Diffusion of community heart failure service innovation in Northamptonshire: a qualitative study

Problem

Heart failure is a complex disorder leading to frequent hospitalisation and specialist care. Patients often experience challenges accessing care. In Northamptonshire, an innovative approach to heart failure services involving Community Cardiology Clinics in primary care, and Community Asset Groups at the community level was introduced to address these challenges. Diffusion, adoption, and implementation of the heart failure intervention remain understudied. Building on the Greenhalgh et al (2004) framework for diffusion of health service innovations, this study investigated the implementation of this new heart failure model. The aim was to explore and understand the diffusion dynamics of the new heart failure service model in Northamptonshire, with a focus on identifying the key determinants of adoption and implementation.

Approach

We conducted a secondary analysis of qualitative data from 11 in-depth interviews with four patients, two community carers, one general practitioner, one community heart failure nurse, one programme director, and two interviews with a community cardiologist. Inductive and deductive thematic analysis, guided by the diffusion of innovation conceptual framework, enabled the identification of themes and subthemes.

Findings

The successful implementation of community heart failure services, incorporating Community Cardiology Clinics and Community Asset Groups, was found to be both innovative and adoptable. Implementation of the innovation was characterised by competent leadership, positive managerial relationships between community cardiologist, general practitioners and third-sector professionals, a tension for change to reduce hospital admissions and expand access to care for heart failure, and dedicated funding ('slack resources'). Both service providers and patients identified the advantages of community heart failure services, highlighting improved access to specialist care closer to home and provision of rehabilitation, education, and nutrition within the community ('relative advantage'). The heart failure innovation aligned with the organisational values of primary care and third-sector organisations, facilitating readiness for adoption and implementation. Despite an overall successful implementation, challenges emerged from limited management accountabilities, such as inadequate administrative and information technology support for community cardiologists leading the innovation and its implementation.

Consequences

Heart failure innovation in Northamptonshire was perceived to improve access to care, navigating both facilitators and challenges. The application of the diffusion of innovation framework enabled identification of the governance and performance of community heart failure services within a complex intervention context. The findings on diffusion dynamics and implementation factors identified in this study are significant for the future adoption of community heart failure models in similar contexts. Moreover, this study contributes to knowledge on the establishment, adoption, and involvement of health and social care professionals in heart failure innovations.