Assessing the Integrative Framework for the Implementation of Change in Nursing Practice: Comparative Case Studies in French Hospitals

Abstract

The implementation of healthcare policies in healthcare organizations is a pivotal issue for managers. They generally require a change in professional practices. In previous work, we developed the Integrative Framework for Implementation of change in Nursing Practices (IFINP) to support implementation initiatives for such change in nursing practices. We aimed to assess the generalizability of IFINP in other organizational settings and explore links between strategic and socio-material factors during implementation. We used a comparative qualitative case study at three French hospitals to assess the implementation of certification procedures. Data were collected from 33 semi-structured interviews with managers and nurses. Narratives reflecting actions and interactions were extracted and deductively analyzed using IFINP components. The results showed that the framework was flexible and captured the different aspects of implementation actions and interactions at the three hospitals. Strong interferences were identified between mobilization mechanisms and strategic elements. Interferences were observed mostly between 'reflexive monitoring and work articulation', and 'reflexive monitoring and sense-making' mechanisms. Leadership was integrated into the different mechanisms, especially the 'translation' mechanism. The IFINP facilitated a greater understanding of strategic elements and associated relationships with social and material factors during implementation. It helps to provide a clear definition of the managers' role when implementing new nurse practices.

Keywords: implementation; integrative framework for implementation of change in nursing practices; interferences; leadership; local managers; mechanisms of mobilization; socio-material factors; strategic level.

Figure 1

Flow diagram summarizing the used methodology to construct and assess the IFINP.

Figure 2

The Integrative Framework for Implementation of change in Nursing Practices (IFINP).

Figure 3

General representation of interference on mobilization mechanisms and leadership elements. The + signs represent interference levels, the power of interferences seen is reflected by the number of + signs such as ++, +++ or ++++. Dashed lines represent intra-interference mechanisms. Full lines represent the inter-interference of leadership and mechanisms.