Raheelah Ahmad

Technology adoption and implementation in organisations: comparative case studies of 12 English NHS Trusts

Objectives To understand organisational technology adoption (initiation, adoption decision, implementation) by looking at the different types of innovation knowledge used during this process. Design Qualitative, multisite, comparative case study design. Setting One primary care and 11 acute care organisations (trusts) across all health regions in England in the context of infection prevention and control. Participants and data analysis 121 semistructured individual and group interviews with 109 informants, involving clinical and non-clinical staff from all organisational levels and various professional groups. Documentary evidence and field notes were also used. 38 technology adoption processes were analysed using an integrated approach combining inductive and deductive reasoning. Main findings Those involved in the process variably accessed three types of innovation knowledge: ‘awareness’ (information that an innovation exists), ‘principles’ (information about an innovations functioning principles) and ‘how-to’ (information required to use an innovation properly at individual and organisational levels). Centralised (national, government-led) and local sources were used to obtain this knowledge. Localised professional networks were preferred sources for all three types of knowledge. Professional backgrounds influenced an asymmetric attention to different types of innovation knowledge. When less attention was given to ‘how-to’ compared with ‘principles’ knowledge at the early stages of the process, this contributed to 12 cases of incomplete implementation or discontinuance after initial adoption. Conclusions Potential adopters and change agents often overlooked or undervalued ‘how-to’ knowledge. Balancing ‘principles’ and ‘how-to’ knowledge early in the innovation process enhanced successful technology adoption and implementation by considering efficacy as well as strategic, structural and cultural fit with the organisations context. This learning is critical given the policy emphasis for health organisations to be innovation-ready.

Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in healthcare. study protocol.

BackgroundWe know that patient care can be improved by implementing evidence-based innovations and applying research findings linked to good practice. Successfully implementing innovations in complex organisations, such as the UKs National Health Service (NHS), is often challenging as multiple contextual dynamics mediate the process. Research studies have explored the challenges of introducing innovations into healthcare settings and have contributed to a better understanding of why potentially useful innovations are not always implemented in practice, even if backed by strong evidence. Mediating factors include health policy and health system influences, organisational factors, and individual and professional attitudes, including decision makers perceptions of innovation evidence. There has been limited research on how different forms of evidence are accessed and utilised by organisational decision makers during innovation adoption. We also know little about how diverse healthcare professionals (clinicians, administrators) make sense of evidence and how this collective sensemaking mediates the uptake of innovations.MethodsThe study will involve nine comparative case study sites of acute care organisations grouped into three regional clusters across England. Each of the purposefully selected sites represents a variety of trust types and organisational contexts. We will use qualitative methods, in-depth interviews, observation of key meetings, and systematic analysis of relevant secondary data to understand the rationale and challenges involved in sourcing and utilising innovation evidence in the empirical setting of infection prevention and control. We will use theories of innovation adoption and sensemaking in organisations to interpret the data. The research will provide lessons for the uptake and continuous use of innovations in the English and international health systems.DiscussionUnlike most innovation studies, which involve single-level analysis, our study will explore the innovation-adoption process at multiple embedded levels: micro (individual), meso (organisational), and macro (interorganisational). By comparing and contrasting across the nine sites, each with different organisational contexts, local networks, leadership styles, and different innovations considered for adoption, the findings of the study will have wide relevance. The research will produce actionable findings responding to the political and economic need for healthcare organisations to be innovation-ready.

When the user is not the chooser: learning from stakeholder involvement in technology adoption decisions in infection control

