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Implementing a tailored intervention for hip fracture patients with cognitive impairments requires adapting services to patient needs. This study explored a flexible, multicomponent approach in hospitals, highlighting the importance of change agents navigating implementation challenges for sustained practice change.

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Area of Science:

  • Healthcare Management
  • Patient Care Models
  • Implementation Science

Background:

  • Current healthcare systems struggle to adapt specialized clinical services for patients with complex needs.
  • Patients with cognitive impairments admitted for hip fractures experience challenges when care is not tailored.
  • This study investigated the feasibility of a flexible, multicomponent intervention for this patient group in acute hospital settings.

Purpose of the Study:

  • To explore the implementation of a flexible, multicomponent intervention adapting hospital services to the needs of hip fracture patients with cognitive impairments.
  • To understand the process of embedding this intervention within acute hospital settings.

Main Methods:

  • Action research with a case study design across three English hospital sites.
  • Utilized the Plan-Do-Study-Act (PDSA) model for intervention introduction.
  • Employed qualitative data from researcher observations, teleconference meetings, and change agent reports, analyzed using Normalization Process Theory (NPT).

Main Results:

  • Change agents faced challenges in understanding the intervention, PDSA model, and their role (coherence).
  • Successful implementation required engaging colleagues (cognitive participation) and mobilizing resources (collective action).
  • Sustaining the intervention involved continuous self-review and adaptation of clinical routines (reflexive monitoring).

Conclusions:

  • Successful implementation hinges on change agents aligning the intervention with local values and practice.
  • Sustaining practice changes is fragile in constantly changing contexts, requiring ongoing sense-making.
  • A recursive, two-way sense-making process is crucial for re-energizing implementation and overcoming barriers.