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E-Thesis 20863 views 255 downloads

Implementing Innovation, Improvement and Evidence-Based Practice in Service Delivery: A Model for the Primary Care Sector in NHS Wales / ALEX O'BRIEN

Swansea University Author: ALEX O'BRIEN

DOI (Published version): 10.23889/SUthesis.63004

Abstract

The British NHS has continuously innovated since its inception almost 75 years ago.Innovations come in many forms and range from process innovations to advances intechnology and digital enablers, which have radically changed professional practice. Thereare also a large volume and wide range of manag...

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Published: Swansea University 2023
Institution: Swansea University
Degree level: Doctoral
Degree name: Ph.D
Supervisor: Davies, Fern.
URI: https://cronfa.swan.ac.uk/Record/cronfa63004
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Abstract: The British NHS has continuously innovated since its inception almost 75 years ago.Innovations come in many forms and range from process innovations to advances intechnology and digital enablers, which have radically changed professional practice. Thereare also a large volume and wide range of managerial improvement programmes andsignificant levels of evidence-based practice as well as clinical research. The challenge lies indetermining how best to implement these innovations into existing systems so that theirpotential can be realised.Throughout all of these years, the locus of research activity has been on secondary care andspecialist innovations. This bias has favoured clinical and professional groups who operate inhighly specialised and distinctive areas of health and care provision. The majority of NHSactivity, however, occurs in primary care where there is less specialisation and organisationstend to be smaller. With more limited financial resources, general practices face significantchallenges in their attempts to embrace the latest innovations for the benefit of patients andlocal communities. This research addresses the determinants (enablers and inhibitors) thatrelate to the adoption of innovation by primary care organisations, building theory andredressing the imbalance in research activities.While some models of implementation already exist, they have been drawn from the field ofsecondary care. Having exposed a gap, this research responds by developing a frameworkthat specifically focuses on the implementation of innovation, improvement and evidencebasedpractice (known as ‘EBP’) in primary care.The study takes a realist pragmatic approach to understanding the enablers and inhibitors ofthe implementation of innovation, improvement and EBP into primary care. The research hasbeen conducted by means of several distinct phases. This includes an initial conceptualmodel, drawn from a review of the existing academic literature, followed by a qualitativephase of expert interviews with purposively selected informants as well as the developmentof an empirical model. The researcher also created a questionnaire which was sent to expertsfrom various parts of the Welsh NHS innovation ecosystem. The research study contributes much to our understanding of innovation in primary care andhas resulted in a final and tested model of the innovation, improvement and EBPimplementation that is in operation in Wales. The research finds many failings in the currentsystem, which are preventing the seamless migration of promising innovations and advancesin care into the primary care sector. These inhibitors include a lack of trust between the actorswithin the system, the imposition of national directives – without any form of support to thegeneral practices – and a lack of competence in the form of variable staff competence ingeneral practitioners’ surgeries.The research concludes that the determinants identified and the poor levels of trust and jointparticipation between providers, commissioners and government are preventing acollaborative systems approach. Primary care in the Welsh NHS, therefore, is currentlyunable – as a system – to create a critical mass of general practices that all use similar andinteroperable innovations. Without such sharing of innovation, improvement and EBP, andwithout addressing the way in which the stakeholders of the Welsh NHS interact, it isunlikely that meaningful progress will be made across all general practices in Wales.
Item Description: Copyright: The Author, Alex O'Brien, 2023.
Keywords: Implementation of innovation, improvement and evidence based practice in primary care service systems
College: Faculty of Humanities and Social Sciences
Funders: KESS

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