The implementation of care pathways to improve children’s allergy services
File(s)
Author(s)
Spitters, Sophie
Type
Thesis
Abstract
National reviews demonstrate quality deficiencies in UK health services for allergic children. In response, the RCPCH developed care pathways to improve the organisation and delivery of allergy care. However, care pathway interventions have variable success. Consequently, a literature review and four ethnographic case studies were conducted to theorise care pathway implementation and inform practical recommendations for health service improvements. This process followed the four stages of MELD dialectic: First Moment (1M) of (non-)being, Second Edge (2E) of becoming, Third Level (3L) of integrated totality, and Fourth Dimension (4D) of agency.
The 1M results define the mechanisms that cause allergy health service deficiencies and how to address them. Deficiencies were found to emerge from causal mechanisms interacting at physiological, inter-personal, and systemic levels. Care pathway interventions that address these mechanisms could improve the quality of children’s allergy services. However, healthcare improvements also depend on the implementation process and contextual influences.
The 2E results describe the unfolding journeys of four teams improving their local health services for allergic children.
The 3L results integrate the 1M theoretical understanding and 2E empirical experiences into an advanced understanding of allergy care pathway implementation. The improvement context totality captures contextual factors that manifest differently depending on geohistorical contingencies. This creates unique local challenges and opportunities. The child allergy intervention totality integrates care pathway interventions implemented across case studies. What intervention elements are implemented and to what degree is negotiated based on local challenges and opportunities. The improvement process totality captures the quality improvement methods used to develop interventions and overcome contextual challenges. Children’s allergy health service improvements emerge from the three totalities operating as a dynamic whole.
The 4D results discuss the resolution of dialectical contradictions related to the improvement of children’s allergy services. They integrate contradictory theoretical insights identified across academic disciplines by grounding them in the 2L empirical case study experiences and relating them to the 3L structural understanding. These theoretical developments are subsequently translated into practical strategies to navigate and optimise local efforts to improve children’s allergy services.
This study used MELD to make theoretical contributions in clinical allergy and improvement science with the aim to support the improvement of children’s allergy services in practice.
The 1M results define the mechanisms that cause allergy health service deficiencies and how to address them. Deficiencies were found to emerge from causal mechanisms interacting at physiological, inter-personal, and systemic levels. Care pathway interventions that address these mechanisms could improve the quality of children’s allergy services. However, healthcare improvements also depend on the implementation process and contextual influences.
The 2E results describe the unfolding journeys of four teams improving their local health services for allergic children.
The 3L results integrate the 1M theoretical understanding and 2E empirical experiences into an advanced understanding of allergy care pathway implementation. The improvement context totality captures contextual factors that manifest differently depending on geohistorical contingencies. This creates unique local challenges and opportunities. The child allergy intervention totality integrates care pathway interventions implemented across case studies. What intervention elements are implemented and to what degree is negotiated based on local challenges and opportunities. The improvement process totality captures the quality improvement methods used to develop interventions and overcome contextual challenges. Children’s allergy health service improvements emerge from the three totalities operating as a dynamic whole.
The 4D results discuss the resolution of dialectical contradictions related to the improvement of children’s allergy services. They integrate contradictory theoretical insights identified across academic disciplines by grounding them in the 2L empirical case study experiences and relating them to the 3L structural understanding. These theoretical developments are subsequently translated into practical strategies to navigate and optimise local efforts to improve children’s allergy services.
This study used MELD to make theoretical contributions in clinical allergy and improvement science with the aim to support the improvement of children’s allergy services in practice.
Version
Open Access
Date Issued
2023-09
Date Awarded
2023-10
Copyright Statement
Creative Commons Attribution NonCommercial Licence
License URL
Advisor
Warner, John
Reed, Julie
Sponsor
National Institute for Health Research (Great Britain)
Publisher Department
National Heart & Lung Institute
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)