Rapid spread of complex change: a case study in inpatient palliative care.
BMC Health Serv Res
; 9: 245, 2009 Dec 29.
Article
em En
| MEDLINE
| ID: mdl-20040099
ABSTRACT
BACKGROUND:
Based on positive findings from a randomized controlled trial, Kaiser Permanente's national executive leadership group set an expectation that all Kaiser Permanente and partner hospitals would implement a consultative model of interdisciplinary, inpatient-based palliative care (IPC). Within one year, the number of IPC consultations program-wide increased almost tenfold from baseline, and the number of teams nearly doubled. We report here results from a qualitative evaluation of the IPC initiative after a year of implementation; our purpose was to understand factors supporting or impeding the rapid and consistent spread of a complex program.METHODS:
Quality improvement study using a case study design and qualitative analysis of in-depth semi-structured interviews with 36 national, regional, and local leaders.RESULTS:
Compelling evidence of impacts on patient satisfaction and quality of care generated 'pull' among adopters, expressed as a remarkably high degree of conviction about the value of the model. Broad leadership agreement gave rise to sponsorship and support that permeated the organization. A robust social network promoted knowledge exchange and built on an existing network with a strong interest in palliative care. Resource constraints, pre-existing programs of a different model, and ambiguous accountability for implementation impeded spread.CONCLUSIONS:
A complex, hospital-based, interdisciplinary intervention in a large health care organization spread rapidly due to a synergy between organizational 'push' strategies and grassroots-level pull. The combination of push and pull may be especially important when the organizational context or the practice to be spread is complex.
Texto completo:
1
Temas:
ECOS
/
Aspectos_gerais
Bases de dados:
MEDLINE
Assunto principal:
Cuidados Paliativos
/
Sistemas Pré-Pagos de Saúde
/
Difusão de Inovações
/
Hospitalização
Tipo de estudo:
Clinical_trials
/
Evaluation_studies
/
Prognostic_studies
/
Qualitative_research
/
Sysrev_observational_studies
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
BMC Health Serv Res
Assunto da revista:
PESQUISA EM SERVICOS DE SAUDE
Ano de publicação:
2009
Tipo de documento:
Article
País de afiliação:
Estados Unidos