Realistic nurse‐led policy implementation, optimization and evaluation: novel methodological exemplar

Noyes, Jane; Lewis, Mary; Bennett, Virginia; Widdas, David; Brombley, Karen

doi:10.1111/jan.12169

Cited by 10 publications

(12 citation statements)

References 23 publications

(36 reference statements)

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“…, Noyes et al . ,b). Change in any complex and large health system that involves several different organizations, interfaces with external bodies and communication between different stakeholders is, however, known to be challenging.…”

Section: Discussionmentioning

confidence: 99%

Reconceptualizing children's complex discharge with health systems theory: novel integrative review with embedded expert consultation and theory development

Noyes

Brenner

Fox

et al. 2013

Journal of Advanced Nursing

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The novel evidence-based model, which reconceptualizes 'discharge' as a highly complex longitudinal health system intervention, makes a significant contribution to global knowledge to drive practice development. Research is required to develop process and outcome measures at different time points in the discharge process and future trials are needed to determine the effectiveness of integrated health system discharge models.

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Section: Discussionmentioning

confidence: 99%

Reconceptualizing children's complex discharge with health systems theory: novel integrative review with embedded expert consultation and theory development

Noyes

Brenner

Fox

et al. 2013

Journal of Advanced Nursing

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“…5 NO. 28 We recognise that there is much more to cover in terms of the breadth and depth of the training materials we have produced. Because realist evaluation is developing as an approach to evaluation, the 'wish list' we were able to elicit from our fellow evaluators who have used this approach was quite long.…”

Section: Doi: 103310/hsdr05280mentioning

confidence: 99%

Quality and reporting standards, resources, training materials and information for realist evaluation: the RAMESES II project

Wong

Westhorp

Greenhalgh

et al. 2017

Health Serv Deliv Res

117

163

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Background Many of the problems confronting policy- and decision-makers, evaluators and researchers today are complex, as are the interventions designed to tackle them. Their success depends both on individuals’ responses and on the wider context of people’s lives. Realist evaluation tries to make sense of these complex interventions. It is a form of theory-driven evaluation, based on realist philosophy, that aims to understand why these complex interventions work, how, for whom, in what context and to what extent. Objectives Our objectives were to develop (a) quality standards, (b) reporting standards, (c) resources and training materials, (d) information and resources for patients and other lay participants and (e) to build research capacity among those interested in realist evaluation. Methods To develop the quality and reporting standards, we undertook a thematic review of the literature, supplemented by our content expertise and feedback from presentations and workshops. We synthesised findings into briefing materials for realist evaluations for the Delphi panel (a structured method using experts to develop consensus). To develop our resources and training materials, we drew on our experience in developing and delivering education materials, feedback from the Delphi panel, the RAMESES JISCMail e-mail list, training workshops and feedback from training sessions. To develop information and resources for patients and other lay participants in realist evaluation, we convened a group consisting of patients and the public. We built research capacity by running workshops and training sessions. Results Our literature review identified 152 realist evaluations, and when 37 of these had been analysed we were able to develop our briefing materials for the Delphi panel. The Delphi panel comprised 35 members from 27 organisations across six countries and five disciplines. Within three rounds, the panels had reached a consensus on 20 key reporting standards. The quality standards consist of eight criteria for realist evaluations. We developed resources and training materials for 15 theoretical and methodological topics. All resources are available online (www.ramesesproject.org). We provided methodological support to 17 projects and presentations or workshops to help build research capacity in realist evaluations to 29 organisations. Finally, we produced a generic patient information leaflet for lay participants in realist evaluations. Limitations Our project had ambitious goals that created a substantial workload, leading to the need to prioritise objectives. For example, we truncated the literature review and focused on standards and training material development. Conclusions Although realist evaluation holds much promise, misunderstandings and misapplications of it are common. We hope that our project’s outputs and activities will help to address these problems. Our resources are the start of an iterative journey of refinement and development of better resources for realist evaluations. The RAMESES II project seeks not to produce the last word on these issues, but to capture current expertise and establish an agreed state of the science. Much methodological development is needed in realist evaluation but this can take place only if there is a sufficient pool of highly skilled realist evaluators. Capacity building is the next key step in realist evaluation. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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“… 16 Top-down policy has limitations; therefore, communities, service users, and lay educators must be engaged and involved in service planning and delivery processes. 17 – 19 In effect, all health professionals must be part of the solution to avert the global health challenge of avoidable NCDs. 10…”

Section: Challenges Confronting Health Service Policy Makers and Manamentioning

confidence: 99%

“…Existing models are limited by factors such as the aforementioned professional boundaries, regulatory and licensing restrictions, mismatched funding models, the availability of health professionals with advanced practice competencies, deficits in policy implementation, and more. 19 , 45 …”

Section: What Further Developments Are Needed?mentioning

confidence: 99%

Public health service options for affordable and accessible noncommunicable disease and related chronic disease prevention and management

Brownie¹,

Hills²,

Rossiter³

2014

JMDH

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Globally, nations are confronted with the challenge of providing affordable health services to populations with increasing levels of noncommunicable and chronic disease. Paradoxically, many nations can both celebrate increases in life expectancy and bemoan parallel increases in chronic disease prevalence. Simply put, despite living longer, not all of that time is spent in good health. Combined with factors such as rising levels of obesity and related noncommunicable disease, the demand for health services is requiring nations to consider new models of affordable health care. Given the level of disease burden, all staff, not just doctors, need to be part of the solution and encouraged to innovate and deliver better and more affordable health care, particularly preventative primary health care services. This paper draws attention to a range of exemplars to encourage and stimulate readers to think beyond traditional models of primary health service delivery. Examples include nurse-led, allied health-led, and student-led clinics; student-assisted services; and community empowerment models. These are reported for the interest of policy makers and health service managers involved in preventative and primary health service redesign initiatives.

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Realistic nurse‐led policy implementation, optimization and evaluation: novel methodological exemplar

Abstract: Realistic policy implementation methods have advantages over top-down approaches, especially where clinical expertise is low and unlikely to diffuse innovations 'naturally' without facilitated implementation and local optimization.

Cited by 10 publications

References 23 publications

Reconceptualizing children's complex discharge with health systems theory: novel integrative review with embedded expert consultation and theory development

Reconceptualizing children's complex discharge with health systems theory: novel integrative review with embedded expert consultation and theory development

Quality and reporting standards, resources, training materials and information for realist evaluation: the RAMESES II project

Public health service options for affordable and accessible noncommunicable disease and related chronic disease prevention and management

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