Background Introducing new practices in complex environments like the Neonatal Intensive Care Unit (NICU) is challenging, but is important in order to improve care. There is a need to better understand the process of implementation in complex environments in order to develop more effective ways of embedding new practices into routine care.
Methods Following the successful introduction of a guideline based intervention to improve the nutritional care of preterm infants on NICU, qualitative staff interviews were carried out to understand the factors affecting implementation. Data were analysed using the framework of Normalisation Process Theory (NPT). NPT considers that new practices become normalised when staff understand them (coherence), engage with them (cognitive participation), enact them (collective action) and can see the benefit of them in their work (reflexive monitoring).
Results 22 staff interviews were carried out. Key factors in successful implementation were the desire for consistent practice and the distribution of nutritional decisions to nurses and junior medical staff. Clear guidelines empowered these groups to make consistent decisions, allowing a move away from a consultant led model, which was felt to be less consistent. Being able to see the benefits of the new practices in their daily work and their patients was a key driver for continued investment by staff.
Conclusions Desire for improvements and consistency in care are a potent driver for change, and empowering new groups of staff to make decisions offers a relatively untapped way of implementing change. Seeing benefit from new practices over time reinforces their use.
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