Understanding the initiation, formation, functioning, and performing of networks to change practices – Realist evaluation of a programme to improve newborn care in Kenya

Katherine Kalaris , Mike English , Geoff Wong
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Abstract

Networks are increasingly employed to tackle health system challenges by either explicitly or implicitly targeting the relational aspects of health systems. We undertook a Realist evaluation to test a programme theory developed during a previous Realist review on network initiation, formation, and functioning. Our aim was to further develop an understanding of the processes involved in the initiation, formation, functioning, performing, and sustaining change and impact of networks that enable changes in practice to improve quality of care and services. We undertook a multiple-methods single case study of the Newborn Essential Solutions and Technologies programme in Kenya to evolve the programme theory. The revised programme theory explains how a network evolves through three phases: Initiation & Formation, Functioning & Performing, and Sustaining Change & Impact through interrelated processes (identify a problem; collective vision; taking action to solve a problem; identity and culture), activities (knowledge and skills dissemination; cross-learning; resourcing; leadership; champions; adaptability), foundations (teamwork; psychological safe space; commitment; engaged, motivated, empowered, and confident network members; purposeful relationships, linkages, and partnerships), and cross-cutting factors (communication; trust; energy, effort, and passion). This network programme theory provides a roadmap for the relational work those employing networks should perform to promote success in changing practices to improve quality of care, service delivery, and health system functioning.
了解网络改变实践的启动、形成、运作和执行——对改善肯尼亚新生儿护理计划的现实主义评估
网络越来越多地被用于解决卫生系统的挑战,通过明确或含蓄地针对卫生系统的关系方面。我们进行了一项现实主义评估,以测试在之前的现实主义回顾中发展起来的关于网络启动、形成和功能的程序理论。我们的目的是进一步了解网络的发起、形成、运作、执行和维持变化和影响的过程,这些变化和影响使实践中的变化能够提高护理和服务的质量。我们对肯尼亚新生儿基本解决方案和技术方案进行了多方法单一案例研究,以发展方案理论。修正后的程序理论解释了网络如何通过三个阶段进化:初始阶段;形成、运作& &;执行和维持变革;通过相互关联的过程产生影响(识别问题;集体愿景;采取行动解决问题的;身份和文化)、活动(知识和技能传播;cross-learning;资源分配;领导力;冠军;适应能力)、基础(团队合作;心理安全空间;承诺;参与,积极,授权和自信的网络成员;有目的的关系、联系和伙伴关系)和跨领域因素(沟通;信任;精力、努力和激情)。这一网络规划理论为那些使用网络的人应该执行的关系工作提供了路线图,以促进成功地改变实践,提高护理质量、服务提供和卫生系统功能。
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