Evidence map›Paper›PMID 37286318›Full record

ArticleBMJ open2023

Guiding principles for effective collaborative implementation strategies for multisite hospital improvement initiatives: a mixed-method realist evaluation of collaborative strategies used in four multisite initiatives at public hospitals in New South Wales, Australia.

Janet C Long, Mitchell N Sarkies, Emilie Francis-Auton, Natalie Roberts, Rebecca Hardwick, Hoa Mi Nguyen, Jean-Frederic Levesque, Diane E Watson, Johanna Westbrook, Peter D Hibbert and 2 more

Abstract read
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In one paragraph

Article in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Janet C LongAustralian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia janet.long@mq.edu.au.ORCID 0000-0002-0553-682X
Mitchell N SarkiesAustralian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Emilie Francis-AutonAustralian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Natalie RobertsAustralian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.ORCID 0000-0003-0939-5777
Rebecca HardwickPeninsula Medical School, University of Plymouth, Plymouth, UK.ORCID 0000-0002-2488-829X
Hoa Mi NguyenAustralian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.ORCID 0000-0002-8431-9160
Jean-Frederic LevesqueNSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia.ORCID 0000-0002-5418-8593
Diane E WatsonBureau of Health Information, St Leonards, New South Wales, Australia.
Johanna WestbrookFaculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.ORCID 0000-0003-1083-8192
Peter D HibbertFaculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.ORCID 0000-0001-7865-343X
Frances RapportAustralian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.ORCID 0000-0002-4428-2826
Jeffrey BraithwaiteAustralian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia.ORCID 0000-0003-0296-4957

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveLarge-scale, multisite hospital improvement initiatives can advance high-quality care for patients. Implementation support is key to adoption of change in this context. Strategies that foster collaboration within local teams, across sites and between initiative developers and users are important. However not all implementation strategies are successful in all settings, sometimes realising poor or unintended outcomes. Our objective here is to develop guiding principles for effective collaborative implementation strategies for multi-site hospital initiatives.

designMixed-method realist evaluation. Realist studies aim to examine the underlying theories that explain differing outcomes, identifying mechanisms and contextual factors that may trigger them.

settingWe report on collaborative strategies used in four multi-site initiatives conducted in all public hospitals in New South Wales, Australia (n>100).

participantsUsing an iterative process, information was gathered on collaborative implementation strategies used, then initial programme theories hypothesised to underlie the strategies' outcomes were surfaced using a realist dialogic approach. A realist interview schedule was developed to elicit evidence for the posited initial programme theories. Fourteen participants from 20 key informants invited participated. Interviews were conducted via Zoom, transcribed and analysed. From these data, guiding principles of fostering collaboration were developed.

resultsSix guiding principles were distilled: (1) structure opportunities for collaboration across sites; (2) facilitate meetings to foster learning and problem-solving across sites; (3) broker useful long-term relationships; (4) enable support agencies to assist implementers by giving legitimacy to their efforts in the eyes of senior management; (5) consider investment in collaboration as effective well beyond the current projects; (6) promote a shared vision and build momentum for change by ensuring inclusive networks where everyone has a voice.

conclusionStructuring and supporting collaboration in large-scale initiatives is a powerful implementation strategy if contexts described in the guiding principles are present.

Indexed as

Hospitals, PublicAustraliaHumansNew South Waleschange managementhealth & safetyquality in health care

Identifiers

PMID37286318
PMCPMC10254988

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.