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Chong N, Azwa I, Hassan AA, Mousavi ME, Wong PL, Ng RX, Saifi R, Basri S, Omar SFS, Walters SM, Collier ZK, Haddad MS, Altice FL, Kamarulzaman A, Earnshaw VA. HIV Activist Identity, Commitment, and Orientation Scale (HAICOS): Psychometric Evaluation to Assess Clinician's Propensity Towards HIV Activism in Malaysia. AIDS Behav 2024:10.1007/s10461-024-04381-4. [PMID: 38806844 DOI: 10.1007/s10461-024-04381-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 05/30/2024]
Abstract
HIV activism has a long history of advancing HIV treatment and is critical in dismantling HIV-related stigma. This study evaluated the psychometric quality of the HIV Activist Identity, Commitment, and Orientation Scale (HAICOS) to assess clinicians' propensity towards HIV activism in Malaysia. From November 2022 to March 2023, 74 general practitioners and primary care physicians in Malaysia participated in the study. The exploratory factor analysis (EFA) extracted an internally consistent three-factor solution with 13 items: (1) HIV activist identity and commitment, orientation towards (2) day-to-day, and (3) structural activism. The Cronbach's alpha value was 0.91, and intra-class correlation coefficient for test-retest reliability was 0.86. Stigma-related (prejudice and discrimination intent) and clinical practice (comfort in performing clinical tasks with key populations and knowledge about HIV pre-exposure prophylaxis) measures supported the construct validity of the scale. The study provided concise, structurally valid, and reliable measures to evaluate HIV activism among clinicians.
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Affiliation(s)
- Norman Chong
- Center of Excellence for Research in AIDS (CERiA), Universiti Malaya, Level 17, Wisma R&D, Jalan Pantai Baharu, Kuala Lumpur, 59990, Malaysia
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- Center of Excellence for Research in AIDS (CERiA), Universiti Malaya, Level 17, Wisma R&D, Jalan Pantai Baharu, Kuala Lumpur, 59990, Malaysia.
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Asfarina Amir Hassan
- Center of Excellence for Research in AIDS (CERiA), Universiti Malaya, Level 17, Wisma R&D, Jalan Pantai Baharu, Kuala Lumpur, 59990, Malaysia
| | | | - Pui Li Wong
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rong Xiang Ng
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rumana Saifi
- Center of Excellence for Research in AIDS (CERiA), Universiti Malaya, Level 17, Wisma R&D, Jalan Pantai Baharu, Kuala Lumpur, 59990, Malaysia
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sazali Basri
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Suzan M Walters
- School of Global Public Health, Department of Epidemiology, New York University, New York, USA
- Center for Drug Use and HIV/HCV Research, New York, USA
| | - Zachary K Collier
- Department of Educational Psychology, University of Connecticut, Connecticut, USA
| | - Marwan S Haddad
- Center for Key Populations, Community Health Center, Inc., Middletown Connecticut, USA
| | - Frederick L Altice
- Yale School of Public Health, Yale University, New Haven, USA
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, USA
| | - Adeeba Kamarulzaman
- Center of Excellence for Research in AIDS (CERiA), Universiti Malaya, Level 17, Wisma R&D, Jalan Pantai Baharu, Kuala Lumpur, 59990, Malaysia
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, New York, USA
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Curtis K, McKenzie J, Melville G, Moules P, Wylie C, Tyler A, Mulholland B. Implementation Evaluation of an Early Notification Care Bundle for Patients with Hip Fracture (eHIP). Gerontology 2024; 70:536-543. [PMID: 38452743 DOI: 10.1159/000538182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 03/01/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Hip fracture in older adults results in significant mortality and is one of the costliest fall-related injuries. The Australian Commission for Quality and Safety in Health Care hip fracture clinical care standards consolidate the best available evidence for managing this patient group; however, uptake is variable. The aim of this study was to evaluate the implementation and effectiveness of a multidisciplinary early activation mechanism and bundle of care (eHIP) on patient and health service outcomes. METHODS This controlled pre- and post-test study was conducted from June 2019-June 2021 at a large regional hospital in Australia. We hypothesised that eHIP would result in at least 50% of hip fracture patients receiving six or more components of the ACSQHC Hip Fracture Clinical Care Standard. Secondary outcomes include hospital-acquired complication rates and acute treatment costs. RESULTS There were 565 