Engaging with theory: from theoretically informed to theoretically informative improvement research

Kislov, Roman

doi:10.1136/bmjqs-2018-009036

Cited by 31 publications

(44 citation statements)

References 18 publications

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“…Where—as intended—whole ward teams had been trained in the principles underlying Productive Ward (Hospital B and initially in Hospital A) we found that staff continued to apply these principles to their QI work even as organisational contexts changed over time. This finding has parallels with that of Jones et al who identified ‘collective change agency’ as one way of closing a compatibility gap between a QI intervention and adopting hospital 13 19. More positive legacies were apparent at the time of our fieldwork in those hospitals (A, B, C and D) which enacted (and importantly maintained) higher fidelity to empowering ward-based teams as a fundamental aspect of the recommended implementation approach.…”

Section: Discussionsupporting

confidence: 80%

“…In seeking to address calls to examine both the ‘extent, nature (and) impact of adaptations to … programmes once implemented’19 and to ‘yield new theoretical insights applicable to a broader range of settings’,13 we have explored (although retrospectively) how adoption, implementation and assimilation processes shaped variations in the legacies of a QI programme in six hospitals over a 10-year period. Our findings emphasise how sustainability is best considered as an evolutionary and adaptive process of change, rather than a stable state 14…”

Section: Discussionmentioning

confidence: 99%

“…Our overall research aim is to explore the impacts and wider legacies of the Productive Ward since its introduction over a decade ago. Responding to a call for more ‘theoretically informative improvement research’13 we seek to add to knowledge relating to the implementation and assimilation of QI interventions into routine day-to-day practice, and their sustainability in terms of maintenance of benefits, continuation of activities and continued capacity manifesting at individual, ward and/or hospital level 14…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the 10-year impact of the ‘Productive Ward: Releasing Time to Care’ programme in English acute hospitals

et al. 2019

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BackgroundThe ‘Productive Ward: Releasing Time to Care’ programme is a quality improvement (QI) intervention introduced in English acute hospitals a decade ago to: (1) Increase time nurses spend in direct patient care. (2) Improve safety and reliability of care. (3) Improve experience for staff and patients. (4) Make changes to physical environments to improve efficiency.ObjectiveTo explore how timing of adoption, local implementation strategies and processes of assimilation into day-to-day practice relate to one another and shape any sustained impact and wider legacies of a large-scale QI intervention.DesignMultiple methods within six hospitals including 88 interviews (with Productive Ward leads, ward staff, Patient and Public Involvement representatives and senior managers), 10 ward manager questionnaires and structured observations on 12 randomly selected wards.ResultsResource constraints and a managerial desire for standardisation meant that, over time, there was a shift away from the original vision of empowering ward staff to take ownership of Productive Ward towards a range of implementation ‘short cuts’. Nonetheless, material legacies (eg, displaying metrics data; storage systems) have remained in place for up to a decade after initial implementation as have some specific practices (eg, protected mealtimes). Variations in timing of adoption, local implementation strategies and contextual changes influenced assimilation into routine practice and subsequent legacies. Productive Ward has informed wider organisational QI strategies that remain in place today and developed lasting QI capabilities among those meaningfully involved in its implementation.ConclusionsAs an ongoing QI approach Productive Ward has not been sustained but has informed contemporary organisational QI practices and strategies. Judgements about the long-term sustainability of QI interventions should consider the evolutionary and adaptive nature of change processes.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the 10-year impact of the ‘Productive Ward: Releasing Time to Care’ programme in English acute hospitals

et al. 2019

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“…A cross-case study by Bergerød [43] refined the OQ framework based on empirical results to include next-of-kin involvement. It is important to see how the empirical results can be used to refine theory [41]. Hsieh [18] also argues that the strength of a directed approach to content analysis is that theory can be supported and extended.…”

Section: Adaptation Of Theoretical Framework To Norwegian Nursing Hommentioning

confidence: 99%

Exploring challenges in quality and safety work in nursing homes and home care – a case study as basis for theory development

