Collective action for implementation: a realist evaluation of organisational collaboration in healthcare

Journal article

Rycroft-Malone, J., Burton, C.R., Wilkinson, J., Harvey, G., McCormack, B., Baker, R., Dopson, S., Graham, I.D., Staniszewska, S., Thompson, C., Ariss, S., Melville-Richards, L. and Williams , L. 2016. Collective action for implementation: a realist evaluation of organisational collaboration in healthcare. Implementation Science : IS. 11 (17). https://doi.org/10.1186/s13012-016-0380-z
AuthorsRycroft-Malone, J., Burton, C.R., Wilkinson, J., Harvey, G., McCormack, B., Baker, R., Dopson, S., Graham, I.D., Staniszewska, S., Thompson, C., Ariss, S., Melville-Richards, L. and Williams , L.
Abstract

Background: Increasingly, it is being suggested that translational gaps might be eradicated or narrowed by
bringing research users and producers closer together, a theory that is largely untested. This paper reports a
national study to fill a gap in the evidence about the conditions, processes and outcomes related to collaboration and implementation.

Methods: A longitudinal realist evaluation using multiple qualitative methods case studies was conducted with three Collaborations for Leadership in Applied Health Research in Care (England). Data were collected over four rounds of theory development, refinement and testing. Over 200 participants were involved in semi-structured interviews, non-participant observations of events and meetings, and stakeholder engagement. A combined inductive and deductive data analysis process was focused on proposition refinement and testing iteratively over data collection rounds.

Results: The quality of existing relationships between higher education and local health service, and views about whether implementation was a collaborative act, created a path dependency. Where implementation was
perceived to be removed from service and there was a lack of organisational connections, this resulted in a focus on knowledge production and transfer, rather than co-production. The collaborations’ architectures were
counterproductive because they did not facilitate connectivity and had emphasised professional and epistemic boundaries. More distributed leadership was associated with greater potential for engagement. The creation of boundary spanning roles was the most visible investment in implementation, and credible individuals in these roles resulted in cross-boundary work, in facilitation and in direct impacts. The academic-practice divide played out strongly as a context for motivation to engage, in that ‘what’s in it for me’ resulted in variable levels of engagement along a co-operation-collaboration continuum. Learning within and across collaborations was patchy depending on attention to evaluation.

Conclusions: These collaborations did not emerge from a vacuum, and they needed time to learn and develop.
Their life cycle started with their position on collaboration, knowledge and implementation. More impactful attempts at collective action in implementation might be determined by the deliberate alignment of a number of features, including foundational relationships, vision, values, structures and processes and views about the nature of the collaboration and implementation.

