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Exploring relationships between health professionals through the implementation of a reablement program for people with dementia: A mixed methods study

Published online by Cambridge University Press:  20 March 2020

Jennifer Culph Open the ORCID record for Jennifer Culph [Opens in a new window] ,
Lindy Clemson ,
Justin Scanlan ,
Luke Craven ,
Yun-Hee Jeon  and
Kate Laver
Jennifer Culph*
Affiliation:
The University of Sydney, Sydney, Australia
Lindy Clemson
Affiliation:
The University of Sydney, Sydney, Australia
Justin Scanlan
Affiliation:
The University of Sydney, Sydney, Australia
Luke Craven
Affiliation:
The University of New South Wales, Sydney, Australia
Yun-Hee Jeon
Affiliation:
The University of Sydney, Sydney, Australia
Kate Laver
Affiliation:
Flinders University, Adelaide, Australia
*
*Corresponding author. Email: Jennifer.Culph@sydney.edu.au
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Abstract

Aims:

Implementation of novel interventions occurs within broad organisational contexts, which contain many relationships and moving parts. Efforts need to be made to understand these relationships as they are an important predictor of successful implementation. This study examines the relationships between health professionals involved in the implementation of an evidence-based community program for people with dementia and their carers in Australia, The Care of People with dementia in their Environments program.

Methods:

This study utilised mixed methods including in-depth interviews and organisational diagrams. Qualitative data from 28 interviews were collected from occupational therapists, nurses and their managers. Recruitment ensured a variety of different organisational contexts were represented. Thematic analysis was used to capture key emergent themes.

Findings:

The strongest relationships were usually between the occupational therapist and their manager. Strong trusting relationships with managers were instrumental in advocating for the need for reablement programs and the occupational therapy professional role in dementia care. Large teams of occupational therapists were seen to be beneficial in supporting each other in case complexities. Relationships between occupational therapists and nurses were often missing or perceived as weak relationships. A conducive physical environment contributed to stronger more collaborative relationships, where individuals were visible and therefore felt to be more approachable.

Conclusion:

Our study highlights the additional preparation work that is required of organisations to consider relationships in their strategies for implementation.

Keywords

Dementiaimplementationorganisational cultureoccupational therapyreablement
Type
Articles
Information
Brain Impairment , Volume 21 , Special Issue 3: Knowledge translation and dementia care , December 2020 , pp. 286 - 298
Copyright
© Australasian Society for the Study of Brain Impairment 2020

