Contextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions

Abstract Background In 2012, Alberta Health Services created Strategic Clinical NetworksTM (SCNs) to develop and implement evidence-informed, clinician-led and team-delivered health system improvement in Alberta, Canada. SCNs have had several provincial successes in improving health outcomes. Little...

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Autores principales:	Rachel Flynn, Kelly Mrklas, Alyson Campbell, Tracy Wasylak, Shannon D. Scott
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Sustainability Strategic clinical networks Quality improvement Realist evaluation Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/88e4b7df75684b3ea8afcfb266f1fbac
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spelling	oai:doaj.org-article:88e4b7df75684b3ea8afcfb266f1fbac2021-11-07T12:10:45ZContextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions10.1186/s12913-021-07214-51472-6963https://doaj.org/article/88e4b7df75684b3ea8afcfb266f1fbac2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12913-021-07214-5https://doaj.org/toc/1472-6963Abstract Background In 2012, Alberta Health Services created Strategic Clinical NetworksTM (SCNs) to develop and implement evidence-informed, clinician-led and team-delivered health system improvement in Alberta, Canada. SCNs have had several provincial successes in improving health outcomes. Little research has been done on the sustainability of these evidence-based implementation efforts. Methods We conducted a qualitative realist evaluation using a case study approach to identify and explain the contextual factors and mechanisms perceived to influence the sustainability of two provincial SCN evidence-based interventions, a delirium intervention for Critical Care and an Appropriate Use of Antipsychotics (AUA) intervention for Senior’s Health. The context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic guided our research. Results We conducted thirty realist interviews in two cases and found four important strategies that facilitated sustainability: Learning collaboratives, audit & feedback, the informal leadership role, and patient stories. These strategies triggered certain mechanisms such as sense-making, understanding value and impact of the intervention, empowerment, and motivation that increased the likelihood of sustainability. For example, informal leaders were often hands-on and influential to front-line staff. Learning collaboratives broke down professional and organizational silos and encouraged collective sharing and learning, motivating participants to continue with the intervention. Continual audit-feedback interventions motivated participants to want to perform and improve on a long-term basis, increasing the likelihood of sustainability of the two multi-component interventions. Patient stories demonstrated the interventions’ impact on patient outcomes, motivating staff to want to continue doing the intervention, and increasing the likelihood of its sustainability. Conclusions This research contributes to the field of implementation science, providing evidence on key strategies for sustainability and the underlying causal mechanisms of these strategies that increases the likelihood of sustainability. Identifying causal mechanisms provides evidence on the processes by which implementation strategies operate and lead to sustainability. Future work is needed to evaluate the impact of informal leadership, learning collaboratives, audit-feedback, and patient stories as strategies for sustainability, to generate better guidance on planning sustainable improvements with long term impact.Rachel FlynnKelly MrklasAlyson CampbellTracy WasylakShannon D. ScottBMCarticleSustainabilityStrategic clinical networksQuality improvementRealist evaluationPublic aspects of medicineRA1-1270ENBMC Health Services Research, Vol 21, Iss 1, Pp 1-17 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Sustainability Strategic clinical networks Quality improvement Realist evaluation Public aspects of medicine RA1-1270
spellingShingle	Sustainability Strategic clinical networks Quality improvement Realist evaluation Public aspects of medicine RA1-1270 Rachel Flynn Kelly Mrklas Alyson Campbell Tracy Wasylak Shannon D. Scott Contextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions
description	Abstract Background In 2012, Alberta Health Services created Strategic Clinical NetworksTM (SCNs) to develop and implement evidence-informed, clinician-led and team-delivered health system improvement in Alberta, Canada. SCNs have had several provincial successes in improving health outcomes. Little research has been done on the sustainability of these evidence-based implementation efforts. Methods We conducted a qualitative realist evaluation using a case study approach to identify and explain the contextual factors and mechanisms perceived to influence the sustainability of two provincial SCN evidence-based interventions, a delirium intervention for Critical Care and an Appropriate Use of Antipsychotics (AUA) intervention for Senior’s Health. The context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic guided our research. Results We conducted thirty realist interviews in two cases and found four important strategies that facilitated sustainability: Learning collaboratives, audit & feedback, the informal leadership role, and patient stories. These strategies triggered certain mechanisms such as sense-making, understanding value and impact of the intervention, empowerment, and motivation that increased the likelihood of sustainability. For example, informal leaders were often hands-on and influential to front-line staff. Learning collaboratives broke down professional and organizational silos and encouraged collective sharing and learning, motivating participants to continue with the intervention. Continual audit-feedback interventions motivated participants to want to perform and improve on a long-term basis, increasing the likelihood of sustainability of the two multi-component interventions. Patient stories demonstrated the interventions’ impact on patient outcomes, motivating staff to want to continue doing the intervention, and increasing the likelihood of its sustainability. Conclusions This research contributes to the field of implementation science, providing evidence on key strategies for sustainability and the underlying causal mechanisms of these strategies that increases the likelihood of sustainability. Identifying causal mechanisms provides evidence on the processes by which implementation strategies operate and lead to sustainability. Future work is needed to evaluate the impact of informal leadership, learning collaboratives, audit-feedback, and patient stories as strategies for sustainability, to generate better guidance on planning sustainable improvements with long term impact.
format	article
author	Rachel Flynn Kelly Mrklas Alyson Campbell Tracy Wasylak Shannon D. Scott
author_facet	Rachel Flynn Kelly Mrklas Alyson Campbell Tracy Wasylak Shannon D. Scott
author_sort	Rachel Flynn
title	Contextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions
title_short	Contextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions
title_full	Contextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions
title_fullStr	Contextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions
title_full_unstemmed	Contextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions
title_sort	contextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions
publisher	BMC
publishDate	2021
url	https://doaj.org/article/88e4b7df75684b3ea8afcfb266f1fbac
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Contextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions

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