Laetitia BERT
Scaling up and sustaining innovations focused on improving the transition of care for the elderly: a mixed sequential design study of two support tools for project leaders and two cases of innovative interventions in Chaudière-Appalaches (Quebec)
INTRODUCTION: The sustainability and scaling up of innovations facilitating care transitions for the elderly constitute a challenge for the efficiency of the healthcare system and equitable access to care. Two innovations aimed at improving care transitions for seniors in complex situations are currently implemented in Chaudière-Appalaches: the implementation of specialized geriatric nurses in the Emergency Department, and the development of the CoMPAS+ continuous quality improvement program, focusing on the care transition of seniors living with a major neurocognitive disorder. The NHS SM and the ISSaQ-4.0 are theoretical frameworks and tools that support project leaders in the sustainability and scaling up of health innovations. They could benefit the two innovations studied, but there is little evidence about them and the scientific literature remains theoretical and not very operationalized. General objective: To discriminate the links between the processes of sustaining and scaling up health innovations relating to the transition of care for the elderly in Quebec. Sub-objective a: To compare and contrast two tools measuring the factors of sustainability (NHS SM) and scaling up (ISSaQ-4.0) of health innovations. Sub-objective b: To evaluate the factors of sustainability and scaling up of health innovations relating to the transition of care for the elderly in Chaudière-Appalaches.
METHOD: My thesis is based on a mixed sequential design using a multiple case study. I rely on a theoretical framework mobilizing renewed neo-institutional theories and structuration theory to frame my analyses. Sub-objective a: To explore the depth and breadth of the evidence on the tools, I conduct literature reviews. I also carry out a comparative study of the use of these tools in the context of the implementation of the two innovations studied. After the dissemination of a quantitative questionnaire, I conduct semi-structured interviews with users of the two tools participating in the implementation of these innovations, to identify the strengths and weaknesses related to their use. Sub-objective b: I conduct a comparative case study based on a mixed sequential design, which describes and compares the two innovations. In addition to reconstructing their implementation process through an analysis of project documents, I study the factors of sustainability and scaling up of these innovations using the NHS SM and ISSaQ-4.0. A questionnaire from these tools is distributed to stakeholders in the two cases studied. The quantitative results then guide individual and group interviews, in order to understand how the different factors identified impact the sustainability and scaling up of these innovations.
EXPECTED RESULTS: The results should increase the impact of innovations aimed at improving care transitions for the elderly through recommendations targeting their sustainability and scaling up factors. These results will also improve the use of the NHS SM and ISSaQ-4.0.
CONCLUSION: This thesis illustrates the operationalization of theoretical frameworks for the sustainability and scaling up of health innovations. Ultimately, these results will contribute to the efficiency of health services, better health equity, improved quality of life for the elderly, and implementation science.