Implementation barriers in dementia care: the Machine Trick

My colleague Jo Thompson Coon and I were invited to attend Alzheimer’s Society Annual Research Conference last week and give a workshop on implementation in dementia research – a topic in which we’ve a particular interest and on which the Society is funding us to do some work.

'Myee'_chaff_cutter_from_The_Powerhouse_Museum

We ran the session based around a shortened version of Howie Becker’s “Machine Trick”; the trick involves coming to understand a social problem better by imagining that you have to design a machine that would produce the situation you have observed: in this case, the failures of knowledge mobilisation around dementia research and the practice of dementia care. (A future post will go into more detail on Becker’s trick and how it can be used in implementation workshops.)

The workshop was attended by just over 40 people, a mix of researchers and research network volunteers – that is, the lay people who review and advise on Alzheimer’s Society research projects. After a brief introduction we challenged those in the room to split into small groups and identify the components that they thought our machine should have. Each of the six groups then fed back the three most important bits they had thought of, and a few people shouted out other things they though important at the end.

The components the workshop participants identified are listed below. Those that came up more than once are marked (“x2)”.

• Use of different languages by different parts of the machine x2
• Lack of understanding of barriers at outset of (research) project x2
• No patient and public involvement x2
• Lack of willingness to change or accept innovation
• Research not grounded in or exposed to reality
• Lack of leadership
• Poor quality research
• Lack of polish in presentation of findings to wider audience
• Reactive workplace with no time to plan – both for researchers and practitioners
• Poor communication and/or excessive communication between parties
• No use of experience or prior learning from previous work – for both researchers and practitioners
• Lack of appreciation of time it takes to evaluate something
• Lack of trust between parties
• Kudos and benefits only accrue to one side (typically researchers)
• Priorities geared towards immediate clinical care – lack of time and resources to think about research
• Funding geared towards finding out new stuff rather than implementing or disseminating – and no time in grants to think about implementation and dissemination
• Stifling of innovation and creativity – no time or attention available for new things
• Lack of understanding of politics – both with a small ‘p’ and a big ‘P’

These components are pretty clear and need little interpretation: the problems inherent in them, if we wanted to fix or correct the machine, are readily apparent. They also cover a lot of ground and capture some of the complications and complexities inherent in implementing healthcare research – and I use that term purposefully, since most if not all of them could be applied to many care situations, not just to dementia. In a longer workshop we might have gone on to explore how the challenges represented in the machine could be overcome or negotiated; as it was I think the format was useful in bringing researchers and non-researchers together to think about, discuss, and identify the challenges of implementation.