What drives change in neonatal intensive care units? A qualitative study with physicians and nurses in six European countries

• Published in: Pediatric research 2020-08, Vol.88 (2), p.257-264
• Main Authors: Cuttini, Marina, Forcella, Emanuela, Rodrigues, Carina, Draper, Elizabeth S., Martins, Ana F., Lainé, Agnés, Willars, Janet, Hasselager, Asbjørn, Maier, Rolf F., Croci, Ileana, Bonet, Mercedes, Zeitlin, Jennifer
• Format: Article
• Language: English
• Subjects: Adult; Attitude of Health Personnel; Clinical; Clinical Research Article; Denmark; Diffusion of Innovation; Evidence-Based Medicine - organization & administration; Female; France; Germany; Humanities and Social Sciences; Humans; Infant; Infant, Newborn; Infant, Premature; Innovations; Intensive care; Intensive Care Units, Neonatal; Intensive Care, Neonatal - organization & administration; Italy; Life Sciences; Male; Medicine; Medicine & Public Health; Middle Aged; Models, Organizational; Neonatal Nursing; Nurses; Organizational change; Pediatric Surgery; Pediatrics; Perinatal Care - organization & administration; Physicians; Portugal; Qualitative Research; Treatment Outcome; United Kingdom
• ISSN: 0031-3998; 1530-0447
• DOI: 10.1038/s41390-019-0733-9

Background Innovation is important to improve patient care, but few studies have explored the factors that initiate change in healthcare organizations. Methods As part of the European project EPICE on evidence-based perinatal care, we carried out semi-structured interviews ( N  = 44) with medical and nursing staff from 11 randomly selected neonatal intensive care units in 6 countries. The interviews focused on the most recent clinical or organizational change in the unit relevant to the care of very preterm infants. Thematic analysis was performed using verbatim transcripts of recorded interviews. Results Reported changes concerned ventilation, feeding and nutrition, neonatal sepsis, infant care, pain management and care of parents. Six categories of drivers to change were identified: availability of new knowledge or technology; guidelines or regulations from outside the unit; need to standardize practices; participation in research; occurrence of adverse events; and wish to improve care. Innovations originating within the unit, linked to the availability of new technology and seen to provide clear benefit for patients were more likely to achieve consensus and rapid implementation. Conclusions Innovation can be initiated by several drivers that can impact on the success and sustainability of change.