Application of the critical incident technique in refining a realist initial programme theory

Cunningham, Una; Brún, Aoife De; McAuliffe, Éilish

doi:10.1186/s12874-020-01016-9

Cited by 8 publications

(10 citation statements)

References 22 publications

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“…20 The use of CIT complements KII by drawing on more specific experiences and thereby eliciting richer data for realist enquiry. 21 Study setting and population Northern Uganda has an estimated population of 7.1 million and a total fertility rate of 5.4 children per woman. 5 The first part of this study was carried out in northern Uganda to explore the pathway to care of mothers accessing EmONC services through the referral system to Lacor Hospital.…”

Section: Methodsmentioning

confidence: 99%

Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda

et al. 2021

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ObjectivesTo critically explore and describe the pathways that women who require emergency obstetrics and newborn care (EmONC) go through and to understand the delays in accessing EmONC after reaching a health facility in a conflict-affected setting.DesignThis was a qualitative study with two units of analysis: (1) critical incident technique (CIT) and (2) key informant interviews with health workers, patients and attendants.SettingThirteen primary healthcare centres, one general private-not-for-profit hospital, one regional referral hospital and one teaching hospital in northern Uganda.ParticipantsForty-nine purposively selected health workers, patients and attendants participated in key informant interviews. CIT mapped the pathways for maternal deaths and near-misses selected based on critical case purposive sampling.ResultsAfter reaching the health facility, a pregnant woman goes through a complex pathway that leads to delays in receiving EmONC. Five reasons were identified for these delays: shortage of medicines and supplies, lack of blood and functionality of operating theatres, gaps in staff coverage, gaps in staff skills, and delays in the interfacility referral system. Shortage of medicines and supplies was central in most of the pathways, characterised by three patterns: delay to treat, back-and-forth movements to buy medicines or supplies, and multiple referrals across facilities. Some women also bypassed facilities they deemed to be non-functional.ConclusionOur findings show that the pathway to EmONC is precarious and takes too long even after making early contact with the health facility. Improvement of skills, better management of the meagre human resource and availing essential medical supplies in health facilities may help to reduce the gaps in a facility’s emergency readiness and thus improve maternal and neonatal outcomes.

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Section: Methodsmentioning

confidence: 99%

Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda

et al. 2021

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“…A systematic search of the literature was undertaken using a realist synthesis approach [26] and interviews were conducted with practitioners in the field who had been involved in the delivery or design of interventions (key informants) [7]. Through these stages, we proposed 7 context-mechanism-outcome configurations (CMOCs) (see Table 1 below for explanation of realist definitions) that enable successful team interventions in acute hospital contexts and described how and why they work from the team's perspective.…”

Section: Research Aims and Objectivesmentioning

confidence: 99%

“…For the purpose of this study, these interventions have been defined as: "Two or more healthcare disciplines working together in an acute hospital context and in receipt of a programme or intervention or directly involved in implementation of a programme or intervention to improve team-working and/or quality and safety of patient care" [7,8].…”

Section: Introductionmentioning

confidence: 99%

A Realist Evaluation of Team Interventions in Acute Hospital Contexts—Use of Two Case Studies to Test Initial Programme Theories

Cunningham

Brún

Willgerodt

et al. 2021

IJERPH

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Background: Designing and implementing team interventions to improve quality and safety of care in acute hospital contexts is challenging. There is little emphasis in the literature on how contextual conditions impact interventions or how specific active ingredients of interventions impact on team members’ reasoning and enact change. This realist evaluation helps to deepen the understanding of the enablers and barriers for effective team interventions in these contexts. Methods: Five previously developed initial programme theories were tested using case studies from two diverse hospital contexts. Data were collected from theory driven interviews (n = 19) in an Irish context and from previously conducted evaluative interviews (n = 16) in a US context. Data were explored to unpack the underlying social and psychological drivers that drove both intended and unintended outcomes. Patterns of regularity were identified and synthesised to develop middle-range theories (MRTs). Results: Eleven MRTs demonstrate how and why intervention resources introduced in specific contextual conditions enact reasoning mechanisms and generate intended and unintended outcomes for patients, team members, the team and organisational leaders. The triggered mechanisms relate to shared mental models; openness, inclusivity and connectedness; leadership and engagement; social identity and intrinsic motivational factors. Conclusions: The findings provide valuable information for architects and facilitators of team interventions in acute hospital contexts, as well as help identify avenues for future research. Dataset: The data presented in this study are available on request from the corresponding author. The data are not publicly available due to their sensitive nature and potential identification of participants.

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“…An intervention where a team of two or more disciplines is trying to improve how the team delivers patient care- for example: quality improvement, service improvement or change initiatives; process re-design or team training events 28 .…”

Section: Introductionmentioning

confidence: 99%

“…This paper is the third in a series of papers which explore enablers and barriers to team interventions. Previous papers focused on the development of initial programme theories (IPTs) through a systematic search of the literature using realist synthesis 32 and interviews with key informants 28 . These IPTs describe the conditions in which multi-disciplinary team interventions appear to work best and why team interventions work best in these conditions…”

Section: Introductionmentioning

confidence: 99%

Team interventions in acute hospital contexts: protocol for the evaluation of an initial programme theory using realist methods

et al. 2021

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Introduction: Literature on multi-disciplinary healthcare team interventions to improve quality and safety of care in acute hospital contexts tends to focus on evaluating the success of the intervention by assessing patient outcomes. In contrast, there is little focus on the team who delivered the intervention, how the team worked to deliver the intervention or the context in which it was delivered. In practice, there is therefore a poor understanding of why some interventions work and are sustained and why others fail. There is little emphasis in the literature on how the team delivering the intervention might impact success or failure. Given that team is the vehicle through which these interventions are introduced, it is important to understand interventions from their perspectives. This research seeks to deepen understanding of enablers and barriers for effective team interventions. Using two case studies, we will evaluate previously developed initial programme theories to understand, what worked for whom, in what conditions, why, to what extent and how? Methods and analysis: A realist evaluation approach will be employed to test the previously formed set of initial programme theories. Two multi-disciplinary acute hospital team interventions in two different geographical and organisational contexts will be identified. In case study 1, a theory based approach to interviewing will be used. In case study 2, interview transcripts obtained using a semi- structured approach for primary research purposes will undergo secondary analysis. This will enable a more sensitive look at patterns and variations in patterns of multi-disciplinary team interventions. Researchers will first iteratively interrogate each respective dataset to identify the characteristics or resources present within the specific context that influenced how the team intervention worked to produce particular outcomes. Data will then be synthesised across contexts in order to produce middle range theories and thereby more generalisable insights.

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Application of the critical incident technique in refining a realist initial programme theory

Cited by 8 publications

References 22 publications

Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda

Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda

A Realist Evaluation of Team Interventions in Acute Hospital Contexts—Use of Two Case Studies to Test Initial Programme Theories

Team interventions in acute hospital contexts: protocol for the evaluation of an initial programme theory using realist methods

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