L PURTELL1,2,3, HG HEALY2,3,4, A BONNER1,2,
31Faculty of Health, Queensland University of Technology, Brisbane, Australia, 2Kidney Health Service, Metro North Hospital & Health Service, Brisbane, Australia, 3Chronic Kidney Disease Centre of Research Excellence, Brisbane, Australia, 4Kidney Research Laboratory, Queensland Institute of Medical Research, Brisbane, Australia
Aim: To identify successful strategies used in optimising the implementation of a kidney supportive care (KSC) program.
Background: KSC offers effective interdisciplinary care to people with advanced stages of kidney disease to relieve symptoms and/or psychosocial distress. However, KSC represents a significant cultural change from traditional quantitative-based nephrological models of care. For the care pathway to be successfully implemented within these traditional models, it needs to be responsive to the local culture.
Methods: A KSC program was introduced into a hospital-based networked kidney service with no history of such a care pathway, and its implementation was evaluated using an implementation science framework (the Consolidated Framework for Implementation Research [CFIR]). Eighteen clinical and executive staff members connected to the program were interviewed and qualitative content analyses, based on the CFIR, were performed to identify factors in the program’s implementation.
Results: Stakeholders identified i) short-term limited funding creating anxiety around sustainability and difficulties in future planning; and ii) unfamiliarity with the concept of kidney supportive care as barriers to implementation. The embedded implementation team, comprising researchers and clinicians, responded by demonstrating clinical and patient-reported outcomes of the program and embarking on a campaign of engagement with clinicians referring into the program and executive decision-makers in the organisation. One outcome was successful transition to permanent funding. Other outcomes include local and national awards for research excellence, clinical excellence and patient safety.
Conclusions: The methodology of implementation science is a robust approach to recognising and addressing challenges in the important domain of managing key stakeholders. The data we obtained allowed us to refine the implementation, as it was proceeding, of a new care pathway for patients.
Dr Louise Purtell is a postgraduate research fellow in the Faculty of Health, Queensland University of Technology and a member of the Chronic Kidney Disease Centre of Research Excellence.