Implementation between text and work-a qualitative study of a readmission prevention program targeting elderly...

Area of Science:

• Healthcare Management
• Implementation Science
• Sociology of Health

Background:

• Healthcare implementation is heavily influenced by institutional context, often communicated through text-based materials.
• These materials can impose contradictory expectations on healthcare professionals, impacting their daily work routines.
• Understanding the role of text in mediating these expectations is crucial for successful program adoption.

Purpose of the Study:

• To examine health professionals' experiences with implementing a readmission prevention program for elderly patients.
• To investigate contradictions between program demands and existing work routines.
• To explore the role of text-based materials in mediating these contradictions.

Main Methods:

• Conducted five focus group interviews with 24 healthcare professionals in Denmark.
• Included diverse roles: physicians, nurses, medical secretaries, care managers, and general practitioners.
• Analyzed text-based materials identified as important by participants, using an institutional ethnography approach.

Main Results:

• Healthcare professionals experienced conflicts between program demands and daily routines.
• Tensions arose from resistance to control, digital communication tools, and standardized enrollment requirements.
• Striving for autonomy and mono-professional routines conflicted with the program's need for interdisciplinary work, mediated by text-based materials.

Conclusions:

• Successful implementation of prevention programs is hindered by tensions between program demands and existing healthcare work.
• Text-based materials act as mediators of institutional context demands within healthcare work.
• These materials significantly influence the implementation process and its outcomes.