Achieving Motivation and Adoption when Implementing Clinical Pathways The Social and Infrastructural Dimensions of Episodic Interventions within the Radboud University Medical Center.
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2023-07-12
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en
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This research analyses the implementation of a clinical pathway structure within the Radboud University Medical Centre (Radboudumc) by incorporating the 3D-model for episodic interventions by Achterbergh & Vriens (2019). As the Radboudumc is currently making progress in their change program called ‘Fit for the Future’, some clinical pathways have been developed and partly implemented while the majority of the projected clinical pathways still need to be
developed. Although some clinical pathways have made successful progress, and also prove to be an advancement in terms of efficiency and quality of care, some clinical pathways are still in the midst of development and are accompanied by problems that are likely to be related to the social dimension of episodic interventions. For this reason, this research diagnoses the social dimension in order to identify the problems on the social dimension, while also analyzing the infrastructural dimension in order to identify the infrastructural causes for the identified social problems. Additionally the functional dimension is also indirectly incorporated in order to assess its’ role in achieving motivation and
adoption. The purpose of this research is to provide practical recommendations for the Radboudumc that could improve the change program for implementing clinical pathways. Based on the 3D-model for episodic interventions, criteria for the motivation and adoption goals of the social dimension, and the infrastructural dimension have been compiled. With these criteria, the social dimension problems can be identified by means of a gap analysis between the desired and
actual state of the criteria. Next, the criteria for the infrastructural dimension can be used to identify infrastructural causes for these social problems. These criteria formed the background for the interview questions, hence it is a qualitative research. Interviews with organizational members originating from three different, anonymized, clinical pathways (pathways A, B, and C) provided insights in the actual state regarding motivation, adoption, and the infrastructural dimension.
Respondents within these clinical pathways ranged from employees subjected to the clinical pathway change (e.g., healthcare employees and supportive staff), policymakers for the change process, and employees that are part of both policy making and working within the clinical pathway. Doing so, various perspectives regarding the change can be incorporated. Results showed that all three pathways failed to meet the desired state of motivation following the criteria, from which only pathway C came close to meeting the desired state. Additionally, only pathways B and C were diagnosed for adoption, as pathway A has not yet started designing the pathway, and both pathways failed to meet the desired state. However, again pathway C came closest to the desired state. The following infrastructural causes for the problems on the social dimension have been identified: 1) the lack of explicit social goals in the blueprint, 2) the lack of clarity regarding the existing (functional) goals, 3) the dependency on information management regarding the most significant disturbances in the development of pathways, 4) the lack of clarity regarding the future state of support the clinical pathway teams can receive, 5) the lack of additional hours for employees participating in the pathway teams, 6) the lack of involvement of employees outside the pathway team due to 7) the lack of representation by members of the pathway team, 8) the lack of proper support for employees joining the pathway development along the way, 9) the abundance of available information, 10) lack of clarity regarding the overall goal of pathway implementation, and 11) the lack of practical examples of already implemented pathways. Additionally, the diagnosis on the functional dimension overall provides clarity about the identified bottlenecks within the care processes, but had limited impact on the creation of a sense
of urgency as the bottlenecks were often already known beforehand. Designing the pathway did contribute to a shared vision as employees jointly developed the pathway and openly discussed the design. This partly also influenced adoption as they build confidence in the design. However, within pathway B this confidence is not complete as they have not yet been able to pilot their design, while pathway C has been able to test and implement parts of the designed pathway and hence build confidence in the functioning of the pathway. Following these results, the recommendations for the Radboudumc are to 1) include social goals in the blueprint, 2) concretely communicate the overall goal and goals within the blueprint and consistently use these throughout the various phases, 3) apply job- and goal-based selection criteria when selecting employees throughout the various phases of the pathway development to ensure the correct employees are involved for each step, 4) introduce pathway (development) more firmly prior to the start of a pathway development in order to make sure that employees possess the correct knowledge to participate, 5) actively promote and facilitate the representative role for employees within the pathway team to involve and inform employees outside the pathway team throughout the process, 6) apply an adequate onboarding process for employees joining the pathway development
along the way, 7) provide additional hours by default to employees joining the pathway team, 8) provide practical examples of an implemented pathway in order to explain to employees what a pathway can deliver, and 9) clearly communicate the support a pathway team can receive throughout its development, also for future phases to minimize uncertainty.
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Faculteit der Managementwetenschappen