cases included for analysis. After implementation of eHIP (the post-period), 88% of patients received a correct activation of the eHIP pathway, sustained over 12 months. The proportion of patients receiving the primary outcome of six or more components increased from 36% to 49%. Care at presentation (pain and cognitive assessment) increased by 23%, and unrestricted mobilisation within 24 h improved by 10%. Prescription of appropriate analgesia improved 10-fold (5.2-57%), and patients receiving the gold standard fascia iliaca block increased from 68% to 88%. Acute treatment costs did not significantly change. DISCUSSION/CONCLUSION eHIP, a hip fracture care program incorporating evidence-based behaviour change theory, resulted in sustained improvements to patient care as recommended by the ACSQHC Hip Fracture Clinical Care Standard.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, New South Wales, Australia
| | - John McKenzie
- Illawarra Shoalhaven LHD, Department of Geriatric Medicine, Wollongong, New South Wales, Australia
| | - Geoffrey Melville
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, New South Wales, Australia,
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia,
| | - Peter Moules
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, New South Wales, Australia
| | - Cayce Wylie
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, New South Wales, Australia
| | - Alexandra Tyler
- Illawarra Shoalhaven LHD, Wollongong, New South Wales, Australia
| | - Bridie Mulholland
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Mersey Community and North West Regional Hospital, Latrobe, Tasmania, Australia
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Curtis K, Clark B, Lam MK, Huckle R, Melville G, Binks S, Ryan MW, Gardner T, Parsons MB, Ashford B. Rethinking the tiered trauma team response: A case-series study in a regional trauma centre. Emerg Med Australas 2024. [PMID: 38451003 DOI: 10.1111/1742-6723.14399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/12/2023] [Accepted: 02/18/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To reduce perceived unnecessary resource use, we modified our tiered trauma response. If a patient was not physiologically compromised, surgical registrar attendance was not mandated. We investigated the effect of this change on missed injury, unplanned representation to ED, diagnostic imaging rates and staff satisfaction. METHODS A retrospective case series study assessing the 3-month period before and after the intervention was conducted. Logistic regression analyses were used to examine the association between ordering of computerised tomography (CT) and ED length of stay (LOS), injury severity (ISS), age, surgical review and admission. A staff survey was conducted to investigate staff perceptions of the practice change. Free text data were analysed using inductive content analysis. RESULTS There were 105 patients in the control and 166 in the intervention group and their mean (SD) ISS was the same (ISS [SD] = 4 [±4] [P = 0.608]). A higher proportion of the control group were admitted (56.3% vs 42.2% [P = 0.032]) and they had a shorter ED LOS (274 min [202-456] vs 326 min [225-560], P = 0.044). The rate of missed injury was unchanged. A surgical review resulted in a 26-fold increase in receipt of a whole-body CT scan (odds ratio = 26.89, 95% confidence interval = 3.31-218.17). Just over half of survey respondents felt the change was safe (54.4%), and more surgical (90%) than ED staff (69%) reported the change as positive. CONCLUSION The removal of the surgical registrar from the initial trauma standby response did not result in any adverse events, reduced admissions, pathology and imaging, but resulted in an increased ED LOS and time to surgical review.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Emergency Department, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Benjamin Clark
- Emergency Department, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Mary K Lam
- Department of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Ryan Huckle
- Emergency Department, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Geoffrey Melville
- Emergency Department, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
- Research Operations, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
- Faulty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Simon Binks
- Emergency Department, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Ms Wende Ryan
- Emergency Department, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Trevor Gardner
- Emergency Department, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Ms Brooke Parsons
- Emergency Department, Southern NSW Local Health District, Cooma Hospital, Cooma, New South Wales, Australia
