Barriers and Facilitators to the Implementation of Injury Prevention Programs: A Qualitative Exploration and Model Development

Abstract

Background: In 2006, the American College of Surgeons Committee on Trauma mandated implementation of injury prevention programs as a requirement for Level I and II trauma center designation. Little is known about the factors that facilitate or create barriers to establishing evidence-based injury prevention program implementation. The purpose of this research is to generate hypotheses regarding processes used to implement injury prevention programs at trauma centers, identify the factors that facilitate and serve as a barrier to implementation, and develop a model reflecting these factors and relationships. Methods: This is a qualitative study of injury prevention programs at trauma centers. Study participants were chosen from 24 sites representing trauma centers of different patient volumes, geographic regions, and settings in the United States. Subjects participated in phone interviews based on guides developed from pilot interviews with prevention coordinators. Transcribed interviews from eight subjects were analyzed using a system of member checking to code; analysis informed the identification of factors that influence the establishment of evidence-based injury prevention programs. Results: Five themes emerged from the data analysis: external factors, internal organizational factors, program capacity, program selection, and program success. Analysis revealed that successful program implementation was related to supportive leaders and collaborative, interdepartmental relationships. Additional themes indicated that while organizations were motivated primarily by verification requirements (external factor), strong institutional leadership (internal factor) was lacking. Employee readiness (program capacity) was hindered by limited training opportunities, and programs were often chosen (selection) based on implementation ease rather than evidence base or local data. Conclusions: Data analysis reveals five emerging themes of program implementation; using these data, we suggest an initial model of barriers and facilitators for implementing evidence-based injury prevention programs that could serve as the springboard for additional research involving a larger representative sample.

Facilitators and barriers impacting in-hospital Trauma Quality Improvement Program (TQIP) implementation across country income levels: a scoping review

“…The injury prevention coordinators’ work was influenced by the support from direct managers and senior leadership 26 …”

Impact of COVID-19 on U.S. Hospital-Based Injury Prevention Professionals: A National Survey

“…In a qualitative study of hospital-based injury prevention programs identifying factors that facilitate or serve as barriers to implementing evidence-based prevention programs, the analysis revealed that successful implementation was related to supportive institutional leadership and collaborative interdepartmental relationships; however, study participants indicated these factors were not the norm. Instead, limited training opportunities for staff orientation, professional development, funding availability, and program selection hindered program capacity ( Newcomb et al, 2020 ).…”

Facilitators and barriers impacting in-hospital Trauma Quality Improvement Program (TQIP) implementation: A scoping review on the implementation of TQIPs across income levels

“…A trauma training clinician survey emphasised developing interpersonal staff communication alongside strengthening emergency communication methods [30]. Limited staff knowledge acts as a hurdle to improved communication [9,22,23,31]. A subject from a US injury prevention program highlighted the lack of healthy understanding of QI requirements as they are viewed as "the black sheep" of the department, making it a constant struggle to "seek out other mentors of people that do similar work" [31 p.339].…”

“…Identifying staff to as a champion for the QI intervention is signi cant [17,31,33,39]. Trauma registry questionnaire respondents felt that limited stakeholder engagement could be overcome by having a champion to drive and mobilise buy-in [33].…”

“…Almost half of newly-graduated physicians do not have experience working with this QI tool during their training[23] 2. Not a healthy understanding of how we do our work or what's needed to do our work[31]…”