Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

© 2020 English M et al. In low and middle-income countries (LMIC) general hospitals are important for delivering some key acute care services. Neonatal care is emblematic of these acute services as averting deaths requires skilled care over many days from multiple professionals with at least basic equipment. However, hospital care is often of poor quality and large-scale change is needed to improve outcomes. However, achieving large scale change in health systems remains challenging. To set the scene we first characterise the problems of hospital newborn units (NBU) in Kenya. We then combine our understanding of theory and context with reflection on our own position as an embedded research group with no formal authority to help us propose a feasible intervention strategy linked to in initial programme theory. We explain this programme theory and suggest how within a multi-level clinical professional network leaders at the ward or mid-level of hospital hierarchies are key potential change agents. In support of our programme theory we briefly outline and seek to integrate key ideas drawn from a wider set of theories. We propose how an intervention might be developed and employed in a phased approach to create the ownership, relationships and momentum that will be needed to achieve change at scale. Finally, we discuss the implications of such a strategy for our research design that is based on a prospective, in-depth case study that includes quantitative and qualitative data collection linked to specific sub-studies. We suggest using Realistic Evaluation to integrate our findings and develop an updated programme theory that should inform future large-scale change efforts before briefly discussing some of the challenges of evaluating a network as an intervention

Original publication

DOI

10.12688/wellcomeopenres.16379.1

Type

Journal article

Journal

Wellcome Open Research

Publication Date

01/01/2020

Volume

5