| | - Bruce Ashford
- Research Operations, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
- Faulty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Nankervis K, MacKechnie-Guire R, Maddock C, Pyatt A. Experiences of Interdisciplinary Working from the Perspective of the Society of Master Saddlers Qualified Saddle Fitters. Animals (Basel) 2024; 14:559. [PMID: 38396527 PMCID: PMC10886140 DOI: 10.3390/ani14040559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
Horse owners seek the advice and support of a number of equestrian professionals in carrying out their duty of care for their animal. In some instances, these professionals form a multi-disciplinary team (MDT). The aim of this study was to explore the experiences of the Society of Master Saddlers' qualified saddle fitters (SMSQSFs) working with other professionals and to understand the nature of inter-disciplinary working from an SMSQSF perspective. Semi-structured, one-to-one online interviews with fourteen SMSQSFs were completed. Areas explored included the nature of the participant's client base; the frequency and nature of their interactions with other professionals; their perceptions of horse owner expectations of an MDT approach; and any benefits, challenges, and barriers to an MDT approach within an equestrian setting. Interviews were video and audio recorded (MS Teams), transcribed verbatim (Otter ai), and imported into qualitative data analysis software (NVivo, version 12). Data were analysed using thematic analysis. Six themes were identified: (1) effective communication; (2) multidisciplinary expectations; (3) horse welfare; (4) professionalism; (5) relationships; (6) working together. Communication was recognised as a crucial component of an effective MDT. Most participants valued and desired an MDT approach. They felt they had a key role to play within the equestrian MDT, not only in the prevention of deterioration in horse welfare but also in improving the functionality and performance of the horse-rider partnership. Effective MDT working was also seen as having benefits to SMSQSFs and other professional stakeholders alike, although time and financial constraints were identified as barriers to MTD working. The role of the horse owner within the MDT was unclear and potentially complex, and this and other factors such as the professional identity of the SMSQSF, personal relationships, and input from others outside of the MDT team were identified as challenges to effective MDT working. This present study found that SMSQSFs experience similar benefits and challenges to an MDT approach as seen in human healthcare settings. The role of the horse owner, communication, and professional recognition are indicated as pivotal to MDT effectiveness in achieving optimal saddle fit.
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Affiliation(s)
- Kathryn Nankervis
- Equine Department, Hartpury University, Gloucestershire GL19 3BE, UK; (R.M.-G.); (C.M.)
| | | | - Christy Maddock
- Equine Department, Hartpury University, Gloucestershire GL19 3BE, UK; (R.M.-G.); (C.M.)
| | - Alison Pyatt
- International Office, Veterinary Medicines Directorate, Addlestone KT15 3LS, UK;
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Barlow M, Watson B, Jones E, Morse C, Maccallum F. The application of communication accommodation theory to understand receiver reactions in healthcare speaking up interactions. J Interprof Care 2024; 38:42-51. [PMID: 37702325 DOI: 10.1080/13561820.2023.2249939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/28/2023] [Indexed: 09/14/2023]
Abstract
Speaking up for patient safety is a well-documented, complex communication interaction, which is challenging both to teach and to implement into practice. In this study we used Communication Accommodation Theory to explore receivers' perceptions and their self-reported behaviors during an actual speaking up interaction in a health context. Intergroup dynamics were evident across interactions. Where seniority of the participants was salient, the within-profession interactions had more influence on the receiver's initial reactions and overall evaluation of the message, compared to the between profession interactions. Most of the seniority salient interactions occurred down the hierarchy, where a more senior professional ingroup member delivered the speaking up message to a more junior receiver. These senior speaker interactions elicited fear and impeded the receiver's voice. We found that nurses/midwives and allied health clinicians reported using different communication behaviors in speaking up interactions. We propose that the term "speaking up" be changed, to emphasize receivers' reactions when they are spoken up to, to help receivers engage in more mutually beneficial communication strategies.
