ArticleBMJ open2022
Conceptualising contexts, mechanisms and outcomes for implementing large-scale, multisite hospital improvement initiatives: a realist synthesis.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- From legalisation to practice: implementation of newly legalised health interventions in healthcare settings - a systematic review.BMJ open · 2026Pooled it
- SkipTheQ: Impact of a digital appointment system on waiting times and patient satisfaction at a tertiary hospital pharmacy in Gauteng province, South Africa.Dialogues in health · 2026Article
- Context, Mechanisms and Outcomes of Reasonable Adjustments Across Acute Hospital Settings for People With Intellectual Disabilities: A Scoping Review Protocol.Campbell systematic reviews · 2026Review
- The Kitchen and the Cook: Context and Roles in Community Health Worker Programs.Journal of general internal medicine · 2026Article
- Participatory Rapid Appraisal and Focus Groups to co-design technology-supported integrated care.PloS one · 2026Article
- Article
- Implementation of large, multi-site hospital interventions: a realist evaluation of strategies for developing capability.BMC health services research · 2024Article
- Four System Enablers of Large-System Transformation in Health Care: A Mixed Methods Realist Evaluation.The Milbank quarterly · 2024Review
- REPEAT BP: Reviewing Effective Practices for Elevating Adherence in Treatment of Hypertension.AMIA ... Annual Symposium proceedings. AMIA Symposium · 2024Article
- Audit and feedback to reduce unwarranted clinical variation at scale: a realist study of implementation strategy mechanisms.Implementation science : IS · 2023Article
- Article
- Turning evidence into action using a senior friendly hospital framework and a collaborative network.Healthcare management forum · 2022Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
designRealist synthesis. STUDY
backgroundLarge-scale hospital improvement initiatives can standardise healthcare across multiple sites but results are contingent on the implementation strategies that complement them. The benefits of these implemented interventions are rarely able to be replicated in different contexts. Realist studies explore this phenomenon in depth by identifying underlying context-mechanism-outcome interactions.
objectivesTo review implementation strategies used in large-scale hospital initiatives and hypothesise initial programme theories for how they worked across different contexts.
methodsAn iterative, four-step process was applied. Step 1 explored the concepts inherent in large-scale interventions using database searches and snowballing. Step 2 identified strategies used in their implementation. Step 3 identified potential initial programme theories that may explain strategies' mechanisms. Step 4 focused on one strategy-theory pairing to develop and test context-mechanism-outcome hypotheses. Data was drawn from searches (March-May 2020) of MEDLINE, Embase, PubMed and CINAHL, snowballed from key papers, implementation support websites and the expertise of the research team and experts. INCLUSION CRITERIA: reported implementation of a large-scale, multisite hospital intervention. RAMESES reporting standards were followed.
resultsConcepts were identified from 51 of 381 articles. Large-scale hospital interventions were characterised by a top-down approach, external and internal support and use of evidence-based interventions. We found 302 reports of 28 different implementation strategies from 31 reviews (from a total of 585). Formal theories proposed for the implementation strategies included Diffusion of Innovation, and Organisational Readiness Theory. Twenty-three context-mechanism-outcome statements for implementation strategies associated with planning and assessment activities were proposed. Evidence from the published literature supported the hypothesised programme theories and were consistent with Organisational Readiness Theory's tenets.
conclusionThis paper adds to the literature exploring why large-scale hospital interventions are not always successfully implemented and suggests 24 causative mechanisms and contextual factors that may drive outcomes in the planning and assessment stage.
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