To Örebro University

BACKGROUND: Effective implementation processes play a central role in health care organizations and affect the care of patients. Managers are pivotal in facilitating the use of new practices, but their experience and how it affects the implementation outcome are still largely unknown. In the field of disability health care in particular, managers experiences have scarcely been investigated. Therefore, the aim of this study is to explore managers' experiences of the implementation process when transferring new practices into disability health care settings.

METHODS: Semi-structured individual telephone interviews were conducted with managers at disability health care organizations in four administrative regions in central Sweden. A total of 23 managers with formal managerial responsibility from both public and private health care were strategically selected to be interviewed. The interviews were analysed using reflexive thematic analysis with an inductive approach.

RESULTS: The analysis resulted in two themes about factors influencing the implementation process: firstly, Contextual factors set the agenda for what can be achieved, which highlighted aspects that hinder or enable the implementation process, such as internal and external conditions, the workplace culture, the employees and managers' attitudes and openness to change: secondly, Leadership in the winds of change, which described the challenges of balancing managerial tasks with leading the change, and the importance of a leadership that involves the participation of the employees.

CONCLUSIONS: This study explored how and to what extent managers address and manage the implementation process and the many associated challenges. The findings highlight the importance of leadership support and organizational structure in order to transfer new practices into the work setting, and to encourage an organizational culture for leading change that promotes positive outcomes. We suggest that identifying strategies by focusing on contextual factors and on aspects of leadership will facilitate implementation processes.

TRIAL REGISTRATION: The SWAN (Structured Water Dance Intervention) study was retrospectively registered on April 9, 2019 and is available online at ClinicalTrials.gov (ID: NCT03908801).

Introduction: Contextual factors influence interventions in healthcare and pose a particular challenge in interventions designed for people with profound intellectual and multiple disabilities (PIMD). Exploring support persons’ and health personnel’s experience of an intervention may improve our understanding of the influence of contextual factors. Such exploration is important for revealing areas and focus points for future implementations. Therefore, the aim of this study is to explore support persons’ and health personnel’s experience of contextual factors during involvement in an intervention for people with PIMD.

Methods: This focus group study includes eight groups, comprising a total of 34 support persons and health personnel, at habilitation centres at four regions in central Sweden. Data were analysed inductively using a content analysis approach.

Results: Three themes emerged from the analysis of the informants’ perspectives on the contextual factors: (1) structure and support enhances intervention feasibility; (2) an intervention’s benefit for people with PIMD increases its acceptability; and (3) being engaged and involved increases support persons’ and health personnel’s motivation. Our findings show that the implementation of an intervention for people with PIMD should focus on the recipients of the intervention in its context, forming a clear communication plan. A training programme should be provided for the recipients and providers of the intervention.

Discussion: Finally, the implementation process can be facilitated by creating space for staff to contribute and by encouraging participation and ownership for everyone involved. Using a co-design strategy can enable a shared responsibility to solve the identified challenges, while contributing to the development and design of future interventions for people with disabilities.

BACKGROUND: People with disabilities experience significant health inequities compared with the general population. Addressing these inequities requires the development and implementation of tailored interventions, but a gap often exists between recommended best practices and the actual care provided. Successful implementation is complex, involving multiple organizational factors. Assessing organizational readiness for change is crucial to overcome barriers and improve health outcomes for people with disabilities. This study aims to examine managers' perceptions of their organization's readiness for change regarding the implementation of interventions within disability healthcare in Sweden.

METHODS: This descriptive cross-sectional study employs an embedded mixed-methods approach. The primary approach for the overall study is based on quantitative data, while qualitative data is analyzed to provide supplementary deepened information. Both types of data were collected simultaneously through a web-based survey. The data analysis involves various statistical techniques for the quantitative data and inductive content analysis for the qualitative data.

RESULTS: Several key factors influence managers' perceptions of their organization's readiness for change, including gender, age, tenure, organizational type, managerial level, and experience. Enabling factors for implementation include trust-based leadership, staff involvement, motivation, and engagement. Barriers include complex processes, lack of support, resistance and fear, and insufficient time and resources.

CONCLUSIONS: This study highlights the complexity of organizational readiness for disability healthcare interventions, shaped by both individual and organizational factors. In particular, managerial characteristics, organizational dynamics, and resource availability play key roles. These findings suggest that a comprehensive strategy can strengthen healthcare organizations' ability to navigate implementation challenges effectively.