Oilcloth sessions as an implementation strategy: a qualitative study in Denmark

Abstract

Background The aim of this study was to explore healthcare professionals, managers, and other key employees’ experiences of oilcloth sessions as a strategy when implementing new emergency departments in Denmark, based on their participations in these sessions. The study addresses the importance of securing alignment in implementation strategies. Too often, this does not get enough attention in the literature and in practice. In this study, alignment among components was achieved in an educational implementation strategy called oilcloth sessions. Methods The study is based on participants’ observations of 13 oilcloth sessions and follow-up via 53 semi-structured interviews with the board of directors, managers, and key employees from the present emergency department and different specialty departments. Data were analysed deductively using Biggs and Tang’s model of didactic alignment. Results The analysis showed the complexity of challenges when using oilcloth sessions as a strategy when implementing a new emergency department described in terms of three phases and nine main themes (a–i): the preparation phase: (a) preparing individually and collectively, (b) objectives, (c) involving participants, (d) selecting cases; the execution phase: (e) using materials, (f) facilitating the sessions, (g) temporal structures; evaluation: (h) following up on the sessions, (i) adapting to the context. Conclusions This study shows that it is important to ensure alignment among elements in implementation strategies. Thus, oilcloth sessions with high alignment are useful if the challenges experienced are to be overcome and the strategy will be experienced as a useful way to support the implementation of a new emergency department from the participants’ point of view. Bigg and Tang's didactic model is useful as an analytical framework to ensure alignment in implementation strategies in general.

How do oilcloth sessions work? A realist evaluation approach to exploring ripple effects in an implementation strategy

“…Our results demonstrate the importance of ensuring alignment between didactic elements in the oilcloth session (e.g. objectives, suitable participants, and clinical cases) if the strategy is to have a positive outcome (Kirk et al, 2022). Given a lack of alignment between the selected clinical cases, the invited participants and unclear objectives, which was identified as a challenge, addressing ripple effects became a priority for practice and research.…”

Influences of specialty identity when implementing a new emergency department in Denmark: a qualitative study

“…Ethnographic eld studies are well suited to study the meaning that participants attribute to phenomena in their naturalistic settings and the social interactions between participants [26,27]. The context for this examination is the observation of 13 oilcloth sessions [28,29] used to support the implementation of a new ED [22].…”

“…Oilcloth sessions are an educational implementation strategy [31] with the purpose of training staff, key employees and managers in new patient pathways and introducing a new physical building design. A key employee is de ned as an employee appointed by managers to play a central role in the implementation of a new ED in their department [22]. Staff, managers and key employees work together on a blueprint with plastic gures representing ED staff on a scale of 1:50 to generate knowledge and workplace learning about the planned implementation.…”

“…Each oilcloth session lasted between 1.5 and 2 hours. Kirk et al [22] have described the oilcloth method in detail.…”

“…One limitation the study was our sole focus on the physicians as representatives for the specialty. A focus solely on the physicians emerged from our several years of experience following the implementation of the new ED, where structures for physicians' work (specialists at the forefront) have generated the most resistance over time [18,22,23]. Consequently, physicians were represented most prominently in the oilcloth sessions.…”