Background
The administration of magnesium sulphate (MgSO4) in preterm labour is an evidence-based intervention recommended by the United Kingdom’s National Institute for Health and Care Excellence (NICE) to prevent neurological damage to the infant. However, uptake varies across UK maternity units. We used findings from implementation research in England, Scotland and Wales to explore knowledge mobilisation as a mechanism for improving adherence to clinical guidance.
Methods
Data were collected using semi-structured interviews for a process evaluation of the PReCePT (Preventing Cerebral Palsy in Pre-Term Labour) National Programme, the PReCePT cRCT study, and a study investigating MgSO4 guidance implementation in Scotland and Wales. Normalisation Process Theory informed data collection and analysis. Data were analysed using the framework method.
Results
Interviews with 68 strategic and clinical leads and implementers from the three nations suggested that despite evidence being necessary and important for policy decision-making, clinical leadership intervention decisions were motivated by audit data and benchmarking. Implementation success was impaired by degrees of silo working and rigid role boundaries, alongside differences in implementers’ ability to mobilise social-cognitive (e.g. commitment by maternity, neonatal and obstetric teams), and social-structural resources such as staff capacity, articulated workflows, and culture.
Cross-organisational, diverse and collaborative communities of practice (CoPs) rooted in distributed leadership created a nexus between national and regional leadership, patient group representatives, implementers i.e. clinical leads and champions, and perinatal clinical teams. They provided a platform for CoP participants to build relationships and share knowledge, and together negotiate meaning, co-design implementation plans, share operational enablers such as strategies and products, and assess progress. Where training opportunities were provided alongside mentoring and peer support, CoPs created implementation resource i.e. capacity and capability within the perinatal system. Backfill funding for champions and protected time away from clinical duties were required to enable participation, especially for champions in resource-poor settings.
Conclusions
Opportunities to participate in collaborative, diverse, cross-organisational CoPs where knowledge and innovation can be co-created, shared, and spread across the perinatal ecosystem, can help address disparities in clinical teams’ ability to implement evidence-based interventions. Participation relies on backfill funding for champions, and a system-wide commitment to improvement.