Balancing Yin and Yang: the development of a framework using Participatory Action Research for the Translation and Implementation (Part 1) of new practices

Abstract

Context: Despite the demonstrable benefits of many healthcare innovations, embedding research findings into practice has been slow and sporadic. [1,2] Many implementation frameworks exist, however most have been criticised for not having a strong theoretical underpinning. This study addresses this gap by reviewing the current models to propose a new, theoretically driven framework for change management and translation. Methods: This study is reported in two parts. In part 1, a systematically-based literature review was undertaken. Following this, part 2 included conducting focus groups with academics to verify the model and provide feedback on the new framework. Findings: The gaps in current implementation frameworks identified include deficiencies in the areas of individual and social behaviour, participatory action, operationalisation and evaluation of the frameworks. The Quality Implementation Framework (QIF) [3] was used to provide the basis to develop a robust extended model, which addressed those areas that were identified as deficient in the current frameworks. By combining the best parts of extant models with a translation and implementation foci, we developed the PARTI model that is underpinned by commitment to change (Ying) and change fidelity (Yang) at each of its four stages, which included a behavioural questionnaire and implementation checklist. PARTI stands for Participatory Action Research, Translation and Implementation. Conclusions: The implementation of change in healthcare delivery is difficult and demanding, and healthcare managers look to change frameworks for guidance. The PARTI model has been developed to provide a systematic approach to implementing changed practices that is repeatable, reliable and scalable. Abbreviations: ISF – Interactive Systems Framework; PAR – Participatory Action Research; PARTI – Participatory Action Research for Translation and Implementation; QIF – Quality Implementation Framework; TDF – Theoretical Domains Framework.

Keywords

• knowledge translation; evidence-based practice; organisation innovation; implementation framework; managing change; healthcare.