Health care transformation in a resource-limited environment: exploring the determinants of a good climate for change

• Published in: Journal of multidisciplinary healthcare Vol. 12; pp. 173 - 182
• Main Authors: van Boekholt, Tessa A, Duits, Ashley J, Busari, Jamiu O
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01-01-2019; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Analysis; Care pathway; Censuses; Curaçao; Decubitus ulcer; Demographics; Demography; Employee motivation; Health aspects; Health care policy; Health care reform; Healthcare; Hospitals; Implementation; Infrastructure (Economics); Intervention; Leadership; Medical care quality; Medical education; Medical personnel; Netherlands; Organizational communication; Organizations; Original Research; Pressure ulcers; Qualitative research; Quality; Ulcers; Netherlands; Curaçao; Curacao; Uganda; care pathway; implementation; leadership; Caribbean; health care; interprofessional collaboration; pressure ulcer
• ISSN: 1178-2390; 1178-2390
• DOI: 10.2147/JMDH.S194180

In a continued effort to improve the health care services, a project was set up to develop and implement a care pathway for the effective management of pressure ulcers in the St Elisabeth Hospital in Curaçao, the Dutch Caribbean. To ensure the effective implementation of our intervention, we decided to investigate what factors define the implementation climate of a health care institution within a resource-limited environment.
We used a participatory tool approach in this study, where a mixed team of health professionals worked on two parts of a health improvement project, namely: 1) workforce leadership development through a clinical leadership training program; and 2) health care quality improvement through the pressure ulcer care pathway development. In-depth interviews were held with ten participants to gain insight into their experiences of the implementation climate in the hospitals and inductive analysis was used to identify the (sub)themes.
Identified themes that described the implementation climate included: 1) the attitude of staff toward policy changes; 2) vision of the organization; 3) collaboration; 4) transparency and communication; 5) personal development; and 6) resources. These factors were interrelated and associated with several potential consequences such as loss of motivation among staff, loss of creativity to solve issues, the emergence of the feeling "us" vs "them", short-term solutions to problems, and a sense of suspicion/frustration among staff members.
From this study, positive subconstructs for a favorable implementation climate in a hospital organization were lacking and those that were identified were suboptimal. The inability to satisfy all the subconstructs seemed to be the consequence of insufficient resources and infrastructure within the current health system. A favorable implementation climate in a resource-limited environment is closely tied to the availability of health care resources and infrastructure.