KeywordsApplied Health; Translational Gaps; Higher Education; Local Health Services; Implementation Science; Path Dependency; Collaboration; Evidence; Knowledge
Year2016
JournalImplementation Science : IS
Journal citation11 (17)
PublisherBioMed Central
ISSN1748-5908
Digital Object Identifier (DOI)https://doi.org/10.1186/s13012-016-0380-z
Official URLhttp://doi.org/10.1186/s13012-016-0380-z
Publication dates
Online09 Feb 2016
Publication process dates
Accepted04 Feb 2016
Deposited22 May 2020
Output statusPublished
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Brocklehurst, P.R., Williams, L., Burton, C., Goodwin, T. and Rycroft-Malone, J. 2017. Implementation and trial evidence: a plea for fore-thought. British Dental Journal. 222 (5), pp. 331-335. https://doi.org/10.1038/sj.bdj.2017.213
What works for whom in the management of diabetes in people living with dementia: a realist review
Bunn, F., Goodman, C., Jones, P. R., Russell, B., Trivedi, D., Sinclair, A., Bayer, A., Rait, G., Rycroft-Malone, J. and Burton, C. 2017. What works for whom in the management of diabetes in people living with dementia: a realist review. BMC Medicine. 15 (141). https://doi.org/10.1186/s12916-017-0909-2
Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions
Rycroft-Malone, J., Burton, C., Williams, L., Edwards, S., Fisher, D., Hall, B., McCormack, B., Nutley, S., Seddon, D. and Williams, R. 2016. Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions. National Institute of Health Research. https://doi.org/10.3310/hsdr04120
Implementing a Systematic Voiding Program for Patients With Urinary Incontinence After Stroke
French, B., Thomas, L.H., Harrison, J., Burton, C., Forshaw, D., Booth, J., Britt, D., Cheater, F.M., Roe, B. and Watkins, C.L. 2016. Implementing a Systematic Voiding Program for Patients With Urinary Incontinence After Stroke. Qualitative Health Research. 26 (10). https://doi.org/10.1177/1049732316630975
Implementing best practice in infection prevention and control. A realist evaluation of the role of intermediaries
Williams, L., Rycroft-Malone, J. and Burton, C. 2016. Implementing best practice in infection prevention and control. A realist evaluation of the role of intermediaries. International Journal of Nursing Studies. 60, pp. 156-167. https://doi.org/10.1016/j.ijnurstu.2016.04.012
Bringing critical realism to nursing practice: Roy Bhaskar's contribution
Williams, L., Rycroft-Malone, J. and Burton, C. 2016. Bringing critical realism to nursing practice: Roy Bhaskar's contribution. nursing philosophy: an international journal for healthcare professionals. 18 (2). https://doi.org/10.1111/nup.12130
Managers' use of nursing workforce planning and deployment technologies: protocol for a realist synthesis of implementation and impact
Burton, C., Rycroft-Malone, J., Williams, L., Davies, S., McBride, A., Hall, B., Rowlands, A.M. and Jones, A. 2016. Managers' use of nursing workforce planning and deployment technologies: protocol for a realist synthesis of implementation and impact. BMJ Open. 6 (8). https://doi.org/10.1136/bmjopen-2016-013645
Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions
Williams, L., Rycroft-Malone, J., Burton, C., Edwards,S., Fisher, D., Hall, B., McCormack, B., Nutley, S.M., Seddon, D. and Williams, R. 2016. Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions. BMJ Open. 6 (8). https://doi.org/10.1136/bmjopen-2016-011964
Strategies to prevent oral disease in dependent older people
Brocklehurst, P., Williams, L., Hoare, Z., Goodwin, T., McKenna, G., Tsakos, G., Chestnutt, I.G., Pretty, I., Wassall, R., Jerkovic-Cosic, K., Hayes, M., Watt, R.G. and Burton, C. 2016. Strategies to prevent oral disease in dependent older people. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD012402
Process evaluations in neurological rehabilitation: a mixed-evidence systematic review and recommendations for future research
Masterson-Algar, P., Burton, C. and Rycroft-Malone, J. 2016. Process evaluations in neurological rehabilitation: a mixed-evidence systematic review and recommendations for future research. BMJ Open. 6 (11). https://doi.org/10.1136/bmjopen-2016-013002
Managing diabetes in people with dementia: protocol for a realist review
Bunn, F., Goodman, C., Rycroft Malone, J., Reece Jones, P., Burton, C., Rait, G., Trivedi, D., Bayer, A. and Sinclair, A. 2016. Managing diabetes in people with dementia: protocol for a realist review. Systematic Reviews. 5 (5). https://doi.org/10.1186/s13643-015-0182-4
Collaboration and co-production knowledge in healthcare: opportunities and challenges
Rycroft-Malone, J., Burton, C.R., Bucknall , T., Graham, I.D., Hutchinson, A. and Stacey, D. 2016. Collaboration and co-production knowledge in healthcare: opportunities and challenges. International Journal of Health Policy and Management. 5 (4), pp. 221-223. https://doi.org/10.15171/IJHPM.2016.08
An occupational therapy intervention for residents with stroke-related disabilities in UK care homes (OTCH): cluster randomised controlled trial with economic evaluation
Sackley, C.M., Walker, M.F., Burton, C.R., Watkins,C.L, Mant, J., Roalfe, A.K., Wheatley, K., Sheehan, B., Sharp, L., Stant, K.E., Fletcher-Smith, J., Steel, K., Barton, G.R., Irvine, L. and Peryer, G. 2016. An occupational therapy intervention for residents with stroke-related disabilities in UK care homes (OTCH): cluster randomised controlled trial with economic evaluation. Health Technology Assessment. 20 (15). https://doi.org/10.3310/hta20150
Identifying Continence OptioNs after Stroke (ICONS): an evidence synthesis, case study and exploratory cluster randomised controlled trial of the introduction of a systematic voiding programme for patients with urinary incontinence after stroke in secondary care
