The Woes of Implementation Practice: Getting Caught by the “Program of the Month”

Abstract

Senior leaders from a large American hospital told me that they wanted their hospital to become more "patient-centric" and asked me to help them. I was hired to conduct an ethnographic study of the hospital with a team of six employees and the goal of improving patient experiences. Sixteen months later, the research was completed, effective models of hospital work practices documented, recommendations made, and 16 tools developed to improve hospital culture. Yet none of our work was implemented. I returned to my field notes to discover clues that might explain why. This article explains the process I followed, the stories that revealed unwanted messages, the transcripts that enabled sensemaking, and the program-of-the-month cycle that prevented implementation from occurring.

ReHumanizing Hospital Satisfaction Data: Text Analysis, the Lifeworld, and Contesting Stakeholders’ Beliefs in Evidence

“…Often, changes made to improve patient flow (e.g., medical assistants sitting together so they can efficiently room patients instead of with the rest of the clinical team) impeded staff relationships by creating a less cohesive environment. Awareness of the trade-offs in improvement efforts and their impact on patient and staff experience may need re-evaluation, especially given staff burnout from initiative fatigue and constantly shifting priorities (Briody 2018).…”

“…For example, a team was prepared to address patient expectations but would need administrative support and escalation to address technology issues. Finally, ethnographic findings struggle to take hold when new organizational initiatives supersede the initial request (Briody 2018). A bias towards quantitative evidence is implicit, with its clean, easily understood format that can be neatly placed in improvement work and measured (regardless of the reality underpinning that belief), despite end users continuing to ask for meaning in analytic results.…”