From Better Implementation Diagnostics to Better Implementation Strategy and Outcome: a Qualitative Study

Abstract

Aim: To gain insight into the best-fitting strategy for implementing the “Education CVA-patients and caregivers” guideline, taking characteristics and experiences of registered nurses (RNs) into implementation diagnostics. Methods: A qualitative exploratory study was conducted using a Grounded Theory approach. Seven semi-structured interviews and one focus group (FG) interview were held with ward RNs. Analytical techniques that are common in Grounded Theory were used to gain insight into their personal characteristics and experiences with the guideline and its previous implementation in 2014. This research is part of a larger mixed-method study being undertaken to improve implementation diagnostics and thus implementation by creating a more effective and tailored implementation strategy. Results: Five themes that outline RNs’ experiences with the guideline and its former implementation were identified: the current guideline does not fit in daily practices, implementation of common innovations, implementation of the 2014 guideline was unsuccessful, necessary preconditions are missing, control is lacking. These five themes were discussed in the FG interview to identify important factors about the organisation’s configuration in relation to successful implementation of the guideline. Consensus was reached with participants about the organisation’s configuration, which they feel should be ruled-oriented. Conclusion and Implications of Key Findings: Experiences of RNs show that the guideline needs adjustment before it can be implemented in daily practice. Their experiences confirm pre-existing knowledge about successful implementation, for example the need for a TL as a role model. In this organisation, the innovative guideline best suits a rule-oriented configuration. Qualitative research can be a valuable complement of the IC-Model during development of an implementation strategy. Based on these outcomes, a tailor-made implementation strategy was developed. However, further research must be undertaken concerning the guideline’s contents before it can be implemented following the steps of this strategy.