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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.