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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

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DOI (Published version): 10.1371/journal.pone.0255564

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...

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ISSN: 1932-6203
Published: Public Library of Science (PLoS) 2021
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2021-09-08T13:40:54.9476222</datestamp><bib-version>v2</bib-version><id>57578</id><entry>2021-08-10</entry><title>Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists</title><swanseaauthors><author><sid>a5fdd0f9bc9dd4b6716fc42cb1ee8a30</sid><firstname>Simon</firstname><surname>Read</surname><name>Simon Read</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>128cdedfba6e5e6374fdc85d5c78c428</sid><firstname>Pippa</firstname><surname>Anderson</surname><name>Pippa Anderson</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2021-08-10</date><deptcode>PHAC</deptcode><abstract>BackgroundNormalisation process theory reports the importance of contextual integration in successfully embedding novel interventions, with recent propositions detailing the role that &#x2018;plasticity&#x2019; of intervention components and &#x2018;elasticity&#x2019; 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&#x2019;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.</abstract><type>Journal Article</type><journal>PLOS ONE</journal><volume>16</volume><journalNumber>8</journalNumber><paginationStart>e0255564</paginationStart><paginationEnd/><publisher>Public Library of Science (PLoS)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1932-6203</issnElectronic><keywords/><publishedDay>2</publishedDay><publishedMonth>8</publishedMonth><publishedYear>2021</publishedYear><publishedDate>2021-08-02</publishedDate><doi>10.1371/journal.pone.0255564</doi><url/><notes/><college>COLLEGE NANME</college><department>Public Health</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>PHAC</DepartmentCode><institution>Swansea University</institution><apcterm>Other</apcterm><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.</funders><lastEdited>2021-09-08T13:40:54.9476222</lastEdited><Created>2021-08-10T12:06:46.7723407</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care - Public Health</level></path><authors><author><firstname>Simon</firstname><surname>Read</surname><order>1</order></author><author><firstname>James</firstname><surname>Morgan</surname><order>2</order></author><author><firstname>David</firstname><surname>Gillespie</surname><order>3</order></author><author><firstname>Claire</firstname><surname>Nollett</surname><order>4</order></author><author><firstname>Marjorie</firstname><surname>Weiss</surname><order>5</order></author><author><firstname>Davina</firstname><surname>Allen</surname><order>6</order></author><author><firstname>Pippa</firstname><surname>Anderson</surname><order>7</order></author><author><firstname>Heather</firstname><surname>Waterman</surname><order>8</order></author></authors><documents><document><filename>57578__20784__cf630e028d784ac1b896d1e80cdb4629.pdf</filename><originalFilename>57578.pdf</originalFilename><uploaded>2021-09-08T13:39:53.9048901</uploaded><type>Output</type><contentLength>751598</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2021 Read et al. 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spelling 2021-09-08T13:40:54.9476222 v2 57578 2021-08-10 Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists a5fdd0f9bc9dd4b6716fc42cb1ee8a30 Simon Read Simon Read true false 128cdedfba6e5e6374fdc85d5c78c428 Pippa Anderson Pippa Anderson true false 2021-08-10 PHAC 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. Journal Article PLOS ONE 16 8 e0255564 Public Library of Science (PLoS) 1932-6203 2 8 2021 2021-08-02 10.1371/journal.pone.0255564 COLLEGE NANME Public Health COLLEGE CODE PHAC Swansea University Other This research was funded in full by the Health and Care Research Wales Research for Patient and Public Benefit fund, ref: RfPPB-16a-1296. 2021-09-08T13:40:54.9476222 2021-08-10T12:06:46.7723407 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health Simon Read 1 James Morgan 2 David Gillespie 3 Claire Nollett 4 Marjorie Weiss 5 Davina Allen 6 Pippa Anderson 7 Heather Waterman 8 57578__20784__cf630e028d784ac1b896d1e80cdb4629.pdf 57578.pdf 2021-09-08T13:39:53.9048901 Output 751598 application/pdf Version of Record true © 2021 Read et al. This is an open access article distributed under the terms of the Creative Commons Attribution License true eng http://creativecommons.org/licenses/by/4.0/
title Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists
spellingShingle Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists
Simon Read
Pippa Anderson
title_short Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists
title_full Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists
title_fullStr Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists
title_full_unstemmed Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists
title_sort Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists
author_id_str_mv a5fdd0f9bc9dd4b6716fc42cb1ee8a30
128cdedfba6e5e6374fdc85d5c78c428
author_id_fullname_str_mv a5fdd0f9bc9dd4b6716fc42cb1ee8a30_***_Simon Read
128cdedfba6e5e6374fdc85d5c78c428_***_Pippa Anderson
author Simon Read
Pippa Anderson
author2 Simon Read
James Morgan
David Gillespie
Claire Nollett
Marjorie Weiss
Davina Allen
Pippa Anderson
Heather Waterman
format Journal article
container_title PLOS ONE
container_volume 16
container_issue 8
container_start_page e0255564
publishDate 2021
institution Swansea University
issn 1932-6203
doi_str_mv 10.1371/journal.pone.0255564
publisher Public Library of Science (PLoS)
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
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description 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.
published_date 2021-08-02T04:13:26Z
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