Table 2 |
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Diagnostic findings: implications |
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| Organisational Factors |
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| Barriers |
Facilitators |
Implications |
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| Communication problems, lack of staff consultation, preparation and ownership associated
with past history of poorly managed change |
Good communication, planning and training provision associated with past history of
well managed change. |
Build on previous success. Clarify lines of communication; establish local ownership;
use training intervention to benefit staff skills related to changes. |
| Uncertainty relating to a potential Trust merger; possible negative impact on management,
staff capacity and work environment |
Positive staff views of the work environment and management structure. Local project support explicit. |
Strengthen teamwork; set up project steering group with influential support; work
across organisational boundaries. |
| Nursing workforce shortages; use of agency staff leading to potential discontinuity
in assessment and care planning. |
Core of stable senior staff: median service of interviewees 10 years. |
Ensure agency staff included in outreach training to implement assessments; flexible
scheduling of training to maximise attendance. |
| Processes for implementing innovations not clear in organisational strategy. |
Strategic commitment to clinical effectiveness, multidisciplinary working, evidence-based medicine, education of staff. |
Develop strategy using recognised clinical effectiveness methods, education/training,
multidisciplinary approaches |
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| Teamwork Factors |
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| Team work less well developed in medicine and some areas of nursing |
Team work strongly developed in therapies and some areas of nursing; positive role
models exist. |
Create positive focus and environment for team work within strategy eg shared training;
outreach necessary in areas of weak team work and staff shortages. |
| Team concept; unidisciplinary Negative views of multidisciplinary ward meetings and
efficacy of liaison. Service teams and ward meetings largely medically led. |
Positive views of multidisciplinary ward meetings and efficacy of liaison. Leadership potential evident within therapy and some nursing teams |
Professional representatives/champions needed to provide leadership on equal basis
to drive change |
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| Stroke Assessment Factors |
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| Assessments unidisciplinary, fragmented, variable evidence-base, and using separate
recording systems. Negative experiences of patients on discharge information provided |
Local commitment to developing evidence-based practice. Need for assessment project
supported by Trust. Positive views of patients on assessment and care provided |
Utilise evidence-based guidelines for assessment and recording. Mechanisms for critical appraisal to be set up. Guidelines for discharge information needed |
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Hamilton et al. Implementation Science 2007 2:21 doi:10.1186/1748-5908-2-21 |
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