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Journal Articles BMC Health Services Research Year : 2021

A framework for the implementation of certification procedures in nurse level: a mixed approach study


Background:The implementation of certification procedures across healthcare systems is an essential componentof the management process. Several promising approaches were developed toward a successful implementation ofsuch policies; however, a precise adaptation and implementation to each local context was essential. Local activitiesmust be considered in order to generate more pragmatic recommendations for managers. In this study, we built aframework for the implementation of certification procedures at nurse activity level. This was developed using twoobjectives: the identification of key implementation process components, and the integration of these componentsinto a framework which considered the local socio-material context of nurses’work.Methods:We used a two-step mixed approach. The first was inductive and consisted of a qualitative case studyconducted between April and December 2019. Here, we analyzed the implementation of certification procedures ina French teaching hospital. Data were collected using semi-structured interviews and observations. In the secondapproach, emerging data were deductively analyzed using the Quality Implementation Tool (QIT) and TranslationalMobilization Theory (TMT). Analyses were combined to construct an implementation framework.Results:Sixteen interviews were conducted with participants from different organizational levels, managers, mid-managers, and nurses. Additionally, 83 observational hours were carried out in two different wards. Our resultsshowed that, (1) All retrieved elements during the process were successfully captured by the QIT components, onlyone component was not applicable. (2) We identified elements related to the local activity context, with thedifferent interrelationships between actors, actions, and contexts using the TMT. (3) Our analyses were integratedand translated into a framework that presents the implementation of certification procedures in healthcare facilities,with a specific interest to the nurse/mid-manager level. By initially using QIT, the framework components took on atransversal aspect which were then adapted by TMT to the local work context.Conclusions:We successfully generated a framework that supports the implementation of certification proceduresat the activity level. Our approach identified a broader vision of the interactions between proximity managers,teams, and contexts during change mobilization, which were not encompassed by transversal framework only, suchas QIT. In the future, more empirical studies are needed to test this framework.
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hal-03404596 , version 1 (26-10-2021)



Israa Salma, Mathias Waelli. A framework for the implementation of certification procedures in nurse level: a mixed approach study. BMC Health Services Research, 2021, 21 (1), ⟨10.1186/s12913-021-06940-0⟩. ⟨hal-03404596⟩
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