Implementation of person-centred care: management perspective

Abstract

Objective: In this study the implementation of a care model was examined in a public hospital in Sweden. The aim was to identify, from the management perspective, barriers and facilitators with respect to the implementation. A further aim was to study the explanatory power of a theoretical framework, normalization process theory (NPT). Method: Semi-structured interviews were conducted with all of the members of a hospital departments’ managerial group. Interview transcripts were analysed by means of directed deductive content analysis, applying NPT as theoretical frame work. Results: The respondents identified factors, which were perceived as facilitating or obstructing the implementation process. These factors were; organizational culture, distribution of power, patient characteristics, resistance to change, teamwork, efficiency, time and speed of implementation. The theoretical framework, NPT, was partly supported by the data. There was however an absence of collective action and reflexive monitoring constructs. Conclusion: The implementation process, according to NPT, was incomplete and there was a risk that it could regress to the previous work routines. However, implementation theories, including NPT, do not have a timeframe for the implementation process. Even though theories are able of describing in detail the steps for successfully embedding and sustaining an innovation, they do not describe or identify factors influencing the speed of the implementation. A possible reason might be that time is a subjective factor.