No Cover Image

Journal article 113 views 20 downloads

Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists

Simon Read, James Morgan, David Gillespie, Claire Nollett, Marjorie Weiss, Davina Allen, Pippa Anderson, Heather Waterman

PLOS ONE, Volume: 16, Issue: 8, Start page: e0255564

Swansea University Authors: Simon Read, Pippa Anderson

  • 57578.pdf

    PDF | Version of Record

    © 2021 Read et al. This is an open access article distributed under the terms of the Creative Commons Attribution License

    Download (733.98KB)

Abstract

BackgroundNormalisation process theory reports the importance of contextual integration in successfully embedding novel interventions, with recent propositions detailing the role that ‘plasticity’ of intervention components and ‘elasticity’ of an intended setting contribute. We report on the introdu...

Full description

Published in: PLOS ONE
ISSN: 1932-6203
Published: Public Library of Science (PLoS) 2021
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa57578
Tags: Add Tag
No Tags, Be the first to tag this record!
Abstract: BackgroundNormalisation process theory reports the importance of contextual integration in successfully embedding novel interventions, with recent propositions detailing the role that ‘plasticity’ of intervention components and ‘elasticity’ of an intended setting contribute. We report on the introduction of a clinical pathway assessing patient non-responsiveness to treatment for glaucoma and ocular hypertension. The aim of this study was to assess the feasibility of implementing the Cardiff Model of Glaucoma Care into hospital eye services, identifying any issues of acceptability for staff through the filter of normalisation process theory.MethodsA prospective observational study was undertaken in four hospital eye services. This incorporated detailed qualitative semi-structured interviews with staff (n = 8) to gather their perceptions on the intervention’s usefulness and practicality. In addition, observational field notes of patient and staff consultations (n = 88) were collected, as well as broader organisational observations from within the research sites (n = 52). Data collection and analysis was informed by the normalisation process theory framework.ResultsStaff reported the pathway led to beneficial knowledge on managing patient treatment, but the model was sometimes perceived as overly prescriptive. This perception varied significantly based on the composition of clinics in relation to staff experience, staff availability and pre-existing clinical structures. The most commonly recounted barrier came in contextually integrating into sites where wider administrative systems were inflexible to intervention components.ConclusionsFlexibility will be the key determinant of whether the clinical pathway can progress to wider implementation. Addressing the complexity and variation associated with practice between clinics required a remodelling of the pathway to maintain its central benefits but enhance its plasticity. Our study therefore helps to confirm propositions developed in relation to normalisation process theory, contextual integration, intervention plasticity, and setting elasticity. This enables the transferability of findings to healthcare settings other than ophthalmology, where any novel intervention is implemented.
College: College of Human and Health Sciences
Funders: This research was funded in full by the Health and Care Research Wales Research for Patient and Public Benefit fund, ref: RfPPB-16a-1296.
Issue: 8
Start Page: e0255564