From: Sticky knowledge: A possible model for investigating implementation in healthcare contexts
Kate has finished her training year and is working as a 0.6 full-time equivalent salaried family doctor in a busy practice in central London. Brimming with enthusiasm after winning a prize for successfully implementing palliative care improvement in her previous practice, she decides to talk to the partners and the practice manager about instituting the Gold Standards Framework in this practice. It proves difficult to get all the relevant people to meet, as there are no informal meetings. There are two formal practice meetings a week but they have full agendas, and it proves difficult to add a new item. In addition, the meetings rarely achieve consensus. Kate decides to use the practice's e-mail system and sends a message to all the clinicians describing her proposal to address the quality of palliative care by using a proven method and framework of best practice. She only receives one reply, which although encouraging ends by saying "we already are doing enough for cancer, but we need to look at flu-vaccination uptake if that's of interest to you?". In addition, one of the senior doctors views Kate as lacking the necessary experience to introduce changes into their organization. Kate perseveres, but two months later has only managed to achieve four of the seven points set out by the Framework. She wants contributions from the clinicians to maintain and update the profiles of patients receiving palliative care, but has to resort to repeated prompting to obtain information, compared with her experience at her previous practice where this was done automatically and where clinical records were updated as part of routine practice. Kate feels unsupported and her motivation to continue implementing the framework wanes. |