Page 93 - Demo

Implementation interventions through the lens of Normalisation Process Theory914BackgroundImplementing and sustaining new methods in complex organisational and policy contexts in health care is known to be a challenge. Dynamic and often unpredictable interactions and behaviours occur between various actors within complex adaptive contexts (Greenhalgh et al., 2004; May et al., 2016; Plsek & Greenhalgh, 2001). These interactions and behaviours are also known as the social mechanisms which determine the outcome of implementation processes (May et al., 2009). Various implementation interventions have been identified that may be used to steer these social mechanisms towards successful implementation. To facilitate the evaluation of these interventions, the Cochrane Effective Practice and Organisation of Care Review Group (EPOC, 2002) have defined four types of such interventions: professional, organisational, financial and regulatory. Professional implementation interventions as identified by EPOC, such as educational meetings and reminders (Table 2), have been used to explain and comprehend the take-up of innovations by professionals in various medical fields, such as hospitals, nursing homes (Breimaier et al., 2013), mental health care (Williams & Beidas, 2019), and oral health care (Weening-Verbree et al., 2013). However, professional implementation interventions and their definitions may be specific to their domains of practice and need to be described in detail (Michie et al., 2009). Little is known about interventions promoting professional behaviour change used in implementation processes in complex long-term care organisations for people with intellectual disabilities. Scientific knowledge about implementation in curative health care cannot simply be generalised to longterm care, because this type of care involves integrated and lifelong 24/7 care and support (Kersten et al., 2018). Moreover, these care organisations usually have conservative systems which pursue stability and predictability. Change is perceived as difficult and challenging by both clients and professionals. From this perspective, it is valuable to evaluate EPOC%u2019s implementation interventions used in a Dutch long-term care organisation for people with intellectual disabilities and to analyse social mechanisms initiated by these interventions.