How To Fall Into A New Routine: Factors Influencing The Implementation Of An Admission And Discharge Program In Hospitals And General Practices

Introduction: The VESPEERA programme is a multifaceted programme to enhance information transfers across the whole process from admission, stay and discharge from the hospital to general practice. It was implemented in 7 hospitals and 72 general practices in Southern Germany. Intervention fidelity was heterogeneous, but overall low. A process evaluation aimed at identifying factors associated with the implementation of the VESPEERA programme.Methods: This was a qualitative study, using semi-structured interviews, in a purposeful sample of health workers in hospitals and general practices in the VESPEERA programme. Qualitative framework analysis using the Consolidated Framework for Implementation Research was performed and revealed the topic of previous and new routines to be protruding. Then, content analysis was used and an inductive set of four stages to describe the process of staying in a previous or falling into a new routine by implementing the VESPEERA programme was developed.Results: Thirty-six interviews were conducted with 17 participants from general practices and 19 participants from hospitals. The interviewees were in different stages of the implementation process at the time of the interviews. The four stages are as following: Stage 1, “Previous routine and tension for change”, describes the initial setting in which VESPEERA was to be implemented and the factors leading to the decision to participate. In stage 2, “Adoption of the VESPEERA programme”, factors that influenced whether individuals decided to employ the innovation is described. Stage 3 comprises ”Determinants for falling into and staying in the new VESPEERA-routine”, and finally, in stage 4, the participants reflect on the success of the implementation. Conclusions: The individuals and organisations participating in the VESPEERA programme were in different stages of a from the previous to the new routine. These stages were characterised by different determinants to implementation. Emerging topics were related to organisational characteristics, such as size of the organisation, hierarchy, and leadership. Developing a new routine was identified as beneficial for implementation the innovation.Trial Registration: DRKS00015183 on DRKS / Universal Trial Number (UTN): U1111-1218-0992