Qualitative analysis of the implementation of a hospital room service in a large metropolitan hospital: foundations for transformation.

INTRODUCTION AND AIMS: Room service is a hospital meal service model with demonstrated improved nutrition intake, reduced wastage and cost benefits in some settings compared with traditional models. However, uptake across public hospital settings appears low; the underlying reasons require exploration. In 2019, room service was introduced in a Queensland Hospital and Health Service site. The aim of this article is to identify the barriers and enablers to implementing room service to provide recommendations for future implementation of this model. METHODS: The current qualitative descriptive study utilized semistructured interviews with project members and key stakeholders involved in implementation of the room service meal delivery model at the Prince Charles Hospital (Queensland, Australia). A convenience sample of participants were recruited. Interviews explored project experiences from commencement to completion, barriers and enablers to implementation, strategies to overcome challenges and recommendations for implementation at other sites. Interviews were coded to identify themes and subthemes. RESULTS: Nine participants were interviewed. Key themes with associated subthemes were (1) foundations of transformation, (2) navigating implementation and (3) embedding sustainable practices. CONCLUSION: The current study adds rich information to understand factors that support the implementation of a room service model in a large public hospital. Future implementation of room service should not only consider measuring quantifiable outcomes, but also the importance of qualitative descriptive studies surveying project members and key stakeholders to further explore experiences, barriers and enablers to implementation and develop strategies to overcome challenges to assist further sites implement this model.

Re-evaluating the nutritional awareness, knowledge and eating behaviours of women attending a tertiary maternity hospital following iterative service redesign.

AIM: Since the opening of the new Mater Mothers' Hospital in 2008, innovative initiatives were developed, implemented and evaluated to meet women's nutritional needs. This study evaluated changes in women's nutritional awareness, knowledge and behaviours and compared these data with our baseline survey. METHODS: During 2014-2017, 421 postnatal women were surveyed across nine survey periods. Results were compared with those from our 2008 survey (n = 102). Surveys assessed nutrition knowledge, attitudes, behaviour, education preferences, and dietetic service awareness and were distributed on meal trays. RESULTS: A greater proportion of women accessed the nutrition services in 2014-2017 compared with 2008 (19.7% vs 9.9%) and rated the resources favourably (≥3.5 out of 5). A similar proportion rated the importance of eating well postnatally (83.1% vs 92.1%) and returning to their pre-pregnancy weight (62.4% vs 68.3%) as important/very important. In both periods, women had poor diet quality, despite identifying healthy eating as a high priority. A reduction in median gestational weight gain (GWG) approached significance, 13.0 kg (2014-2017) versus 14.0 kg (2008), P = 0.055. There was a significant association between GWG and cohort with an increase in the proportion of women gaining within their correct guidelines (by 15.4%), a reduction of excessive gain (by 24.7%, P < 0.001) over time. CONCLUSIONS: Evidence-based service changes made since 2008 have effected positive change in women's GWG, service preferences, and access. However, women still require awareness-raising and behaviour change programs to improve diet quality and GWG to ensure optimal pregnancy outcomes.

Clinically relevant improvements achieved from a facilitated implementation of a gestational diabetes model of care.

AIM: Medical nutrition therapy is a cornerstone treatment in gestational diabetes; however, most Australian women diagnosed with gestational diabetes do not receive this. The project evaluated adaptation of a successful evidence-based gestational diabetes model of care implementation from a tertiary centre into regional sites with varied demographics, population size and service capacity. METHODS: The project used a hub (project team)-spoke (sites) model in Far North Queensland (Site 1) and regional South-East Queensland (Site 2). Sites selected demonstrated strong gestational diabetes team cohesiveness and project commitment. The project phases were consultation, baseline, transition and implementation. A best practice decision tree tool was provided to assess/manage barriers to the model of care and clinical outcomes captured through a project database. RESULTS: Role clarification of site members, management engagement, site visits, decision tree and database refinement were completed in the project's first phase. Unexpected organisational and team barriers prevented timeline implementation as planned. Sites negotiated relevant reallocation of resources to achieve project deliverables. The proportion of women seen according to best practice increased from 3.5 to 87.8% (P < 0.001) (Site 1) and nil to 4.8% (P = 0.09) (Site 2), and those on medication dropped by 3.4 (Site 1) and 9.1% (Site 2). CONCLUSIONS: This project demonstrates a successful implementation using a facilitated and rigorous approach. Support, engagement and tools at many levels were keys to success at both sites. The present study illustrates the opportunities and challenges of conducting implementation research within routine clinical care, particularly in resource-challenged sites.