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Strategic Implementation: the fit between innovation and context in introducing pain registration at an internal oncology ward

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Strategic Implementation: the fit between innovation and context in introducing pain registration at an internal oncology ward

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Samenvatting

Background: Although pain registration increases the quality of pain care, its implementation
might be better (De Rond, 2001). Grol (1999) holds that an evidence-based practice calls for
an evidence-based implementation. The contingency model designed by Van Linge (1998)
provides options for examining the congruence between the innovation and the context, and
adjusting the implementation accordingly.
Aims and Objectives: Using the contingency model designed by Van Linge, the aims are to
observe the course of the congruence between the innovation and the context during the
implementation of pain registration at the Internal Oncology Ward of a regional hospital in
the Randstad (the urban agglomeration in the Netherlands) according to a standard
implementation strategy, and to gather supplementary data on the perception of the innovation
by the professionals involved throughout the implementation process.
Design and Methods: A case study in which a quantitative single organization experiment is
supplemented by qualitative information from a focus group.
Results: Although all the configurations are clearly present in both the measurements, the
ward developed from being predominantly group-focused to being more aim-focused. The
external focus and control that are characteristic of an aim-focused configuration go hand in
hand with the flexibility and internal focus from the group-focused configuration. The explicit
values layer manifests itself most emphatically in most of the configurations. This is in
keeping with the impression of the innovation given in the post-measurement. Except for the
aim-focused aspect, the configurations are lacking in the operationalization of the explicit
values and an in-depth aspect. Although they are limited, the results of the focus group do
confirm and clarify the impression of the ward obtained using the contingency model.
Conclusions: The congruence between the layers of the innovation and the ward increased
after the application of the standard implementation strategy. In order to increase the internal
congruence on the ward, an evolutionary strategy is recommended focused on initiating
fundamental learning processes to be worked out under decentralized steering.
Relevance to clinical practice: The information that has been gathered on the implementation
process on the ward can serve as a basis for management decisions regarding innovations in
care. The contingency model can give other wards valuable information about the mode of
implementation in the decision to introduce pain registration and in other innovations.

Toon meer
OrganisatieHogeschool Utrecht
OpleidingVerpleegkunde
AfdelingVerpleegkundige Studies
Jaar2008
TypeMasterscriptie
TaalEngels

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