Academic Journal
Four System Enablers of Large‐System Transformation in Health Care: A Mixed Methods Realist Evaluation
| العنوان: | Four System Enablers of Large‐System Transformation in Health Care: A Mixed Methods Realist Evaluation |
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| المؤلفون: | FRANCIS‐AUTON, E, LONG, JC, SARKIES, M, ROBERTS, N, WESTBROOK, J, LEVESQUE, J, WATSON, DE, HARDWICK, R, HIBBERT, P, POMARE, C, BRAITHWAITE, J |
| بيانات النشر: | Wiley United States |
| سنة النشر: | 2024 |
| المجموعة: | PEARL (Plymouth Electronic Archiv & ResearchLibrary, Plymouth University) |
| مصطلحات موضوعية: | realist evaluation, organizational change, innovation, complex adaptive systems, implementation science, health care reform, enablers of transformative change |
| الوصف: | Policy Points The implementation of large-scale health care interventions relies on a shared vision, commitment to change, coordination across sites, and a spanning of siloed knowledge. Enablers of the system should include building an authorizing environment; providing relevant, meaningful, transparent, and timely data; designating and distributing leadership and decision making; and fostering the emergence of a learning culture. Attention to these four enablers can set up a positive feedback loop to foster positive change that can protect against the loss of key staff, the presence of lone disruptors, and the enervating effects of uncertainty. Context Large-scale transformative initiatives have the potential to improve the quality, efficiency, and safety of health care. However, change is expensive, complex, and difficult to implement and sustain. This paper advances system enablers, which will help to guide large-scale transformation in health care systems. Methods A realist study of the implementation of a value-based health care program between 2017 and 2021 was undertaken in every public hospital (n = 221) in New South Wales (NSW), Australia. Four data sources were used to elucidate initial program theories beginning with a set of literature reviews, a program document review, and informal discussions with key stakeholders. Semistructured interviews were then conducted with 56 stakeholders to confirm, refute, or refine the theories. A retroductive analysis produced a series of context-mechanism-outcome (CMO) statements. Next, the CMOs were validated with three health care quality expert panels (n = 51). Synthesized data were interrogated to distill the overarching system enablers. Findings Forty-two CMO statements from the eight initial program theory areas were developed, refined, and validated. Four system enablers were identified: (1) build an authorizing environment; (2) provide relevant, authentic, timely, and meaningful data; (3) designate and distribute leadership and decision making; and ... |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | 183-211; Print-Electronic; application/pdf |
| اللغة: | English |
| تدمد: | 0887-378X 1468-0009 |
| Relation: | E-ISSN:1468-0009; https://pearl.plymouth.ac.uk/handle/10026.1/21933 |
| DOI: | 10.1111/1468-0009.12684 |
| الاتاحة: | https://pearl.plymouth.ac.uk/handle/10026.1/21933 https://doi.org/10.1111/1468-0009.12684 |
| رقم الانضمام: | edsbas.E97B8C3C |
| قاعدة البيانات: | BASE |
Full Text Finder | تدمد: | 0887378X 14680009 |
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| DOI: | 10.1111/1468-0009.12684 |