程模型应用于规划的评价阶段的随机对照试验作为一种手段，探索实施of the cases案件load量model模型of care护理.我们认为，在医院等复杂环境中研究复杂的干预措施时，对实施和可持续性相关问题的理论理解可以做出有价值的贡献。理论模型在复杂干预研究中的应用使人们能够更好地理解引入新护理模式的组织背景，并识别促进或挑战的因素实施这些护理模式。
Objective: Research on new models of care in health service provision is complex, as is the introduction and embedding of such models, and positive research findings are only one factor in whether a new model of care will be implemented. In order to understand why this is the case, research design must not only take account of proposed changes in the clinical encounter, but the organisational context that must sustain and normalise any changed practices. We use two case studies where new models of maternity care were implemented and evaluated via randomised controlled trials (RCTs) to discuss how (or whether) the use of theory might inform implementation and sustainability strategies. The Normalisation Process Model is proposed as a suitable theoretical framework, and a comparison made using the two case studies - one where a theoretical framework was used, the other where it was not.Context and approach: In the maternity sector there is considerable debate about which model of care provides the best outcomes for women, while being sustainable in the organisational setting. We explore why a model of maternity care - team midwifery (where women have a small group of midwives providing their care) - that was implemented and tested in an RCT was not continued after the RCT's conclusion, despite showing the same or better outcomes for women in the intervention group compared with women allocated to usual care. We then discuss the conceptualisation and rationale leading to the use of the 'Normalisation Process Model' as an aid to exploring aspects of implementation of a caseload midwifery model (where women are allocated a primary midwife for their care) that has recently been evaluated by RCT.Discussion: We demonstrate how the Normalisation Process Model was applied in planning of the evaluation phases of the RCT as a means of exploring the implementation of the caseload model of care. We argue that a theoretical understanding of issues related to implementation and sustainability can make a valuable contribution when researching complex interventions in complex settings such as hospitals.Conclusion and implications: Application of a theoretical model in the research of a complex intervention enables a greater understanding of the organisational context into which new models of care are introduced and identification of factors that promote or challenge implementation of these models of care.