University Health Care Research Center, Faculty of Medicine and Health, Orebro University, Orebro, Sweden.
The Swedish Institute for Disability Research, Orebro University, Orebro, Sweden.
BMC Health Serv Res. 2021 Jun 10;21(1):571. doi: 10.1186/s12913-021-06570-6.
Effective implementation processes play a central role in health care organizations and affect the care of patients. Managers are pivotal in facilitating the use of new practices, but their experience and how it affects the implementation outcome are still largely unknown. In the field of disability health care in particular, managers experiences have scarcely been investigated. Therefore, the aim of this study is to explore managers' experiences of the implementation process when transferring new practices into disability health care settings.
Semi-structured individual telephone interviews were conducted with managers at disability health care organizations in four administrative regions in central Sweden. A total of 23 managers with formal managerial responsibility from both public and private health care were strategically selected to be interviewed. The interviews were analysed using reflexive thematic analysis with an inductive approach.
The analysis resulted in two themes about factors influencing the implementation process: firstly, Contextual factors set the agenda for what can be achieved, which highlighted aspects that hinder or enable the implementation process, such as internal and external conditions, the workplace culture, the employees and managers' attitudes and openness to change: secondly, Leadership in the winds of change, which described the challenges of balancing managerial tasks with leading the change, and the importance of a leadership that involves the participation of the employees.
This study explored how and to what extent managers address and manage the implementation process and the many associated challenges. The findings highlight the importance of leadership support and organizational structure in order to transfer new practices into the work setting, and to encourage an organizational culture for leading change that promotes positive outcomes. We suggest that identifying strategies by focusing on contextual factors and on aspects of leadership will facilitate implementation processes.
The SWAN (Structured Water Dance Intervention) study was retrospectively registered on April 9, 2019 and is available online at ClinicalTrials.gov (ID: NCT03908801).
有效的实施过程在医疗保健组织中起着核心作用，并影响着患者的护理。管理者在促进新实践的应用方面起着关键作用，但他们的经验以及经验如何影响实施结果在很大程度上仍不为人知。特别是在残疾保健领域，管理者的经验几乎没有被调查过。因此，本研究的目的是探讨管理者在将新实践引入残疾保健环境时实施过程的经验。
对瑞典中部四个行政区的残疾保健组织的管理者进行了半结构式的个人电话访谈。共选择了 23 名具有正式管理职责的管理者进行访谈，他们来自公共和私营医疗保健部门。采用反思性主题分析方法进行分析，采用归纳法。
分析结果得出了两个影响实施过程的因素主题：首先，背景因素为可以实现的目标设定了议程，突出了阻碍或促进实施过程的方面，如内部和外部条件、工作场所文化、员工和管理者对变化的态度和开放性；其次，变革之风的领导力，描述了平衡管理任务和领导变革的挑战，以及涉及员工参与的领导力的重要性。
本研究探讨了管理者如何以及在何种程度上处理和管理实施过程及其相关的许多挑战。研究结果强调了领导支持和组织结构在将新实践引入工作环境以及鼓励促进积极成果的领导变革的组织文化方面的重要性。我们建议通过关注背景因素和领导方面来确定策略，将有助于实施过程。
SWAN（结构化水舞干预）研究于 2019 年 4 月 9 日被追溯性注册，并可在 ClinicalTrials.gov 上在线获得（ID：NCT03908801）。
