What drives adoption of a computerised, multifaceted quality improvement intervention for cardiovascular disease management in primary healthcare settings? A mixed methods analysis using normalisation process theory
Open accessAbstract
BACKGROUND: A computerised, multifaceted quality improvement (QI) intervention for cardiovascular disease (CVD) management in Australian primary healthcare was evaluated in a cluster randomised controlled trial. The intervention was associated with improved CVD risk factor screening but there was no improvement in prescribing rates of guideline-recommended medicines. The aim of this study was to conduct a process evaluation to identify and explain the underlying mechanisms by which the intervention did and did not have an impact. METHODS/DESIGN: Normalisation process theory (NPT) was used to understand factors that supported or constrained normalisation of the intervention into routine practice. A case study design was used in which six of the 30 participating intervention sites were purposively sampled to obtain a mix of size, governance, structure and performance. Multiple data sources were drawn on including trial outcome data, surveys of job satisfaction and team climate (68 staff) and in-depth interviews (19 staff). Data were primarily analysed within cases and compared with quantitative findings in other trial intervention and usual care sites. RESULTS: We found a complex interaction between implementation processes and several contextual factors affecting uptake of the intervention. There was no clear association between team climate, job satisfaction and intervention outcomes. There were four spheres of influence that appeared to enhance or detract from normalisation of the intervention: organisational mission and history (e.g. strategic investment to promote a QI culture enhanced cognitive participation), leadership (e.g. ability to energise or demotivate others influenced coherence), team environment (e.g. synergistic activities of team members with different skill sets influenced collective action) and technical integrity of the intervention (e.g. tools that slowed computer systems limited reflective action). DISCUSSION: Use of NPT helped explain how certain contextual factors influence the work that is done by individuals and teams when implementing a novel intervention. Although these factors do not necessarily distil into a recipe for successful uptake, they may assist system planners, intervention developers, and health professionals to better understand the trajectory that primary health care services may take when developing and engaging with QI interventions. TRIAL REGISTRATION: ACTRN 12611000478910 . Registered 08 May 2011.
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No significant associations were found between team climate and fidelity to a multifaceted cardiovascular disease management intervention.
“In contrast, no significant associations were found between team climate and fidelity to a multifaceted cardiovascular disease management intervention, with qualitative data suggesting variation in the influence of teamwork across practices [77].”
From Teamwork and implementation of innovations in healthcare and human service settings: a systematic review (2024) · cites this paper as [77]
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Cites
(1984) · Cited by 81,983 · see citing works
Designing and Conducting Mixed Methods Research
Robinson, P. M. (2007) · Australian and New Zealand Journal of Public Health · doi:10.1111/j.1753-6405.2007.00096.x · Cited by 23,297 · see citing works
Institute of Medicine (2000) · National Academies Press eBooks · doi:10.17226/9728 · Cited by 14,174 · see citing works
Developing and evaluating complex interventions: the new Medical Research Council guidance
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008) · BMJ · doi:10.1136/bmj.a1655 · Cited by 10,995 · see citing works
Crossing the Quality Chasm: A New Health System for the 21st Century
Baker, A. (2001) · BMJ · doi:10.1136/bmj.323.7322.1192 · Cited by 10,754 · see citing works
Qualitative Case Study Methodology: Study Design and Implementation for Novice Researchers
Baxter, P., & Jack, S. (2015) · The Qualitative Report · doi:10.46743/2160-3715/2008.1573 · Cited by 7,594 · see citing works
Process evaluation of complex interventions: Medical Research Council guidance
