Evaluation of a learning collaborative on team-based care: qualitative analysis of coaching calls using normalisation...

Area of Science:

• Healthcare Improvement
• Organizational Behavior
• Implementation Science

Background:

• Evaluating learning collaboratives (LC) requires understanding how teams implement and normalize new practices.
• Normalisation Process Theory (NPT) offers a framework to analyze these implementation mechanisms.
• Team-based primary care implementation presents unique challenges in healthcare settings.

Purpose of the Study:

• To analyze the use of Normalisation Process Theory (NPT) mechanisms during a learning collaborative (LC) aimed at implementing team-based primary care.
• To examine how NPT mechanisms (coherence, cognitive participation, collective action, reflexive monitoring) are used by participating teams.
• To understand the temporal and concurrent nature of these normalization mechanisms in real-time practice.

Main Methods:

• Constant comparison coding of transcripts from weekly calls between team coaches and mentors.
• Analysis of Normalisation Process Theory (NPT) mechanisms over a 9-month learning collaborative.
• Inclusion of 13 health centers implementing team-based primary care.

Main Results:

• Normalization mechanisms operate concurrently, recursively, and in both positive and negative ways, not linearly.
• Clarity of purpose (coherence) and team commitment (cognitive participation) developed over time with regular meetings.
• Sufficient coherence and cognitive participation took 3-4 months; 9 months was insufficient for reflexive monitoring using data for some teams.

Conclusions:

• Successful implementation of new practices in learning collaboratives depends on the dynamic interplay of normalization mechanisms.
• Teams need time to establish core mechanisms like coherence and cognitive participation before focusing on reflexive monitoring.
• Understanding the non-linear, concurrent nature of NPT mechanisms is crucial for optimizing healthcare improvement initiatives.