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.


The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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