Silver Santana R, Jones Kayla Christine, Hook Kimberly, Crable Erika L, George Emily R, Serwint Janet R, Austad Kirsten, Walkey Allan, Drainoni Mari-Lynn
Department of Medicine, Evans Center for Implementation and Improvement Sciences, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
BMC Health Serv Res. 2024 Dec 18;24(1):1592. doi: 10.1186/s12913-024-12034-4.
Understanding how and when a new evidence-based clinical intervention becomes standard practice is crucial to ensure that healthcare is delivered in alignment with the most up-to-date knowledge. However, rigorous methods are needed to determine when a new clinical practice becomes normalized to the standard of care. To address this gap, this study qualitatively explores how, when, and why a clinical practice change becomes normalized within healthcare organizations.
We used purposive sampling to recruit clinical leaders who worked in quality improvement and/or implementation science in diverse health contexts. Enrolled participants completed semi-structured interviews around implementing evidence-based practices. Qualitative data was inductively and deductively analyzed, and was guided by a modified version of the Normalization Process Theory (NPT) framework to identify salient themes. Additionally, identified normalization strategies were mapped to the Expert Recommendations for Implementation Change (ERIC) project.
A total of 17 individuals were interviewed. Two categories of themes emerged: 1) signals of when a new clinical practice is considered to be normalized within clinical care; and 2) strategies utilized to normalize new clinical innovations. Participants described four key signals for identifying when a novel clinical practice becomes the new normal: 1) integrated seamlessly into existing workflows; 2) scaled across the entire organizational unit; 3) has strong staff buy-in and ownership; and 4) no longer needs monitoring and evaluation to be sustained. Major strategies to normalize new clinical interventions included: 1) taking a patient approach that starts slow and gains momentum; 2) identifying and using methods to gain staff buy-in and ownership; and 3) conducting ongoing measurement of progress towards normalization.
The results offer valuable insight into the indicators that signify when a novel clinical practice becomes normalized, and the strategies employed to facilitate this transition. These findings can inform future research to develop instruments that implementation leaders can use to systematically measure the clinical change process.
了解新的循证临床干预措施如何以及何时成为标准做法，对于确保医疗服务与最新知识保持一致至关重要。然而，需要严谨的方法来确定新的临床实践何时规范化至护理标准。为填补这一空白，本研究定性探索临床实践变革在医疗组织内如何、何时以及为何实现规范化。
我们采用目的抽样法招募在不同健康环境中从事质量改进和/或实施科学工作的临床领导者。入选参与者围绕实施循证实践完成半结构化访谈。对定性数据进行归纳和演绎分析，并以规范化过程理论（NPT）框架的修改版为指导，以识别突出主题。此外，将确定的规范化策略映射到实施变革专家建议（ERIC）项目。
共访谈了17人。出现了两类主题：1）新临床实践在临床护理中被视为规范化的标志；2）用于使新临床创新规范化的策略。参与者描述了识别新临床实践何时成为新常态的四个关键标志：1）无缝融入现有工作流程；2）在整个组织单位推广；3）获得员工的大力支持和认同；4）不再需要监测和评估即可持续。使新临床干预措施规范化的主要策略包括：1）采取循序渐进、逐步推进的患者导向方法；2）识别并采用方法以获得员工的支持和认同；3）持续衡量规范化进展情况。
研究结果为标志新临床实践何时实现规范化的指标以及促进这一转变所采用的策略提供了有价值的见解。这些发现可为未来研究提供参考，以开发实施领导者可用于系统衡量临床变革过程的工具。
