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[Preprint]. 2024 May 21:rs.3.rs-4366064.
doi: 10.21203/rs.3.rs-4366064/v1.

Defining the transition from new to normal: a qualitative investigation of the clinical change process

Santana R Silver  1 , Kayla Christine Jones  1 , Kimberly Hook  2 , Erika L Crable  3 , Emily R George  4 , Janet R Serwint  5 , Kirsten Austad  1 , Allan Walkey  6 , Mari-Lynn Drainoni  1
Affiliations

Defining the transition from new to normal: a qualitative investigation of the clinical change process

Santana R Silver et al. Res Sq. .

Update in

Abstract

Background: Understanding how and when a new evidence-based clinical intervention becomes standard practice is crucial to ensure that healthcare is delivered in alignment with the most up-to-date knowledge. However, rigorous methods are needed to determine when a new clinical practice becomes normalized to the standard of care. To address this gap, this study qualitatively explores how, when, and why a clinical practice change becomes normalized within healthcare organizations.

Methods: We used purposive sampling to recruit clinical leaders who worked in implementation science across diverse health contexts. Enrolled participants completed semi-structured interviews. Qualitative data analysis was guided by a modified version of the Normalization Process Theory (NPT) framework to identify salient themes. Identified normalization strategies were mapped to the Expert Recommendations for Implementation Change (ERIC) project.

Results: A total of 17 individuals were interviewed. Participants described four key signals for identifying when a novel clinical practice becomes the new normal: 1) integration into existing workflows; 2) scaling across the entire organizational unit; 3) staff buy-in and ownership; and 4) sustainment without ongoing monitoring. Participants identified salient strategies to normalize new clinical interventions: 1) taking a patient approach; 2) gaining staff buy-in and ownership; and 3) conducting ongoing measurement of progress towards normalization.

Conclusions: The results offer valuable insight into the indicators that signify when a novel clinical practice becomes normalized, and the strategies employed to facilitate this transition. These findings can inform future research to develop instruments that implementation leaders can use to systematically measure the clinical change process.

Keywords: Clinical practice change; evidence-based practice; healthcare delivery; implementation science; normalization; sustainment.

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Conflict of interest statement

Competing interests The authors declare that they have no competing interests.

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References

    1. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510–520. doi:10.1258/jrsm.2011.110180 - DOI - PMC - PubMed
    1. Kellogg KC, Breen E, Ferzoco SJ, Zinner MJ, Ashley SW. Resistance to Change in Surgical Residency: An Ethnographic Study of Work Hours Reform. J Am Coll Surg. 2006;202(4):630–636. doi:10.1016/j.jamcollsurg.2005.11.024 - DOI - PubMed
    1. Wang Z, Bero L, Grundy Q. Understanding professional stakeholders’ active resistance to guideline implementation: The case of Canadian breast screening guidelines. Soc Sci Med. 2021;269:113586. doi:10.1016/j.socscimed.2020.113586 - DOI - PubMed
    1. Fischer F, Lange K, Klose K, Greiner W, Kraemer A. Barriers and Strategies in Guideline Implementation-A Scoping Review. Healthcare. 2016;4(3):36. doi:10.3390/healthcare4030036 - DOI - PMC - PubMed
    1. Successes Grol R. and Failures in the Implementation of Evidence-Based Guidelines for Clinical Practice. Med Care. 2001;39(8):II. - PubMed

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