Assessing the impact of context during the implementation of a co-designed, collective leadership intervention

Abstract

Introduction: As the field of implementation science continues to evolve, context is emerging as a key factor that requires consideration for successful implementation. Although the importance and impact of context is emphasised in implementation science frameworks, there is limited guidance in the literature on how to understand context and assess its contribution to intervention success or failure.This research aims to contribute to the implementation science literature by 1) developing a methodology for studying and mapping context within the complexity of the hospital environment; and 2) applying this methodology to evaluate how context influences the implementation of a co-designed (with healthcare professionals and patient advocates), collective leadership intervention with two heterogeneous healthcare teams. Methods: A multiple case study approach using triangulation of qualitative research methods was chosen to explore the complexity of the hospital environments of study. Guided by the Consolidated Framework for Implementation Research (CFIR) and literature on implementation outcomes, an observation template has been developed specifically for the needs of this research to facilitate note-taking during the implementation of the co-designed, collective leadership intervention. A context coding framework using CFIR constructs has also been developed to enable the identification of contextual changes and variations across settings at different levels of the healthcare system (organisation and team level). Data collection for this research is on-going. Results: This research deepens our understanding of the contextual factors that influence implementation and explore how contextual factors may contribute to variances in implementation success across hospital settings. This research also contributes to the methodological literature by offering guidance for researchers on how to effectively map and account for the influence of context in implementation research. Discussion: This research contributes to the empirical literature by generating rich data to provide insights and recommendations for implementing initiatives in contextually diverse settings. This work also advances the methodological literature as an observation template and context mapping framework have been designed which could be used to document the contextual characteristics of any setting during implementation. Conclusions: Rigorous assessments of context using methods that allow comparison across studies have the potential to advance our understanding of how and why interventions may be more or less effective, or why intervention implementation may vary across settings. Lessons learned: Despite its noted importance within the literature, context is a poorly reported and understood construct. Consequently, this research will highlight the need to adequately examine the influence of context when evaluating an intervention to understand why, when and where it works most effectively. Limitations: The study focuses on an in-depth analysis of the same intervention with two teams, generating rich contextual information on how the intervention works in these settings. While the methodological contribution will be applicable to other settings, as with studies of this nature, the generalisability of the findings may be limited. Suggestions for future research: The observation template and context mapping methods should be further tested with a wider variety of healthcare teams to explore if adaptation of the tools may be required based on setting or intervention type.

Keywords

• context
• implementation
• healthcare
• qualitative methods