The process of implementing a new working method - a project towards change in a Swedish psychiatric clinic

Abstract

The implementation of evidence-based methods in hospital settings is difficult and complex. The aim of the present study was to highlight the implementation process concerning a new working method, i.e. a new assessment tool, based on the International Classification of Functioning Disability and Health (ICF), among psychiatric nursing staff on five participating wards at a Swedish county hospital. Descriptive, qualitative data were collected through focus group interviews pre-and post-implementation. Data were analysed using directed content analysis, guided by Normalization Process Theory (NPT). The results revealed that just one of the five participating wards met the criteria for a successful implementation process. The results confirm previous studies showing the difficulty of implementation. Although participants agreed with the intention of the model, they were reluctant to apply it in practice. The implementation process seemed to be influenced by factors such as: time pressure; heavy workload; stress; lack of routines in using the tool; lack of nursing staff; as well as cultural characteristics and resistance to change.

A New Working Method in Psychiatric Care – The Impact of Implementation

“…1 and 2 (Johansson, Åstrom, Kauffeldt, Helldin, & Cartström, 2014). A follow-up study based on the qualitative data supported the results of the study (Alverbratt, Carlström, Åström, Kauffeldt, & Berlin, 2014). In the follow-up study, I.W.…”

“…It was reasonably equal in the distribution of the cultural characteristics. Alverbratt et al (2014) showed that the implementation process of the DLDA was not successful at all in I.W. 1 and I.W.…”

“…Another explanation might be that the DLDA was a completely new tool, and there was no previous experience of using the DLDA or the ICF for that matter, in the participating wards. It might also depend on factors such as the implementation strategy (Alverbratt et al, 2014;Killaspy et al, 2015). In Radaelli et al's (2014) study, the promotion of a new practice was considered to be a crucial factor explaining the outcome of an innovative healthcare model.…”

“…The implementation took place in 12 hospitals; however, it failed in all but (Radaelli et al, 2014). A further explanation could be the selection of the key participants and the fact that this was part of a research study (Alverbratt et al, 2014). Even the status of mental health might have affected the outcome (cf., Killaspy et al, 2015;Schröder et al, 2010).…”

“…In the follow-up study, I.W. 3 was pointed out as the most successful ward in implementing and sustaining new working models, compared with the other two wards in the intervention hospital (Alverbratt et al, 2014). In order to compare the included wards, the cultural characteristics of the control group (C.W.…”