Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, Alberta, T6G 2R7, Canada.
School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada.
Arch Osteoporos. 2020 Mar 12;15(1):44. doi: 10.1007/s11657-020-0692-0.
We assessed the context in which a hip Fracture Liaison Service was implemented. We conducted semi-structured interviews with 21 key informants at two time points to understand organizational readiness, facilitators, and barriers to change. We identified strategies important to successful implementation, particularly in the context of change fatigue.
Fracture Liaison Service (FLS) is effective for secondary fracture prevention. Two hospital sites implemented FLS for hip fracture patients, 50 + years, in Alberta, Canada. We assessed organizational readiness, facilitators, and barriers to change to better understand the context in which the FLS was implemented to inform its potential spread provincially.
We recruited individuals involved in FLS implementation at provincial and site levels to participate in telephone interviews at baseline and 16 months post-implementation. Interviews were transcribed and analyzed using thematic content analysis. In addition, site-level participants were invited to complete the Organizational Readiness to Implement Change tool at baseline.
We conducted 33 semi-structured interviews (20 at baseline; 13 at post-implementation) with 21 key informants. Participants included managers (24%), FLS physicians/clinical nurses (19%), operational/leadership roles (19%), physicians/surgeons (14%), pharmacists (10%), nurse practitioners (10%), and social work (5%). Seventeen site-level participants completed the ORIC tool at baseline; all participants scored high (71%) or neutral (29%). We found that the use of several strategies, including demonstrating value, providing resources, and selecting appropriate sites, were important to implementation, particularly in the context of change fatigue. Participants perceived the FLS as acceptable and there was evidence of facilitated learning rather than simply monitoring implementation as intended.
An effective change management approach neutralized change fatigue. This approach, if maintained, bodes well for the potential spread of the FLS provincially if proven effective and cost effective. Change readiness assessment tools could be used strategically to inform the spread of the FLS to early adopter sites.
骨折联络服务（FLS）可有效预防继发性骨折。加拿大艾伯塔省的两个医院站点为 50 岁及以上髋部骨折患者实施了 FLS。我们评估了组织准备情况、促进因素和变革障碍，以更好地了解 FLS 实施的背景，为其在全省范围内的推广提供信息。
我们招募了省级和现场各级参与 FLS 实施的人员，在实施前和实施后 16 个月进行电话访谈。访谈记录被转录并进行主题内容分析。此外，邀请现场级别的参与者在基线时完成组织准备实施变革工具。
我们对 21 名关键信息员进行了 33 次半结构化访谈（基线 20 次，实施后 13 次）。参与者包括经理（24%）、FLS 医生/临床护士（19%）、运营/领导角色（19%）、医生/外科医生（14%）、药剂师（10%）、执业护士（10%）和社会工作者（5%）。17 名现场级参与者在基线时完成了 ORIC 工具；所有参与者的得分均较高（71%）或中性（29%）。我们发现，使用几种策略，包括展示价值、提供资源和选择合适的地点，对于实施非常重要，尤其是在变革疲劳的情况下。参与者认为 FLS 是可以接受的，并且有证据表明促进了学习，而不仅仅是按照预期进行监测。
有效的变革管理方法中和了变革疲劳。如果这种方法被证明有效且具有成本效益，那么这种方法如果保持下去，对于在全省范围内推广 FLS 是有希望的。变革准备评估工具可以战略性地用于为 FLS 向早期采用者站点的推广提供信息。
