ArticleBMJ quality & safety2022
Conceptualising interventions to enhance spread in complex systems: a multisite comprehensive medication review case study.
Article in BMJ quality & safety, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- A trust-wide quality improvement programme to reduce out-of-area placements, length of stay and costs across inpatient mental health services.Future healthcare journal · 2026Article
- Enablers and constraints influencing implementation of a novel, multi-site community-based frailty programme: perspectives of leaders and implementers.BMC geriatrics · 2025Article
- Improving therapeutic engagement and observations on inpatient mental health wards in the English National Health Service: lessons from using quality improvement to scale up interventions.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2025Article
- Dissemination, adaptation, and uptake of patient-facing materials to improve care coordination in primary care.PEC innovation · 2025Article
- Enhancing the Innovation Ecosystem: Overcoming Challenges to Introducing Information-Driven Technologies in Health Care.Journal of medical Internet research · 2025Article
- Implementation of hospital-initiated complex interventions for adult people with multiple long-term conditions: a scoping review.BMC health services research · 2025Article
- A qualitative exploration of the health needs and goals of urban women to inform the tailoring and adaptation of Strong Hearts Healthy Communities: a community-based cardiovascular disease prevention intervention.BMC public health · 2024Article
- What is improvement science, and what makes it different? An outline of the field and its frontiers.Frontiers in health services · 2024Article
- Unpacking the 'process of sustaining'-identifying threats to sustainability and the strategies used to address them: a longitudinal multiple case study.Implementation science communications · 2023Article
- Identifying core strategies and mechanisms for spreading a national medicines optimisation programme across England-a mixed-method study applying qualitative thematic analysis and Qualitative Comparative Analysis.Implementation science communications · 2022Article
- Improving Multidisciplinary Team Working to Support Integrated Care for People with Frailty Amidst the COVID-19 Pandemic.International journal of integrated careArticle
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAdvancing the description and conceptualisation of interventions in complex systems is necessary to support spread, evaluation, attribution and reproducibility. Improvement teams can provide unique insight into how interventions are operationalised in practice. Capturing this 'insider knowledge' has the potential to enhance intervention descriptions.
objectivesThis exploratory study investigated the spread of a comprehensive medication review (CMR) intervention to (1) describe the work required from the improvement team perspective, (2) identify what stays the same and what changes between the different sites and why, and (3) critically appraise the 'hard core' and 'soft periphery' (HC/SP) construct as a way of conceptualising interventions.
designA prospective case study of a CMR initiative across five sites. Data collection included: observations, document analysis and semistructured interviews. A facilitated workshop triangulated findings and measured perceived effort invested in activities. A qualitative database was developed to conduct thematic analysis.
resultsSites identified 16 intervention components. All were considered essential due to their interdependency. The function of components remained the same, but adaptations were made between and within sites. Components were categorised under four 'spheres of operation': Accessibility of evidence base; Process of enactment; Dependent processes and Dependent sociocultural issues. Participants reported most effort was invested on 'dependent sociocultural issues'. None of the existing HC/SP definitions fit well with the empirical data, with inconsistent classifications of components as HC or SP.
conclusionsThis study advances the conceptualisation of interventions by explicitly considering how evidence-based practices are operationalised in complex systems. We propose a new conceptualisation of 'interventions-in-systems' which describes intervention components in relation to their: proximity to the evidence base; component interdependence; component function; component adaptation and effort.
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