Kelly Yvonne, O'Rourke Niamh, Flynn Rachel, Hegarty Josephine, Keyes Laura M
Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland.
Health Information and Standards Directorate, Health Information and Quality Authority, Cork, Ireland.
J Adv Nurs. 2025 Mar;81(3):1489-1504. doi: 10.1111/jan.16346. Epub 2024 Jul 24.
National health and social care standards are complex, quality improvement interventions. Standards typically describe a process and/or outcome of safe, quality, person-centred care according to best evidence. Currently, there are 11 national standards that apply to diverse services in Ireland including residential centres, acute hospitals and rehabilitation and community inpatient healthcare services. A better understanding of contextual factors influencing implementation will inform decision-making when selecting implementation strategies to enhance the implementation of standards.
To explore experiences of implementing national health and social care standards and secondly, to identify enablers and barriers to implementation with stakeholders from across multiple levels of the health system.
A qualitative descriptive study.
We conducted six focus groups and eight individual interviews from October to November 2021 with stakeholders at system level (n = 14), organizational level (n = 14) and individual level (n = 10). Focus groups and interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis.
Six themes were generated; (1) Top-down, bottom-up, a team approach: everybody together, we are all involved, we are all responsible, (2) Support tools: accessible tools and bite-size material pertaining to standards will support us to implement standards, (3) Empower with knowledge: increase awareness and understanding of standards, make them relatable in practice so we can make sense of them, (4) A system-wide malaise: we do not have the bandwidth to implement standards, (5) Follow the leader: we need a lead person at every level to inspire implementation, (6) A bi-directional influence: we know inspections drive quality improvements but we still feel trepidation around inspection outcomes.
Key enablers identified related to teamwork, support tools, leadership and inspections. Key barriers related to workforce issues, a lack of awareness of standards and fear of inspection outcomes. Our findings can be incorporated into strategies to support implementation of standards, ultimately for the benefit of service-users.
The enablers and barriers described in this study reflect the importance of organizational factors in the implementation of standards. Interdisciplinary teams can infer from these findings, which enablers and barriers apply to their own context. These findings can inform decision-making when selecting strategies that can be effective in supporting the implementation of standards.
We have adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines.
No patient or public contribution.
国家卫生和社会护理标准是复杂的质量改进干预措施。这些标准通常根据最佳证据描述安全、高质量、以患者为中心的护理过程和/或结果。目前，爱尔兰有11项国家标准适用于包括住宿中心、急症医院以及康复和社区住院医疗服务在内的各种服务。更好地理解影响实施的背景因素将为选择实施策略以加强标准的实施提供决策依据。
一是探讨实施国家卫生和社会护理标准的经验，二是确定卫生系统多个层面的利益相关者在实施过程中的促进因素和障碍。
一项定性描述性研究。
2021年10月至11月，我们对系统层面（n = 14）、组织层面（n = 14）和个人层面（n = 10）的利益相关者进行了6次焦点小组讨论和8次个人访谈。焦点小组讨论和访谈进行了录音，逐字转录，并采用反思性主题分析进行分析。
产生了六个主题；（1）自上而下、自下而上、团队方法：大家齐心协力，我们都参与其中，我们都有责任，（2）支持工具：与标准相关的可获取工具和简洁的材料将支持我们实施标准，（3）知识赋能：提高对标准的认识和理解，使其在实践中具有相关性，以便我们能够理解它们，（4）全系统的问题：我们没有精力实施标准，（被打乱）（5）效仿领导：我们需要各级都有一个带头的人来推动实施，（6）双向影响：我们知道检查推动质量改进，但我们仍然对检查结果感到担忧。
确定的关键促进因素与团队合作（被打乱）支持工具、领导力和检查有关。关键障碍与劳动力问题、对标准缺乏认识以及对检查结果的恐惧有关。我们的研究结果可以纳入支持标准实施的策略中，最终造福于服务使用者。
本研究中描述的促进因素和障碍反映了组织因素在标准实施中的重要性。跨学科团队可以从这些发现中推断出哪些促进因素和障碍适用于他们自己的情况。这些发现可以为选择有效支持标准实施的策略提供决策依据。
我们遵循了定性研究报告标准（SRQR）指南。
无患者或公众参与。
