Table 1 Substantive theory for acting scientifically and pragmatically – challenges and corresponding actions required for successful evidence translation and improvement
From: Simple rules for evidence translation in complex systems: A qualitative study
Act scientifically and pragmatically | |
|---|---|
Common challenges | Simple rules: strategies for overcoming challenges |
Pre-selected interventions may not solve the problems of the local system - People will not be motivated to change if they do not perceive a problem exists, or if wider concerns prevail - Varying perceptions of current practice - Conflicting views of problem and improvement approach | Understand the problem and opportunities - Draw on evidence and local knowledge to understand the problem and opportunities - Understand perceptions of local needs and priorities - Identify common improvement goals |
‘Evidence’ and interventions need to be perceived as locally relevant and actionable - Varying perceptions of evidence - Interventions may not be used or work effectively - Interventions need to fit with or modify existing practices, behaviours and competencies - Interconnected challenges emerge as changes are made - Changes have unintended consequences - Multiple interventions are likely to be required | Identify, test and iteratively develop potential solutions - Identify intervention ideas based on evidence and build theory of change - Incremental experimental approach to introduce changes - Identify and respond to emergent challenges - Identify adverse effects in other parts of the system - Modify and refine change theory in response to learning - Review and balance investment of effort across problems and potential interventions to maximise impact |
Individual perceptions of system performance are unreliable - System performance and characteristics can be hard to see from any individual perspective as they do not take into account system complexity - Objective measures can reveal how the system is performing but may not reveal why or what changes are required - A lack of data and narrative limits learning, including within teams, organisations or for research | Assess whether improvement is achieved, capture and share learning - Carefully select a small number of measures as an objective indication of system performance - Use regular measurement to assess impact and inform actions - Use formal and informal methods to obtain feedback that can explain performance and guide future actions - Capture change narrative and use for organisational memory, to spread learning and to inform research |
Interventions need to be reviewed and adapted as systems evolve over time - Healthcare is a continually changing dynamic system - Competing factors threaten long-term success - New evidence, priorities and opportunities emerge | Invest in continual improvement - Anticipate, plan and monitor for threats to sustainability - Proactively identify and incorporate new evidence - Continually respond to new ‘problems’ and opportunities |