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Affiliation(s)
- Melanie Barlow
- Faculty of Health Sciences, Australian Catholic University, Banyo, Australia
- School of Psychology, University of Queensland, St Lucia, Australia
| | - Bernadette Watson
- School of Psychology, University of Queensland, St Lucia, Australia
- Department of English and Communication, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Elizabeth Jones
- School of Psychology, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Catherine Morse
- College of Nursing & Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Fiona Maccallum
- School of Psychology, University of Queensland, St Lucia, Australia
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Rogers L, Hughes Spence S, Aivalli P, De Brún A, McAuliffe E. A systematic review critically appraising quantitative survey measures assessing power dynamics among multidisciplinary teams in acute care settings. J Interprof Care 2024; 38:156-171. [PMID: 36708308 DOI: 10.1080/13561820.2023.2168632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/07/2023] [Indexed: 01/29/2023]
Abstract
By valuing the knowledge of each discipline holistic patient-centered care can be achieved as decisions arise from expertise rather than established hierarchies. While healthcare has historically operated as a hierarchical power structure (i.e., some voices have more influence), these dynamics are rarely discussed. This review addresses this issue by appraising extant quantitative measures that assess multidisciplinary team (MDT) power dynamics. By identifying psychometrically sound measures, change agents can uncover the collective thought processes informing power structures in practice and develop strategies to mitigate power disparities. Several databases were searched. English language articles were included if they reported on quantitative measures assessing power dynamics among MDTs in acute/hospital settings. Results were synthesized using a narrative approach. In total, 6,202 search records were obtained of which 62 met the eligibility criteria. The review reveals some promising measures to assess power dynamics (e.g., Interprofessional Collaboration Scale). However, the findings also confirm several gaps in the current evidence base: 1) need for further psychometric and pragmatic testing of measures; 2) inclusion of more representative MDT samples; 3) further evaluation of unmatured power dimensions. Addressing these gaps will support the development of future interventions aimed at mitigating power imbalances and ultimately improve collaborative working within MDTs.
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Affiliation(s)
- Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Shannon Hughes Spence
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Praveenkumar Aivalli
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Aoife De Brún
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Eilish McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
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Curtis K, Fry M, Shaban RZ, Wolf L, Delao A, Kolbuk ME, Kennedy B, Considine J. Emergency nurses' perceptions of the utility, adaptability and feasibility of the emergency nursing framework HIRAID TM for practice change in US: An exploratory study. Int Emerg Nurs 2023; 71:101377. [PMID: 37972519 DOI: 10.1016/j.ienj.2023.101377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Patient assessment is a core component of nursing practice and underpins safe, high-quality patient care. HIRAIDTM, an evidence-informed emergency nursing framework, provides nurses with a structured approach to patient assessment and management post triage. In Australia, HIRAIDTM resulted in significant improvements to nurse-led communication and reduced adverse patient events. OBJECTIVES First, to explore United States (US) emergency nurses' perceptions of the evidence-informed emergency nursing framework, HIRAIDTM; second, to determine factors that would influence the feasibility and adaptability of HIRAIDTM into nursing clinical practice in EDs within the US. METHODS A cross-sectional cohort study using a survey method with a convenience sample was conducted. A 4-hour workshop introduced the HIRAIDTM framework and supporting evidence at the Emergency Nurses Association's (ENA) conference, Emergency Nursing 2022. Surveys were tested for face validity and collected information on nurse-nurse communication, self-efficacy, the practice environment and feedback on the HIRAIDTM framework. RESULTS The workshop was attended by 48 emergency nurses from 17 US States and four countries. Most respondents reported that all emergency nurses should use the same standardised approach in the assessment of patients. However, the greatest barriers to change were a lack of staff and support from management. The most likely interventions reported to enable change were face-to-face education, the opportunity to ask questions and support in the clinical environment. CONCLUSION HIRAIDTM is an acceptable and suitable emergency nursing framework for consideration in the US. Successful uptake will depend on training methods and organizational support. HIRAIDTM training should incorporate face-to-face interactive workshops.
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Affiliation(s)
- Kate Curtis
- Emergency and Trauma Nursing RC Mills Building, Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia.
| | - Margaret Fry
- Emergency and Critical Care, Conjoint Clinical Chair, Northern Sydney Local Health District, Australia; University of Technology Sydney Faculty of Health School of Nursing and Midwifery, PO Box 123 Broadway, NSW 2007, Australia.
| | - Ramon Z Shaban
- Communicable Diseases Control and Infection Prevention, Sydney Institute for Infectious Diseases and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia; Communicable Diseases Control, Public Health Unit, Centre for Population Health. Director and Chief Infection Control Practitioner Western Sydney LHD, Building 68, 5 Fleet Street, North Parramatta, NSW 2151, Australia; New South Wales Biocontainment Centre, Australia.
| | - Lisa Wolf
- Emergency Nursing Research, Emergency Nurses Association, Schaumburg, IL, USA; Elaine Marieb College of Nursing, University of Massachusetts, Amherst, MA, USA.
| | - Altair Delao
- Research, Emergency Nurses Association, 930 Woodfield Rd., Schaumburg, IL 60173, USA.
| | - Monica Escalante Kolbuk
- Novice Nurse Education Programs, Emergency Nurses Association, 930 E. Woodfield Road, Schaumburg, IL 60173, USA.
| | - Belinda Kennedy
- The University of Sydney, Rm 169, RC Mills, Camperdown, NSW 2006, Australia.
| | - Julie Considine
- Chair in Nursing (Eastern Health), Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia.
