Ziemann Alexandra, Sibley Andrew, Tuvey Sam, Robens Sarah, Scarbrough Harry
Centre for Healthcare Innovation Research, City, University of London, Northampton Square, London, EC1V 0HB, UK.
Department for Social & Policy Sciences, University of Bath, Building 3 East, Claverton Down, Bath, BA2 7AY, UK.
Implement Sci Commun. 2022 Oct 29;3(1):116. doi: 10.1186/s43058-022-00364-5.
Achieving widespread adoption of innovations across health systems remains a challenge. Past efforts have focused on identifying and classifying strategies to actively support innovation spread (replicating an innovation across sites), but we lack an understanding about the mechanisms which such strategies draw on to deliver successful spread outcomes. There is also no established methodology to identify core strategies or mechanisms which could be replicated with fidelity in new contexts when spreading innovations. We aimed to understand which strategies and mechanisms are connected with successful spread using the case of a national medicines optimisation programme in England.
The study applied a comparative mixed-method case study approach. We compared spread activity in 15 Academic Health Science Networks (AHSN) in England, applied to one innovation case, Transfers of Care Around Medicines (TCAM). We followed two methodological steps: (1) qualitative thematic analysis of primary data collected from 18 interviews with AHSN staff members to identify the strategies and mechanisms and related contextual determinants and (2) Qualitative Comparative Analysis (QCA) combining secondary quantitative data on spread outcome and qualitative themes from step 1 to identify the core strategies and mechanisms.
We identified six common spread strategy-mechanism constructs that AHSNs applied to spread the TCAM national spread programme: (1) the unique intermediary position of the AHSN as "honest broker" and local networking organisation, (2) the right capacity and position of the spread facilitator, (3) an intersectoral and integrated stakeholder engagement approach, (4) the dynamic marriage of the innovation with local health and care system needs and characteristics, (5) the generation of local evidence, and (6) the timing of TCAM. The QCA resulted in the core strategy/mechanism of a timely start into the national spread programme in combination with the employment of a local, senior pharmacist as an AHSN spread facilitator.
By qualitatively comparing experiences of spreading one innovation across different contexts, we identified common strategies, causal mechanisms, and contextual determinants. The QCA identified one core combination of two strategies/mechanisms. The identification of core strategies/mechanisms and common pre-conditional and mediating contextual determinants of a specific innovation offers spread facilitators and implementers a priority list for tailoring spread activities.
在整个卫生系统中广泛采用创新措施仍然是一项挑战。过去的努力主要集中在确定和分类积极支持创新传播的策略（在不同地点复制一项创新），但我们并不了解这些策略赖以实现成功传播成果的机制。也没有既定的方法来确定在传播创新时可以在新环境中忠实地复制的核心策略或机制。我们旨在以英格兰一项全国药品优化计划为例，了解哪些策略和机制与成功传播相关。
本研究采用了比较性混合方法案例研究方法。我们比较了英格兰15个学术健康科学网络（AHSN）针对一项创新案例——药品护理转移（TCAM）的传播活动。我们遵循了两个方法步骤：（1）对从18名AHSN工作人员访谈中收集的原始数据进行定性主题分析，以确定策略、机制及相关背景决定因素；（2）定性比较分析（QCA），将传播结果的二级定量数据与步骤1中的定性主题相结合，以确定核心策略和机制。
我们确定了AHSN用于传播TCAM全国传播计划的六种常见传播策略 - 机制结构：（1）AHSN作为“诚实中介”和地方网络组织的独特中介地位；（2）传播促进者的适当能力和地位；（3）跨部门和综合的利益相关者参与方法；（4）创新与地方卫生和护理系统需求及特征的动态结合；（5）地方证据的生成；（6）TCAM的时机。QCA得出的核心策略/机制是及时启动全国传播计划，并聘请一名当地资深药剂师作为AHSN传播促进者。
通过定性比较在不同背景下传播一项创新的经验，我们确定了常见策略、因果机制和背景决定因素。QCA确定了两种策略/机制的一种核心组合。确定特定创新的核心策略/机制以及常见的前提条件和中介背景决定因素，为传播促进者和实施者提供了一份定制传播活动的优先事项清单。
