A Realist Evaluation of Team Interventions in Acute Hospital Contexts—Use of Two Case Studies to Test Initial Programme Theories

Una Cunningham, Aoife De Brún, Mayumi Willgerodt, Erin Abu-Rish Blakeney and Eilish McAuliffe
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Una Cunningham: Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, D04 V1W8 Dublin 4, Ireland
Aoife De Brún: Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, D04 V1W8 Dublin 4, Ireland
Mayumi Willgerodt: Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA 98195, USA
Erin Abu-Rish Blakeney: Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA 98195, USA
Eilish McAuliffe: Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, D04 V1W8 Dublin 4, Ireland

IJERPH, 2021, vol. 18, issue 16, 1-26

Abstract: Background: Designing and implementing team interventions to improve quality and safety of care in acute hospital contexts is challenging. There is little emphasis in the literature on how contextual conditions impact interventions or how specific active ingredients of interventions impact on team members’ reasoning and enact change. This realist evaluation helps to deepen the understanding of the enablers and barriers for effective team interventions in these contexts. Methods: Five previously developed initial programme theories were tested using case studies from two diverse hospital contexts. Data were collected from theory driven interviews ( n = 19) in an Irish context and from previously conducted evaluative interviews ( n = 16) in a US context. Data were explored to unpack the underlying social and psychological drivers that drove both intended and unintended outcomes. Patterns of regularity were identified and synthesised to develop middle-range theories (MRTs). Results: Eleven MRTs demonstrate how and why intervention resources introduced in specific contextual conditions enact reasoning mechanisms and generate intended and unintended outcomes for patients, team members, the team and organisational leaders. The triggered mechanisms relate to shared mental models; openness, inclusivity and connectedness; leadership and engagement; social identity and intrinsic motivational factors. Conclusions: The findings provide valuable information for architects and facilitators of team interventions in acute hospital contexts, as well as help identify avenues for future research. Dataset: The data presented in this study are available on request from the corresponding author. The data are not publicly available due to their sensitive nature and potential identification of participants.

Keywords: team; interventions; quality and safety; acute hospital; contexts; realist evaluation; generative causation; initial programme theories; middle-range theories; case studies (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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