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Table 2 JIGSAW implementation project context

From: Understanding the uptake of a clinical innovation for osteoarthritis in primary care: a qualitative study of knowledge mobilisation using the i-PARIHS framework

Context to the Joint Implementation of GuidelineS for osteoarthritis in the West midlands (JIGSAW) implementation project
Overview In 2013, JIGSAW identified 15 general practices in the local Clinical Commissioning Group (CCG) in England to be pilot sites, with the initial aims of:
1. Testing out the practicalities of implementing the model osteoarthritis (OA) consultation developed in the MOSAICS study
2. Improving the alignment of OA care with current recommendations through the provision of innovations (OA e-template, training, enhanced consultation and patient materials)
3. Supporting primary care with the systematic implementation of international guidelines and quality standards for OA at a practice level
4. Reducing clinical variation, and improving evidence-based practice, patient satisfaction and clinical outcomes
Theoretical approach used to inform JIGSAW:
•Normalisation Process Theory (NPT) – NPT can be used to describe, assess and enhance implementation activity by explaining the processes in which complex interventions become sustained or routinely embedded, in their social context (healthcare practice) [29]. NPT was used in the MOSAICS study qualitative evaluation as a framework for exploring aspects of adoption and implementation of the innovation [27] and as a result informed JIGSAW.
Context The JIGSAW implementation project was initiated as a result of a primary care led demand to implement the MOSAICS innovation. Professionals within practices in the MOSAICS trial who had delivered the enhanced OA consultation recognised the benefits of the approach in improving the quality of care for people with OA and that the innovations had a positive impact for example with regards to clinicians knowledge and confidence in managing the condition and increased uptake of some quality standards of OA care [30]. Practice-based learning enabled adaptation of the innovation (training component) that was required to scale-up empirically tested MOSAICS innovations (from a research trial) into ‘real world’ primary care (JIGSAW).
Innovation The JIGSAW approach required practices to implement the four key innovations that were delivered in MOSAICS: clinician training, structured consultations with follow-up, patient information in the form of the OA guidebook and the e-template. These innovations can be delivered flexibly in a way that suits local healthcare context.
The refined JIGSAW training package comprised a one-hour all practice meeting and a 2-day primary care nurse training programme. The training content included; what is OA, how should OA be explained, core management of OA and goal setting with patients. Much of the training was interactive including a session with simulated patients.
Recipients GPs and practice nurses
Facilitation Facilitation was led by an inter-disciplinary team who provided a knowledge brokering service nested within a clinical academic unit of expertise. The team comprised:
•Academic leadership – recognised international leaders in OA research, particularly developing models of care for the management of OA
•Specific management expertise including project management and health services management
•Patient and public involvement and engagement (PPIE) supported by a knowledge broker
•Clinical leadership and expertise – clinical champions with local and national profile
•Education expertise
•Information technology expertise
Services offered and support provided (knowledge mobilisation methods and facilitation activities) by the team included:
•Stakeholder engagement
•Applying for and securing funding to offer free training to local practices
•Hosted workshops and events for professionals and the public based on the research training for the MOSAICS trial to share practice-based learning
•Profession specific and lay JIGSAW champions
•Conducted whole practice meetings with relevant champions
•Supported Clinical Commissioning Group (CCG) led implementation as part of a Locally Enhanced Service (LES) in one area
•PPIE liaison in general practices