Introduction
Background
Realist synthesis approach
Purpose
Methods
Realist review process
Search methods and data sources
Middle-range theory identification
Quality appraisal
Data abstraction and synthesis
Explanatory focus
Results
Search outcomes
Implementation | Number of studies (n = 35) | Reported in | |
---|---|---|---|
Types of interventions |
n
a
| % | |
Opinion leaders | 5 | 14.3 | |
Modelling | 4 | 11.4 | |
Widespread communication | 10 | 28.6 | |
Educational sessions | 16 | 45.7 | Askarian et al. [30], Bashford et al. [31], Bliss et al. [32], Bohmer et al. [33], de Vries et al. [34], Gillespie et al. [35], Haugen et al. [36], Haynes et al. [37], Helmio et al. [38], Kwok et al. [39], Levy et al. [40], Anonymous [41], Sparkes and Rylah [42], Styer et al. [43], Kasatpibal et al. [18], Yuan et al. [44] |
Self-assessment | 1 | 2.8 | Bashford et al. [31] |
Clinical training | 11 | 31.4 | |
Audit and feedback | 7 | 20.0 | |
Environmental redesign | 1 | 2.8 | Mainthia et al. [46] |
Rewards/incentives | 0 | 0 | - |
Coercion | 0 | 0 | - |
Restrictions/sanctions | 0 | 0 | - |
Performance data | 8 | 22.8 | |
Approach | |||
Planned | 16 | 45.7 | Askarian et al. [30], Bashford et al. [31], Bell and Pontin [57], Berrisford et al. [58], Bittle [62], Bliss et al. [32], Conley et al. [60], Haugen et al. [36], Haynes et al. [37], Helmio et al. [38], Kwok et al. [39], Norton and Rangel [45], Anonymous [41], Stryer et al. [43], van Klei et al. [61], Yuan et al. [44] |
Limited/none | 15 | 42.8 | Bohmer et al. [33], Calland et al. [47], Gillespie et al. [35], Levy et al. [40], Mainthia et al. [46], Pérez-Guisado [48], Sparks and Rylah [42], Takala et al. [49], Kearns et al. [50], Sewell et al. [53], Rydenfalt et al. [52], Truran et al. [51], Vats et al. [54], Vogts et al. [55], Kasatpibal et al. [18] |
Evidence of tailoring | 2 | 5.7 |
Application of the data to the explanatory model
Explanatory model
Proposition | Mechanism of implementation | Coherence with middle-range theory (supporting data from review studies) |
---|---|---|
Checklist protocols that are prospectively tailored to the context are more likely to be used and sustained in practice. | Process simplification | Normalisation Process Theory |
• Keeping it simple | ||
• Modifying to reflect workflow | ||
• Tailoring to context | ||
Reflection | ||
• Collective learning | ||
• Monitoring | ||
• Feeding back | ||
Fidelity and sustainability is increased when checklist protocols can be seamlessly integrated into daily professional practice. | Process simplification | Normalisation Process Theory |
• Keeping it simple | ||
Responsive Regulation Theory | ||
• Modifying to reflect workflow | ||
• Tailoring to context | ||
Reflection | ||
• Collective learning | ||
• Monitoring | ||
• Feeding back | ||
Routine embedding of checklist protocols in practice is influenced by factors that promote or inhibit clinicians’ participation. | Active leadership | Responsive Regulation Theory |
• Discipline leader | ||
Normalisation Process Theory | ||
• Frontline decision-making | ||
• Active participation | ||
Support strategies | ||
• Controlled roll-out | ||
• Support without sanction | ||
• Communicating the message | ||
Process simplification | ||
• Keeping it simple | ||
• Modifying to reflect workflow | ||
• Tailoring to context | ||
Reflection | ||
• Collective learning | ||
• Monitoring | ||
• Feeding back | ||
Regulation reinforcement mechanisms that are more contextually responsive should lead to greater compliance with using checklist protocols. | Active leadership | Responsive Regulation Theory |
• Discipline leader | ||
• Frontline decision-making | ||
• Active participation | ||
Support strategies | ||
• Controlled roll-out | ||
• Support without sanction | ||
• Communicating the message |