Abstract：
BACKGROUND: The implementation of person-centred care (PCC) is advocated worldwide. Stakeholders in charge of implementing PCC as a broad-scale change across the health care sector face two intertwined and complex challenges. First, making sense of PCC as an intervention with complex innovation characteristics and second, staging implementation of PCC by choosing appropriate implementation strategies. We aimed to explore one of these challenges by tracking, naming, specifying, and comparing which strategies and how strategies were enacted to support the implementation of more PCC in a real-world setting represented by one health care region in Sweden.
METHODS: A case study with seven embedded units at two organisational levels within a health care region was conducted from 2016 to 2019. Data were collected from three sources: activity logs, interviews, and written documents. Strategies were identified from all sources and triangulated deductively by name, definition, and cluster in line with the taxonomy Expert Recommendations for Implementing Change (ERIC) and specified according to recommendations by Proctor and colleagues as actor, action, action target, temporality, dose, outcome, and justification.
RESULTS: Four hundred thirteen activities were reported in logs, representing 43 discrete strategies identified in ERIC (n = 38), elsewhere (n = 1), or as emerging strategies (n = 4). The highest reported frequencies of discrete strategies were identified as belonging to two clusters: Train and educate stakeholders (40%) and Develop stakeholder interrelationships (38%). We identified a limited number of strategies belonging to the cluster Use evaluative and iterative strategies (4.6%) and an even smaller number of strategies targeting information to patients about the change initiative (0.8%). Most of the total dose of 11,076 person-hours in the 7 units was spent on strategies targeting health care professionals who provide PCC (81.5%) while the dose of strategies targeting support functions was 18.5%.
CONCLUSIONS: Our findings show both challenges and merits when strategies for implementation of PCC are conducted in a real-world setting. The results can be used to support and guide both scientists and practitioners in future implementation initiatives.
METHODS: A case study with seven embedded units at two organisational levels within a health care region was conducted from 2016 to 2019. Data were collected from three sources: activity logs, interviews, and written documents. Strategies were identified from all sources and triangulated deductively by name, definition, and cluster in line with the taxonomy Expert Recommendations for Implementing Change (ERIC) and specified according to recommendations by Proctor and colleagues as actor, action, action target, temporality, dose, outcome, and justification.
RESULTS: Four hundred thirteen activities were reported in logs, representing 43 discrete strategies identified in ERIC (n = 38), elsewhere (n = 1), or as emerging strategies (n = 4). The highest reported frequencies of discrete strategies were identified as belonging to two clusters: Train and educate stakeholders (40%) and Develop stakeholder interrelationships (38%). We identified a limited number of strategies belonging to the cluster Use evaluative and iterative strategies (4.6%) and an even smaller number of strategies targeting information to patients about the change initiative (0.8%). Most of the total dose of 11,076 person-hours in the 7 units was spent on strategies targeting health care professionals who provide PCC (81.5%) while the dose of strategies targeting support functions was 18.5%.
CONCLUSIONS: Our findings show both challenges and merits when strategies for implementation of PCC are conducted in a real-world setting. The results can be used to support and guide both scientists and practitioners in future implementation initiatives.
摘要：
背景：在全球范围内提倡实施以人为本的护理（PCC）。负责实施PCC作为整个医疗保健部门的广泛变革的利益相关者面临着两个相互交织的复杂挑战。首先,把PCC理解为具有复杂创新特征的干预措施，其次，通过选择适当的实施策略，分阶段实施PCC。我们旨在通过跟踪来探索这些挑战之一，命名,指定,并比较哪些策略以及如何制定策略来支持在瑞典一个医疗保健地区代表的现实世界中实施更多PCC。
方法：2016年至2019年，在医疗保健地区的两个组织级别对七个嵌入式单元进行了案例研究。数据从三个来源收集：活动日志，采访,和书面文件。从所有来源确定策略，并按名称演绎三角，定义,并根据分类专家实施变更建议（ERIC）进行聚类，并根据Proctor及其同事作为参与者的建议进行指定，行动,行动目标,时间性,剂量,结果,和理由。
结果：日志中报告了四百十三项活动，代表ERIC中确定的43种离散策略(n=38)，其他地方（n=1），或作为新兴策略(n=4)。离散策略的最高报告频率被确定为属于两个集群：培训和教育利益相关者（40％）和发展利益相关者相互关系（38％）。我们确定了属于集群的有限数量的策略使用评估和迭代策略（4.6％），以及针对患者有关变更计划的信息的更少数量的策略（0.8％）。7个单位中11,076人小时的总剂量大部分用于针对提供PCC的医疗保健专业人员的策略（81.5％），而针对支持功能的策略的剂量为18.5％。
结论：我们的研究结果表明，在现实环境中实施PCC的策略时，既有挑战，也有优点。研究结果可用于支持和指导科学家和从业人员未来的实施举措。
方法：2016年至2019年，在医疗保健地区的两个组织级别对七个嵌入式单元进行了案例研究。数据从三个来源收集：活动日志，采访,和书面文件。从所有来源确定策略，并按名称演绎三角，定义,并根据分类专家实施变更建议（ERIC）进行聚类，并根据Proctor及其同事作为参与者的建议进行指定，行动,行动目标,时间性,剂量,结果,和理由。
结果：日志中报告了四百十三项活动，代表ERIC中确定的43种离散策略(n=38)，其他地方（n=1），或作为新兴策略(n=4)。离散策略的最高报告频率被确定为属于两个集群：培训和教育利益相关者（40％）和发展利益相关者相互关系（38％）。我们确定了属于集群的有限数量的策略使用评估和迭代策略（4.6％），以及针对患者有关变更计划的信息的更少数量的策略（0.8％）。7个单位中11,076人小时的总剂量大部分用于针对提供PCC的医疗保健专业人员的策略（81.5％），而针对支持功能的策略的剂量为18.5％。
结论：我们的研究结果表明，在现实环境中实施PCC的策略时，既有挑战，也有优点。研究结果可用于支持和指导科学家和从业人员未来的实施举措。
