Mechanisms of impact
SIL
Multiple mechanisms of impact were identified. A major strategy was peer pressure within the ward environment from SILs who enacted spot checks and audits of whether new or existing intervention practices were carried out, often followed up with reminders, ‘nagging’ and/or education.Staff are aware that these need updating regularly and these are now part of the weekly ward audits to establish compliance. (SIL Report, Ward A)…she just nagged us all the time. (Ward Manager, Ward A)Spot check on new patient documentation to ensure that items are being used… Remains very hit and miss …ward staff identified and reminder letter given out. (SIL Report, Ward B)Spent most of the day providing short education sessions to individual staff. (SIL Report, Ward C)These actions suggest that SILs, as formally appointed internal implementation leaders, believed in their own self-efficacy in driving and accomplishing implementation goals.Networks and communication were key to implementation work. SILs created and used networks; cascading and acquiring information via email correspondence, meetings, presentations to staff members, noticeboard use, education sessions and ongoing informal communication.Good networking with other staff who are committed to providing a quality service. (SIL Report, Ward C)Preparing for my presentation for the first of the ward time out days. I have a 45-min slot to discuss and promote PERFECT-ER (SIL Report, Ward A)Ward managers played a key role as gatekeepers of change and SILs waited for their authorisation before implementing any PERFECT-ER elements.Agreed to meet the senior charge nurse at next visit to get an agreement …and start the wheels in motion. (SIL Report, Ward C)They and other key clinicians, such as PLs, facilitated implementation using their powerful positions as opinion leaders on the ward to endorse and enforce implementation.The ward sister [manager] has introduced this to the staff and put it in the ‘Hot Topics’ folder. (SIL Report, Ward B)Two wards (A and E) enlisted PERFECT-ER ‘Champions’ to take on some responsibility and facilitate implementation while undertaking their usual roles.I then decided to have PERFECT-ER Champions… I can only do so much really …it is like ‘right I want you to, you know, it is your responsibility to try and speak to your peers about this’ (SIL, Ward A)Implementation was enabled by aligning new elements of practice with current practices and organisational initiatives.…putting one of those charts in the Admission Pack …if it is not visible people won’t think to use it, so we are trying to put it so as it is normal for them and they will grab a pack and everything is there ready (SIL, Ward E)