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References

Aarons, G. A., Horowitz, J. D., Dlugosz, L. R., & Ehrhart, M. G. (2012). The role of organisational processes in dissemination and implementation research. In Brownson, R. C., Colditz, G. A. & Proctor, E. K. (Eds.), Dissemination and implementation research in health: Translating science to practice (pp. 128–153), New York, USA: Oxford University Press, Inc.CrossRefGoogle Scholar
Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4–23. doi: 10.1007/s10488-010-0327-7.CrossRefGoogle ScholarPubMed
Best, A., Berland, A., Herbert, C., Bitz, J., van Dijk, M. W., Krause, C., … Millar, J. (2016). Using systems thinking to support clinical system transformation. Journal of Health Organization and Management, 30(3), 302–323. doi: 10.1108/JHOM-12-2014-0206.CrossRefGoogle ScholarPubMed
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. doi: 10.1191/1478088706qp063oa.CrossRefGoogle Scholar
Brooke-Sumner, C., Petersen-Williams, P., Kruger, J., Mahomed, H., & Myers, B. (2019). ‘Doing more with less’: A qualitative investigation of perceptions of South African health service managers on implementation of health innovations. Health Policy and Planning, 34(2), 132–140. doi: 10.1093/heapol/czz017.CrossRefGoogle ScholarPubMed
Clemson, L., Laver, K., Jeon, Y.-H., Comans, T. A., Scanlan, J., Rahja, M., … Gitlin, L. N. (2018). Implementation of an evidence-based intervention to improve the wellbeing of people with dementia and their carers: Study protocol for ‘Care of People with dementia in their Environments (COPE)’ in the Australian context. BMC Geriatrics, 18(1), 108. doi: 10.1186/s12877-018-0790-7.CrossRefGoogle Scholar
Creswell, J. W. (2007). Five qualitative approaches to inquiry. In Creswell, J. W. (Ed.), Qualitative inquiry and research design: Choosing among five approaches (3rd ed., pp. 69–110), Thousand Oaks, USA: SAGE Publications, Inc.Google Scholar
Curran, M. G., Bauer, M. M., Mittman, M. B., Pyne, M. J., & Stetler, M. C. (2012). Effectiveness-implementation hybrid designs: Combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical Care, 50(3), 217–226. doi: 10.1097/MLR.0b013e3182408812.CrossRefGoogle ScholarPubMed
Dementia Australia. (2017). Public consultation: Redesign of dementia consumer supports. Barton, Australia: Dementia Australia.Google Scholar
Döpp, C. M. E., Graff, M. J. L., Rikkert, M. G. M. O., van der Sanden, M. W. G. N., & Vernooij-Dassen, M. J. F. J. (2013). Determinants for the effectiveness of implementing an occupational therapy intervention in routine dementia care. Implementation Science, 8(1), 131. doi: 10.1186/1748-5908-8-131.CrossRefGoogle ScholarPubMed
Gitlin, L. N., Winter, L., Dennis, M. P., Hodgson, N., & Hauck, W. W. (2010). A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: The COPE randomized trial. JAMA, 304(9), 983–991. doi: 10.1001/jama.2010.1253.CrossRefGoogle ScholarPubMed
Jennings, L. A., Reuben, D. B., Evertson, L. C., Serrano, K. S., Ercoli, L., Grill, J., … Wenger, N. S. (2015). Unmet needs of caregivers of individuals referred to a dementia care program. Journal of the American Geriatrics Society, 63(2), 282–289. doi: 10.1111/jgs.13251.CrossRefGoogle ScholarPubMed
Karnieli-Miller, O., Strier, R., & Pessach, L. (2009). Power relations in qualitative research. Qualitative Health Research, 19(2), 279–289. doi: 10.1177/1049732308329306.CrossRefGoogle ScholarPubMed
Kirchner, J. E., Waltz, T. J., Powell, B. J., Smith, J. L., & Proctor, E. K. (2017). Implementation strategies: Dissemination and implementation research in health (2nd ed.), New York: Oxford University Press.CrossRefGoogle Scholar
Laver, K., Dyer, S., Whitehead, C., Clemson, L., & Crotty, M. (2016). Interventions to delay functional decline in people with dementia: A systematic review of systematic reviews. BMJ Open, 6(4), e010767. doi: 10.1136/bmjopen-2015-010767.CrossRefGoogle ScholarPubMed
Mann, L. (2005). From “silos” to seamless healthcare: Bringing hospitals and GPs back together again. Medical Journal of Australia, 182(1), 34–37. doi: 10.5694/j.1326-5377.2005.tb06552.x.CrossRefGoogle Scholar
Maslow, K. (2012). Translating innovation to impact: Evidence based interventions to support people with Alzheimer’s disease and their caregivers at home and in the community [White paper]. Retrieved from Alliance for Aging Research, Washington, DC http://www.agingresearch.org/backend/app/webroot/files/Publication/18/508%20Compliant%20AoA-White-Paper%20for%20Release.pdf.Google Scholar
May, C., & Finch, T. (2009). Implementing, embedding, and integrating practices: An outline of Normalization Process Theory. Sociology, 43(3), 535–554. doi: 10.1177/0038038509103208.CrossRefGoogle Scholar
Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science, 10(1), 53. doi: 10.1186/s13012-015-0242-0.CrossRefGoogle ScholarPubMed
Oliver-Baxter, J., Brown, L., & Bywood, P. (2013). Integrated care: What strategies and other arrangements support and influence integration at the meso/organisational level? Adelaide: Primary Health Care Research & Information Service.Google Scholar
Powell, B. J., McMillen, J. C., Proctor, E. K., Carpenter, C. R., Griffey, R. T., Bunger, A. C., … York, J. L. (2012). A compilation of strategies for implementing clinical innovations in health and mental health. Medical Care Research and Review, 69(2), 123–157. doi:10.1177/1077558711430690.CrossRefGoogle ScholarPubMed
Proctor, E. K., Powell, B. J., & McMillen, J. C. (2013). Implementation strategies: Recommendations for specifying and reporting. Implementation Science, 8(1), 139–139. doi: 10.1186/1748-5908-8-139.CrossRefGoogle ScholarPubMed
QSR International Pty Ltd. (2012). NVivo qualitative data analysis software (Version 10).Google Scholar
Riley, B. L., Willis, C. D., Holmes, B., Finegood, D. T., Best, A., & McIsaac, J.-L. D. (2017). Systems thinking and dissemination and implementation research: Dissemination and implementation research in health (2nd ed.), New York: Oxford University Press.CrossRefGoogle Scholar
Sandhu, J. S., Hosang, R., & Madsen, K. A. (2015). Solutions that stick: Activating cross-disciplinary collaboration in a graduate-level public health innovations course at The University of California, Berkeley. American Journal of Public Health, 105(S1), S73–S77.CrossRefGoogle Scholar
Thomas, L., & Galla, C. (2013). Building a culture of safety through team training and engagement. Postgraduate Medical Journal, 89(1053), 394–401. doi: 10.1136/postgradmedj-2012-001011rep.CrossRefGoogle ScholarPubMed
Thorne, S. (2016). Interpretive description: Qualitative research for applied practice (2nd ed.). New York, NY: Routledge.Google Scholar
Tobin, G. A., & Begley, C. M. (2004). Methodological rigour within a qualitative framework. Journal of Advanced Nursing, 48(4), 388–396. doi: 10.1111/j.1365-2648.2004.03207.x.CrossRefGoogle ScholarPubMed
Weiss, S. J., Haber, J., Horowitz, J. A., Stuart, G. W., & Wolfe, B. (2009). The inextricable nature of mental and physical health: Implications for integrative care. Journal of the American Psychiatric Nurses Association, 15(6), 371–382. doi: 10.1177/1078390309352513.CrossRefGoogle ScholarPubMed
World Health Organisation. (2017). Global action plan on the public health response to dementia 2017-2025. Geneva, Switzerland: WHO Document Production Services.Google Scholar
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