Dr Adrienne Young1, Prof Heather Keller2, Ms Rhiannon Barnes1, Ms Jan Hill3, Dr Merrilyn Banks1, A/Prof Tracy Comans4, Dr Jack Bell5
1Royal Brisbane And Women’s Hospital, Herston, Australia, 2University of Waterloo, Waterloo, Canada, 3Princess Alexandra Hospital, Woolloongabba, Australia, 4Metro North Hospital and Health Service, Herston, Australia, 5The Prince Charles Hospital, Chermside, Australia
Aim: Allied health clinicians are often recruited to project positions to facilitate the implementation of complex interventions into practice. Facilitation is a key implementation strategy, but how it might be operationalised, particularly by clinicians, has not been well explored. This study aims to advance understanding of implementation science, by describing the function of novice clinician facilitators, and barriers and enablers they experience while implementing a new model of care for managing hospital malnutrition.
Methods: Semi-structured interviews were undertaken with local facilitators (six dietitians, one occupational therapist; each funded 0.2FTE for six months) involved in implementing The SIMPLE Approach (Systematised Interdisciplinary Malnutrition Pathway Implementation and Evaluation) in six hospitals in Queensland, Australia. A hybrid approach to analysis was used, with deductive framework approach used to identify facilitator activities, and inductive analysis to identify barriers and enablers to fulfilling their role.
Results: Key functions of the facilitator role over the six-month project were building relationships and trust; understanding the problem and stimulating change through data; negotiating and implementing the change; and measuring, sharing and reflecting on success. Facilitators appeared to focus efforts on the ‘clarifying and engaging’ stage, and experienced challenges in building an improvement team and creating a common vision for change. ‘Dedicated role, time and support’ was identified as a theme encompassing key barriers and enablers to successful facilitation, with time referring to adequate duration of implementation phase and need for protected time from clinical tasks.
Conclusions: When implementing complex interventions within short project timelines, it is critical that novice clinician facilitators are given adequate and protected time within their role, and have access to regular support from peers and experienced facilitators. Without these structures in place, facilitators may experience difficulties in building trust and relationships, co-designing strategies with teams, and developing capacity for change, compromising the success of implementation.
Dr Adrienne Young is an Accredited Practicing Dietitian, and is currently Principal Research Fellow, Allied Health Professions at the Royal Brisbane and Women’s Hospital. Her PhD research on improving nutritional intake of older medical inpatients has been of interest nationally and internationally, with Adrienne awarded the Health Practitioner Researcher of the Year at the Royal Brisbane and Women’s Hospital research symposium in 2018, and New Researcher Award at the International Congress of Dietetics in 2012. Adrienne has continued to research in the area of malnutrition in older people, with recent work also focused on workforce development to prepare allied health professionals to translate research into their practice.