Specifying the ’who’ in multi-level clinical contexts: potential challenges for intervention development

Abstract

Background: Designing behaviour change interventions requires clear specification of the target action and target person (i.e. whose behaviour needs to change). This study aims to illustrate the challenge of achieving this when developing organisational level interventions, such as audit and feedback, for complex clinical contexts. Methods: Semi-structured interviews with healthcare professionals (HCPs) involved in blood transfusion explored current feedback processes within four purposively sampled hospitals. Data were extracted on the different types of HCPs involved in transfusion, their role in responding to feedback, and pathways for disseminating feedback in hospitals. Findings: 25 HCPs were interviewed. In all hospitals, responding to feedback involved HCPs at multiple organisational levels. The hospital transfusion team were the core group at the first point of responding to feedback. Pathways for disseminating feedback through organisational levels (nurses, managers, consultants, junior doctors) varied across hospitals. Discussion: The target people were part of complex, multi-level networks within hospitals, posing challenges for designing interventions. Findings suggest that interventions to support change in transfusion practice should be tailored to organisational levels.