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Improving facility-based care: eliciting tacit knowledge to advance intervention design

Attention has turned to improving the quality and safety of healthcare within health facilities to reduce avoidable mortality and morbidity. Interventions should be tested in health system environments that can support their adoption if successful. To be successful, interventions often require chang...

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Autores principales: English, Mike, Nzinga, Jacinta, Oliwa, Jacquie, Maina, Michuki, Oluoch, Dorothy, Barasa, Edwine, Irimu, Grace, Muinga, Naomi, Vincent, Charles, McKnight, Jacob
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9396143/
https://www.ncbi.nlm.nih.gov/pubmed/35985694
http://dx.doi.org/10.1136/bmjgh-2022-009410
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author English, Mike
Nzinga, Jacinta
Oliwa, Jacquie
Maina, Michuki
Oluoch, Dorothy
Barasa, Edwine
Irimu, Grace
Muinga, Naomi
Vincent, Charles
McKnight, Jacob
author_facet English, Mike
Nzinga, Jacinta
Oliwa, Jacquie
Maina, Michuki
Oluoch, Dorothy
Barasa, Edwine
Irimu, Grace
Muinga, Naomi
Vincent, Charles
McKnight, Jacob
author_sort English, Mike
collection PubMed
description Attention has turned to improving the quality and safety of healthcare within health facilities to reduce avoidable mortality and morbidity. Interventions should be tested in health system environments that can support their adoption if successful. To be successful, interventions often require changes in multiple behaviours making their consequences unpredictable. Here, we focus on this challenge of change at the mesolevel or microlevel. Drawing on multiple insights from theory and our own empirical work, we highlight the importance of engaging managers, senior and frontline staff and potentially patients to explore foundational questions examining three core resource areas. These span the physical or material resources available, workforce capacity and capability and team and organisational relationships. Deficits in all these resource areas may need to be addressed to achieve success. We also argue that as inertia is built into the complex social and human systems characterising healthcare facilities that thought on how to mobilise five motive forces is needed to help achieve change. These span goal alignment and ownership, leadership for change, empowering key actors, promoting responsive planning and procurement and learning for transformation. Our aim is to bridge the theory—practice gap and offer an entry point for practical discussions to elicit the critical tacit and contextual knowledge needed to design interventions. We hope that this may improve the chances that interventions are successful and so contribute to better facility-based care and outcomes while contributing to the development of learning health systems.
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spelling pubmed-93961432022-09-06 Improving facility-based care: eliciting tacit knowledge to advance intervention design English, Mike Nzinga, Jacinta Oliwa, Jacquie Maina, Michuki Oluoch, Dorothy Barasa, Edwine Irimu, Grace Muinga, Naomi Vincent, Charles McKnight, Jacob BMJ Glob Health Practice Attention has turned to improving the quality and safety of healthcare within health facilities to reduce avoidable mortality and morbidity. Interventions should be tested in health system environments that can support their adoption if successful. To be successful, interventions often require changes in multiple behaviours making their consequences unpredictable. Here, we focus on this challenge of change at the mesolevel or microlevel. Drawing on multiple insights from theory and our own empirical work, we highlight the importance of engaging managers, senior and frontline staff and potentially patients to explore foundational questions examining three core resource areas. These span the physical or material resources available, workforce capacity and capability and team and organisational relationships. Deficits in all these resource areas may need to be addressed to achieve success. We also argue that as inertia is built into the complex social and human systems characterising healthcare facilities that thought on how to mobilise five motive forces is needed to help achieve change. These span goal alignment and ownership, leadership for change, empowering key actors, promoting responsive planning and procurement and learning for transformation. Our aim is to bridge the theory—practice gap and offer an entry point for practical discussions to elicit the critical tacit and contextual knowledge needed to design interventions. We hope that this may improve the chances that interventions are successful and so contribute to better facility-based care and outcomes while contributing to the development of learning health systems. BMJ Publishing Group 2022-08-19 /pmc/articles/PMC9396143/ /pubmed/35985694 http://dx.doi.org/10.1136/bmjgh-2022-009410 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Practice
English, Mike
Nzinga, Jacinta
Oliwa, Jacquie
Maina, Michuki
Oluoch, Dorothy
Barasa, Edwine
Irimu, Grace
Muinga, Naomi
Vincent, Charles
McKnight, Jacob
Improving facility-based care: eliciting tacit knowledge to advance intervention design
title Improving facility-based care: eliciting tacit knowledge to advance intervention design
title_full Improving facility-based care: eliciting tacit knowledge to advance intervention design
title_fullStr Improving facility-based care: eliciting tacit knowledge to advance intervention design
title_full_unstemmed Improving facility-based care: eliciting tacit knowledge to advance intervention design
title_short Improving facility-based care: eliciting tacit knowledge to advance intervention design
title_sort improving facility-based care: eliciting tacit knowledge to advance intervention design
topic Practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9396143/
https://www.ncbi.nlm.nih.gov/pubmed/35985694
http://dx.doi.org/10.1136/bmjgh-2022-009410
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