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Deliberate and emergent strategies for implementing person-centred care: a qualitative interview study with researchers, professionals and patients

Artikel i vetenskaplig tidskrift
Författare Öncel Naldemirci
Axel Wolf
Mark Elam
Doris Lydahl
Lucy Moore
Nicky Britten
Publicerad i BMC Health Services Research
Volym 17
Nummer/häfte 527
ISSN 1472-6963
Publiceringsår 2017
Publicerad vid Centrum för personcentrerad vård vid Göteborgs universitet (GPCC)
Institutionen för sociologi och arbetsvetenskap
Institutionen för vårdvetenskap och hälsa
Språk en
Länkar https://bmchealthservres.biomedcent...
Ämnesord Person-centred care – Implementation strategies – Normalization process theory – Deliberate and emergent strategies – Qualitative
Ämneskategorier Sociologi, Sociologi (exklusive socialt arbete, socialpsykologi och socialantropologi), Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi, Hälsovetenskaper

Sammanfattning

Abstract Background The introduction of innovative models of healthcare does not necessarily mean that they become embedded in everyday clinical practice. This study has two aims: first, to analyse deliberate and emergent strategies adopted by healthcare professionals to overcome barriers to normalization of a specific framework of person-centred care (PCC); and secondly, to explore how the recipients of PCC understand these strategies. Methods This paper is based on a qualitative study of the implementation of PCC in a Swedish context. It draws on semi-structured interviews with 18 researchers and 17 practitioners who adopted a model of PCC on four different wards and 20 patients who were cared for in one of these wards. Data from these interviews were first coded inductively and emerging themes are analysed in relation to normalization process theory (NPT). Results In addition to deliberate strategies, we identify emergent strategies to normalize PCC by (i) creating and sustaining coherence in small but continuously communicating groups (ii) interpreting PCC flexibly when it meets specific local situations and (iii) enforcing teamwork between professional groups. These strategies resulted in patients perceiving PCC as bringing about (i) a sense of ease (ii) appreciation of inter-professional congruity (ii) non-hierarchical communication. Conclusion NPT is useful to identify and analyse deliberate and emergent strategies relating to mechanisms of normalization. Emergent strategies should be interpreted not as trivial solutions to problems in implementation, but as a possible repertoire of tools, practices and skills developed in situ. As professionals and patients may have different understandings of implementation, it is also crucial to include patients’ perceptions to evaluate outcomes.

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