Page 179 - Demo

General discussion1777The main aim of this dissertation was to contribute to a better understanding of implementation processes in intellectual disability care organisations concerning methods that focus on involuntary care reduction, and to test effectiveness of these methods in relation to these implementation processes. Over the last 25 years implementation science studies have produced helpful insights into implementation processes in general healthcare (Albers et al., 2020; Greenhalgh, 2017; Nilsen & Birken, 2020). Such insights could potentially also be gained in intellectual disability care. For instance, implementation studies in general healthcare have highlighted the importance of professionals working together to change their collective and individual behaviour to embed innovations in their daily work routines (May & Finch, 2009; Nilsen et al., 2012). Additionally, studies have underscored the importance of organisational contexts in implementation processes (May et al., 2016), as well as the importance of considering implementation determinants and aligning implementation strategies with these determinants to foster successful implementation (Damschroder et al., 2009; Powell et al., 2015; Vis et al., 2023). Furthermore, implementation theories such as Normalisation Process Theory (NPT) have been developed to address the challenges of implementing and embedding innovations in healthcare, focusing on studying the social mechanisms within implementation processes (May & Finch, 2009). However, implementing innovations in long-term intellectual disability care, which involves life-long 24/7 care and support for clients who depend on it for their well-being, might present challenges specific for this care sector. Moreover, reduction of involuntary care and restrictive measures might have challenges of its own. The Care and Coercion Act (CCA) mandates that care organisations and care professionals strive to provide voluntary care to clients (Staatsblad, 2018). Voluntary care is care that clients chose themselves or consented to. However, involuntary care measures are still employed in situations involving a significant risk of harm to both clients and care staff. Care staff might have reasonable concerns that are addressed with involuntary care, which may complicate implementation of methods aimed at reducing such measures. Addressing these implementation challenges through collaborative efforts, such as a Community of Practice (CoP) (Wenger, 1998; Wenger et al., 2002), might increase the likelihood