Contributions to the literature
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Dissemination and adoption of interventions in the hospital setting has been readily described in the literature but little research has focused specifically on the implementation of government-directed policy.
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A number of key factors associated with implementation of policy were identified. Many of these were related to the regulatory nature of government-directed policy or policy characteristics established at the time of development.
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This study highlights that implementation of government-directed policy is different from the adoption of other interventions. Greater understanding is needed if more effective implementation of these interventions is to be facilitated.
Background
Methods
Study participants
Ethical review
Survey design
Factor | |
---|---|
Policy characteristics | |
Perception of the quality and validity of the evidence | |
Policy content and requirements/actions | |
Valid and reliable evidence for policy requirements/actions | |
Cost of implementation | |
Outer setting | |
External systems and infrastructure | |
Alignment with national/corporate goals | |
Regulatory mechanisms (e.g. accreditation, financial penalties) | |
Inner setting | |
Internal systems and infrastructure | |
Established roles and responsibilities | |
Internal relationships | |
Organisational lines of accountability | |
Methods for monitoring and reporting policy implementation outcomes | |
Organisational stability | |
Organisational goal setting | |
Individuals | |
Resources and tools | |
Integration of policy requirements into current practice | |
Implementation process | |
Resourcing and preparedness | |
Development of implementation plan | |
Establishment of capacity in implementation planning |
Data collection
Analysis
Results
Round 1
Demographic | Frequency | Percentage |
---|---|---|
Country | ||
Australia | 6 | 54.5 |
United Kingdom | 2 | 18.2 |
Israel | 2 | 18.2 |
Global (multi-country) | 1 | 9.1 |
Policy experience | ||
Development | 11 | 100.0 |
Implementation | 11 | 100.0 |
Years of experience | ||
5–10 years | 2 | 18.2 |
11–15 years | 4 | 36.4 |
16–20 years | 3 | 27.3 |
20–30 years | 1 | 9.1 |
30+ years | 1 | 9.1 |
Current role | ||
Academic/researcher | 3 | 27.3 |
Hospital/health services management | ||
- Organisation level role | 1 | 9.1 |
- Jurisdiction/state level role | 3 | 27.3 |
- National level role | 3 | 27.3 |
Other (healthcare consultant) | 1 | 9.1 |
Round 1 | Level of agreement | |
---|---|---|
Factor | Importance | Feasibility |
Policy characteristics | ||
Perception of the quality and validity of the evidence | 90.9% | 72.7% |
Policy content and requirements/actions | 100% | 90.9% |
Valid and reliable evidence for policy requirements/actions | 100% | 54.6% |
Cost of implementation | 100% | 100% |
Outer setting | ||
External systems and infrastructure | 100% | 72.7% |
Alignment with national/corporate goals | 90.9% | 81.8% |
Regulatory mechanisms (e.g. accreditation, financial penalties) | 81.8% | 90.9% |
Inner setting | ||
Internal systems and infrastructure | 90.9% | 100% |
Established roles and responsibilities | 81.8% | 63.6% |
Internal relationships | 100% | 36.4% |
Organisational lines of accountability | 90.9% | 63.6% |
Methods for monitoring and reporting policy implementation outcomes | 90.9% | 72.7% |
Organisational stability | 90.9% | 27.3% |
Organisational goal setting | 90.9% | 72.7% |
Individuals | ||
Resources and tools | 81.8% | 90.9% |
Integration of policy requirements into current practice | 100% | 90.9% |
Implementation process | ||
Resourcing and preparedness | 90.9% | 81.8% |
Development of implementation plan | 100% | 72.7% |
Establishment of capacity in implementation planning | 72.7% | 63.6% |
Round 2
Survey questions | Level of agreement |
---|---|
Policy characteristics | |
Where valid and reliable evidence is available, how feasible is it to ensure policy requirements/actions are supported by valid and reliable evidence when developing policy for implementation? | 88.9% |
Where valid and reliable evidence is not available, how important is it for proposed changes to be assessed/tested for unforeseen consequences and/or acceptability? | 88.9% |
Where valid and reliable evidence is not available, how feasible is it for proposed changes to be assessed/tested for unforeseen consequences and/or acceptability? | 66.7% |
How important is clinician perception that a policy will benefit patient care/outcomes for policy implementation? | 77.8% |
