Pushing the rock up the hill: an autoethnography of adapting an evidence-based health intervention in a hospital

This study explored the challenges of adapting an evidence-based intervention (EBI) within a hospital setting, focusing on how individuals perceived and responded to these challenges throughout the adaptation process. While successful implementation often requires contextual adaptation, few studies have explored the obstacles encountered by individuals carrying out these adaptations. To address this gap, the researchers used autoethnography to investigate the adaptation of a medication reconciliation intervention, an EBI, within a hospital setting. Drawing on personal experiences as both a hospital pharmacist and doctoral student, the study used reflective analysis to uncover individual struggles and systemic barriers. Three key challenges emerged, including organizational silos, legitimacy concerns, and self-sacrifice. All of these challenges gradually depleted the internal resources of those involved in the adaptation. These challenges were interpreted through Foucault’s concept of discipline, highlighting how disciplinary power manifested in the adaptation process. In addition, the study engaged with Albert Camus’s notion of ‘absurdity’ from The Myth of Sisyphus to reflect on personal resilience and recovery, offering a novel lens on the complexities of implementing EBIs in clinical practice.