Abstract
BACKGROUND: The Dutch Obstetric Telephone Triage System (DOTTS) was developed to improve the quality of acute obstetric care. To achieve optimal effect, DOTTS should be adopted in the daily care process by triage staff.
OBJECTIVE: The aim of this study was primarily to evaluate the degree of implementation (i.e., normalization) of the DOTTS and secondarily to evaluate which lessons can be learned from its current implementation in Dutch hospitals.
METHODS: An evaluation study with a mixed methods design was performed. All triage staff in nine Dutch hospitals who implemented DOTTS before 1 September 2019 were invited to complete the Normalization MeAsure Development (NoMAD) questionnaire between December 2019 and July 2020. The questionnaire is based on the Normalization Process Theory. This self-report questionnaire gives insight into the work people do in order to integrate and embed new practice in routine care. NPT is based on four constructs: coherence, cognitive participation, collective action and reflexive monitoring. Within the questionnaire each construct is represented by 4-7 questions. Questions could be scored on a 5-point Normalization Process Score. Descriptive statistics were used for analysis of questionnaire scores. Subsequently, analysis of questionnaires were discussed during a focus group. Template analysis following the four constructs of NPT was used for analyzing the results of the focus group.
RESULTS: In total 173 out of 294 (59%) triage-staff members completed the NoMAD-questionnaire. Ninety percent of the participants had used DOTTS for over six months. The digital application was used as much as possible or always by 137 out of 173 participants (79%). The overall Normalization Process Score was 3.77 (SD=0.36). The constructs Coherence and Cognitive Participation scored 4.01 (SD=0.47) and 4.05 (SD=0.45) respectively. Collective Action scored 3.5 (SD=0.45) and Reflexive Monitoring scored 3.72 (SD=0.47). Analysis of the focus group discussion showed that the added value of DOTTS was seen as a quality improvement for the care of pregnant women. Dedication of the complete multidisciplinary implementation team is important for facilitating normalization. Support from the medical staff, as well as proper use by all disciplines involved in the triage, were seen as facilitating factors. Participants appreciated training and evaluation and indicated a need for ongoing training and evaluation in relation to goal achievement.
CONCLUSIONS: The DOTTS has been integrated into normal care in daily practice. Evaluation by NoMAD-questionnaires gave a positive overall score. These results are in line or, in some aspects better, when compared to other evaluation studies. Key factors in the normalization process of the DOTTS in obstetric triage are the shared added value for stakeholders, the dedication of the complete multidisciplinary implementation team and implementation plans that are tailor made in the practical context of the hospital.
CLINICALTRIAL:
| Original language | English |
|---|---|
| Article number | e33709 |
| Pages (from-to) | 1-12 |
| Number of pages | 12 |
| Journal | JMIR Formative Research |
| Volume | 6 |
| Issue number | 6 |
| Early online date | 17 Jun 2022 |
| DOIs | |
| Publication status | Published - Jun 2022 |
Bibliographical note
Funding Information:The authors wish to thank all participating obstetric professionals. The authors also wish to thank Dr DJ Cronie for feedback and editing assistance.
Publisher Copyright:
©Bernice Engeltjes, Ageeth Rosman, Fedde Scheele, Christiaan Vis, Eveline Wouters.
Keywords
- hierarchy
- implementation strategy
- medical staff
- Normalization Process Theory
- obstetric triage