How feasible is it to consider clinician and decision-maker perception of whether a policy will benefit patient care/outcomes when developing policy for implementation? | 88.9% |
Outer setting | |
How important is the alignment of policy actions and outcomes with other externally developed requirements for policy implementation? | 100% |
How feasible is it to ensure required policy actions and outcomes do not contradict other externally developed requirements during policy development? | 88.9% |
Inner setting | |
How feasible is it for hospitals to consider roles and responsibilities before commencing policy implementation? | 66.7% |
How feasible is it for hospitals to undertake internal system and infrastructure assessment to identify potential local factors that influence policy implementation? | 100% |
How feasible is it for hospitals to establish organisational lines of accountability for implementation outcomes when developing policy for implementation? | 100% |
How feasible is it for hospitals to consider organisational stability when planning for policy implementation? | 55.6% |
How important are clinical leaders/professional peers (both formal and informal) in facilitating policy implementation? | 100% |
How feasible is it for hospitals to identify potential clinical leaders/professional peers that may influence implementation before commencing policy implementation? | 88.9% |
Implementation process | |
How feasible is it for hospitals to quantify and build capacity for implementation before commencing policy implementation? | 66.7% |
How important is the identification of change/s required to move from current practice to proposed practice? | 100% |
How feasible is it to consider the change/s required to move from current practice to proposed practice and consider this transition when developing policy for implementation? | 100% |
Factors of importance
Factor | Feasibility | ||
---|---|---|---|
Yes | Local level | No | |
Policy characteristics | |||
Perception of the quality and validity of the evidence | ✓ | ||
Policy content and requirements/actions | ✓ | ||
Valid and reliable evidence for policy requirements/actions | ✓ | ||
Assessment/testing of policy | x | ||
Perception of benefit to patient care outcomes | ✓ | ||
Cost of implementation | ✓ | ||
Outer setting | |||
External systems and infrastructure | ✓ | ||
Alignment of policy with other external requirements | ✓ | ||
Alignment with national/corporate goals | ✓ | ||
Regulatory mechanisms (e.g. accreditation, financial penalties) | ✓ | ||
Inner setting | |||
Internal systems and infrastructure | ✓ | ||
Hospitals establish roles and responsibilities | x | ||
Hospitals assess for internal factors/relationships | ✓ | ||
Hospitals establish organisational lines of accountability | ✓ | ||
Hospitals consider organisational stability | x | ||
Methods for monitoring and reporting policy implementation outcomes | ✓ | ||
Clinical leaders/professional peers | ✓ | ||
Organisational goal setting | ✓ | ||
Individuals | |||
Resources and tools | ✓ | ||
Integration of policy requirements into current practice | ✓ | ||
Implementation process | |||
Resourcing and preparedness | ✓ | ||
Development of implementation plan | ✓ | ||
Hospitals establish and build capacity for implementation | x | ||
Identification of changes needed in planning | ✓ |
Feasibility
“The feasibility question is difficult given that [these] internal system and structures generally do not support implementation in any effective way.” (Participant 10)
“It is often very poorly done because those writing the policy do not have a clear understanding of how work is actually delivered and how policy is likely to be interpreted at the coal face.” (Participant 10)
“It is important from an implementation point of view because a stable organisation is more likely to be able to implement necessary change. It is not feasible though to consider this when developing a policy as this can change so quickly so you need to assume that each health service is stable.” (Participant 1)
“Evidence from peer reviewed literature is important, although even if the evidence is strong, if it does not match with the core beliefs of the clinician, it will not be sufficient to drive behaviour change.” (Participant 11)
“Gaining traction with policy changes that do not directly benefit the patient is more challenging irrespective of the strength of the evidence.” (Participant 2)
“In healthcare, more so than other fields, there is a need for the evidence to ‘tell a story’ that leads to improved patient outcomes through the proposed change.” (Participant 2)
“This is dependent on how the organisation views implementation and how many resources are provided. There is generally no further capacity for implementation.” (Participant 2)