Nursing Education, Practice & Research

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