Abstract
Background
Innovation is important to improve patient care, but few studies have explored the factors that initiate change in healthcare organizations.
Methods
As part of the European project EPICE on evidence-based perinatal care, we carried out semi-structured interviews (N = 44) with medical and nursing staff from 11 randomly selected neonatal intensive care units in 6 countries. The interviews focused on the most recent clinical or organizational change in the unit relevant to the care of very preterm infants. Thematic analysis was performed using verbatim transcripts of recorded interviews.
Results
Reported changes concerned ventilation, feeding and nutrition, neonatal sepsis, infant care, pain management and care of parents. Six categories of drivers to change were identified: availability of new knowledge or technology; guidelines or regulations from outside the unit; need to standardize practices; participation in research; occurrence of adverse events; and wish to improve care. Innovations originating within the unit, linked to the availability of new technology and seen to provide clear benefit for patients were more likely to achieve consensus and rapid implementation.
Conclusions
Innovation can be initiated by several drivers that can impact on the success and sustainability of change.
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Acknowledgements
We are grateful to all the physicians and nurses who participated in the interviews and shared their experiences with us. We thank Nikola Jeck for carrying out the interviews in Germany. The EPICE project was funded by the European Union's Seventh Framework Programme [FP7/2007−2013] (grant no. 259882). In Portugal, this study was also funded by FEDER through the Operational Programme Competitiveness and Internationalization and from the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education), under the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; ref.UID/DTP/04750/2013) and the Ph.D. Grant SFRH/BD/111794/2015 (Carina Rodrigues), co-funded by the FCT and the POCH/FSE Program.
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M.C. designed the study, drafted the study protocol, coordinated data analyses and prepared the manuscript. E.F. coordinated data acquisition and analyses across the participating regions, carried out and transcribed the interviews in Italy and performed the overall second-stage data analyses. C.R., E.S.D., R.F.M. and M.B. participated in the finalization of the study protocol and materials, supervised data acquisition in their region and contributed to the manuscript for important aspects related to the interpretation of results and the discussion. A.F.M., A.L., J.W., A.H. carried out and transcribed the interviews in their region and performed first-stage data analyses; they contributed to the paper as regards the validity of data reporting and interpretation. I.C. prepared and maintained the quantitative database of the study, prepared the tables and figure, and performed the literature review. J.Z. initiated and coordinated the EPICE project, participated in the definition of this study aims, protocol and instrument, and substantially contributed to the manuscript for important aspects. All authors have read and approved the final version of the manuscript.
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Cuttini, M., Forcella, E., Rodrigues, C. et al. What drives change in neonatal intensive care units? A qualitative study with physicians and nurses in six European countries. Pediatr Res 88, 257–264 (2020). https://doi.org/10.1038/s41390-019-0733-9
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DOI: https://doi.org/10.1038/s41390-019-0733-9
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