Table 4 Attributes of an embedded intervention mapped onto four domains
| Â | Attributes |
|---|---|
It is valued: Intervention is supported by evidence Distinct from but not at odds with current practice Staff need to understand/see the value Confidence/trust in intervention Assists with role Fits QOF, wider policy, regulation etc Fits NHS pathway | • Cost effective • Demonstrable clinical and quality of life outcomes • Demonstrable relevance to other NHS services • Based on evidence and academic freedom • Aligned with national & local standards of care • Incorporates evaluation & auditing • Accreditation fits existing models • Examples of good practice are disseminated • Potential benefits and staff’s achievements in using the intervention are celebrated and communicated via announcements, newsletters, and e-alerts • Champions volunteer to undertake role • In addition to recruiting enthusiasts, sceptics are also recruited, working with the developers until their needs are met and are convinced of the value of the intervention |
It is integrated into local systems: Integrated/joined up systems Time to do it Support materials Practice staff are trained Central leadership & coordination Monitoring & evaluation built in There is follow up and support afterwards | • Availability of referrals & booking systems for practice staff • Collaboration between departments is fostered & maintained in order to maximise the potential of the intervention • Potential to be used for other chronic conditions • Employment of clinical champions and community advocates • Creation of links to community activities and venues • Quality assurance criteria are adhered to throughout • Different elements of the intervention (e.g. content, pedagogy and technology) work in unison • Prominent agenda item at high level meetings • Time for staff to master the intervention • Practice staff awareness of what the intervention offers and does • A strong commitment is needed from the practices and sites in terms of strategies, plans and processes to support and upskill staff • Provision of on-going support for staff • Provision of free resources • Provision of access to appropriate, reliable and future proofed equipment • Build time for delivering the intervention into staff job plans • Provision of follow on care and advice • Integration with diabetes care |
It is permeable: Awareness exists Provision is tailored to local context Access is individualised Communication with recipients is effective | • Accessible in a number of ways • Involves wider support network [than the patient] where appropriate, including partners, parents, children and carers • Delivered by practice staff who can develop an ongoing relationship with recipients and at a local, accessible and familiar venue • Recipients should be able to drop in and out as required • Flexible to patients, practices and sites, in terms of being tailored to local needs • Adaptable to the needs of different individuals and communities • Group sessions should be arranged for peer groups (e.g. similar age/background/culture/fitness levels) |
It is effectively delivered: Content is tailored appropriately Delivery is flexible Consistent content & messages throughout | • Delivered in residential & care homes • Available in a variety of formats/languages • Style & delivery is adapted to meet the needs of individuals • Developed and delivered in respect of copyright rules • Provision of easy to use with navigational tools and supporting material (e.g. guidelines) • Associated resources are coordinated and shared to maximise efficiency • Regularly modified and kept up to date • Developed and led by those who use it, user piloting and feedback is crucial • Implement systematic procedures for obtaining staff input • Problems are addressed with quick solutions • Continuity of care & delivery (i.e. by the same people) |