BACKGROUNDnHealth systems need efficient and effective innovation decisions to provide maximum benefit to patients, particularly in a climate of financial constraints. Although evidence-based innovations exist for helping to address healthcare-associated infections, the uptake and implementation of these is highly variable and in some cases very slow.nnnAIMnTo investigate innovation adoption decisions and implementation processes from an organizational perspective, focusing on the implications of stakeholder involvement during the innovation process.nnnMETHODSnThirty-eight technology adoption decisions and implementation processes were examined through 121 qualitative interviews in 12 National Health Service healthcare organizations across England.nnnFINDINGSnStakeholder involvement varied across organizations with decisions highly exclusive to the infection prevention and control (IPC) team, to highly inclusive of wider organizational members. The context, including organizational culture, previous experience, and logistical factors influenced the level of stakeholder engagement. The timing of stakeholder involvement in the process impacted on: (i) the range of innovations considered; (ii) the technologies selected, and (iii) the success of technology implementation. Cases of non-adoption, discontinued adoption, and of successful implementation are presented to share learning. The potential benefits of stakeholder involvement for successful innovation adoption are presented including a goal-oriented framework for involvement.nnnCONCLUSIONSnKey stakeholder involvement can lead to innovation adoption and implementation compatible with structural and cultural contexts, particularly when involvement crosses the phases of initiation, decision-making and implementation. Involving members of the wider healthcare organization can raise the profile of IPC and reinforce efforts to make IPC everybodys business.

Provision and consumption of alcohol-based hand rubs in European hospitals

Hand hygiene is considered to be the most effective way of preventing microbial transmission and healthcare-associated infections. The use of alcohol-based hand rubs (AHRs) is the reference standard for effective hand hygiene. AHR consumption is a valuable surrogate parameter for hand hygiene performance, and it can be easily tracked in the healthcare setting. AHR availability at the point of care ensures access to optimal agents, and makes hand hygiene easier by overcoming barriers such as lack of AHRs or inconvenient dispenser locations. Data on AHR consumption and availability at the point of care in European hospitals were obtained as part of the Prevention of Hospital Infections by Intervention and Training (PROHIBIT) study, a framework 7 project funded by the European Commission. Data on AHR consumption were provided by 232 hospitals, and showed median usage of 21xa0mL (interquartile range (IQR) 9-37xa0mL) per patient-day (PD) at the hospital level, 66xa0mL/PD (IQR 33-103xa0mL/PD) at the intensive-care unit (ICU) level, and 13xa0mL/PD (IQR 6-25xa0mL/PD) at the non-ICU level. Consumption varied by country and hospital type. Most ICUs (86%) had AHRs available at 76-100% of points of care, but only approximately two-thirds (65%) of non-ICUs did. The availability of wall-mounted and bed-mounted AHR dispensers was significantly associated with AHR consumption in both ICUs and non-ICUs. The data show that further improvement in hand hygiene behaviour is needed in Europe. To what extent factors at the national, hospital and ward levels influence AHR consumption must be explored further.

Defining the user role in infection control

BACKGROUNDnHealth policy initiatives continue to recognize the valuable role of patients and the public in improving safety, advocating the availability of information as well as involvement at the point of care. In infection control, there is a limited understanding of how users interpret the plethora of publicly available information about hospital performance, and little evidence to support strategies that include reminding healthcare staff to adhere to hand hygiene practices.nnnAIMnTo understand how users define their own role in patient safety, specifically in infection control.nnnMETHODSnThrough group interviews, self-completed questionnaires and scenario evaluation, user views of 41 participants (15 carers and 26 patients with recent experience of inpatient hospital care in London, UK) were collected and analysed. In addition, the projects patient representative performed direct observation of the research event to offer inter-rater reliability of the qualitative analysis.nnnFINDINGSnUsers considered evidence of systemic safety-related failings when presented with hospital choices, and did not discount hospitals with high (red flagged) rates of meticillin-resistant Staphylococcus aureus. Further, users considered staff satisfaction within the workplace over and above user satisfaction. Those most dissatisfied with the care they received were unlikely to ask staff, Have you washed your hands?nnnCONCLUSIONnThis in-depth qualitative analysis of views from a relatively informed user sample shows what matters, and provides new avenues for improvement initiatives. It is encouraging that users appear to take a holistic view of indicators. There is a need for strategies to improve dimensions of staff satisfaction, along with understanding the implications of patient satisfaction.

