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Facilitating implementation of the Decision-Making Capacity Assessment (DMCA) Model: senior leadership perspectives on the use of the National Implementation Research Network (NIRN) Model and frameworks.

ABSTRACT: OBJECTIVE:Dementia and other chronic conditions can compromise a person's ability to make independent personal and financial decisions. In the wake of an ageing population and rising incidence of chronic conditions, the number of persons who may require Decision-Making Capacity Assessments (DMCAs) is likely to increase. Legislation (e.g., Trusteeship, Guardianship, Medical Assistance in Dying) also necessitates that DMCAs adhere to legislative requirements and principles. An intentional, explicit and systematic means of implementing standardized DMCA best-practices is advisable. This single exploratory case-study examined the perspectives of senior leaders and clinical experts regarding the utility of using the National Implementation Research Network (NIRN) Model to facilitate implementation, spread and sustainability of a DMCA Model. Participants learned about the NIRN Model and discussed its application during working and focus groups, all of which were audio-recorded, transcribed, and analyzed using thematic analysis. RESULTS:Participants found that the NIRN Model aligned well with the DMCA Model, and offered utility to support implementation, spread and sustainability of DMCA best-practices. Participants also noted barriers related to its language, inability to capture personal change, resource requirements, and complexity. It was recommended that a NIRN-informed DMCA-specific implementation framework and toolkit be developed and NIRN-champions be available to guide implementation.

SUBMITTER: Bremault-Phillips S

PROVIDER: S-EPMC6107947 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectiveThis study investigated the barriers and facilitators that senior leaders' experience when using knowledge generated from the analysis of administrative health or care records ('analytics') to inform strategic health and care decision-making.SettingOne London-based sustainability and transformation partnership (STP) in England, as it was on the cusp of forming an integrated care system (ICS).Participants20 senior leaders, including health and social care commissioners, public health leads and health providers. Participants were eligible for inclusion if they were a senior leader of a constituent organisation of the STP and involved in using analytics to make decisions for their own organisations or health and care systems.DesignSemi-structured interviews conducted between January 2020 and March 2020 and analysed using the framework method to generate common themes.ResultsOrganisational fragmentation hindered use of analytics by creating siloed data systems, barriers to data sharing and different organisational priorities. Where trusted and collaborative relationships existed between leaders and analysts, organisational barriers were circumvented and access to and support for analytics facilitated. Trusted and collaborative relationships between individual leaders of different organisations also aided cross-organisational priority setting, which was a key facilitator of strategic health and care decision-making and use of analytics. Data linked across health and care settings were viewed as an enabler of use of analytics for decision-making, while concerns around data quality often stopped analytics use as a part of decision-making, with participants relying more so on expert opinion or intuition.ConclusionsThe UK Governments' 2021 White Paper set out aspirations for data to transform care. While necessary, policy changes to facilitate data sharing across organisations will be insufficient to realise this aim. Better integration of organisations with aligned priorities could support and sustain cross-organisational relationships between leaders and analysts, and leaders of different organisations, to facilitate use of analytics in decision-making.

Dataset Information

Facilitating implementation of the Decision-Making Capacity Assessment (DMCA) Model: senior leadership perspectives on the use of the National Implementation Research Network (NIRN) Model and frameworks.

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