Health Care Home implementation in Otago and Southland: a qualitative evaluation

Abstract

Introduction Health systems internationally have developed new models of primary care to address health-care challenges. One such model is the Health Care Home (HCH),which has been widely adopted across New Zealand. Aim To explore the facilitators and barriers to implementation of the HCH in the southern health district (Otago and Southland). Methods Interviews with staff (n = 15) from seven general practices were undertaken. A rapid thematic analysis informed by the Consolidated Framework for Implementation Research (CFIR) was conducted using the framework method. Results A number of implementation facilitators and barriers across three CFIR domains were identified: intervention characteristics, inner setting and implementation process. The intervention – the HCH – has well-designed core components (eg clinician triage, patient portals), but the adaptable periphery also needs addressing to ensure the core components fit the local context. In the inner setting, a positive implementation climate and readiness for change (a strong need for the change, compatibility, strong leadership, availability of resources, and a clear understanding of the HCH and timely practical support) were key for successful implementation. Although the HCH practices had detailed planning and performance monitoring systems in place, a successful implementation process required having a change management plan and ensuring whole-of-practice engagement. Discussion This evaluation has identified facilitators and barriers to implementing the HCH in one health district using implementation science theory (CFIR). It is imperative to tailor the HCH model to local needs and individual general practices for successful implementation.

Keywords

• CFIR
• evaluation,health care
• Health Care Home (HCH)
• implementation or implementation science
• model of care
• primary care