Barriers and enablers to the implementation of a complex quality improvement intervention for acute kidney injury: A qualitative evaluation of stakeholder perceptions of the Tackling AKI study
Autoři:
Laura Lamming aff001; Eileen McDonach aff001; Mohammed A. Mohammed aff001; John Stoves aff002; Andy J. Lewington aff003; Russell Roberts aff002; Yohan Samarasinghe aff006; Nikunj Shah aff007; Richard J. Fluck aff008; Natalie Jackson aff009; Melanie Johnson aff009; Carol Jones aff007; Nicholas M. Selby aff008
Působiště autorů:
Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, United Kingdom
aff001; Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire, United Kingdom
aff002; Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom
aff003; The NIHR Leeds In Vitro Diagnostics Co-operative, Leeds, West Yorkshire, United Kingdom
aff004; Bradford Institute for Health Research, Bradford, West Yorkshire, United Kingdom
aff005; Frimley Health NHS Foundation Trust, Frimley, United Kingdom
aff006; Ashford and St Peter’s NHS Foundation Trust, Surrey, United Kingdom
aff007; Department of Renal Medicine, Derby Teaching Hospitals NHS Foundation Trust, Derby, United Kingdom
aff008; Yorkshire & Humber AHSN improvement academy, Bradford Institute for Health Research, Bradford, West Yorkshire, United Kingdom
aff009; Centre for Kidney Research and Innovation, School of Medicine, University of Nottingham, Derby Teaching Hospitals NHS Foundation Trust, Derby, United Kingdom
aff010
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0222444
Souhrn
Background
Acute kidney injury in hospital patients is common and associated with reduced survival and higher healthcare costs. The Tackling Acute Kidney Injury (TAKI) quality improvement project aimed to reduce mortality rates in patients with acute kidney injury by implementing a multicomponent intervention comprising of an electronic alert, care bundle and education in five UK hospitals across a variety of wards. A parallel developmental evaluation using a case study approach was conducted to provide the implementation teams with insights into factors that might impact intervention implementation and fidelity. The qualitative element of the evaluation will be reported.
Methods
29 semi-structured interviews with implementation teams across the five hospitals were carried out to identify perceived barriers and enablers to implementation. Interviews were taped and transcribed verbatim and Framework analysis was conducted.
Results
Interviews generated four ‘barriers and enablers’ to implementation themes: i) practical/contextual factors, ii) skills and make-up of the TAKI implementation team, iii) design, development and implementation approach, iv) staff knowledge, attitudes, behaviours and support. Enablers included availability of specialist teams (e.g. educational teams), multi-disciplinary implementation teams with strong leadership, team-based package completion and proactive staff. Barriers were frequently the converse of facilitators.
Conclusions
Despite diversity of sites, a range of common local factors–contextual, intervention-based and individual–were identified as potential barriers and enablers to fidelity, including intervention structure/design and process of/approach to implementation. Future efforts should focus on early identification and management of barriers and tailored optimisation of known enablers such as leadership and multidisciplinary teams to encourage buy-in. Improved measures of real-time intervention and implementation fidelity would further assist local teams to target their support during such quality improvement initiatives.
Klíčová slova:
People and places – Population groupings – Professions – Medical personnel – Pharmacists – Medicine and health sciences – Health care – Health care providers – Nurses – Medical doctors – Patients – Health care facilities – Hospitals – Geriatrics – Biology and life sciences – Anatomy – Renal system – Kidneys – Population biology – Population metrics – Death rates
Zdroje
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PLOS One
2019 Číslo 9
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