Phase 1: Evidence synthesis and qualitative methods

Feb 1

Written By Advancing Women in Healthcare Leadership

The field of implementation research has grown significantly, with more studies aiming to understand the complexity and dynamics of different settings and their impact on implementation outcomes. Qualitative methods, such as interviews and focus groups, offer a valuable approach to informing implementation efforts as they provide insights into how and why an intervention may succeed or fail. When looking at organisational change, qualitative methods also help answer questions on how those affected by the process of implementation, (i.e. the workforce), may experience this change.

My research at Monash University, in collaboration with Epworth Healthcare, via the Graduate Research Industry Partnership program, has led to the development of a range of qualitative research studies, including the collection of data, and analytical strategies to make sense of evidence-based interventions, their implementation processes, and the sustainment of desired outcomes. The findings generated from these studies have proven valuable to the broader Advancing Women in Healthcare Leadership (AWHL) research project as they allow us to answer high priority questions, important for addressing gender equity change at the organisational level.

High priority question 1: What are the organisational interventions that advance women in leadership?

By conducting a cross-industry systematic review and qualitative meta-synthesis new insights were gained into interventions that can be effectively implemented to enhance gender equity for women in leadership (read protocol here and read paper here).

This work provides the basis for developing a taxonomy of intervention outcomes, necessary for assessing implementation effectiveness (i.e., approaches employed to integrate an intervention into a new practice setting) especially when valid measures are not yet available. This research was warmly welcomed, see here and here. Findings directly informed the design of interview, survey and focus group questions, to identify priority areas within AWHL project partners.

High priority question 2: How could we effectively implement evidence-based interventions in a healthcare setting?

To answer this question, I conducted a meta-ethnographic analysis to examine the factors that impact implementation effectiveness in the healthcare, medical and academic medicine sectors. The findings of this study highlight factors relevant to the leadership of the organisation, the culture of the workforce and the structure and fit of the intervention, which may function as facilitators or inhibitors for implementation outcomes.

With this work, we now understand the mechanisms of change needed for effective implementation of interventions that advance women in leadership; i.e. we have bridged a knowledge gap between the theorised and the actual mechanisms of change by identifying and explaining which elements of the intervention or its implementation can in fact result in change in the sector. This exercise was necessary as mechanisms of change often differ between contexts and settings and therefore, impact on how interventions (and the change facilitated through them) might be sustained beyond implementation. These findings will influence implementation of interventions across the AWHL partners, including design, pre-implementation, and sustainability post implementation.

High priority question 3: Why would an intervention succeed or fail when implemented in a healthcare setting?

I took a grounded theory approach to the analysis of interviews with women leaders in healthcare, which led to a deeper understanding of the organisational processes that support career advancement into leadership. This study explored what is of importance from the participants perspective, and why interventions may have worked in their experience. This research found four factors relevant to intervention fit, outlining what individuals respond to, with recommendations for strategies that support implementation within organisations.

We produced stakeholder-centred perspectives for implementation design and delivery of interventions that support women in leadership. Here, the voices of women in leadership, as well as those who have a “stake” in implementation and who are responsible for decisions that impact on health are informed by research evidence. By understanding the perspectives of those affected by implementation, interventions can be designed to address high priority problems, that are relevant, acceptable and feasible within the context of actual practice. For example, participants gave perceptions of intervention credibility, with insights on important implementation features, organisational context, and support needed to maintain changes brought about by interventions.

ABOUT THE RESEARCHER

Mariam Mousa is a PhD candidate within the Monash Centre for Health Research and Implementation at Monash University, jointly funded by Epworth HealthCare and Monash University. Her research centres on the study of organisations and the structures, practices and processes that enable career advancement for women in leadership. She brings to this work over fifteen years of Industry expertise as an organisational psychologist, where she has dedicated her career to understanding the various intersections of interpersonal, social, and structural issues, with the view to mobilize empirically-driven organisational change. She draws on mixed-methods, participatory and co-design approaches, critical methodologies as well as new and emerging technologies to conduct her research. Mariam published a recent systematic review and meta-synthesis in a Lancet series journal on organisational interventions for gender equity.

Mariam is working currently with supervisor Prof Helena Teede and A/Prof Jacqueline Boyle who are also leads on the Advancing Women in Healthcare leadership program, along with a multi-disciplinary team of national and international academics, and business experts to translate and scale her PhD research. This entails aspects of organisational change management, including leadership training and development, and the co-design and implementation of tools and resources to support sustainable systems change for organisations in the health sector.

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