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The Quality in Acute Stroke Care (QASC) global scale-up using a cascading facilitation framework: a qualitative
Elizabeth McInnes1,2, Simeon Dale3,4, Kathleen Bagot1
1Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne; and Australian Catholic University, Sydney, Australia.
BMC Health Services Research
|January 29, 2024
Summary
Implementing nurse-led stroke protocols across Europe was successful using a cascading facilitation model. This approach, involving academics and the Angels Initiative, overcame challenges in evidence translation for better stroke care.
Area of Science:
- Stroke care research
- Evidence-based medicine implementation
- Healthcare quality improvement
Background:
- Hospital stroke care variation impacts patient outcomes.
- The Quality in Acute Stroke (QASC) Australia trial showed FeSS Protocols reduce death and disability.
- Upscaling the FeSS Protocols internationally required evaluating implementation factors.
Purpose of the Study:
- To identify factors influencing the international implementation of FeSS Protocols.
- To evaluate the effectiveness of a cascading facilitation framework for evidence translation.
- To understand stakeholder engagement in large-scale healthcare intervention rollouts.
Main Methods:
- A qualitative process evaluation using semi-structured interviews.
- Interview participants included executives, Angel Team leaders, Angel Consultants, and Country Co-ordinators.
- Data analysis involved inductive thematic analysis within NVivo.
Main Results:
- Key themes influencing upscale included readiness for change, roles and relationships, and managing multiple changes.
- Readiness for change involved negotiating expectations and ensuring intervention feasibility.
- Effective roles and relationships, particularly with nurse champions, were crucial.
Conclusions:
- A cascading facilitation model with academic, industry, and clinical partners enabled international evidence translation.
- Managing multi-level changes and strategic stakeholder engagement facilitated protocol adoption.
- This model shows promise for future large-scale evidence translation programs in stroke care.
