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Archives of Osteoporosis
Published in: Archives of Osteoporosis 1/2020

01-12-2020 | Original Article

Applying normalization process theory and process mapping to understand implementation of a co-management program for older hip fracture patients in China: a qualitative study

Authors: Ke Peng, Hueiming Liu, Jing Zhang, Minghui Yang, Yishu Liu, Maoyi Tian, Hongling Chu, Xinbao Wu, Rebecca Ivers

Published in: Archives of Osteoporosis | Issue 1/2020

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Abstract

Summary

This qualitative study identified the barriers to the implementation of a multidisciplinary co-management program for older hip fracture patients and provided evidence for future intervention improvement and scale-up.

Introduction

Multidisciplinary co-management has been recommended as an effective intervention for hip fracture management in older people. This study is a process evaluation of a multidisciplinary co-management program in an orthopaedic hospital in Beijing, China, to better understand the barriers to implementation.

Methods

Data collection involved semi-structured interviews with key implementers of the co-management intervention (surgeon, geriatrician, physician, nurse, physiotherapist and anaesthetist) and observations of patients’ journey to map the care processes were conducted in Beijing Jishuitan Hospital. Data were transcribed, qualitatively coded and analysed using normalization process theory to understand the intervention process from four constructs: coherence, cognitive participation, collective action and reflexive monitoring.

Results

Ten stakeholder interviews were conducted. Despite multidisciplinary co-management intervention was meaningful and valued by participants, barriers to its implementation were identified. These included unmatched investment and benefit (cognitive participation), challenges of facing increased workload (collective action), deficient training and supervision system (collective action), limited accommodating capacity of hospital (collective action) and difficulties in accessing information about the effect of the intervention (reflexive monitoring).

Conclusions

Multiple barriers to the effective implementation of the multidisciplinary co-management program in China were identified. The process evaluation highlights key aspects in less willingness to fully invest in the program, inappropriate workload allocation and lack of training and supervision which need to be addressed before scaling up.
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Metadata
Title
Applying normalization process theory and process mapping to understand implementation of a co-management program for older hip fracture patients in China: a qualitative study
Authors
Ke Peng
Hueiming Liu
Jing Zhang
Minghui Yang
Yishu Liu
Maoyi Tian
Hongling Chu
Xinbao Wu
Rebecca Ivers
Publication date
01-12-2020
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2020
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-020-00760-1

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