A discrete event simulation model to evaluate the use of community services in the treatment of patients with Parkinson’s disease in the United Kingdom

BackgroundThe number of people affected by Parkinson’s disease (PD) is increasing in the United Kingdom driven by population ageing. The treatment of the disease is complex, resource intensive and currently there is no known cure to PD. The National Health Service (NHS), the public organisation delivering healthcare in the UK, is under financial pressures. There is a need to find innovative ways to improve the operational and financial performance of treating PD patients. The use of community services is a new and promising way of providing treatment and care to PD patients at reduced cost than hospital care. The aim of this study is to evaluate the potential operational and financial benefits, which could be achieved through increased integration of community services in the delivery of treatment and care to PD patients in the UK without compromising care quality.MethodsA Discrete Event Simulation model was developed to represent the PD care structure including patients’ pathways, treatment modes, and the mix of resources required to treat PD patients. The model was parametrised with data from a large NHS Trust in the UK and validated using information from the same trust. Four possible scenarios involving increased use of community services were simulated on the model.ResultsShifting more patients with PD from hospital treatment to community services will reduce the number of visits of PD patients to hospitals by about 25% and the number of PD doctors and nurses required to treat these patients by around 32%. Hospital based treatment costs overall should decrease by 26% leading to overall savings of 10% in the total cost of treating PD patients.ConclusionsThe simulation model was useful in predicting the effects of increased use of community services on the performance of PD care delivery. Treatment policies need to reflect upon and formalise the use of community services and integrate these better in PD care. The advantages of community services need to be effectively shared with PD patients and carers to help inform management choices and care plans.

Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis

Objective (1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. Design A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice. Setting 2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals). Participants 3 senior managers from 5 hospitals for qualitative interviews. Primary and secondary outcome measures As primary outcome measures, a ‘Red-Amber-Green’ (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results. Results National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management. Conclusions For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can be extended to other country settings.

Building grass roots capacity to tackle childhood obesity

Aims: In recognition of the increasing problem of child obesity in London and elsewhere, we were commissioned to build capacity to tackle this major public health concern. This paper describes one of the outputs of this work: to develop and deliver effective brief intervention training on the subject of childhood healthy/unhealthy weight and obesity to be used by anyone who works with children and families, regardless of their job title or level of educational achievement. Methods: A literature review informed the process. The slim evidence derived was combined with the expertise of an expert working group to develop clear learning objectives for training and then to develop a flexible one-day training programme suitable for delivery to mixed groups of participants, to meet the learning objectives. Evaluation was built into the programme by means of a questionnaire at the end of the training session and by the use of a structured reflective log to be returned by participants once they had put their training into practice. Results: The training programme was delivered free of charge to over 560 people during the course of a Regional Public Health Group-sponsored project. Subsequently it has been delivered to several more audiences working in the NHS, local government and third sectors in London on a not-for-profit basis. Conclusions: The programme, based on best available evidence and clear evidence of needs, provides a low-cost evaluated intervention that permits people from diverse professional and occupational backgrounds to acquire the knowledge, skills and confidence needed to raise the subject of healthy and unhealthy weight with parents of primary school-aged children and signpost them to appropriate local facilities and services. Although developed in London, the programme may be used anywhere in the UK, with the substitution of local information about prevalence of overweight and obesity and about local services and facilities.

Involving citizens in priority setting for public health research: Implementation in infection research

Public sources fund the majority of UK infection research, but citizens currently have no formal role in resource allocation. To explore the feasibility and willingness of citizens to engage in strategic decision making, we developed and tested a practical tool to capture public priorities for research.

Comparison of governance approaches for the control of antimicrobial resistance: Analysis of three European countries

Policy makers and governments are calling for coordination to address the crisis emerging from the ineffectiveness of current antibiotics and stagnated pipe-line of new ones – antimicrobial resistance (AMR). Wider contextual drivers and mechanisms are contributing to shifts in governance strategies in health care, but are national health system approaches aligned with strategies required to tackle antimicrobial resistance? This article provides an analysis of governance approaches within healthcare systems including: priority setting, performance monitoring and accountability for AMR prevention in three European countries: England, France and Germany. Advantages and unresolved issues from these different experiences are reported, concluding that mechanisms are needed to support partnerships between healthcare professionals and patients with democratized decision-making and accountability via collaboration. But along with this multi-stakeholder approach to governance, a balance between regulation and persuasion is needed.