Johannessen

Ree

Aase

et al. 2020

BMC Health Serv Res

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Background: Management, culture and systems for better quality and patient safety in hospitals have been widely studied in Norway. Nursing homes and home care, however have received much less attention. An increasing number of people need health services in nursing homes and at home, and the services are struggling with fragmentation of care, discontinuity and restricted resource availability. The aim of the study was to explore the current challenges in quality and safety work as perceived by managers and employees in nursing homes and home care services. Method: The study is a multiple explorative case study of two nursing homes and two home care services in Norway. Managers and employees participated in focus groups and individual interviews. The data material was analyzed using directed content analysis guided by the theoretical framework 'Organizing for Quality', focusing on the work needed to meet quality and safety challenges. Results: Challenges in quality and safety work were interrelated and depended on many factors. In addition, they often implied trade-offs for both managers and employees. Managers struggled to maintain continuity of care due to sick leave and continuous external-facilitated change processes. Employees struggled with heavier workloads and fewer resources, resulting in less time with patients and poorer quality of patient care. The increased external pressure affected the possibility to work towards engagement and culture for improvement, and to maintain quality and safety as a collective effort at managerial and employee levels. Conclusion: Despite contextual differences due to the structure, size, nature and location of the nursing homes and home care services, the challenges were similar across settings. Our study indicates a dualistic contextual dimension. Understanding contextual factors is central for targeting improvement interventions to specific settings. Context is, however, not independent from the work that managers do; it can be and is acted upon in negotiations and interactions to better support managers' and employees' work on quality and safety in nursing homes and home care.

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“…Second, a thematic analysis based on deductive approach could imply missing some of the inductive results. However, the framework we used in the deductive analysis contributed to guide the analysis and we were able to suggest further refinement of the typology which is often missing when using theory to guide research [61].…”

Section: Strength and Limitationsmentioning

confidence: 99%

Exploring hospital certification processes from the certification body’s perspective - a qualitative study

Johannesen

Wiig

2020

BMC Health Serv Res

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Background: Hospital certification is an external assessment mechanism to assure quality and safety systems. Auditors representing the certification body play a key role in certification processes, as they perform the assessment activities and interact with the involved healthcare organizations. There is limited knowledge about the approaches and methods that auditors use, such as role repertoire, conduct, and assessment practice. The purpose of this study was to explore auditors' practice in hospital certification processes, guided by the following research questions: What styles do auditors apply in hospital certification processes, and how do auditors perceive their role in hospital certification processes? Methods: The study was performed in two stages. In the first stage, non-participant observations (59 h) were conducted, to explore the professional practice of three lead auditors in certification processes of Norwegian hospitals. In the second stage, semi-structured interviews were conducted with these three observed lead auditors. The role repertoires and conducts identified were analyzed by using a deductive approach according to a surveyor (equivalent with auditor) styles typology framework. Results: Two distinct auditor styles ("explorer" and "discusser") were identified among the three studied auditors. Both styles were characterized by their preference for an opportunistic and less structured type of interview practice during certification audits. All three auditors embedded a guiding approach (reflections about findings, stimulate improvements, experience transfer from other industries) to their perception and practice of certification audits, interacting with the auditees. The use of group interviews instead of individual interviews during certification audits, was the rule of their professional practice. Conclusion: The auditors' perceptions and styles demonstrated a multifaceted certification reality, in contrast to what is often presumed as consistent, stringent and independent practices. These findings may have implications for reliability judgements when developing hospital certification programs, and for the refinement of the current framework used here to study the different auditing practices.

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Engaging with theory: from theoretically informed to theoretically informative improvement research

Cited by 31 publications

References 18 publications

Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the 10-year impact of the ‘Productive Ward: Releasing Time to Care’ programme in English acute hospitals

Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the 10-year impact of the ‘Productive Ward: Releasing Time to Care’ programme in English acute hospitals

Exploring challenges in quality and safety work in nursing homes and home care – a case study as basis for theory development

Exploring hospital certification processes from the certification body’s perspective - a qualitative study

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