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Journal of Nursing & Care | ISSN: 2167-1168 | Volume 7
3
rd
World Congress on
May 16-17, 2018 | Montreal, Canada
Nursing Education, Practice & Research
National clinical programs in the Republic of Ireland: Aqualitative study of acute hospitals
Geraldine Shaw
Health Service Executive, Ireland
Background:
The national clinical programs were established in 2010 to achieve three objectives, namely to improve quality,
access and cost effectiveness. Limited research exists on their implementation in the Republic of Ireland (ROI). This qualitative
study identified key stakeholders’ perceptions on; a) implementation, thus far, of the national clinical programs in the Republic
of Ireland acute hospitals with a specific emphasis on these three overarching objectives and b) the conditions perceived
necessary for their implementation.
Method:
Twenty participants agreed to be interviewed. This was by means of using face-to-face audio recorded semi-structured
interviews. The data was transcribed, coded and analyzed and a number of significant themes emerged from the dataset relating
to the study questions.
Results:
While some progress was reported, overall implementation was perceived as being inconsistent. Barriers were
reported as: the structure of the approach to implementation; insufficient audit and monitoring; insufficient communication;
insufficient resources; insufficient senior management support; lack of clarity on objectives/expectations; and insufficient
leadership. Outcomes were identified as: best practice guidelines, models of care, protocols, pathways; education and training;
new services; improved discharges; improved patient outcomes; reduced length of stay; timely access; reduced waiting lists;
cost effectiveness and other intangible outcomes. Sixteen conditions grouped under four main themes, representing a synthesis
approach were perceived as necessary for implementation, namely: Governance – structure, audit and monitoring, senior
management support, accountability, clear objectives and expectations; Communication – visible face to face engagement,
internal awareness, external awareness; Leadership – program level, national level, hospital level, professional level; Resources
– budget, staff, information technology, training, skills, and competency.
Conclusions:
This study seeks to add to the existing limited body of knowledge on implementation of the national clinical
programs in the acute hospitals in the Republic of Ireland whilst also contributing to the wider international literature in
this area. It provides hitherto unreported knowledge on the conditions that are perceived necessary by key senior healthcare
stakeholders (at different levels) for their implementation in the Republic of Ireland (ROI) acute hospitals. Novel in the ROI
context is the perceived necessity to condense the number of national clinical programs and placing greater emphasis on
the need to (a) structurally integrate the national clinical programs across the continuum of care and (b) the importance
of communication through visible face-to-face engagement. This study concludes that significant progress has been made
by the national clinical programs towards meeting the objectives albeit to varying degrees. There is a strong perception that
the national clinical programs should remain and that addressing the conditions perceived necessary for implementation in
the areas of governance, communications, leadership and resources by both top-down senior health officials and bottom-
up front-line hospital staff would significantly enhance the ability of the national clinical programs to meet objectives and
implementation. It provides the Republic of Ireland health services with valuable information to inform future reform, strategic
planning and national clinical program implementation.
Biography
Dr Geraldine Shaw BA, MA, Adjunct Associate Professor University College Dublin (UCD) School of Nursing, Midwifery and Health Systems is a highly experienced
senior member of the National Office of Nursing & Midwifery Services Director’s (ONMSD) leadership team as well as the Clinical Strategy and Programmes Divi-
sion, Health Service Executive, Republic of Ireland. Actively contributes at a national strategic level to position the nursing & midwifery contribution within the wider
service context aligned to the mission and objectives of the Health Service Executive (HSE). A strategic thinker with good influencing and communication skills.
geraldine.shaw@hse.ieGeraldine Shaw, J Nurs Care 2018, Volume 7
DOI: 10.4172/2167-1168-C3-070