Using benefit levers to develop an operational plan for spread of best practices in health systems
Ten Ham, Wilhelmina Hendrika
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This study addressed the use of benefit levers to develop a guide for an operational plan for spread of best practices in the health system of South Africa. Using the best evidence to inform practice is the cornerstone of quality patient care. Besides uptake and implementation, spreading best practices is crucial as this provides more patients with evidence-informed care and to improve practice and health (care) outcomes. However, spread of best practices is not always effectively done. An example includes Kangaroo Mother Care (KMC) as this best practice is translated for practice and implemented on a limited scale; spread to the whole system seems to be problematic. Various factors can be used to facilitate the spread of best practices. Edwards and Grinspun identified four benefit levers which create the tipping point towards successful adoption, implementation and spread of evidence: alignment, permeation plans, leadership for change, and supporting and reinforcing structures. However, little is known about these benefit levers and it remains unclear what the use of benefit levers for system-wide spread would entail, specifically for other contexts as the model (including the benefit levers) has never been operationalised (Edwards & Grinspun, 2011:19). The overall aim of this study entails therefore the development of a guide for an operational plan, formulating the use of benefit levers in the spread of best practices. To achieve this aim the following objectives for this study were set: 1. To explore and describe characteristics of benefit levers to facilitate spread of best practices. 2. To develop a guide for an operational plan to use benefit levers for the spread of best practices. This study was embedded in the postmodern paradigm, whereby the systems theory was used as a theoretical framework. The first objective was achieved by two steps. Firstly, an integrative literature review of concept clarification of the four benefit levers was done. Secondly, semi-structured individual interviews were conducted with key informants from a variety of levels of the health system involved in the spread of KMC in South Africa. Findings were used to achieve objective two. A draft guide for an operational plan was developed, based on the findings of the individual interviews. A logic model was used as format. This guide was refined by experts using the Delphi technique. The Delphi involved two rounds. From the feedback of the first round of the Delphi, a logic model which provides a graphic outlook of the guide, was suggested and refined in the second round, together with the guide. Further, after the Delphi, a template useable for practice was derived from the guide. The guide, logic model and template could help organisations or departments planning to spread best practices in a certain context (e.g. South Africa), to develop an operational plan, where these benefit levers are considered. This is crucial as currently best practices (such as Kangaroo Mother Care) are often not spread on a system-wide basis to improve practice. The guide will therefore be made accessible to health care workers and researchers in South Africa Finally, conclusions were drawn, the research was evaluated, limitations were identified and recommendations were formulated for nursing practice, education and research. Overall, it can be concluded that for effective spread of best practices the benefit levers alignment, permeation plans, leadership for change and supporting and reinforcing structures are required. Further, specifically regarding the objectives and steps of this study the following conclusions can be made: • Literature/studies about leadership for change and supporting and reinforcing structures was found, but regarding alignment and permeation plans, limited rigorous literature was found (Objective 1 – Step 1). • Key informants involved in the spread of a specific best practice (Kangaroo Mother Care) could see the value of benefit levers used for the spread of best practices in the South African health system (Objective 1 – Step 2). • Benefit levers were found useful for development of a guide for an operational plan to spread best practices. This guide will be made accessible to be used by healthcare organisations and departments in South Africa (Objective 2 – Steps 1 and 2).
- Health Sciences