TY - JOUR

T1 - How do oilcloth sessions work? A realist evaluation approach to exploring ripple effects in an implementation strategy

AU - Kirk, Jeanette Wassar

AU - Stefansdottir, Nina Thorny

AU - Andersen, Ove

AU - Lindstroem, Mette Bendtz

AU - Powell, Byron

AU - Nilsen, Per

AU - Tjørnhøj-Thomsen, Tine

AU - Broholm-Jørgensen, Marie

N1 - Publisher Copyright: © 2024, Jeanette Wassar Kirk, Nina Thorny Stefansdottir, Ove Andersen, Mette Bendtz Lindstroem, Byron Powell, Per Nilsen, Tine Tjørnhøj-Thomsen and Marie Broholm-Jørgensen.

PY - 2024

Y1 - 2024

N2 - Purpose: 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. Design/methodology/approach: 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. Findings: 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. Originality/value: 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.

AB - Purpose: 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. Design/methodology/approach: 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. Findings: 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. Originality/value: 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.

KW - Ethnography

KW - Implementation strategies

KW - Qualitative research

KW - Realist evaluation

KW - Ripple effects

KW - Semi-structured interviews

U2 - 10.1108/JHOM-01-2023-0022

DO - 10.1108/JHOM-01-2023-0022

M3 - Journal article

C2 - 38825598

AN - SCOPUS:85194999041

VL - 38

SP - 195

EP - 215

JO - Journal of Health, Organization and Management

JF - Journal of Health, Organization and Management

SN - 1477-7266

IS - 9

ER -