Article Text

Download PDFPDF

HealthPathways implementation in a New Zealand health region: a qualitative study using the Consolidated Framework for Implementation Research
  1. Tim Stokes1,
  2. Emma Tumilty1,2,
  3. Fiona Doolan-Noble1,
  4. Robin Gauld3
  1. 1 Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  2. 2 Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas, USA
  3. 3 Otago Business School, University of Otago, Dunedin, Otago, New Zealand
  1. Correspondence to Professor Tim Stokes; tim.stokes{at}


Objectives To explore the process of implementation of an online health information web-based portal and referral system (HealthPathways) using implementation science theory: the Consolidated Framework for Implementation Research (CFIR).

Setting Southern Health Region of New Zealand (Otago and Southland).

Participants Key Informants (providers and planners of healthcare) (n=10) who were either involved in the process of implementing HealthPathways or who were intended end-users of HealthPathways.

Methods Semistructured interviews were undertaken. A deductive thematic analysis using CFIR was conducted using the framework method.

Results CFIR postulates that for an intervention to be implemented successfully, account must be taken of the intervention’s core components and the adaptable periphery. The core component of HealthPathways—the web portal and referral system that contains a large number of localised clinical care pathways—had been addressed well by the product developers. Little attention had, however, been paid to addressing the adaptable periphery (adaptable elements, structures and systems related to HealthPathways and the organisation into which it was being implemented); it was seen as sufficient just to deliver the web portal and referral system and the set of clinical care pathways as developed to effect successful implementation. In terms of CFIR’s ‘inner setting’ corporate and professional cultures, the implementation climate and readiness for implementation were not properly addressed during implementation. There were also multiple failures of the implementation process (eg, lack of planning and engagement with clinicians). As a consequence, implementation of HealthPathways was highly problematic.

Conclusions The use of CFIR has furthered our understanding of the factors needed for the successful implementation of a complex health intervention (HealthPathways) in the New Zealand health system. Those charged with implementing complex health interventions should always consider the local context within which they will be implemented and tailor their implementation strategy to address these.

  • primary care
  • qualitative research

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors TS conceived and designed the study with input from RG and FD-N. ET conducted the interviews and led on the data analysis with input from TS. TS drafted the manuscript. All authors read, provided critical review and approved the final manuscript.

  • Funding University of Otago Research Grant and the Dean’s Bequest Fund, Dunedin School of Medicine.

  • Disclaimer The funding body had no involvement in the design of the study and collection, analysis and interpretation of data and in writing the manuscript.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval was obtained from the Otago University Human Ethics Committee (16/024). Written informed consent was obtained from all participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Full deidentified interview transcripts will not be shared. Informed consent, in line with the approving ethics committee, only allows for the use of deidentified extracts within research reporting and writing, in order to maintain the privacy of participants based in a defined regional area and population, thus making their identification with full transcripts more likely.