Hospital-based interventions: a systematic review of staff-reported barriers and facilitators to implementation processe
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SYSTEMATIC REVIEW
Open Access
Hospital-based interventions: a systematic review of staff-reported barriers and facilitators to implementation processes Liesbeth Geerligs1,2* , Nicole M. Rankin2,3, Heather L. Shepherd1,4 and Phyllis Butow1,2,4
Abstract Background: Translation of evidence-based interventions into hospital systems can provide immediate and substantial benefits to patient care and outcomes, but successful implementation is often not achieved. Existing literature describes a range of barriers and facilitators to the implementation process. This systematic review identifies and explores relationships between these barriers and facilitators to highlight key domains that need to be addressed by researchers and clinicians seeking to implement hospital-based, patient-focused interventions. Methods: We searched MEDLINE, PsychInfo, Embase, Web of Science, and CINAHL using search terms focused specifically on barriers and facilitators to the implementation of patient-focused interventions in hospital settings. To be eligible, papers needed to have collected formal data (qualitative or quantitative) that specifically assessed the implementation process, as experienced by the staff involved. Results: Of 4239 papers initially retrieved, 43 papers met inclusion criteria. Staff-identified barriers and facilitators to implementation were grouped into three main domains: system, staff, and intervention. Bi-directional associations were evident between these domains, with the strongest links evident between staff and intervention. Conclusions: Researchers and health professionals engaged in designing patient-focused interventions need to consider barriers and facilitators across all three identified domains to increase the likelihood of implementation success. The interrelationships between domains are also crucial, as resources in one area can be leveraged to address barriers in others. These findings emphasize the importance of careful intervention design and pre-implementation planning in response to the specific system and staff context in order to increase likelihood of effective and sustainable implementation. Trial registration: This review was registered on the PROSPERO database: CRD42017057554 in February 2017. Keywords: Implementation science, Health services research, Systematic review, Hospital services, Barrier analysis
Introduction Health service interventions that are effectively implemented are associated with improved patient and staff outcomes and increased cost-effectiveness of care [1]. However, despite sound theoretical basis and empirical support, many interventions do not produce real-world change, as few are successfully implemented [2, 3], and * Correspondence: [email protected] 1 Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia 2 Sydney Catalyst Translational Cancer Research Centre, NHMRC Clinical Trials Centre, The University of Sydney, Chris O’Brien Lifehouse, Level 6, 119-143 Missenden Rd, Sydney, N
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