Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, 2109, NSW, Australia.
Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Daniel Mannix Building, Brunswick Street, Fitzroy, Australia.
BMC Health Serv Res. 2023 Jun 7;23(1):584. doi: 10.1186/s12913-023-09614-1.
Unprofessional behaviour among hospital staff is common. Such behaviour negatively impacts on staff wellbeing and patient outcomes. Professional accountability programs collect information about unprofessional staff behaviour from colleagues or patients, providing this as informal feedback to raise awareness, promote reflection, and change behaviour. Despite increased adoption, studies have not assessed the implementation of these programs utilising implementation theory. This study aims to (1) identify factors influencing the implementation of a whole-of-hospital professional accountability and culture change program, Ethos, implemented in eight hospitals within a large healthcare provider group, and (2) examine whether expert recommended implementation strategies were intuitively used during implementation, and the degree to which they were operationalised to address identified barriers.
Data relating to implementation of Ethos from organisational documents, interviews with senior and middle management, and surveys of hospital staff and peer messengers were obtained and coded in NVivo using the Consolidated Framework for Implementation Research (CFIR). Implementation strategies to address identified barriers were generated using Expert Recommendations for Implementing Change (ERIC) strategies and used in a second round of targeted coding, then assessed for degree of alignment to contextual barriers.
Four enablers, seven barriers, and three mixed factors were found, including perceived limitations in the confidential nature of the online messaging tool ('Design quality and packaging'), which had downstream challenges for the capacity to provide feedback about utilisation of Ethos ('Goals and Feedback', 'Access to Knowledge and Information'). Fourteen recommended implementation strategies were used, however, only four of these were operationalised to completely address contextual barriers.
Aspects of the inner setting (e.g., 'Leadership Engagement', 'Tension for Change') had the greatest influence on implementation and should be considered prior to the implementation of future professional accountability programs. Theory can improve understanding of factors affecting implementation, and support strategies to address them.
医院员工的不专业行为很常见。这种行为会对员工的幸福感和患者的治疗效果产生负面影响。专业问责制计划从同事或患者那里收集有关不专业员工行为的信息，将其作为非正式反馈提供，以提高认识、促进反思和改变行为。尽管采用率有所提高，但这些研究并没有利用实施理论来评估这些计划的实施情况。本研究旨在：(1) 确定影响整个医院专业问责制和文化变革计划（Ethos）实施的因素，该计划在一家大型医疗保健提供商集团的八家医院实施；(2) 检查专家推荐的实施策略是否在实施过程中被直观地使用，以及它们在多大程度上被实施以解决已确定的障碍。
从组织文件、高级和中层管理人员的访谈以及医院员工和同行信息员的调查中获取与 Ethos 实施相关的数据，并使用整合实施研究框架 (CFIR) 在 NVivo 中进行编码。使用专家推荐实施变革 (ERIC) 策略生成解决已确定障碍的实施策略，并在第二轮有针对性的编码中使用，然后评估其与背景障碍的一致性程度。
发现了四个促进因素、七个障碍和三个混合因素，包括在线消息传递工具保密性的局限性（“设计质量和包装”），这对提供有关 Ethos 使用情况的反馈能力产生了下游挑战（“目标和反馈”、“获取知识和信息”）。使用了 14 项推荐的实施策略，但只有四项被实施以完全解决背景障碍。
内部环境的各个方面（例如，“领导力参与”、“变革的张力”）对实施的影响最大，在实施未来的专业问责制计划之前应予以考虑。理论可以提高对影响实施的因素的理解，并支持解决这些因素的策略。
