Implementation processes and staff experience of an integrated acute frailty home treatment service

Purpose

Frailty increases the risk of adverse outcomes such as falls and disability and has a major impact on health and care services. Admission to hospital confers significant risks, including deconditioning, delirium and hospital-acquired infection. In the UK, there has been a significant shift towards acute care at home using integrated “hospital at home” (HaH) services as the delivery model. The purpose of this study was to explore the implementation processes and staff experiences of a frailty home treatment service (FHTS) in England.

Design/methodology/approach

Using a multi-method, qualitative case study design, data were collected using semi-structured interviews with seven external stakeholders of the FHTS. A focus group was also conducted with seven members of the FHTS team. Interviews and the focus group were audio-recorded and transcribed. Data were analysed thematically according to an implementation science conceptual framework.

Findings

Facilitating factors for implementation included a shared purpose and vision, the presence of “champions” in leadership roles, the development of trusted relationships, a commitment to collaborative working and a multidisciplinary skill mix. Challenges included the need for clear eligibility criteria, management of staff workloads and interoperable IT systems for digital information sharing.

Originality/value

This paper illuminates the factors which support implementation, maintenance and sustainability of integrated HaH services for frailty. These factors should be explored when services are implemented in other contexts. The impact on staff workload and training needs also needs consideration.