Page 28 - Demo

Chapter 126Moreover, the specific focus of the three innovations on reducing involuntary care measures could be itself a barrier in implementation processes, because this a delicate subject among care professionals (Do%u0308renberg et al., 2018). Involuntary care measures are typically employed in situations in which clients show challenging behaviour involving significant harm or danger to both clients themselves and care staff and their surroundings. Severe challenging behaviour has been found to elicit negative emotional reactions of care staff, which may influence care staff%u2019s behaviour in supporting these clients (Lambrechts et al., 2009). Therefore, care staff often have reasonable grounds when justifying the use of involuntary care and restraints, even when clients resist or evaluate these measures negatively (Fish & Culshaw, 2005; Van der Meulen et al., 2018a; Van der Meulen et al., 2018b). Although they are willing to give clients the right to self-determine their life and care, they may be of the opinion that, given the intellectual disability, clients are not always able to handle this freedom and oversee their actions (Van der Meulen et al., 2018a). Consequently, the prospect of phasing out these measures may encounter resistance among care professionals, especially if they experience lack of organisational support (Bj%u00f6rne et al., 2022).Another aspect to consider is that when care organisations embark on implementing promising innovations, the conditions for implementation may differ from the original research context. Each organisational context varies in terms of size, structure, and culture, necessitating tailored implementation processes to suit specific organisational features (May et al., 2016). This raises the question of what efforts care organisations make during implementation and whether the innovations, after potential adaptation to the organisational contexts, still deliver on their promised outcomes (Moore et al., 2015). To get a better understanding of these implementation challenges in intellectual disability care this dissertation is aimed to get insight into %u201cthe black box%u201d of implementation processes. The black box is the phase between arguing that an innovation should be implemented within organisations%u2019 practices to improve quality of care and the actual implementation or sustainment of the innovation in care practices. Normalisation Process Theory (NPT; May et al., 2009) might help to shed light on this black box.