Seite - 177 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

Who gets what, and how? (Contextual integration) Successful interventions depend not only on individual and collective divisions of labour, but on allocation of resources to support them. Contextual integration looks at how practices and objects become (or fail to become) integrated within the wider context of the intervention setting, in terms of available resources. This component focuses on the processes through which resources are allocated as the intervention project progresses, involving questions such as: who has authority to allocate resources, and to what degree? Are those implementing the intervention able to access additional resources to deal with emergent challenges? Returning to our earlier example of a GP surgery implementing a new EHR, we might explore whether administrators are able to access specialist knowledge support during implementation to help them work with the new system. 1.5 Evaluating implementation to promote embedding (Reflexive monitoring). Having conducted the work of initial implementation, we need to consider how participants appraise the success of the implementation project as a whole, as well as the specific practices and objects associated with it. Components of this construct focus on kind of work done to evaluate the success of the intervention, analyse its impact on working relationships and individual practices, and (if necessary) make changes to it. How is information obtained to support appraisal work (Systemization). What informs how people appraise success, and how is this information obtained? Does information flow in the same way to all participants, or do some individuals and groups gather knowledge that others don’t? Systemization may involve formal processes, such as the gathering of outcomes data within a randomized controlled trial. However, participants may also make use of information gathered through informal processes in both individual and collective appraisal (e.g. anecdotal examples of problems in practice) [3]. How do participants work together to appraise the intervention? (Communal appraisal). Participants often work together to evaluate the worth of interventions (overall or in part), and these can involve formal processes such as team meetings, or informal groups (e.g. coffee break conversations). Different kinds of meeting may involve different processes that affect how the appraisal process is conducted. Formal meetings may have agendas structured around discussions of specific kinds of information (e.g. outcomes data from an RCT). They may also involve implicit or explicit divisions of labour that affect the kinds of information that enter discussions (e.g. formal meetings of consultants may exclude the informal observations of other participants). Likewise, unstructured appraisal may favour specific kinds of information (e.g. informal observations from practice) over others. The significance of this component is to recognize the kinds of appraisal work that are occurring within the field of implementation, and how these may affect the ways that participants understand and work with aspects of the intervention. M.BracherandC.R.May / ImplementingandEmbeddingHealth InformaticsSystems 177