Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Alberta, T6G 1C9, Edmonton, Canada.
Strategic Clinical Networks™, Provincial Clinical Excellence, Alberta Health Services, Calgary, Canada.
BMC Health Serv Res. 2021 Nov 4;21(1):1194. doi: 10.1186/s12913-021-07214-5.
In 2012, Alberta Health Services created Strategic Clinical Networks (SCNs) to develop and implement evidence-informed, clinician-led and team-delivered health system improvement in Alberta, Canada. SCNs have had several provincial successes in improving health outcomes. Little research has been done on the sustainability of these evidence-based implementation efforts.
We conducted a qualitative realist evaluation using a case study approach to identify and explain the contextual factors and mechanisms perceived to influence the sustainability of two provincial SCN evidence-based interventions, a delirium intervention for Critical Care and an Appropriate Use of Antipsychotics (AUA) intervention for Senior's Health. The context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic guided our research.
We conducted thirty realist interviews in two cases and found four important strategies that facilitated sustainability: Learning collaboratives, audit & feedback, the informal leadership role, and patient stories. These strategies triggered certain mechanisms such as sense-making, understanding value and impact of the intervention, empowerment, and motivation that increased the likelihood of sustainability. For example, informal leaders were often hands-on and influential to front-line staff. Learning collaboratives broke down professional and organizational silos and encouraged collective sharing and learning, motivating participants to continue with the intervention. Continual audit-feedback interventions motivated participants to want to perform and improve on a long-term basis, increasing the likelihood of sustainability of the two multi-component interventions. Patient stories demonstrated the interventions' impact on patient outcomes, motivating staff to want to continue doing the intervention, and increasing the likelihood of its sustainability.
This research contributes to the field of implementation science, providing evidence on key strategies for sustainability and the underlying causal mechanisms of these strategies that increases the likelihood of sustainability. Identifying causal mechanisms provides evidence on the processes by which implementation strategies operate and lead to sustainability. Future work is needed to evaluate the impact of informal leadership, learning collaboratives, audit-feedback, and patient stories as strategies for sustainability, to generate better guidance on planning sustainable improvements with long term impact.
2012 年，艾伯塔省卫生服务局（Alberta Health Services）创建了战略临床网络（SCNs），以在加拿大艾伯塔省开发和实施以证据为基础、以临床医生为主导、以团队为基础的医疗系统改进。SCNs 在改善健康结果方面取得了几项省级成功。然而，关于这些基于证据的实施工作的可持续性的研究甚少。
我们采用案例研究方法进行了定性的现实主义评估，以确定和解释影响两个省级 SCN 循证干预措施可持续性的背景因素和机制，这两个干预措施分别是重症监护中的谵妄干预和老年人健康中的抗精神病药物合理使用（AUA）干预。（C）+机制（M）=结果（O）配置（CMOcs）启发式方法指导了我们的研究。
我们在两个案例中进行了 30 次现实主义访谈，发现了促进可持续性的四项重要策略：学习协作、审计与反馈、非正式领导力角色和患者故事。这些策略触发了某些机制，如意义建构、理解干预的价值和影响、赋权和激励，从而增加了可持续性的可能性。例如，非正式领导者通常会亲力亲为并对一线工作人员产生影响。学习协作打破了专业和组织的隔阂，鼓励集体分享和学习，激励参与者继续进行干预。持续的审计反馈干预激励参与者从长期角度想要表现和改进，从而增加了这两个多组件干预措施的可持续性的可能性。患者故事展示了干预对患者结果的影响，激励工作人员想要继续进行干预，从而增加了其可持续性的可能性。
这项研究为实施科学领域做出了贡献，提供了关于可持续性的关键策略以及这些策略的潜在因果机制的证据，从而增加了可持续性的可能性。确定因果机制提供了关于实施策略运作并导致可持续性的过程的证据。未来需要评估非正式领导力、学习协作、审计反馈和患者故事作为可持续性策略的效果，为具有长期影响的可持续改进规划提供更好的指导。
