Barriers to Implementation of the Trauma Survivors Network

Background and Purpose: The Trauma Survivors Network™ (TSN) is a program designed to help trauma patients and their family members cope with the stressors and challenges that begin at the trauma center and continue throughout recovery. The TSN was developed by a group of researchers, clinicians, and trauma survivors in collaboration with the American Trauma Society (ATS). The program is implemented at the hospital level, and incorporates self-management, peer support, timely access to information, and online social networking. The TSN was rolled out nationally in 2008 and 70 representatives of 30 trauma centers have participated in training sessions conducted by the ATS.

Numerous health care programs are never fully implemented. Of the 30 centers that have been trained to implement the TSN between 2008-2010, only three have fully implemented the program, and in total, less than a third have implemented any of its components. The goal of this research was to identify early barriers to implementation of the TSN among potential early adopters of the program.

Methods Subjects were drawn from the 35 healthcare professionals representing 10 hospitals who attended annual trainings run by the ATS from 2008 to 2010. We conducted in-depth phone interviews (N=6) with 2009 and 2010 training participants regarding their experiences from the training and at their institutions following the training. Interviews were audiotaped and transcribed; qualitative data analysis procedures were used to organize and interpret the data. Based on interview results, a survey was designed and electronically distributed to participants from the 2008 annual training (N=41).

Results Complete surveys were obtained from 71% (N=29) of 2008 training participants. Subjects reported enthusiasm for the program even prior to training (93%), increased interest in implementation after the training (69%), and that they would be able to use TSN materials for patient programs in their hospitals (83%). About half of all participants were mostly or completely confident in their abilities to implement program components (ranging between 45% for the self management program to 68% for customization and distribution of a “Patient and Family Handbook”) and enlist support within their institutions to implement the overall program (52%). When looking at program implementation at their hospitals, 45% attempted to implement only one of four TSN components, with the majority of all respondents (59%) customizing the Patient and Family Handbook. Limited time (81%), funding (81%) and a lack of institutional support from hospital leadership (62%) were most often cited as implementation detractors.

Conclusions and Implications Individual trainee confidence in their ability to implement program components was predictive of their success. This should be tracked as a metric during future training programs. Widespread dissemination of programs like the TSN requires the availability of time and funding for implementation at the hospital level. In addition to providing tools and training, program developers must give additional attention to creating a business case and providing follow up to insure the creation of institutional champions needed for widespread dissemination.