Tinkering and tailoring: understanding the trajectory of complex innovations in healthcare settings

Trajectory of complex interventions


Project Plan

Background
The Translating Knowledge into Action (TK2A) theme has undertaken several projects that promote the use of research findings in clinical practice, for example implementing evidence-based National Institute for Health and Clinical Excellent (NICE) quality standards. The literature identifies that implementing research findings is complex and challenging. Much of what is known about the challenges of introducing evidence into practice focuses on the initial process of introducing the innovation, but little is known about how the innovation might be sustained in practice and spread to other clinical areas. It is recognised that when implementing and sustaining an innovation in practice changes may be made in response to the local context and the methods used to promote a change in clinicians’ behaviour may evolve over time, but little is known about the processes involved. Gaining a greater understanding of how an innovation may change over time and spread to other settings could help those involved in introducing and sustaining innovation and provide guidance on how such innovations might be evaluated. 

Research aims   

1. To develop a framework for understanding:

  • How an innovation may evolve and change over time and spread to different settings.
  • The influence of key individuals and groups.
  • The influence of the context in which the innovation take place.

2. To develop guidance to inform the evaluation of complex innovations in healthcare settings

Approach

An in-depth case study (2012-2013) of an innovation introduced by the TK2A theme will be undertaken in order to develop a framework for understanding the trajectory of the innovation over time and in different settings, the influence of key individuals/groups and contextual influences. The case study will focus on the introduction and sustainability of nutrition champions as a means of promoting the uptake of a malnutrition screening tool and associated care guidelines, as part of the EQONS project see here

First, an analysis of documents associated with the project, such as notes of meetings and fieldnotes will be undertaken and key project team members will be interviewed in order to construct a time-line identifying the various stages of implementing the innovation. This will be followed by in-depth interviews with a broad range of healthcare professionals involved in the project and wider members of the project team. The interviews will explore the following.

  • Clinical intervention: the original intention to introduce a nutritional screening tool and associated care guidelines and how this may have evolved to include other initiatives to improve nutritional practice.
  •  The evidence: the different forms of evidence drawn upon to support the clinical intervention(s), how evidence has been brought together and adapted to the local context.
  • Facilitation approach:  the approach to facilitation employed including the style of facilitation and related activities.
  • Knowledge exchange tools and techniques used to promote the uptake of the innovation.
  • The role of key individuals and groups in shaping the innovation over time.
  • The influence of changes in the healthcare system, the organisational and the ward/clinical team contexts.

Data arising from the interviews will be analysed to develop a framework for understanding how and why the innovation evolves over time. The framework will be refined further through testing with other CLAHRC SY implementation projects. These include:

  • Developing the role of ward-based dietitians to promote a multi-disciplinary approach to reducing the risk of malnutrition among hospitalised patients, see here
  • Enhancing the management of patients with dysphagia through blended e-learning, see here
  • Reducing the risk of hospital acquired  venous thromboembolism (VTE) through the implementation of NICE quality standards, see here

The research team will then produce guidance on how the framework might be employed to guide CLAHRC implementation projects and to inform the evaluation of such innovations. 

Outcomes

It is anticipated that this project will lead to:

  • Better understanding of how and why evidence-informed innovations change over time in complex health care environments.
  • Greater understanding of the complexity of change in order to inform strategies for change management and educational initiatives to support change.
  • A framework which may be used to inform the evaluation of complex knowledge translation projects.
  • The identification of further areas for research examining the trajectory of innovations in complex healthcare environments.