Table 4 Realist evaluation: conclusions on the impact of the context and the mechanisms on achieving outcomes
Setting | Context | Mechanism | Outcome |
|---|---|---|---|
General practice | Systemic organisational change in general practice (implementation of the Health & Social Care Act 2012) | GPs avoid additional tasks that increase work burden or are perceived outwith remit | No engagement with the project despite potential for general practice as a discipline and patient gain |
Care homes | Top-down decision to involve care homes, during period of care home chain re-organisation | Care home managers avoid additional imposed tasks | No lasting engagement |
Hospital wards | Top-down decision to involve hospital ward, and period of major staff turnover | Ward staff minimise involvement, momentum lost when key staff leave | Selection of indicators for change in order to minimise workload and maximise gain |
Specialist palliative care schemes in hospices & communities | Competing demands in hospices & community teams, with funding challenges, periods of staff absence; but strong audit & research culture | Value of indicators appreciated, as supplement to existing audit & research culture | Changes made, effects seen, though extended implementation timescale required |