Skip to main content

Table 2 Conceptual frameworks, theories and models: Interrelationship between the elements of the PARiHS framework and linked theories and models. (based on Ostrom's typology).

From: Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges

 

Conceptual Framework

Theory

Model

Definition

Identifies a set of variables and relationships that should be examined in order to understand the phenomenon

Provides a more dense and logically coherent set of relationships and offers views (hypotheses) on the causal relationships and seeks to explain the phenomena

Represents a specific situation; is narrower in scope and more precise in its assumptions

Dimensions EVIDENCE

Sub-elements

Research

Clinical Experience

Patient

Experience

Routine Data

Evidence

Evidence is a broad term comprising 4 key elements : research, clinical experience, patient preferences and routine information

Melding and implementing evidence involves negotiating and developing shared understandings It is a dialectical process

What theories would inform the way evidence has been conceptualised within the PARiHS framework? E.g. How would decision making theory or clinical reasoning or cognitive theory inform/influence/alter the way we would try to make sense of how practitioners at clinical level adopt and value a new innovation?

Would we classify guideline implementation as one model to be tested within the wider clinical reasoning/knowledge generation theoretical tradition?

Are the use of patient narratives, or audit and feedback more examples of models that can test the broader theoretical positions that inform the conceptual framework?

Context

Sub-elements

Context

Culture

Leadership Evaluation

Context

Comprises 4 broad areas:

Context, culture, leadership and evaluation

Some contexts are more conducive to the introduction of new ideas/innovations.

It is the interplay of the elements and sub-elements that make implementation easier or more difficult

Big complex area operating at multiple levels.

Important to be able to see the whole picture when changing practice

The theoretical base of understanding organisations, contexts, cultures and innovation is diverse, multifaceted and very complex.

What criteria would you use to select the more appropriate theories that would elucidate how the elements of the PARiHS framework interact?

How can theories be integrative in order to explain the realities of real world implementation?

How would

Testing different learning styles and experimenting with a variety of leadership roles and styles could be part of the range of interventions or models used.

Selecting one leadership approach within leadership theory in general would be part of the multiple models and theories being tested within the framework

Facilitation

Sub-elements

Purpose,

Role

Skills and Attributes

Facilitation

Broad term describing the human support, guidance, learning, coaching offered by a trained facilitator when initial diagnosis of the "readiness" of the individuals, team and context for the introduction of the innovation

The purpose can be technical e.g. introducing a discrete method or "holistic" sustaining and enabling personal development and system transformation

Method contingent on diagnosis of individual/team understanding/acceptance of evidence and receptiveness for change of context

Facilitation has a strong theoretical base in humanistic psychology, psychoanalytic group theory and adult learning theory. Therapeutic client-centred approaches, experiential learning and self-efficacy theory also contribute to our overall understanding.

The question again remains how researchers and practitioners make sense of these underlying theories to help them construct way of changing practice.

Constructing a particular programme or mentoring experience, based on psychoanalytic theory will be different from an approach based on adult learning.

Facilitation models can range from "doing for others" to "enabling others".

Doing for others covers episodic contact offering practical help using external change agents.

Enabling others focuses more on sustaining partnerships, developing individual potential and encouraging self directed learning

Doing for would use the following:

Project management techniques, technical, marketing skills

Enabling others would select methods around co-counselling, clinical reflection, action learning.