P-229 Evaluating the implementation of the Dorothy house service redesign

Background

In 2022, Dorothy House Hospice Care embarked on implementing a comprehensive redesign of services in line with its mission to ensure everyone has access to outstanding palliative and end of life care. The services redesign had five specific goals: care for more people; local care, closer to home; earlier support; easier access, and more compassionate communities. With limited evidence available to inform implementation of change in hospices, this research focused on understanding the experiences of people involved in the change process.

Aims

The study sought to identify what worked well and less well during the implementation of the Dorothy House hospice service redesign, for whom, in what circumstances, to what extent, and why? The focus was on the first year of implementation (April 2022 – April 2023) and aimed to engage with stakeholders to capture learning about how hospices can transform services in line with stated goals.

Methods

This study is informed by realist evaluation. Thirty-seven semi-structured qualitative interviews were conducted with participants from across the Dorothy House community (including senior leadership team, staff, and volunteers). The interviews explored participants’ experiences of the implementation and their ideas about how and why it led to the outcomes observed in their teams. Framework analysis will enable the development of context-mechanism-outcomes explanations for how the service changes were implemented.

Results

Interview transcripts provide a rich narrative of participants’ direct and indirect experiences. Data analysis is in progress and findings will be presented at the Hospice UK conference.

Conclusions

This project develops evidence-based explanations of ‘what worked for whom’ during the first year of implementing the service redesign at Dorothy House Hospice. Improved understanding of the contexts and mechanisms of change within hospices could help to inform future implementation projects.