Background
Methods
Document analysis
Interviews
Observation
Analysis
Coding assumptions
Results
Components of the implementation strategy and target behaviours
What | Why | Who | Target behaviour | How, when and how often | Tailoring | Modifications | ||
---|---|---|---|---|---|---|---|---|
Component | Rationale | Delivered by | Delivered to | Mode and frequency | Planned adaptation | During the study | ||
Organisational level | 1. Implementation steering group led by clinical project manager | To ensure ‘successful planning, execution, monitoring, controlling and closing of the project’ (document). Project manager ‘problem solving’ (I) | Project Manager, coordinator, representative from hospital, community, management | Heads of disciplines, management, MDTs, referrers | Multiple behaviours: ‘supporting implementation of fall risk assessment clinics’ | Face to face monthly meetings, ongoing email and telephone contact | ‘Communication tailored to the requirements of different audiences’ (D) | |
2. Appointed coordinator and administrator | To create ‘single point of contact’ for referrers, MDTs and clients. Previous efforts failed due to lack of ‘practical support’ (I) | NA | MDTs, referrers, heads of discipline, management | Multiple behaviours: ‘supporting implementation of fall risk assessment clinics’ | Ongoing meetings, phone and email contact with MDTs and referrers | Mode of communication ‘depends on the person’ in each clinic (I) | ||
3. Set up MDT to deliver assessment | Identify and assemble team of physiotherapist, occupational therapist, nurse | Coordinator Project manager | 1. Head of discipline 2. Line managers | Multiple behaviours: ‘supporting implementation of fall risk assessment clinics’ | Face to face meetings and phone contact prior to initiating clinic | No reference | ||
Professional: multidisciplinary team | 4. Training and ‘coaching’ | To provide ‘coaching and mentoring to MDTs’ in conducting assessment to ensure team were ‘comfortable’. (I) | Coordinator Administrator Specialist fall team | MDT | Delivering risk assessment clinic | Face to face Prior to initiation and during weeks 2–3 of implementation | No reference | Number, timing and duration varied based on knowledge, requests and availability |
5. Standard assessment form | Enable standardised assessment and onward referral | Coordinator Administrator | MDT | Delivering risk assessment clinic | Circulated prior to initiating clinic | No reference | Format and level of information changed during pilot | |
6. Equipment | To ensure assessment could be conducted | Coordinator Administrator | MDT | Delivering risk assessment clinic | Prior to initiating clinic | Dependent on existing equipment | ||
Professional: referrers | 7. Standard referral form | Enable efficient referral to service | Coordinator | Referrers | Refer to clinic | Circulated during initial implement | No reference | Level of information changed during pilot |
8. Information meetings with referrers | ‘Selling’ clinics to get referrers ‘on board’ and ‘to discuss criteria on who we want (referred) and [ensure] that is very clear’.(I) | Coordinator Specialists Project manager | Physicians ANPs PHNs | Refer to clinic | Ad-hoc face to face meetings ‘ideally’ before clinic started (I) | Timing depended on clinic being established in that area | Number of meetings increased in areas with low referral rates | |
9. Screening tool for PHNs | Generate referrals for the clinics among PHNs who ‘would be the first line of contact with the health service.’ (I) | Coordinator Director of Public Health Nursing | PHNs | Identify eligible clients and refer to clinic | Ad-hoc face to face meetings to introduce and promote use of tool | No reference | Number and timing of meetings varied by area and level of engagement | |
10. Promotional material | Advertise and inform referrers about clinics | Coordinator Administrator | Referrers Pharmacies, Day centres | Refer to clinic | Flyers, posters, monthly mail shot (to GPs) | No reference | ||
Patient | 11. Invitation letter and information leaflet | To inform clients about appointment, clinic location and how to prepare for their visit, centralising administration to support MDTs. | Coordinator Administrator | Clients | Attend clinic | Documents provided on receipt of referral and arrangement of appointment | No reference |
Behaviour Change Techniques (BCTs)
BCTs and functions used at each level of the implementation strategy
Organisational level
‘I tell them it's an integrated service for an actual screening tool to be used within the community, and that they're the decision makers around it. They can decide whether the client needs to be referred, they can do the plan of care there and then [and] the client can provide input for what they need.’ (interview)
Professional level
Patient level
Participants’ activities to shape knowledge, attitudes and intentions to act in future
‘[we tell them] you can’t do without [these clinics] but it’s no trouble [to refer]’ (interview)
‘What changed was the onward referral form and the process of who we were referring on to, and what form they got and what level of information they got or needed. That changed really on a weekly basis in clinic 1.’ (interview)