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Table 1 Case Study, Year 1. Implementing best practice in a receptive environment

From: Sticky knowledge: A possible model for investigating implementation in healthcare contexts

Kate is starting out as a family doctor in a rural practice and is undertaking her training year. As part of this vocational training, she has to conduct an audit project. Her trainer (a senior clinician) tells her that the practice has not achieved many cancer care quality points in the new general practice contract introduced in the UK [19, 20]. The senior clinician admits that there is no formalized approach for regularly reviewing patients with cancer. He asks Kate to help the practice address this deficiency, thereby communicating his willingness to give her freedom to plan the change.

Kate reads about the Macmillan Gold Standards Framework [18] – a credible source of evidence. The framework consists of seven key areas of palliative care practice. The practice has lunchtime meetings, and Kate describes the framework to two of the partners, a salaried GP and the practice's nurse practitioner. They all agree that it would be a good idea to audit the practice by using the framework as a guide. During the training year, Kate and other practice members make changes to the way palliative patients are reviewed and their caregivers identified. The nurse practitioner purchases a whiteboard, which is completed, updated, and gives information about the entirety of ongoing terminal care cases. The out-of-hours emergency service is provided with details about the active caseload. Kate writes a report about the work and her trainer submits the project for a national competition of improvement projects in general practice.

A few months later, her work wins the first prize of £3000 and a £1000 award celebratory dinner for the entire practice. Whereas in the previous year, the practice scored poorly on cancer care quality points, in the following year, the maximum score is obtained.