Thomas, L. H., French, B., Sutton, C. J., Forshaw, D., Leathley, M. J., Burton, C., Roe, B., Cheater, F. M., Booth, J., McColl, E., Carter, B., Walker, A., Brittain, K., Whiteley, G., Rodgers, H., Barrett, J. and Watkins, C. L. 2015. Identifying Continence OptioNs after Stroke (ICONS): an evidence synthesis, case study and exploratory cluster randomised controlled trial of the introduction of a systematic voiding programme for patients with urinary incontinence after stroke in secondary care. NIHR Journals Library.
Collective action for knowledge mobilisation: a realist evaluation of the collaborations for leadership in applied health research and care
Rycroft-Malone, J., Burton, C., Wilkinson, J., Harvey, G., McCormack, B., Baker, R., Dopson, S., Graham, I., Staniszewska, S., Thompson, C., Ariss, S., Melville-Richards, L. and Williams, L. 2015. Collective action for knowledge mobilisation: a realist evaluation of the collaborations for leadership in applied health research and care. UK NIHR Journals Library. https://doi.org/10.3310/hsdr03440
An untapped resource: patient and public involvement in implementation comment on "Knowledge mobilization in healthcare organizations": a view from the resource-based view of the firm
Burton, C. and Rycroft-Malone, J. 2015. An untapped resource: patient and public involvement in implementation comment on "Knowledge mobilization in healthcare organizations": a view from the resource-based view of the firm. International Journal of Health Policy and Management. 4 (12), pp. 845-847. https://doi.org/10.15171/ijhpm.2015.150
Investigating preferences for support with life after stroke: a discrete choice experiment
Burton, C., Fargher, E., Plumpton, C., Roberts, G.W, Owen, H. and Roberts, E. 2014. Investigating preferences for support with life after stroke: a discrete choice experiment. BMC Health Services Research. 14 (63). https://doi.org/10.1186/1472-6963-14-63
Evaluating a systematic voiding programme for patients with urinary incontinence after stroke in secondary care using soft systems analysis and Normalisation Process Theory: findings from the ICONS case study phase.International journal of nursing studies
Thomas, L.H, French, B., Burton, C., Sutton, C., Forshaw, D., Dickinson, H., Leathley, M.J., Britt, D., Roe, B., Cheater, F.M, Booth, J., Watkins, C.L, ICONS Project Team, ICONS Patient and Public and Carer Involvement Groups 2014. Evaluating a systematic voiding programme for patients with urinary incontinence after stroke in secondary care using soft systems analysis and Normalisation Process Theory: findings from the ICONS case study phase.International journal of nursing studies. International Journal of Nursing Studies. 51 (10), pp. 1308-1320. https://doi.org/10.1016/j.ijnurstu.2014.02.009
Improving skills and care standards in the support workforce for older people: a realist review
Rycroft-Malone, J., Burton, C., Hall, B., McCormack, B., Nutley, S., Seddon, D. and Williams, L. 2014. Improving skills and care standards in the support workforce for older people: a realist review. BMJ Open. 4 (5). https://doi.org/10.1136/bmjopen-2014-005356
Does self-efficacy influence recovery and well-being in osteoarthritis patients undergoing joint replacement? A systematic review
Magklara, E., Burton, C. and Morrison, V. 2014. Does self-efficacy influence recovery and well-being in osteoarthritis patients undergoing joint replacement? A systematic review. Clinical Rehabilitation. 28 (9). https://doi.org/10.1177/0269215514527843
Towards a programme theory for fidelity in the evaluation of complex interventions.
Masterson-Algar, P., Burton, C., Rycroft-Malone, J., Sackley, C.M. and Walker, M.F. 2014. Towards a programme theory for fidelity in the evaluation of complex interventions. Journal of Evaluation in Clinical Practice . 20 (4), pp. 445 - 452. https://doi.org/10.1111/jep.12174
Investigating the organisational impacts of quality improvement: a protocol for a realist evaluation of improvement approaches drawing on the Resource Based View of the Firm.
Burton, C., Rycroft Malone, J., Robert, G., Willson, A. and Hopkins, A. 2014. Investigating the organisational impacts of quality improvement: a protocol for a realist evaluation of improvement approaches drawing on the Resource Based View of the Firm. BMJ Open. 4:e005650. https://doi.org/10.1136/bmjopen-2014-005650
Resource based view of the firm as a theoretical lens on the organisational consequences of quality improvement.
Burton, C. and Rycroft-Malone, J. 2014. Resource based view of the firm as a theoretical lens on the organisational consequences of quality improvement. International Journal of Health Policy and Management. 3 (3), pp. 113 - 115. https://doi.org/10.15171/ijhpm.2014.74
The study protocol of: 'Initiating end of life care in stroke: clinical decision-making around prognosis'.
Burton, C., Payne, S., Turner, M., Bucknall, T., Rycroft-Malone, J., Tyrell, P., Horne, M., Ntambwe, L.I., Tyson, S., Mitchell, H., Williams, S. and Elghenzai, S. 2014. The study protocol of: 'Initiating end of life care in stroke: clinical decision-making around prognosis'. BMC Palliative Care. 13 (55). https://doi.org/10.1186/1472-684X-13-55
Identifying continence options after stroke (ICONS): a cluster randomised controlled feasibility trial.
Thomas, L.H., Watkins, C.L., Sutton, C.J., Forshaw, D., Leathley, M.J., French, B., Burton, C., Cheater, F., Roe, B., Britt, D., Booth, J., McColl, E., The ICONS Project Team and The ICONS Patient, Public and Carer Involvement Groups 2014. Identifying continence options after stroke (ICONS): a cluster randomised controlled feasibility trial. Trials. 15 (509). https://doi.org/10.1186/1745-6215-15-509
What is rehabilitation potential? Development of a theoretical model through the accounts of healthcare professionals working in stroke rehabilitation services
Burton, C.R., Horne, M., Woodward-Nutt, K., Bowen, A. and Tyrrell, P. 2014. What is rehabilitation potential? Development of a theoretical model through the accounts of healthcare professionals working in stroke rehabilitation services. Disability and Rehabilitation. 37 (21), pp. 1955-1960. https://doi.org/10.3109/09638288.2014.991454