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Implementing a new clinical pathway in a non-receptive context : mixed methods evaluation of a new fracture pathway for older people in a hospital Trust in the West Midlands, UK
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Combes, Gill, Owen, Gareth, Damery, Sarah, Flanagan, Sarah, Brown, Celia and Currie, Graeme (2021) Implementing a new clinical pathway in a non-receptive context : mixed methods evaluation of a new fracture pathway for older people in a hospital Trust in the West Midlands, UK. PLoS One, 16 (2). e0247455. doi:10.1371/journal.pone.0247455 ISSN 1932-6203.
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Official URL: https://doi.org/10.1371/journal.pone.0247455
Abstract
Objectives
This paper reports a mixed methods evaluation of a new pathway to improve clinical outcomes for older people with fractures treated at a hospital Trust in the West Midlands, UK. The paper focuses specifically on the context surrounding the translation of the new pathway into practice and the way that external and internal factors influenced its adaptation and implementation.
Methods
Quantitative analysis used a controlled Interrupted Time Series (ITS) to estimate the effect of the new pathway on patient complication rate, median length of hospital stay and 30-day mortality by comparing the pre- and post-intervention periods. ITS data were extracted from the UK Trauma Audit and Research Network (TARN) database and a patient-level control group identified using propensity score matching. Parallel qualitative analysis aimed to examine the context surrounding the new pathway and how external and internal factors might influence its adaption and implementation into clinical practice. Data were collected via semi-structured interviews (n = 16) undertaken with staff and clinical stakeholders within the Trust and were analysed using the COM-B (Capability, Opportunity, Motivation) model of behaviour.
Results
No statistically significant effects were found for any of the patient outcomes studied in the controlled ITS analysis. Qualitative data suggest that the lack of effectiveness of the new initiative can be explained with reference to the capability, opportunity and motivation of internal Trust stakeholders to engage with the pathway, which created a non-receptive environment within the Trust.
Conclusions
Successfully implementing new care pathways in environments that may be non-receptive to change requires efforts to be put into winning ‘hearts and minds’ within the organisation to ensure engagement from key stakeholders during intervention development. Evidence must be provided internally of the way that a given intervention will alleviate the problematic issues being experienced within the organisation, and external dissemination of results should be avoided until there is evidence of a positive effect within the organisation where the new care pathway is first implemented.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RD Surgery |
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| Divisions: | Faculty of Social Sciences > Warwick Business School > Entrepreneurship, Innovation & Management Faculty of Social Sciences > Warwick Business School |
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| Library of Congress Subject Headings (LCSH): | Older people -- Wounds and injuries -- Medical care, Fractures in old age -- Treatment, Bones -- Wounds and injuries, Older people -- Medical care, Medical care -- Needs assessment, Falls (Accidents) in old age | ||||||
| Journal or Publication Title: | PLoS One | ||||||
| Publisher: | Public Library of Science | ||||||
| ISSN: | 1932-6203 | ||||||
| Official Date: | 22 February 2021 | ||||||
| Dates: |
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| Volume: | 16 | ||||||
| Number: | 2 | ||||||
| Article Number: | e0247455 | ||||||
| DOI: | 10.1371/journal.pone.0247455 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 16 February 2021 | ||||||
| Date of first compliant Open Access: | 23 March 2021 | ||||||
| RIOXX Funder/Project Grant: |
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