A longitudinal qualitative evaluation of the rollout of a complex digital intervention across healthcare organisations and the significance of implementation pace

Background The Safe Medication Dashboard (known as SMASH), an intervention to reduce hazardous prescribing in general practice through a pharmacist-led intervention and web-based dashboard, was piloted in 2017. A rollout of SMASH by the regional health innovation network was funded in 2019.

Methods A longitudinal qualitative evaluation of the regional implementation effort was conducted over three years, including in-depth semi-structured interviews with relevant stakeholders (n = 18), non-participant observations (n = 42), and documentary analysis.

Results Assumptions about the replicability and complexity of the intervention led to an implementation strategy and pace that were misaligned. The implementation of SMASH suffered from delays, diversions, and disruptions due to unanticipated infrastructure needs, regulatory changes in data sharing, and the health systems’ response to the COVID-19 pandemic.

Conclusion The findings will be discussed alongside relevant implementation frameworks to highlight how interdependencies between wider policies, organisations, and technologies can significantly shape the trajectories and pace of implementation efforts.