Imperial College London
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Dr Laura Lennox

Faculty of Medicine, School of Public Health

Improvement Science / Health Improvement Lead
 
 
 
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Contact

 

+44 (0)20 3315 3392l.lennox Website

 
 
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Location

 

H4.28Chelsea and Westminster HospitalChelsea and Westminster Campus

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Summary

 

Publications

Citation

BibTex format

@article{Lennox:2021:10.1136/bmjopen-2021-048815,
author = {Lennox, L and Eftychiou, L and Matthew, D and Hanna, J and Winn, T},
doi = {10.1136/bmjopen-2021-048815},
journal = {BMJ Open},
pages = {1--10},
title = {What risks to sustainability are identified throughout care bundle implementation and how can they be addressed? A mixed methods case study},
url = {http://dx.doi.org/10.1136/bmjopen-2021-048815},
volume = {11},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objectives Despite national guidance on how to identify and treat heart failure (HF), variation in HF care persists across UK hospitals. Care bundles have been proposed as a mechanism to deliver reliable optimal care for patients; however, specific challenges to sustain care bundles in practice have been highlighted. With few studies providing insight into how to design or implement care bundles to optimise sustainability, there is little direction for practitioners seeking to ensure long-term impact of their initiatives. This study explores the sustainability risks encountered throughout the implementation of a HF care bundle (HFCB) and describes how these challenges were addressed by a multidisciplinary team (MDT) to enhance sustainability over time.Design A longitudinal mixed method case study examined the HFCB improvement initiative from September 2015 to August 2018. A standardised sustainability tool was used to collect perceptions of sustainability risks and actions throughout the initiative. Observations, key-informant interviews and documentary analysis were conducted to gain in-depth understanding of how the MDT influenced sustainability through specific actions. A qualitative database was developed using a consolidated sustainability framework to conduct thematic analysis. Sustainability outcomes were explored 1-year post funding to ascertain progress towards sustainment.Results The MDT identified six sustainability challenges for the HFCB: infrastructure limitations, coding reliability, delivery consistency, organisational fit, resource stability and demonstrating impact. The MDT undertook multiple actions to enhance sustainability, including: (1) developing a business case to address infrastructure limitations; (2) incorporating staff feedback to increase bundle usability; (3) establishing consistent training; (4) increasing reliability of baseline data; (5) embedding monitoring and communication; and (6) integrating the bundle into current practices.Co
AU  - Lennox,L
AU  - Eftychiou,L
AU  - Matthew,D
AU  - Hanna,J
AU  - Winn,T
DO  - 10.1136/bmjopen-2021-048815
EP  - 10
PY  - 2021///
SN  - 2044-6055
SP  - 1
TI  - What risks to sustainability are identified throughout care bundle implementation and how can they be addressed? A mixed methods case study
T2  - BMJ Open
UR  - http://dx.doi.org/10.1136/bmjopen-2021-048815
UR  - https://bmjopen.bmj.com/content/11/6/e048815
UR  - http://hdl.handle.net/10044/1/89680
VL  - 11
ER  -
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