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Title: Using realistic evaluation to identify influences affecting the successful implementation and sustainability of the Liverpool Care Pathway for the dying patient
Author: McConnell, T. C.
ISNI:       0000 0004 5371 5296
Awarding Body: Queen's University Belfast
Current Institution: Queen's University Belfast
Date of Award: 2014
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Background: End-of-life care has become a priority at local, regional and national level and thus creative approaches to evaluating how to successfully implement tools such as the Liverpool Care Pathway (LCP) are required to enable generalist staff to improve care for patients and their families at the end of life. Aims: To determine the processes and underlying influences that facilitate or hinder appropriate implementation of the LCP. Method: The study was an organisational case study using realistic evaluation designed to identify, test and refine programme theories of what will facilitate success. Semi-structured interviews were used to illuminate the differing viewpoints of key stakeholders involved in the implementation of the LCP in one health and social care trust in Northern Ireland. Results from the National Care of the Dying Audit Hospitals pertaining to the organisation provided data on both intended and unintended outcomes. Analysis was guided by the realistic evaluation maxim "what works, for whom, and in what circumstances?" to help explore context-mechanism-outcome patterns. Results: Key resource inputs included facilitation and education for generating tension for change; clarification of goals; visible benefits and communication skills. The key enabling contexts were the priority of LCP implementation; consistent senior management support; appropriate training for facilitators; palliative care team support; presence of LCP link nurses; positive peer influence among medical teams; robust ongoing education and training; and effective multidisciplinary working. Conclusion: This research provided the opportunity to look beyond the question of whether the intervention was successful or not, and to examine the processes involved. Whilst the overall consensus of respondents was that the LCP was a good idea, in practice there were many underlying social, organisational and individual influences that hindered successful implementation and sustainability of the pathway. This research provides transferable lessons for the future implementation of end-of-life care pathways.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available