Procome research group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm County Council, SE 171 29, Stockholm, Sweden.
Implement Sci. 2019 Jul 8;14(1):70. doi: 10.1186/s13012-019-0919-x.
Many interventions used in health care lack evidence of effectiveness and may be unnecessary or even cause harm, and should therefore be de-implemented. Lists of such ineffective, low-value practices are common, but these lists have little chance of leading to improvements without sufficient knowledge regarding how de-implementation can be governed and carried out. However, decisions regarding de-implementation are not only a matter of scientific evidence; the puzzle is far more complex with political, economic, and relational interests play a role. This project aims at exploring the governance of de-implementation of low-value practices from the perspectives of national and regional governments and senior management at provider organizations.
Theories of complexity science and organizational alignment are used, and interviews are conducted with stakeholders involved in the governance of low-value practice de-implementation, including national and regional governments (focusing on two contrasting regions in Sweden) and senior management at provider organizations. In addition, an ongoing process for governing de-implementation in accordance with current recommendations is followed over an 18-month period to explore how governance is conducted in practice. A framework for the governance of de-implementation and policy suggestions will be developed to guide de-implementation governance.
This study contributes to knowledge about the governance of de-implementation of low-value care practices. The study provides rich empirical data from multiple system levels regarding how de-implementation of low-value practices is currently governed. The study also makes a theoretical contribution by applying the theories of complexity and organizational alignment, which may provide generalizable knowledge about the interplay between stakeholders across system levels and how and why certain factors influence the governance of de-implementation. The project employs a solution-oriented perspective by developing a framework for de-implementation of low-value practices and suggesting practical strategies to improve the governance of de-implementation. The framework and strategies can thereafter be evaluated for validity and impact in future studies.
许多在医疗保健中使用的干预措施缺乏有效性证据，可能是不必要的，甚至可能造成伤害，因此应予以取消。常见的是列出这些无效的、低价值的做法，但如果没有足够的关于如何管理和实施取消的知识，这些清单几乎不可能导致改善。然而，取消的决定不仅是一个科学证据的问题;由于政治、经济和关系利益发挥作用，这个问题要复杂得多。本项目旨在从国家和地区政府以及提供者组织的高级管理层的角度探讨低价值实践取消的治理。
使用复杂性科学和组织一致性理论，对参与低价值实践取消治理的利益相关者进行访谈，包括国家和地区政府（专注于瑞典的两个对比地区）以及提供者组织的高级管理层。此外，还按照当前建议，对一个为期 18 个月的取消治理的持续过程进行了跟踪，以探讨实践中如何进行治理。将制定取消治理框架和政策建议，以指导取消治理。
本研究有助于了解低价值护理实践取消的治理。本研究从多个系统层面提供了关于如何当前管理低价值实践取消的丰富经验数据。本研究还通过应用复杂性和组织一致性理论做出了理论贡献，这些理论可能提供关于系统层面之间利益相关者之间的相互作用以及某些因素如何影响取消治理的原因的可推广知识。该项目通过制定低价值实践取消框架并提出改善取消治理的实际策略，采用了以解决方案为导向的视角。此后，可以在未来的研究中评估框架和策略的有效性和影响。
