The nature of change in health interventions: qualitative findings from two cancer research projects in Scotland

Citation

McInnes M, Teodorowski P, Gadsby E & Hibberd C (2024) The nature of change in health interventions: qualitative findings from two cancer research projects in Scotland. Interventions & co-creation. Society for Social Medicine: Annual Scientific Meeting, Glasgow, 04.09.2024-06.09.2024. https://jech.bmj.com/content/78/Suppl_1/A26.1; https://doi.org/10.1136/jech-2024-ssmabstracts.54

Abstract
Background Many health boards within NHS Scotland find it challenging to meet the 62-day referral to treatment targets for suspected cancer. Cancer Research UK has been supporting innovations aimed at improving cancer diagnostic pathways through their Test, Evidence, Transition (TET) programme. We report on the evaluation of two TET projects designed to improve breast (NHS Forth Valley) and prostate cancer (NHS Fife) pathways. Our objective is to share learning about the nature of change from the design and implementation stage of both projects. Methods Set within a hybrid effectiveness-implementation study design, we purposively identified ten NHS staff for semi-structured interviews (after the initial implementation phase). These captured clinical and non-clinical staff experiences of designing and implementing new pathways for patients with urgent suspected cancer. Interviews were analysed thematically in NVivo 20. An inductive and deductive approach to analysis was adopted, with deductive codes identified based on the projects’ Theories of Change. Data is further enriched by informal observations and field notes. Analysis was informed by a patient contributors’ group and stakeholder feedback. Results We identified four themes that illuminate the change process: scalability refers to sensitivity to the change context; staff attitudes and motivations to change highlight different conceptualisations of change and staff attitudes to the change and adaptations; thinking in systems recognises the interrelatedness of elements in the system and the potential for feedback loops and highlights the importance of considering the whole patient journey; co-evolution illustrates key challenges and facilitators to implementation and the co-evolution that occurred in response. Conclusion Preliminary findings indicate the acceptability of the new pathways from the perspectives of both clinical and non-clinical staff, where the pathways were perceived to improve the patient experience and reduce workload. The pathways could be scalable to other cancer pathways and NHS boards, taking into consideration the local context. Successful implementation requires establishing open lines of communication, clear and concise information to support staff implementing the change. Engaging service providers and stakeholders early in the development of improvement plans may increase understanding, acceptability, and adoption of healthcare innovations.