Conceptualising interventions to enhance spread in complex systems: a multisite comprehensive medication review case study

Abstract

BackgroundAdvancing the description and conceptualisation of interventions in complex systems is necessary to support spread, evaluation, attribution and reproducibility. Improvement teams can provide unique insight into how interventions are operationalised in practice. Capturing this ‘insider knowledge’ has the potential to enhance intervention descriptions.ObjectivesThis exploratory study investigated the spread of a comprehensive medication review (CMR) intervention to (1) describe the work required from the improvement team perspective, (2) identify what stays the same and what changes between the different sites and why, and (3) critically appraise the ‘hard core’ and ‘soft periphery’ (HC/SP) construct as a way of conceptualising interventions.DesignA prospective case study of a CMR initiative across five sites. Data collection included: observations, document analysis and semistructured interviews. A facilitated workshop triangulated findings and measured perceived effort invested in activities. A qualitative database was developed to conduct thematic analysis.ResultsSites identified 16 intervention components. All were considered essential due to their interdependency. The function of components remained the same, but adaptations were made between and within sites. Components were categorised under four ‘spheres of operation’: Accessibility of evidence base; Process of enactment; Dependent processes and Dependent sociocultural issues. Participants reported most effort was invested on ‘dependent sociocultural issues’. None of the existing HC/SP definitions fit well with the empirical data, with inconsistent classifications of components as HC or SP.ConclusionsThis study advances the conceptualisation of interventions by explicitly considering how evidence-based practices are operationalised in complex systems. We propose a new conceptualisation of ‘interventions-in-systems’ which describes intervention components in relation to their: proximity to the evidence base; component interdependence; component function; component adaptation and effort.

Unpacking the ‘process of sustaining’—identifying threats to sustainability and the strategies used to address them: a longitudinal multiple case study

“…Selecting cases from the same programme (CLARHC NWL) allowed for 'literal replication' in cases to uncover patterns of shared threats and strategies [65]. The four selected cases cover a range of clinical conditions and settings [66][67][68][69][70][71] (Table 2). All case interventions came from established evidence, which demonstrated improvements in patient care and/or outcomes [72][73][74][75].…”

Improving Multidisciplinary Team Working to Support Integrated Care for People with Frailty Amidst the COVID-19 Pandemic

“…Learning from this study could be adopted or adapted to new geographical contexts. The model described in this study could be used inform approaches to scaling up capacity and developing culture change designed to promote MDT skills and habits in the workforce [37], [38]. It suggests that a model using evidence-based guidelines to promote shared knowledge and confidence to contribute to MDT working should be an integral part of that effort, that the development of practical networks need to be engineered and these could be an important part of the necessary workforce development required to promote integrated patient care.…”

Identifying core strategies and mechanisms for spreading a national medicines optimisation programme across England—a mixed-method study applying qualitative thematic analysis and Qualitative Comparative Analysis

“…Identifying and understanding the underlying mechanisms of strategies could also lead to more generalisable knowledge to support the spread of innovations. There has been a lot of discussion around the importance of identifying what is the core of an innovation or strategy [ 23 – 25 ]. This core would be defined as being necessary for an innovation or strategy to work, and thus, the core would be the generalisable aspects which are to be replicated in new contexts while peripheral aspects could be adapted to fit the local context [ 20 , 23 , 24 , 26 ].…”

“…building capacity of stakeholders) could be the generalisable or core component. There is no common definition of what core components of spread efforts are, nor is there an established approach to identify them [ 25 , 26 ]. Comparative methodologies could provide a useful methodological approach to identify the core mechanisms [ 27 ].…”