FIRE STUDY
Facilitating Implementation of Research Evidence
BACKGROUND
Between 30-40% of patients do not benefit from care which complies with current scientific evidence (Schuster et al, 1998; Grol et al, 2001). Policy makers have responded with ways to address this and reduce the gap
between research and practice. Despite this there are reports of a highly variable level of uptake ranging from no change to significant changes in practice in line with guidance (Sheldon et al, 2007). Failure to achieve
uptake is resulting in patients being prevented from benefiting from the advances in biomedical sciences (Sung et al, 2003). Facilitating Implementation of Research Evidence (FIRE) is a four year programme of
research to identify and validate key factors determining the successful implementation of research evidence in practice. The study is underpinned by a conceptual framework, the Promoting Action on Research
Implementation in Health Services (PARiHS**) framework, which proposes that the successful implementation of research evidence is dependent on the complex interplay of the evidence, the context of implementation
and the way the process is facilitated. The planned research will focus on evaluating the feasibility and effectiveness of facilitation as an implementation strategy.
Collaboration between: University of Warwick (Seers K), Manchester Business School (Harvey G), University of Bangor (Rycroft-Malone J), University of Ulster (McCormack B), University College Cork (McCarthy G), Karolinska Institute (Wallin L), University of
Alberta (Estabrooks C), Fontys University of Applied Sciences (Titchen A & Cox K), University of Adelaide (Kitson A)
Research Fellows: Eldh A-C (Karolinska Institute), Hawkes C (Bangor University, Wales), Mockford C (University of Warwick), Niessen T and van der Zip T (Fontys, Netherlands), Slater P (University of Ulster) .
Statistician – Crichton N.(London South Bank University,) Health Economists - Linck P, Edwards R. (Bangor University). Project Manager Kennedy D (University of Warwick)
AIMS AND
OBJECTIVES
DESIGN
Phase 2
Phase 3
Phase 1
Objectives for Phase 2 – A randomised controlled trial with an integrated qualitative and
Objectives for Phase 3 – Dissemination
quantitative evaluative and health economic component.
Phase 1 – the development
Objectives for Phase 1 – facilitation
and implementation of two
facilitation packages
1.Develop and deliver a technical facilitation
development programme, for the
implementation and evaluation of continence
care clinical recommendations in nursing home
settings for older people
Phase 2 – a pragmatic RCT
and evaluative study to evaluate
the impact of the different
facilitation packages on
processes and outcomes when
implementing continence
recommendations in nursing
home settings for older people.
Phase 3 – a dissemination
strategy, that runs concurrently
with the first two phases.
References
1. Schuster M, McGlynn E, Brook R H (1998) How good is the quality of
health care in the United States? The Milbank Quarterly, 76: 517-563; 2.
Grol R (2001) Successes and failures in the implementation of evidencebased guidelines for clinical practice. Medical Care, 39 (8 Supp 2): 11461154., 3. Sheldon T A, Cullum N, Dawson D, Lankshear A, Lowson K,
Watt I et al (2007) What’s the evidence that NICE guidance has been
implemented? Results from a national evaluation using time series
analysis, audit of patients’ notes, and interviews. British Medical Journal,
329: 4. Sung N S, Crowley W F, Genel M et al (2003) Central challenges
facing the national clinical research enterprise. Journal of the American
Medical Association, 289:1278-1287 5 5. The EuroQol Group (1990).
EuroQol-a new facility for the measurement of health-related quality of
life. Health Policy 16(3):199-208. 6. Patrick DL, Martin ML, Bushnell
DM. The I-QOL: A Quality-of-Life Instrument Specific to Persons with
Urinary Incontinence: User’s Manual and Scoring Diskette for United
States Version. Seattle, Washington: Health Research Associates, Inc.,
1999. 7. Sandelowski M (2000) Combining qualitative and quantitative
sampling, data collection, and analysis techniques in mixed methods
studies. Research in Nursing and Health, 23:246-255.
2. Develop and deliver an enabling facilitation
development programme for the
implementation, evaluation and diffusion of
continence care clinical recommendations in
nursing home settings for older people.
Facilitation package – Type A
Technical facilitation will be informed by quality
improvement, innovations and organisational
theory literature, innovations literature. This
focuses less on the person as the vehicle of
transformation, more on the approaches to
learning and activities. It focuses on the
improvement of the system-organisation.
Facilitation package – Type B
Enabling facilitation will work with the individual
to develop their capability and capacity to
transform them, including the importance of the
culture in which practice is happening. It is a
collaborative, inclusive and participative
approach. Its theoretical underpinnings come
from critical creativity. The central concepts are
praxis, undertaking mindful action with intent,
and human flourishing.
1. To ascertain whether facilitation can enhance the implementation of evidence into practice, improve clinical
outcomes and be cost effective, using implementation of a clinical guideline as an exemplar
2. Compare the effects of two different levels of facilitation on implementation and clinical and cost
effectiveness.
2. To develop a portfolio of networking and
dissemination activities that will promote
active diffusion of the study findings to key
2) technical facilitation 3) enabling facilitation.
individuals and organisations in the EU,
Europe and internationally.
Evaluative Data
3. To support study participants to
1) The Alberta Context Tool (ACT) - a suite of survey instruments will be given to staff members to
disseminate their experiences and learning
complete and which are designed to assess organizational context and knowledge translation behaviours.
as a result of their involvement in the
2) Interviews
research.
Interviews (telephone and face-to-face) will be conducted with key informants at micro, macro, and meso levels 4. To evaluate the effectiveness of
of sites (including, facilitators, staff, local and regional stakeholders, patients & carers) during the lifetime of the stakeholder involvement and dissemination
project. Interviews will be conducted at critical points in the programme pre, during and post intervention to
activities as the study progresses and revise
ascertain the likelihood of sustainable changes.
accordingly.
Pragmatic Randomised Controlled Trial
The RCT has 3 arms. 1) Standard dissemination of recommendations, including an implementation guide
3) Quality of Life questionnaires i.e. EQ5D/EQ5D by proxy and IQOL will be completed with
DATA ANALYSIS
participating nursing home residents or key workers
•Data analysis will be conducted within and
across data sets and within and across sites.
Analysis of percentage compliance with
guidelines and quantitative data will be
managed in SPSS and analysed using
descriptive and inferential statistics.
Qualitative data will be analysed using
content analysis and managed through
Atlas.ti.
Data analysis will be an iterative process
between data sets and study phases.
Integration and synthesis of data will be
guided by our theoretical framework and
principles of conducting mixed methods
research (Sandelowski 2000).
4) Routinely collected data
Any available routinely collected local data relevant to the delivery of continence care will be collected.
5) Documentation
Relevant continence care specific documentation will be collected from each site such as policies, procedures,
and guidelines.
6) Intervention specific process data
Process data will be collected by facilitators as part of the enabling facilitation intervention, which will include
reflective notes and the administration of the Context Assessment Index (CAI).
This study is funded in the European Commission 7th
framework programme. EU agreement 223646
For further information contact:
kate.seers@warwick.ac.uk,
carole.mockford@warwick.ac.uk or
d.r.kennedy@warwick.ac.uk
**Promoting Action on Research
Implementation in Health
Services www.parihs.org
1. To develop and implement a model of
stakeholder involvement that complements
the theory-driven approach to the study
design and enables stakeholder involvement
throughout the research process
Health Economic Data
This will involve an annual collection of data referring to the costs of urinary incontinence to each nursing home
e.g. pads, laundry, disposal of used pads and staff costs. The EQ5-D will be the quality of life measurement
used.