Abstract：
OBJECTIVE: To explore the mechanisms of the implementation strategy, \"oilcloth sessions\" and understand and explain the ripple effects of oilcloth sessions as a strategy to implement a new emergency department.
METHODS: A qualitative design was used whereby data were collected using field notes from an ethnographic study of the oilcloth sessions and follow-up semi-structured interviews with staff, managers and key employees who participated in the oilcloth sessions. The data analysis was inspired by the realist evaluation approach of generative causality proposed by Pawson and Tilley.
RESULTS: The primary ripple effect was that the oilcloth sessions were used for different purposes than the proposed program theory, including being used as: (1) a stage, (2) a battlefield, (3) a space for imagination and (4) a strategic management tool influencing the implementation outcomes. The results bring essential knowledge that may help to explain why and how a well-defined implementation strategy has unplanned outcomes.
CONCLUSIONS: Unintended outcomes of implementation strategies are an underexplored issue. This study may help implementation researchers rethink the activities required to reduce unintended negative outcomes or explore potential unplanned outcomes and, in this way, hinder or enhance outcomes, effectiveness and sustainability. Future studies within implementation research should incorporate attention to unintended outcomes to fully understand the impact of implementation strategies.
METHODS: A qualitative design was used whereby data were collected using field notes from an ethnographic study of the oilcloth sessions and follow-up semi-structured interviews with staff, managers and key employees who participated in the oilcloth sessions. The data analysis was inspired by the realist evaluation approach of generative causality proposed by Pawson and Tilley.
RESULTS: The primary ripple effect was that the oilcloth sessions were used for different purposes than the proposed program theory, including being used as: (1) a stage, (2) a battlefield, (3) a space for imagination and (4) a strategic management tool influencing the implementation outcomes. The results bring essential knowledge that may help to explain why and how a well-defined implementation strategy has unplanned outcomes.
CONCLUSIONS: Unintended outcomes of implementation strategies are an underexplored issue. This study may help implementation researchers rethink the activities required to reduce unintended negative outcomes or explore potential unplanned outcomes and, in this way, hinder or enhance outcomes, effectiveness and sustainability. Future studies within implementation research should incorporate attention to unintended outcomes to fully understand the impact of implementation strategies.
摘要：
目的：探索实施战略的机制，“油布会议”，并理解和解释油布会议的连锁反应，作为实施新急诊科的策略。
方法：使用了定性设计，通过对油布会议的人种学研究和对员工的后续半结构化访谈收集了数据，参加油布会议的经理和关键员工。数据分析受到Pawson和Tilley提出的生成因果关系的现实主义评估方法的启发。
结果：主要的连锁反应是油布会话用于与所提出的程序理论不同的目的，包括用作：(1)一个舞台，(2)战场,（3）想象空间和（4）影响实施结果的战略管理工具。结果带来了必要的知识，可能有助于解释明确定义的实施战略为何以及如何产生计划外的结果。
结论：实施策略的意外结果是一个未被充分研究的问题。这项研究可能有助于实施研究人员重新思考减少意外负面结果或探索潜在的计划外结果所需的活动，这样,阻碍或增强结果，有效性和可持续性。实施研究中的未来研究应注意意外结果，以充分了解实施策略的影响。
方法：使用了定性设计，通过对油布会议的人种学研究和对员工的后续半结构化访谈收集了数据，参加油布会议的经理和关键员工。数据分析受到Pawson和Tilley提出的生成因果关系的现实主义评估方法的启发。
结果：主要的连锁反应是油布会话用于与所提出的程序理论不同的目的，包括用作：(1)一个舞台，(2)战场,（3）想象空间和（4）影响实施结果的战略管理工具。结果带来了必要的知识，可能有助于解释明确定义的实施战略为何以及如何产生计划外的结果。
结论：实施策略的意外结果是一个未被充分研究的问题。这项研究可能有助于实施研究人员重新思考减少意外负面结果或探索潜在的计划外结果所需的活动，这样,阻碍或增强结果，有效性和可持续性。实施研究中的未来研究应注意意外结果，以充分了解实施策略的影响。
