Collective implementation in primary and specialised health care – a multimethod study on four different health service domains.

At present, Norwegian health services offer patient care that is based on previous clinical research. Every year more than 600 patients die or suffer severe complications due to harmful or inappropriate care in Norwegian hospitals alone. The main challenge for health care services is their capability and efficiency in implementing new knowledge and intervention bundles into every-day practice. By the intervention study Implement-it we will investigating conditions and factors associated with implementation success, develop a training and supportive intervention package, and test its impact on implementation and patient outcome. Implement-it is a research collaboration between primary health care, hospitals, universities and patient representatives, lead by Helse Bergen and Helse Fonna Health Trusts in Norway. We aim to learn with, and from health care providers across nursing homes, homebased care, medical services in Primary Care and hospitals to implement defined patient safety intervention bundles such as the appropriate use of antibiotics, accuracy of medication lists, detection and handling detoriating patients, and/or patient involvement in planning of mental health care. Our aim is to improve knowledge on efficient implementation and improve health services’ competence in integrating new evidence based practices into everyday clinical practice. By this, we expect to contribute to a faster and wider spread of updated clinical practices and thereby improve the probability of survival, improved prognosis and quality of life.

A vast majority of patients do not receive updated, recommended care in every respect. Especially, care interventions that should be implemented collectively across care units and organisational levels, and in cooperation with patients, are often not provided sufficiently. Results of implementation efforts vary by degree of compliance to the guidelines, penetration and sustainability. These insufficiencies imply limited return of the investments made by health services, and hinder provision of high quality health care. This problem is general across fields of medicine and health service levels, but the vast majority of implementation knowledge is developed in the context of hospital units. We need more knowledge on cooperative implementation, i.e. collective implementation efforts across cooperating partners. The purpose of this research is to contribute to the faster up-take of recommended clinical practices across organisational boundaries into everyday work. The objectives are to investigate and describe how implementation of patient safety intervention-bundles in primary and secondary health care settings can be improved. We will study the successful implementation of antibiotics usage guidelines, and investigate if implementation of the national guidelines for detecting deteriorating patients, ensuring medication list coherence and patient involvement in planning of mental health care improve when learning from successful implementation of antibiotics usage guidelines. This proposal introduces a research cooperation between primary care services, specialised health care services, patient representatives and universities. It is a collaboration between existing national clinical research networks, research networks on patient safety and implementation science, patient involvement panels, and clinical practices in both primary and secondary care. This project will establish an evidence based program for efficient implemetation in health care.