Exploring the implementation of national health and social care standards in Ireland: A qualitative descriptive study.

ABSTRACT

BACKGROUND: National health and social care standards are complex, quality improvement interventions. Standards typically describe a process and/or outcome of safe, quality, person-centred care according to best evidence. Currently, there are 11 national standards that apply to diverse services in Ireland including residential centres, acute hospitals and rehabilitation and community inpatient healthcare services. A better understanding of contextual factors influencing implementation will inform decision-making when selecting implementation strategies to enhance the implementation of standards. AIM: To explore experiences of implementing national health and social care standards and secondly, to identify enablers and barriers to implementation with stakeholders from across multiple levels of the health system. DESIGN: A qualitative descriptive study. METHODS: We conducted six focus groups and eight individual interviews from October to November 2021 with stakeholders at system level (n = 14), organizational level (n = 14) and individual level (n = 10). Focus groups and interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis. RESULTS: Six themes were generated; (1) Top-down, bottom-up, a team approach: everybody together, we are all involved, we are all responsible, (2) Support tools accessible tools and bite-size material pertaining to standards will support us to implement standards, (3) Empower with knowledge increase awareness and understanding of standards, make them relatable in practice so we can make sense of them, (4) A system-wide malaise we do not have the bandwidth to implement standards, (5) Follow the leader we need a lead person at every level to inspire implementation, (6) A bi-directional influence we know inspections drive quality improvements but we still feel trepidation around inspection outcomes. CONCLUSION: Key enablers identified related to teamwork, support tools, leadership and inspections. Key barriers related to workforce issues, a lack of awareness of standards and fear of inspection outcomes. Our findings can be incorporated into strategies to support implementation of standards, ultimately for the benefit of service-users. IMPLICATIONS FOR PRACTICE The enablers and barriers described in this study reflect the importance of organizational factors in the implementation of standards. Interdisciplinary teams can infer from these findings, which enablers and barriers apply to their own context. These findings can inform decision-making when selecting strategies that can be effective in supporting the implementation of standards. REPORTING METHOD: We have adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.