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Factors affecting the implementation process of clinical pathways: A mixed method study within the context of Swedish intensive care
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). (Vårdvetenskap)
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. (Vårdvetenskap)
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. (Vårdvetenskap)
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Mälardalens högskola.ORCID-id: 0000-0003-0667-7111
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2015 (Engelska)Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, nr 2, s. 255-261Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

RATIONALE, AIMS AND OBJECTIVES: Clinical pathways (CPs) can improve quality of care on intensive care units (ICUs), but are infrequently utilized and of varying quality. Knowledge regarding factors that facilitate versus hinder successful implementation of CPs is insufficient and a better understanding of the activities and individuals involved is needed. The aim of this study was to explore the implementation process of CPs within the context of ICUs.

METHODS: An exploratory design with a sequential mixed method was used. A CP survey, including all Swedish ICUs, was used to collect quantitative data from ICUs using CPs (n = 15) and interviews with key informants (n = 10) were used to collect qualitative data from the same ICUs. Descriptive statistics and qualitative content analysis were used, and the quantitative and qualitative findings were integrated.

RESULTS: The CP implementation was conceptualized according to two interplaying themes: a process to realize the usefulness of CPs and create new habits; and a necessity of enthusiasm, support and time. Multiple factors affected the process and those factors were organized in six main categories and 14 subcategories.

CONCLUSIONS: Bottom-up initiatives, interprofessional project groups and small ICUs seem to enhance successful implementation of CPs while inadequate electronic health record systems, insufficient support and time constrains can be barriers. Support regarding the whole implementation process from centralized units at the local hospitals, as well as cooperation between ICUs and national guidance, has the potential to raise the quality of CPs and benefit the progress of CP implementation.

Ort, förlag, år, upplaga, sidor
2015. Vol. 21, nr 2, s. 255-261
Nationell ämneskategori
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Identifikatorer
URN: urn:nbn:se:uu:diva-244833DOI: 10.1111/jep.12301ISI: 000351871200013PubMedID: 25678495OAI: oai:DiVA.org:uu-244833DiVA, id: diva2:789956
Tillgänglig från: 2015-02-21 Skapad: 2015-02-21 Senast uppdaterad: 2018-01-29Bibliografiskt granskad
Ingår i avhandling
1. Clinical Pathway Implementation and Teamwork in Swedish Intensive Care: Challenges in Evidence-Based Practice and Interprofessional Collaboration
Öppna denna publikation i ny flik eller fönster >>Clinical Pathway Implementation and Teamwork in Swedish Intensive Care: Challenges in Evidence-Based Practice and Interprofessional Collaboration
2018 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[sv]
Teamarbete och implementering av standardiserade vårdplaner inom svensk intensivvård : Utmaninga med interprofessionellt samarbete och evidensbaserad praktik
Abstract [en]

Suboptimal quality of care is an evident issue in current healthcare services. Clinical pathways (CPs) have the potential to facilitate evidence-based practice and interprofessional teamwork, and thereby improve patient safety and quality of care.

The overall aim of the thesis was to develop comprehensive empirical knowledge and understanding of CP implementation and teamwork in Swedish intensive care units (ICUs). Four studies were included (I-IV).

Study I was a survey including all Swedish ICUs (N84) and a document analysis of CP examples (n12). In total, 17 (20%) ICUs used CPs and many had implementation plans. The quality, extent and content of the CPs (n56) varied greatly, with sometimes insufficient interprofessionalism, evidence base and renewal.

Study II was a mixed method including ICUs using CPs. The implementation processes were retrospectively explored through questionnaire data (n15) and qualitative content analysis of interviews with key informants (n10). The CP implementation was revealed as a process directed at realizing the usefulness and creating new habits, which requires enthusiasm, support and time.

Studies III and IV were grounded theory studies in an action research project in an ICU. Study III explored everyday teamwork through focus group interviews with registered nurses, assistant nurses and anesthesiologists, as well as an individual interview with a physiotherapist (n38). Teamwork was revealed as an act of ‘balancing intertwined responsibilities.’ The type of teamwork fluctuated as the team processes were affected by circumstantial factors and involved individuals. Study IV prospectively explored the implementation process of a CP during a five-year period through repeated focus groups and individual interviews, questionnaires and logbooks/field notes, including the interprofessional project group, staff and managers (n71), and retrospective screening of health records (n136). ‘Struggling for a feasible tool’ was revealed as a central phenomenon. The implementation process included contextual and processual circumstances that enforced negotiations to achieve progress, which made the process tentative and prolonged and had consequences on the process output.

In conclusion, CP implementation processes are affected by multiple interplaying factors. Although progress has been achieved in evidence-based practice and interprofessional collaboration there is still potential for substantial improvements, emphasizing a need for further facilitation.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2018. s. 89
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1425
Nyckelord
Desicion support, Standardized care plans, Research utilization, Organisation, Caring sciences, Beslutstöd, Vårdplanering, Organisation, Forskningsanvändning, Vårdvetenskap
Nationell ämneskategori
Anestesi och intensivvård
Forskningsämne
Vårdvetenskap
Identifikatorer
urn:nbn:se:uu:diva-339967 (URN)978-91-513-0227-0 (ISBN)
Disputation
2018-03-23, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2018-02-26 Skapad: 2018-01-29 Senast uppdaterad: 2018-04-03

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