Abstract
Objectives
Episcissors are an obstetric innovation designed to reduce rates of obstetric anal sphincter injury. Implementation has been encouraged via the NHS Innovation Accelerator Scheme. In the North East and North Cumbria (NENC), the Academic Health Science Network (AHSN) also provided NHS Trusts with initial financial support to purchase Episcissors. The impact of implementation on clinical outcomes was evaluated using routinely collected data. The objective of this evaluation was to explore the barriers and facilitators to implementation of Episcissors across the NENC region.
Methods
One midwifery and one medical contact were identified at eight NHS Trusts in the NENC region. In implementing Trusts (n = 5), a telephone interview was conducted with interviewees at the start of implementation and repeated 4–6 months later. Interviews were also conducted with non-implementing Trusts (n = 3). Notes taken during the interviews were categorised in accordance with two theory driven frameworks (Consolidated Framework for Implementation Research and Taxonomy of Implementation Outcomes).
Results
A number of bureaucratic, cultural, and practical barriers to successful implementation and evaluation of outcomes were identified. Fiscal assistance and support from clinical leaders were significant facilitators. Examples of barriers were complex organisational procurement processes, issues around storage/sterilisation of Episcissors, and concerns about the strength of the evidence base about Episcissors. With regard to the latter, clinicians were reassured by the collection of local data about implementation by the AHSN.
Conclusions
This theory informed evaluation offers a useful insight into factors that significantly support or hinder successful region-wide implementation and evaluation of innovation in NHS services.
Episcissors are an obstetric innovation designed to reduce rates of obstetric anal sphincter injury. Implementation has been encouraged via the NHS Innovation Accelerator Scheme. In the North East and North Cumbria (NENC), the Academic Health Science Network (AHSN) also provided NHS Trusts with initial financial support to purchase Episcissors. The impact of implementation on clinical outcomes was evaluated using routinely collected data. The objective of this evaluation was to explore the barriers and facilitators to implementation of Episcissors across the NENC region.
Methods
One midwifery and one medical contact were identified at eight NHS Trusts in the NENC region. In implementing Trusts (n = 5), a telephone interview was conducted with interviewees at the start of implementation and repeated 4–6 months later. Interviews were also conducted with non-implementing Trusts (n = 3). Notes taken during the interviews were categorised in accordance with two theory driven frameworks (Consolidated Framework for Implementation Research and Taxonomy of Implementation Outcomes).
Results
A number of bureaucratic, cultural, and practical barriers to successful implementation and evaluation of outcomes were identified. Fiscal assistance and support from clinical leaders were significant facilitators. Examples of barriers were complex organisational procurement processes, issues around storage/sterilisation of Episcissors, and concerns about the strength of the evidence base about Episcissors. With regard to the latter, clinicians were reassured by the collection of local data about implementation by the AHSN.
Conclusions
This theory informed evaluation offers a useful insight into factors that significantly support or hinder successful region-wide implementation and evaluation of innovation in NHS services.
| Original language | English |
|---|---|
| Article number | EP.258 |
| Pages (from-to) | 87-114 |
| Journal | BJOG: An International Journal of Obstetrics and Gynaecology |
| Volume | 126 |
| Issue number | S1 |
| DOIs | |
| Publication status | Published - 1 Mar 2019 |
| Externally published | Yes |