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Implementation between text and work—a qualitative study of a readmission prevention program targeting elderly patients

Overview of attention for article published in Implementation Science, March 2018
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  • In the top 25% of all research outputs scored by Altmetric
  • Good Attention Score compared to outputs of the same age (77th percentile)
  • Average Attention Score compared to outputs of the same age and source

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Title
Implementation between text and work—a qualitative study of a readmission prevention program targeting elderly patients
Published in
Implementation Science, March 2018
DOI 10.1186/s13012-018-0730-0
Pubmed ID
Authors

Sara Fokdal Lehn, Jette Thuesen, Gitte Bunkenborg, Ann-Dorthe Zwisler, Morten Hulvej Rod

Abstract

Numerous studies emphasize the importance of context in implementation. Successful implementation across the health care system depends on conditions and requirements that are often presented to health professionals through text-based materials and might present contradictory expectations to the work of health professionals. In this study, we operationalize institutional context as the text-based material, which from the perspective of health professionals, influence health care work. Via the case of a readmission prevention program for elderly patients, we examine the experiences of health professionals that work with implementation, concerning the contradictions that arise between the demands imposed by program implementation and their everyday work routines, and the role of text-based materials in these contradictions. We conducted five focus group interviews among health professionals working at different locations in a single administrative region of Denmark. The 24 health professionals in our study included hospital physicians, hospital nurses, medical secretaries, municipal care managers, registered municipal nurses, and general practitioners. All focus group interviews were transcribed verbatim. Inspired by institutional ethnography, we look into text-based materials, such as written guidelines, if health professionals indicate they are important. The health professionals experience that specific demands of the readmission prevention program come into conflict with the existing demands and daily work routines. Professional resistance to control and the existing digital communication tools create tensions with a program requirement for standardized enrollment of patients to the program. In addition, the striving for autonomy among health professionals and the high level of mono-professional working routines create tension with the program requirements for an additional amount of interdisciplinary work. The different demands are widely mediated by text-based materials such as the existing digital communication tools and the instructions on how to use them, and the official agreement of the role and assignment for Danish GPs. Successful implementation of the prevention program is affected by various tensions between the program demands and the existing health care work. Text-based materials mediate the different demands of the institutional context in to health care work and influence the process of implementation.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 71 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 71 100%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 11 15%
Student > Master 10 14%
Researcher 9 13%
Student > Doctoral Student 5 7%
Student > Bachelor 5 7%
Other 13 18%
Unknown 18 25%
Readers by discipline Count As %
Medicine and Dentistry 13 18%
Nursing and Health Professions 13 18%
Social Sciences 10 14%
Psychology 4 6%
Engineering 2 3%
Other 7 10%
Unknown 22 31%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 9. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 16 January 2019.
All research outputs
#3,946,873
of 24,088,270 outputs
Outputs from Implementation Science
#766
of 1,751 outputs
Outputs of similar age
#75,008
of 334,714 outputs
Outputs of similar age from Implementation Science
#32
of 48 outputs
Altmetric has tracked 24,088,270 research outputs across all sources so far. Compared to these this one has done well and is in the 83rd percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,751 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 14.7. This one has gotten more attention than average, scoring higher than 56% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 334,714 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 77% of its contemporaries.
We're also able to compare this research output to 48 others from the same source and published within six weeks on either side of this one. This one is in the 33rd percentile – i.e., 33% of its contemporaries scored the same or lower than it.