title: Towards multidisciplinary assessment of older people: exploring the change process.
abstract: OBJECTIVE
  This paper discusses the process of change that took place in an intervention study of standardized multidisciplinary assessment guidelines implemented in a female ward for older people in a District General Hospital in South London. This study was one of nine implementation projects in the South Thames Evidence-Based Practice Project.
  
  
  BACKGROUND
  The relationship between the worlds of research and healthcare practice is uneasy and contested and, as such, is a breeding ground for challenging questions about how evidence can be used to foment change in clinical practice. Recent literature on change highlights the importance of understanding complexity, which informed our approach and analysis.
  
  
  METHODS
  A multifaceted approach to change that comprised evidence-based guidelines, leadership (project leader) and change management was evaluated before and after the implementation by telephone interviews with patients, a postal survey of community staff and interviews with ward staff. A diagnostic analysis of current assessment practice informed the change process. The project leader collected data on adherence.
  
  
  RESULTS
  This paper draws on descriptive and qualitative data and addresses the links between contextual issues and the processes and pathways of change, informed by theoretical ideas from the change literature. Key themes emerged: working through others and across boundaries, managing uncertainty and unanticipated challenges. Adherence of ward staff to using the multidisciplinary assessment guidelines was high, with evidence of some dissemination to community staff at follow-up. Three years after the project finished the multidisciplinary assessment is still part of routine clinical practice.
  
  
  CONCLUSIONS
  The analysis contributes to understanding about the nursing leadership of change within an interprofessional arena of practice. It highlights the importance of understanding the context in relation to the impact and sustainability of change and thus the utility of conducting a diagnostic analysis in the early stages of implementation. This has implications for developing approaches to change in nursing and interprofessional practice in other settings.
  
  
  CONCLUSIONS
  Using research to change practice needs clinical leaders who are supported by the organization and have the skills to implement research evidence, manage uncertainty and build trust with a range of other professionals.
authors.affiliation: Nursing Research Unit, King's College London, London, UK. fiona.ross@kcl.ac.uk
authors.forename: Fiona
authors.initials: F
authors.lastname: Ross
authors.forename: Claire
authors.initials: C
authors.lastname: O'Tuathail
authors.forename: Debbie
authors.initials: D
authors.lastname: Stubberfield
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D019317:Evidence-Based Medicine / Q000458:organization & administration; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006302:Health Services Research; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D008131:London; D009718:Nurse Administrators / Q000193:education / Q000458:organization & administration / Q000523:psychology; D009730:Nursing Assessment / Q000458:organization & administration*; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology; D009936:Organizational Innovation; D010348:Patient Care Team / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D011361:Professional Competence / Q000592:standards; D015397:Program Evaluation; D036301:Qualitative Research; D035502:Trust; D035501:Uncertainty