Moore, G. F., Audrey, S., Barker, M., Bond, L., Bonell, C., Hardeman, W., Moore, L., O'Cathain, A., Tinati, T., Wight, D., et al. (2015) · BMJ · doi:10.1136/bmj.h1258 · Cited by 6,204 · see citing works
Audit and feedback: effects on professional practice and healthcare outcomes
Ivers, N., Jamtvedt, G., Flottorp, S., Young, J. M., Odgaard-Jensen, J., French, S. D., O'Brien, M. A., Johansen, M., Grimshaw, J., & Oxman, A. D. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000259.pub3 · Cited by 5,485 · see citing works
Making sense of implementation theories, models and frameworks
Nilsen, P. (2015) · Implementation Science · doi:10.1186/s13012-015-0242-0 · Cited by 4,447 · see citing works
Crossing the Quality Chasm: A New Health System for the 21st Century
Bloom, B. S. (2002) · JAMA · doi:10.1001/jama.287.5.646-a · Cited by 3,732 · see citing works
Garg, A. X., Adhikari, N. K. J., McDonald, H., Rosas-Arellano, M. P., Devereaux, P. J., Beyene, J., Sam, J., & Haynes, R. B. (2005) · JAMA · doi:10.1001/jama.293.10.1223 · Cited by 2,936 · see citing works
Implementing, Embedding, and Integrating Practices: An Outline of Normalization Process Theory
May, C., & Finch, T. (2009) · Sociology · doi:10.1177/0038038509103208 · Cited by 2,115 · see citing works
Cochrane Database of Systematic Reviews
Lyons, R. (2006) · Progress in Neurology and Psychiatry · doi:10.1002/pnp.208 · Cited by 1,907 · see citing works
Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014) · BMJ Quality & Safety · doi:10.1136/bmjqs-2013-001862 · Cited by 1,871 · see citing works
Leavitt, M. (2001) · PubMed · Cited by 1,835 · see citing works
Evidence on the Chronic Care Model in the new millennium
Coleman, K., Austin, B. T., Brach, C., & Wagner, E. H. (2009) · Health Affairs · doi:10.1377/hlthaff.28.1.75 · Cited by 1,606 · see citing works
Murray, E., Treweek, S., Pope, C., MacFarlane, A., Ballini, L., Dowrick, C., Finch, T., Kennedy, A., Mair, F., O'Donnell, C., et al. (2010) · BMC Medicine · doi:10.1186/1741-7015-8-63 · Cited by 1,478 · see citing works
Development of a theory of implementation and integration: Normalization Process Theory
May, C. R., Mair, F., Finch, T., MacFarlane, A., Dowrick, C., Treweek, S., Rapley, T., Ballini, L., Ong, B. N., Rogers, A., et al. (2009) · Implementation Science · doi:10.1186/1748-5908-4-29 · Cited by 1,409 · see citing works
Process evaluation in randomised controlled trials of complex interventions
Oakley, A., Strange, V., Bonell, C., Allen, E., & Stephenson, J. (2006) · BMJ · doi:10.1136/bmj.332.7538.413 · Cited by 1,247 · see citing works
Effect of Clinical Decision-Support Systems: A Systematic Review
Bright, T. J., Wong, A., Dhurjati, R., Bristow, E., Bastian, L., Coeytaux, R. R., Samsa, G., Hasselblad, V., Williams, J. W., Musty, M. D., et al. (2012) · Annals of Internal Medicine · doi:10.7326/0003-4819-157-1-201207030-00450 · Cited by 1,200 · see citing works
Implementation, context and complexity
May, C. R., Johnson, M., & Finch, T. (2016) · Implementation Science · doi:10.1186/s13012-016-0506-3 · Cited by 978 · see citing works
Mental health, job satisfaction, and job stress among general practitioners.
Cooper, C. L., Rout, U. R., & Faragher, B. (1989) · BMJ · doi:10.1136/bmj.298.6670.366 · Cited by 623 · see citing works
Systematic Review and Meta-Analysis of Practice Facilitation Within Primary Care Settings
Baskerville, N. B., Liddy, C., & Hogg, W. (2012) · The Annals of Family Medicine · doi:10.1370/afm.1312 · Cited by 571 · see citing works
Mair, F. S., May, C., O’Donnell, C., Finch, T., Sullivan, F., & Murray, E. (2012) · Bulletin of the World Health Organization · doi:10.2471/blt.11.099424 · Cited by 553 · see citing works
The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement
Institute for Healthcare Improvement (2004) · Diabetes Spectrum · doi:10.2337/diaspect.17.2.97 · Cited by 526 · see citing works
The 10 Building Blocks of High-Performing Primary Care
Bodenheimer, T., Ghorob, A., Willard‐Grace, R., & Grumbach, K. (2014) · The Annals of Family Medicine · doi:10.1370/afm.1616 · Cited by 508 · see citing works
Roshanov, P. S., Fernandes, N., Wilczynski, J. M., Hemens, B. J., You, J. J., Handler, S. M., Nieuwlaat, R., Souza, N. M., Beyene, J., Spall, H. G. C. V., et al. (2013) · BMJ · doi:10.1136/bmj.f657 · Cited by 458 · see citing works
Why use theories in qualitative research?
