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Cited by 173Health Policy Implementation ScienceEvaluation and Performance AssessmentClinical practice guidelines implementation

The DOI matches its Crossref record; 38 of the 40 references it cites were found in a registry or an index.

A realistic evaluation: the case of protocol-based care

Open access
Rycroft-Malone, Jo, Fontenla, Marina, Bick, Debra, Seers, Kate·2010·Implementation Science
DOI 10.1186/1748-5908-5-38PMC PMC2889857
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Abstract

BACKGROUND: 'Protocol based care' was envisioned by policy makers as a mechanism for delivering on the service improvement agenda in England. Realistic evaluation is an increasingly popular approach, but few published examples exist, particularly in implementation research. To fill this gap, within this paper we describe the application of a realistic evaluation approach to the study of protocol-based care, whilst sharing findings of relevance about standardising care through the use of protocols, guidelines, and pathways. METHODS: Situated between positivism and relativism, realistic evaluation is concerned with the identification of underlying causal mechanisms, how they work, and under what conditions. Fundamentally it focuses attention on finding out what works, for whom, how, and in what circumstances. RESULTS: In this research, we were interested in understanding the relationships between the type and nature of particular approaches to protocol-based care (mechanisms), within different clinical settings (context), and what impacts this resulted in (outcomes). An evidence review using the principles of realist synthesis resulted in a number of propositions, i.e., context, mechanism, and outcome threads (CMOs). These propositions were then 'tested' through multiple case studies, using multiple methods including non-participant observation, interviews, and document analysis through an iterative analysis process. The initial propositions (conjectured CMOs) only partially corresponded to the findings that emerged during analysis. From the iterative analysis process of scrutinising mechanisms, context, and outcomes we were able to draw out some theoretically generalisable features about what works, for whom, how, and what circumstances in relation to the use of standardised care approaches (refined CMOs). CONCLUSIONS: As one of the first studies to apply realistic evaluation in implementation research, it was a good fit, particularly given the growing emphasis on understanding how context influences evidence-based practice. The strengths and limitations of the approach are considered, including how to operationalise it and some of the challenges. This approach provided a useful interpretive framework with which to make sense of the multiple factors that were simultaneously at play and being observed through various data sources, and for developing explanatory theory about using standardised care approaches in practice.

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Crossref · 10.1186/1748-5908-5-38

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Figure 1 Theoretical Framework.
Figure 1 Theoretical Framework.CC BY · PubMed Central
Figure 2 Conceptualisation of frequently used standardised care approaches.
Figure 2 Conceptualisation of frequently used standardised care approaches.CC BY · PubMed Central
Figure 3 Examples of how standardised care approaches were used.
Figure 3 Examples of how standardised care approaches were used.CC BY · PubMed Central

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Research works printed but not linked: 1

  1. Pawson R, Tilley N: Realistic evaluation. 1997, London: Sage

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Metadata

Authors
Rycroft-Malone, J., Fontenla, M., Bick, D., & Seers, K.
Affiliations
  • University of Warwick (GB)
  • King's College London (GB)
ORCID
Venue
Implementation Science
Publisher
Springer Science and Business Media LLC
Published
2010-05-26
Volume
5
Issue
1
Pages
38-38
ISSN
1748-5908 (ISSN-L)
DOI
10.1186/1748-5908-5-38
PMC
PMC2889857
OpenAlex
W2032357725
Cited by
173
References
40
Citations by year
2026: 1 · 2025: 2 · 2024: 8 · 2023: 6 · 2022: 9 · 2021: 18 · 2020: 11 · 2019: 15 · 2018: 17 · 2017: 13 · 2016: 10 · 2015: 18 · 2014: 17 · 2013: 8 · 2012: 10
FWCI
15.95
Type
journal article
Language
en
Open access
Licence
Locations
  • Implementation Science (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Lancaster EPrints (Lancaster University) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion)
Funders
  • National Institute for Health and Care Research
  • Service Delivery and Organisation Programme
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Public Administration › Evaluation and Performance Assessment
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
protocol-based care, realist evaluation, realist synthesis, standardization of care, clinical guidelines, care pathways, implementation research, context-mechanism-outcome, evidence-based practice, health service improvement, causal mechanisms

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