Table 2 Main results based on the NPT coding manual [21] adapted to the application of PCOMs in SPHC
CMO Domain | NPT construct | Description and main results |
|---|---|---|
Implementation Context | Strategic intentions | How does the working environment affect the design and planning of the use of PCOMs? Different approaches were recognized as three teams planned to further use PCOMs and two teams only wanted to participate in the study |
Adaptive execution | How does the working environment affect the way in which users can find and implement ways of working that make the use of PCOMs an implementable project for practice? Problems with software documentation in general were barriers and the integration of PCOMs into existing electronic patient record is crucial | |
Negotiating capacity | How does the context affect the extent to which the use of PCOMs can fit or be integrated into the existing ways of working of their users? Internal communication and daily care organisation of teams were decisive for the extend of integration, as well as legal requirements and conditions | |
Reframing organisational logics | How do the existing social-structural and social-cognitive resources affect the implementation environment? This is related to attitude of management level and therefore addressed under cognitive participation and initiation | |
Implementation Mechanisms | Coherence-building How do people individually and collectively make sense of the use of PCOMs? | |
Differentiation | How do participants distinguish the use of PCOMs from their previous way of working? The standardised, repeated outcome measurement framework was new for all participating teams | |
Communal specification | How do participants collectively achieve an understanding about the use of PCOMs? | |
Individual specification | How do participants individually achieve an understanding about the use of PCOMs? PCOMs were unfamiliar to use at first, but manageable after some time; difficulties in assessing psychosocial items/relatives and to achieve a consistent assessment by all team members occurred. In addition, contact in the SPHC setting is irregular which makes it more difficult to use PCOMs | |
Internalisation | Does the use of PCOMs make sense for the people involved? Degree of internalisation was dependent on attitude of professionals and their recognition of benefits | |
Cognitive participation How do people engage to ensure that PCOMs can be applied? | ||
Initiation | Which role does the leadership/key persons take on? Different approaches were recognised, open communication and support of management level was most helpful | |
Enrolment | How do participants assess the introduction to the study and the training material and how was it used? Support of research team (educations sessions, availability for specific questions) and provided training material was mainly considered helpful | |
Legitimation | How do participants come to believe that using PCOMs is right and should be part of their work? Personal process of each individual, recognising own benefits was decisive | |
Activation | How do people involved support the use of PCOMs? All teams had conversations about reliable use; internal facilitators/champions are most helpful for the process | |
Collective action How do people integrate PCOMs into their daily working practice? | ||
Interactional workability | How do participants use PCOMs in their everyday work? PCOMs were used for structuring patient conversations, content-related exchange within the team, deriving actions and evaluating their effectiveness, a quick overview of symptoms/problems, same language spoken, common attitude, simplified/reduced documentation, prioritising of care | |
Relational integration | How does the use of PCOMs affect the trust that participants have in each other? Using PCOMs created a responsibility as colleagues relied on it within their own care | |
Skill-set workability | Is the work required to apply PCOMs allocated appropriately to those involved? Assessing the PCOMs was divided according to expertise of the professionals | |
Contextual integration | Are resources made available for implementing the use of PCOMs? Resources (working hours) were mostly made available for the application of PCOMs in daily care in all SPHC teams | |
Reflexive monitoring How do people individually and collectively appraise the use of PCOMs? | ||
Systematisation | How do those involved have access to information about the impact of using PCOMs? Information about the impact of using PCOMs was provided by the research team through feedbacks and a final report, which was considered positive, but further analyses by the teams themselves had not been done yet | |
Communal appraisal | How do participants evaluate the impact of using PCOMs? Predominantly positive: using PCOMs increased the focus on the patient, symptom burden, and care system/relatives, shortened documentation and reading time, common language spoken, more structure in consultations, same data across settings, therefore avoiding information loss. Negative aspects were additional time burden and work | |
Individual appraisal | What further benefits/use of PCOMs can participants envision? Using PCOMs as screening instruments for palliative care needs, enable comparisons between services, transparent data for third parties and involvement of relatives/employees in nursing homes | |
Reconfiguration | How do practitioners change their own work in response to their appraisal of using PCOMs? Three teams changed documentation in line with the study, one integrated palliative care phases and one kept the original documentation | |
Implementation Outcomes | Intervention performance | What practices have changed over time through the operationalisation, implementation and reproduction of the use of PCOMs?a |
Relational restructuring | In what ways has the use of PCOMs changed the way people are organised and relate to each other?a | |
Normative restructuring | In which way has the use of PCOMs changed the norms, rules and resources that govern action?a | |
Sustainment (normalisation) | In what way has the use of PCOMs become established in practice?a | |