Reeves, S., Albert, M., Kuper, A., & Hodges, B. D. (2008) · BMJ · doi:10.1136/bmj.a949 · Cited by 436 · see citing works
Moja, L., Kwag, K. H., Lytras, T., Bertizzolo, L., Brandt, L., Pecoraro, V. L., Rigon, G., Vaona, A., Ruggiero, F. M., Mangia, M., et al. (2014) · American Journal of Public Health · doi:10.2105/ajph.2014.302164 · Cited by 341 · see citing works
Computerized clinical decision support for prescribing: provision does not guarantee uptake
Moxey, A., Robertson, J., Newby, D., Hains, I., Williamson, M., & Pearson, S.-A. (2010) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m3170 · Cited by 305 · see citing works
Davy, C. P., Bleasel, J. M., Liu, H., Tchan, M., Ponniah, S., & Brown, A. D. H. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-0854-8 · Cited by 290 · see citing works
Why is it difficult to implement e-health initiatives? A qualitative study
Murray, E., Burns, J., May, C., Finch, T., O'Donnell, C., Wallace, P., & Mair, F. (2011) · Implementation Science · doi:10.1186/1748-5908-6-6 · Cited by 270 · see citing works
Agency and implementation: Understanding the embedding of healthcare innovations in practice
May, C. (2013) · Social Science & Medicine · doi:10.1016/j.socscimed.2012.11.021 · Cited by 189 · see citing works
Implementing computerized physician order entry: the importance of special people
Ash, J. S. (2003) · International Journal of Medical Informatics · doi:10.1016/s1386-5056(02)00107-7 · Cited by 183 · see citing works
The impact of clinical leadership on health information technology adoption: systematic review
Ingebrigtsen, T., Georgiou, A., Clay-Williams, R., Magrabi, F., Hordern, A., Prgomet, M., Li, J., Westbrook, J., & Braithwaite, J. (2014) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2014.02.005 · Cited by 165 · see citing works
Understanding the Normalization of Telemedicine Services through Qualitative Evaluation: Table 1
May, C., Harrison, R., Finch, T., MacFarlane, A., Mair, F., & Wallace, P. (2003) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1145 · Cited by 155 · see citing works
Why are we failing to implement effective therapies in cardiovascular disease?
Nieuwlaat, R., Schwalm, J.-D., Khatib, R., & Yusuf, S. (2013) · European Heart Journal · doi:10.1093/eurheartj/ehs481 · Cited by 152 · see citing works
Heeley, E. L., Peiris, D., Patel, A. A., Cass, A., Weekes, A., Morgan, C. L., Anderson, C. S., & Chalmers, J. P. (2010) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2010.tb03502.x · Cited by 145 · see citing works
Self-citationPeiris, D., Usherwood, T. P., Panaretto, K. S., Harris, M., Hunt, J., Redfern, J., Zwar, N. A., Colagiuri, S., Hayman, N. E., Lo, S., et al. (2015) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.114.001235 · Cited by 139 · see citing works
Self-citationDefining Quality Improvement in Public Health
RILEY, W. J., Moran, J. W., Corso, L. C., et al. (2010) · Journal of Public Health Management and Practice · doi:10.1097/phh.0b013e3181bedb49 · Cited by 125 · see citing works
Gaps in cardiovascular disease risk management in Australian general practice
Webster, R. J., Heeley, E. L., Peiris, D., Bayram, C., Cass, A., & Patel, A. A. (2009) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2009.tb02816.x · Cited by 119 · see citing works
Self-citationTeam climate for innovation: what difference does it make in general practice?
Proudfoot, J. G., Jayasinghe, U. W., Holton, C. H., Grimm, J., Bubner, T., Amoroso, C. L., Beilby, J., & Harris, M. (2007) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzm005 · Cited by 114 · see citing works
Self-citationAsh, J. S., Sittig, D. F., Guappone, K. P., Dykstra, R. H., Richardson, J., Wright, A., Carpenter, J., McMullen, C., Shapiro, M., Bunce, A., et al. (2012) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-12-6 · Cited by 103 · see citing works
The new Australian Primary Health Networks: how will they integrate public health and primary care?
Booth, M., Hill, G., Moore, M. G., et al. (2016) · Public Health Research & Practice · doi:10.17061/phrp2611603 · Cited by 100 · see citing works
Banks, E., Crouch, S. R., Korda, R., Stavreski, B., Page, K., Thurber, K. A., & Grenfell, R. D. (2016) · The Medical Journal of Australia · doi:10.5694/mja15.01004 · Cited by 99 · see citing works
Gosling, A. S. (2003) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1285 · Cited by 80 · see citing works
Campbell, S., Ludt, S., van Lieshout, J., Boffin, N., Wensing, M., Petek, D., Grol, R. P. T. M., & Roland, M. O. (2008) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/hjr.0b013e328302f44d · Cited by 78 · see citing works
McMullen, H., Griffiths, C., Leber, W., & Greenhalgh, T. (2015) · Trials · doi:10.1186/s13063-015-0755-5 · Cited by 75 · see citing works
