Table 3 Exemplar responses illustrating the major themes: Leadership; Process; Context
Leadership and engagement (Quote (Q) 1) I think having champions is really useful, so having people who are - and they have to be the right people, because it’s not necessarily going to be the senior leader, it’s someone who is respected within the space, who people listen to, who isn’t necessarily the named leader - and engaging them in a meaningful way and then getting them to lead the change. So I don’t think we necessarily need the senior leaders or the whole units at the table, but we need selected important people to be engaged and be able to be seen to be engaged so that they can take it forward. But I think we do need everyone, and I think there are so many units that if we don’t give the opportunity, at least, for each of them to be engaged then they can be lost. If it’s just engaged at a program level there are an awful lot of people who sit under the same banner and have really, really diverse practices and workforce and everything else, so being able to have representation from areas is, I think, going to be important at the outset, rather than just bringing them in once it’s been decided. Senior Medical Lead (Q2) I think it’s a very collaborative process, because...Mostly people aren’t, people are pretty happy to work you know and I think there may be times in the future where for example, [X] and [Y] are interested in following up some of the children and I would be happy to hand that over, that’s their areas of expertise and I don’t think, I think we all recognise each other’s area and we are all building to each other’s strengths. And so far there hasn’t really been any competiveness. Clinical Lead and senior academic (Q3) We spoke to settlement services, community members, the managers and staff I worked with at the community health centre, because you want to look at where you’re going to get your referrals from. People need to know about the service, they need to know what’s happening and how it’s going to be implemented. Feel that they’re actually a part of the process, not just left out - through meetings, chatting. I think essentially I feel I’m a good networker, and I think that’s something that - when I think back to that work we did in the refugee work and this as well, I’ve also been really fortunate, I’ve worked in [X health service] for 30 years so I know a lot of people, the midwifery staff know me, I know them. I’ve worked with a lot of them. So all those things have helped a lot too. And because, in the sense I’m one of them, that’s probably helped. Project Officer | |
Process of improvement and implementation (Q4) Before we even did the formative research, the important thing was we knew we needed to speak to community members Senior Research Fellow (Psychology) (Q5) The main driver was that it was a very high risk population and we were concerned about that gap and care for them. So as we went through we started talking to more and more people, we met more people. And then we met the CEO from a not for profit non-government organisation that has funding to provide to try and introduce screening in pregnancy for anxiety and depression and they already had – so they had tools and resources and experience that we could leverage off. Senior Research Fellow (Health service research) (Q6) I contacted the maternity services, found out why they weren’t doing it. Looked at what could we do that would enable us to try it and then the important thing for us was you know, before we even did the formative research, the important thing was we knew we needed to speak to community members. Because a lot of people anecdotally have always said that you can’t scene with cultural and linguistically diverse women or women from those backgrounds. Because the screening tool doesn’t work with them, because they have different concepts of mental health and therefore they won’t want to engage with it. But that wasn’t the message and that’s why we really made an effort too. Implementation team member (Q7) The national guidelines are for every woman. We decided to start with refugee women, acknowledging that it was a high risk population and yep, probably where the greatest unmet need was. Of course it was also the most complex population which is one of the reasons why it hasn’t been done. And there was a little bit of an attitude of well if we can make it work in this population we can probably make it work in the general population. So the chances of being able to roll it out across all of the Maternity Service would be great if we could get it to work in this most challenging circumstance. If we can demonstrate that it works in this situation then there can be very little criticism or very little but what if? There are very few excuses that can come up that we have not already seen and addressed. Senior Research Fellow (Health service research) (Q8) We need to prove the effectiveness of the assessment tool, before we set about sustaining it in practice. If it wasn’t effective at achieving the set objective then we would not want to sustain it. Senior Research Fellow | |
Context (Q9) We’ve received funding from [X health service] and [X university] and from [X research translation centre] as well. And the leverage that then gives us is that if we experience really serious barriers we can go to very high levels at those organisations who hold quite a lot of power and say, “Look, you and these other organisations have invested considerably in this project, recognising that it is a key priority for you, and we are experiencing these problems that we haven’t been able to address ourselves and we need some high level support on it.” And we’ve not had to use that because it’s quite a blunt instrument. Yeah we haven’t had to really call that into use yet but it’s nice to have that strategic high level support. Senior Academic Lead (Q10) I can’t speak highly enough of the people above me. I think that they really are cognisant of the impact of perinatal mental health on women and newborn well-being, and they’ve been very keen to explore opportunities to do things differently or to do some short sharp, change management as an intervention that might make a difference to the outcomes that we’re getting. Yeah, so certainly at the levels that I’ve been, they’ve been very engaged and very curious about what we can do and have been more than supportive. Midwife - Nurse manager (Q11) But it’s got to the point where a lot of the hard work has been done. But I think some of that has been because I’ve been quite strategic. I’ve been around long enough to know that research is something that buys you credibility in academic environments. And to be strategically aligned with projects like this, or other projects, buys me credibility, in terms of, you know having bargaining power and having some influence, I suppose. Service manager |