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Available. Open Access. Open Access
Article
Publication date: 27 May 2024

Jeanette Wassar Kirk, Nina Thorny Stefansdottir, Ove Andersen, Mette Bendtz Lindstroem, Byron Powell, Per Nilsen, Tine Tjørnhøj-Thomsen and Marie Broholm-Jørgensen

To explore the mechanisms of the implementation strategy, “oilcloth sessions” and understand and explain the ripple effects of oilcloth sessions as a strategy to implement a new…

350

Abstract

Purpose

To explore the mechanisms of the implementation strategy, “oilcloth sessions” and understand and explain the ripple effects of oilcloth sessions as a strategy to implement a new emergency department.

Design/methodology/approach

A qualitative design was used whereby data were collected using field notes from an ethnographic study of the oilcloth sessions and follow-up semi-structured interviews with staff, managers and key employees who participated in the oilcloth sessions. The data analysis was inspired by the realist evaluation approach of generative causality proposed by Pawson and Tilley.

Findings

The primary ripple effect was that the oilcloth sessions were used for different purposes than the proposed program theory, including being used as: (1) a stage, (2) a battlefield, (3) a space for imagination and (4) a strategic management tool influencing the implementation outcomes. The results bring essential knowledge that may help to explain why and how a well-defined implementation strategy has unplanned outcomes.

Originality/value

Unintended outcomes of implementation strategies are an underexplored issue. This study may help implementation researchers rethink the activities required to reduce unintended negative outcomes or explore potential unplanned outcomes and, in this way, hinder or enhance outcomes, effectiveness and sustainability. Future studies within implementation research should incorporate attention to unintended outcomes to fully understand the impact of implementation strategies.

Details

Journal of Health Organization and Management, vol. 38 no. 9
Type: Research Article
ISSN: 1477-7266

Keywords

Available. Open Access. Open Access
Article
Publication date: 17 July 2019

Jeanette Kirk, Ove Andersen and Janne Petersen

Older patients are at high risk of hospital readmission, which has led to an increasing number of screening and intervention programs. Knowledge on implementing screening tools…

1562

Abstract

Purpose

Older patients are at high risk of hospital readmission, which has led to an increasing number of screening and intervention programs. Knowledge on implementing screening tools for preventing readmissions in emergency department (ED), where the primary focus is often the present-day flow of patients, is scant. The purpose of this paper is to explore whether a new screening tool for predicting readmissions and functional decline in medical patients>65 years of age could be implemented and its influence on cross-continuum collaborations between the primary and secondary sectors.

Design/methodology/approach

The study took place in an ED in Denmark, in collaboration with the surrounding municipalities. An evaluation workshop with nurses and leaders from the ED and the surrounding municipalities took place with the aim of investigating the organizational changes that occurred in daily practice after the implementation of the screening tool. The workshop was designed and analyzed using cultural historical activity theory (CHAT).

Findings

The results showed that it was possible to develop collaboration between the two sectors during the test period. However, the screening tool created different transformations for the municipality employees and in the ED. The contradictions indicated that the screening tool did not mediate a general and sustained transformation in the cross-continuum collaboration.

Research limitations/implications

Screening tools are not objective, neutral or “acontexual” artifacts and must always be adapted to the local context and sectors. CHAT offers a perspective to understand the collective object when working with organizational transformations and implementation.

Practical implications

The study have shown that screening tools are not objective, neutral or “acontexual” artifacts and must always be adapted to the local context. This is called adaption process. This adaption requires time and resources that should be taken into consideration from the beginning of introduction of new screens.

Originality/value

This paper contributes with knowledge about CHAT which offers a way to understand the leading collective object when working with organizational transformations and implementation. CHAT focuses not only on the structural changes but also on the cultural aspects of organizational changes, which is important if we want to reach a sustained change and implement the new screening tool in different sectors.

Details

Journal of Health Organization and Management, vol. 33 no. 5
Type: Research Article
ISSN: 1477-7266

Keywords

Available. Open Access. Open Access
Article
Publication date: 9 April 2021

Jeanette Kirk, Thomas Bandholm, Ove Andersen, Rasmus Skov Husted, Tine Tjørnhøj-Thomsen, Per Nilsen and Mette Merete Pedersen

The aim of this study is to explore and discuss key challenges associated with having stakeholders take part in co-designing a health care intervention to increase mobility in…

3309

Abstract

Purpose

The aim of this study is to explore and discuss key challenges associated with having stakeholders take part in co-designing a health care intervention to increase mobility in older medical patients admitted to two medical departments at two hospitals in Denmark.

Design/methodology/approach

The study used a qualitative design to investigate the challenges of co-designing an intervention in five workshops involving health professionals, patients and relatives. “Challenges” are understood as “situations of being faced with something that needs great mental or physical effort in order to be done successfully and therefore tests a person's ability” (Cambridge Dictionary). Thematic content analysis was conducted with a background in the analytical question: “What key challenges arise in the material in relation to the co-design process?”.

Findings

Two key challenges were identified: engagement and facilitation. These consisted of five sub-themes: recruiting patients and relatives, involving physicians, adjusting to a new researcher role, utilizing contextual knowledge and handling ethical dilemmas.

Research limitations/implications

The population of patients and relatives participating in the workshops was small, which likely affected the co-design process.

Practical implications

Researchers who want to use co-design must be prepared for the extra time required and the need for skills concerning engagement, communication, facilitation, negotiation and resolution of conflict. Time is also required for ethical discussions and considerations concerning different types of knowledge creation.

Originality/value

Engaging stakeholders in co-design processes is increasingly encouraged. This study documents the key challenges in such processes and reports practical implications.

Details

Journal of Health Organization and Management, vol. 35 no. 9
Type: Research Article
ISSN: 1477-7266

Keywords

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