McAlearney, A. S., Robbins, J., Kowalczyk, N. K., Chisolm, D. J., & Song, P. H. (2012) · Medical Care Research and Review · doi:10.1177/1077558711436348 · Cited by 73 · see citing works
Lugtenberg, M., Weenink, J.-W., van der Weijden, T., Westert, G. P., & Kool, R. B. (2015) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-015-0205-z · Cited by 70 · see citing works
Audet, A., Squires, D. A., & Doty, M. M. (2013) · Health Services Research · doi:10.1111/1475-6773.12139 · Cited by 56 · see citing works
The organisational context for teamwork: Comparing health care and business literature
Mickan, S. M., & Rodger, S. (2000) · Australian Health Review · doi:10.1071/ah000179 · Cited by 55 · see citing works
Peiris, D., Usherwood, T. P., Panaretto, K. S., Harris, M., Hunt, J., Patel, B. N., Zwar, N. A., Redfern, J., MacMahon, S. W., Colagiuri, S., et al. (2012) · BMJ Open · doi:10.1136/bmjopen-2012-002177 · Cited by 48 · see citing works
Self-citationA Brief History of Quality Improvement
Parry, G. J. (2014) · Journal of Oncology Practice · doi:10.1200/jop.2014.001436 · Cited by 29 · see citing works
Patel, B. N., Patel, A. A., Jan, S., Usherwood, T. P., Harris, M., Panaretto, K. S., Zwar, N. A., Redfern, J., Jansen, J., Doust, J. A., et al. (2014) · Implementation Science · doi:10.1186/s13012-014-0187-8 · Cited by 19 · see citing works
Self-citationPatel, B. N., Peiris, D., Usherwood, T. P., Li, Q., Harris, M., Panaretto, K. S., Zwar, N. A., & Patel, A. A. (2017) · Journal of the American Heart Association · doi:10.1161/jaha.117.007093 · Cited by 15 · see citing works
Self-citationSchneider, E. C., Sorbero, M. E. S., Haas, A. C., Ridgely, M. S., Khodyakov, D., Setodji, C. M., Parry, G. J., Huang, S. S., Yokoe, D. S., & Goldmann, D. A. (2017) · Implementation Science · doi:10.1186/s13012-017-0579-7 · Cited by 14 · see citing works
Impact of four training conditions on physician use of a web-based clinical decision support system
Kealey, E. M., Leckman‐Westin, E., & Finnerty, M. T. (2013) · Artificial Intelligence in Medicine · doi:10.1016/j.artmed.2013.03.003 · Cited by 6 · see citing works
O'Grady, C. (2013) · Figshare · doi:10.25949/19428176 · Cited by 4 · see citing works
Patel, B. N., Usherwood, T., Harris, M., Panaretto, K. S., Redfern, J., Jansen, J., McKinn, S., Lyford, M., Patel, A. A., & Peiris, D. (2014) · Cited by 3 · see citing works
Self-citationSchneider, E., Sorbero, M. E. S., Haas, A. C., et al. (2017) · Implementation Science · doi:10.1186/s13012-017-0591-y · Cited by 3 · see citing works
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Abimbola, S., Patel, B., Peiris, D., Patel, A., Harris, M., Usherwood, T., & Greenhalgh, T. (2019) · BMC Medicine · doi:10.1186/s12916-019-1463-x · Cited by 102 · see citing works
Self-citationMcGuier, E. A., Kolko, D. J., Aarons, G. A., Schachter, A., Klem, M. L., Diabes, M. A., Weingart, L. R., Salas, E., & Wolk, C. B. (2024) · Implementation Science · doi:10.1186/s13012-024-01381-9 · Cited by 70 · see citing works
Nguyen, M. X. B., Chu, A. V., Powell, B. J., Tran, H. V., Nguyen, L. H., Dao, A. T. M., Pham, M. D., Vo, S. H., Bui, N. H., Dowdy, D. W., et al. (2020) · Implementation Science · doi:10.1186/s13012-020-01020-z · Cited by 19 · see citing works
- Authors
- Patel, B., Usherwood, T., Harris, M., Patel, A., Panaretto, K., Zwar, N., & Peiris, D.
- Affiliations
- UNSW Sydney (AU)
- The University of Sydney (AU)
- The University of Queensland (AU)
- University of Wollongong (AU)
- Corresponding author
- Patel, Bindu
- ORCID
- Venue
- Implementation Science
- Published
- 2018-11-12
- Volume
- 13
- Issue
- 1
- Pages
- 140-140
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC6233504
- OpenAlex
- W2900921803
- Cited by
- 42
- References
- 61
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 13 · 2023: 7 · 2022: 10 · 2021: 4 · 2020: 5 · 2019: 1
- FWCI
- 3.82
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- Research Online (University of Wollongong) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion)
- Funders
- National Health and Medical Research Council (1010547, 1075308)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- cardiovascular care, quality improvement intervention, primary care, Normalisation Process Theory, implementation process evaluation, intervention uptake, organizational leadership, team climate, job satisfaction, implementation barriers and facilitators
- MeSH terms
- Implementation Science, Attitude of Health Personnel, Australia, Cardiovascular Diseases, Environment, Group Processes, Humans, Job Satisfaction, Leadership, Patient Care Team, Primary Health Care, User-Computer Interface, Organizational Culture, Practice Guidelines as Topic, Disease Management, Guideline Adherence, Decision Support Systems, Clinical, Quality Improvement
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