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Conceptualising interventions to enhance spread in complex systems: a multisite comprehensive medication review case

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Understanding how interventions are implemented in complex healthcare systems is crucial. This study explored a medication review intervention, revealing that

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Area of Science:

  • Healthcare systems research
  • Implementation science
  • Health services research

Background:

  • Effective description and conceptualization of interventions in complex systems are vital for their successful spread, evaluation, attribution, and reproducibility.
  • Improvement teams possess unique 'insider knowledge' on how interventions are operationalized in practice, which can enhance intervention descriptions.

Purpose of the Study:

  • To describe the work involved in implementing a comprehensive medication review (CMR) intervention from the improvement team's perspective.
  • To identify consistencies and variations in intervention implementation across different sites and understand the reasons behind them.
  • To critically evaluate the 'hard core' and 'soft periphery' construct for conceptualizing interventions.

Main Methods:

  • Prospective case study design involving a CMR initiative across five healthcare sites.
  • Data collection through observations, document analysis, and semistructured interviews.
  • Qualitative thematic analysis of a developed database, triangulated with a facilitated workshop to measure perceived effort.

Main Results:

  • Sixteen essential intervention components were identified, all interdependent.
  • While component functions remained consistent, adaptations occurred across and within sites, categorized into four spheres of operation.
  • Participants reported the most effort was dedicated to 'dependent sociocultural issues,' and existing 'hard core'/'soft periphery' definitions did not align well with empirical findings.

Conclusions:

  • This study advances intervention conceptualization by examining the operationalization of evidence-based practices within complex systems.
  • A novel 'interventions-in-systems' conceptualization is proposed, detailing intervention components based on their relation to the evidence base, interdependence, function, adaptation, and effort.
  • Understanding the interplay of these factors is key to improving intervention design and implementation in real-world settings.