International Practice Development Journal


Title of Article‘How did it come to this?’ Causal network analysis in practice and service development
Type of ArticleOriginal practice development and research
Author/sJohn Unsworth, Sally Lawton, Gordon Linklater
ReferenceVolume 2, Issue 1, Article 3
Date of PublicationMay 2012
KeywordsAnalysis, methods, outcomes, practice development, service development

Background: Practice development has been widely used to support change in healthcare for more than 20 years (McCormack et al., 2006), as a result there is a growing body of knowledge which, describes the process and context together with the factors that influence the outcomes of such developments. Learning from failure in practice and service development is fundamental if we are to identify and understand what factors can influence success. Too often the analysis of failure has been subjective and has relied upon anecdotal accounts. This article explains the use of the methodology developed by Miles and Huberman (1994) to inductively map how variables and factors interact to produce a particular outcome. Causal Network Analysis (CNA) is useful in exploring the factors, which can influence developments, as well as exploring what triggered the success or failure of a particular development.

Aim:This paper seeks to describe the use of CNA as a method of systematically analysing why some developments succeed while others fail.

Design:CNA represents a method of analysing prospectively or retrospectively data derived from semi-structured interviews, observation or secondary data. Two approaches to the use of CNA are described here. The first approach relates to retrospectively analysing the iterative development of a hospital palliative care service using secondary data from referrals received over a three-month period. The second approach relates to the use of ‘real time’ CNA while planning and implementing two integrated community nursing teams within a Primary Care Trust in the UK.

Results and discussion: These examples illustrate how CNA can be used to identify variables which can influence how a development is implemented and how services develop iteratively over time. CNA allows individuals to identify those factors over which they may be able to exert some influence. This enables practitioners and others to identify how developments in practice can be effectively facilitated and implemented to produce the desired improvements in patient care. Additionally, CNA allows for the presentation and synthesis of large volumes of data into an easy to present and understandable form. This in itself may prove useful when managing a complex development in order to track progress and identify next steps. CNA is a useful adjunct to practice development evaluation, in that it enables and facilitates critical reflection on the process of developing practice and the identification of how a particular outcome occurred. The approach to CNA described in this paper is founded on social constructivism but can be used alongside other evaluation approaches, such as those associated with critical social theory.

Conclusion: While CNA has been used as an approach to analysing narrative data, the use of the method to analyse practice and service development represents a valuable tool to identify why some developments succeed while others fail.

Implications for practice:

  • Not every development in practice will be successful. In order to learn from failure practitioners need a system to analyse why a development was not successful
  • CNA provides a relatively straightforward way of analysing why some developments succeed while others fail
  • Identifying the possible causes of failure allows for the identification of potential solutions and enables practitioners to navigate various organisational and inter-personal factors which can influence a practice development project
  • CNA is a useful method of mapping developments and may assist practitioners to examine the process of developing practice as well as to identify how outcomes were achieved

This article by John Unsworth, Sally Lawton, Gordon Linklater is licensed under a Creative Commons Attribution Non-Commercial 3.0 License.

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