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King OA, Sayner AM, Beauchamp A, West E, Aras D, Hitch D, Wong Shee A. Research translation mentoring for emerging clinician researchers in rural and regional health settings: a qualitative study. BMC MEDICAL EDUCATION 2023; 23:817. [PMID: 37907938 PMCID: PMC10617223 DOI: 10.1186/s12909-023-04786-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Building clinician and organisation-level research translation capacity and capability is fundamental for increasing the implementation of research into health practice and policy and improving health outcomes. Research translation capacity and capability building is particularly crucial in rural and regional settings to address complex problems impacting these socially and economically disadvantaged communities. Programs to build clinicians' research translation capability typically involve training and mentoring. Little is known about the features of and influences on mentorships in the context of training for emerging clinician-researchers working in rural and regional healthcare settings. Research translation mentorships were established as part of the Supporting Translation Research in Rural and Regional settings (STaRR) program developed and delivered in Victoria, Australia from 2020 to 2021. The study sought to address the following research questions: 1) What context-specific types of support do research translation mentors provide to emerging researchers?. 2) How does the mentoring element of a rural research translational training program influence research translation capacity and capability development in rural emerging researchers and mentors, if at all?. 3) How does the mentoring element of the program influence translation capacity and capability at the organisational and regional level, if at all? METHODS We conducted a qualitative descriptive study. Interviews with individuals involved in the STaRR program took place approximately 12 months after the program and explored participants' experiences of the mentored training. Interviews were undertaken via telephone, audio-recorded, and transcribed. Data were analysed using a team-based five-stage framework approach. RESULTS Participants included emerging researchers (n = 9), mentors (n = 5), and managers (n = 4), from five health services and two universities. We identified four themes in the interview data: (1) Mentors play an educative role; (2) Mentoring enhanced by a collaborative environment; (3) Organisational challenges can influence mentorships, and (4) Mentorships help develop research networks and collective research and translation capacity. CONCLUSIONS Mentorships contributed to the development of research translation capabilities. The capabilities were developed through mentors' deepened understanding of the rural and regional healthcare contexts in which their emerging researchers worked, the broadening and strengthening of rural and regional research networks, and building and sharing research translation knowledge and skills.
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Affiliation(s)
- Olivia A King
- Western Alliance, Warrnambool, Australia.
- Monash Centre for Scholarship in Health Education, Clayton, Australia.
- Deakin Rural Health, Deakin University, Warrnambool, Australia.
| | - Alesha M Sayner
- Deakin Rural Health, Deakin University, Warrnambool, Australia
- Grampians Health, Ballarat, Australia
| | - Alison Beauchamp
- Monash University School of Rural Health, Warragul, Australia
- Victorian Heart Institute, Clayton, Australia
| | - Emma West
- Western Alliance, Warrnambool, Australia
- Deakin University, Geelong, Australia
| | - Drew Aras
- Western Alliance, Warrnambool, Australia
| | - Danielle Hitch
- Western Health, Sunshine, Australia
- Occupational Science and Therapy, Deakin University, Geelong, Australia
| | - Anna Wong Shee
- Deakin Rural Health, Deakin University, Warrnambool, Australia
- Grampians Health, Ballarat, Australia
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Waring J, Bishop S, Black G, Clarke JM, Exworthy M, Fulop NJ, Hartley J, Ramsay A, Roe B. Navigating the micro-politics of major system change: The implementation of Sustainability Transformation Partnerships in the English health and care system. J Health Serv Res Policy 2023; 28:233-243. [PMID: 36515386 PMCID: PMC10515458 DOI: 10.1177/13558196221142237] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate how health and care leaders navigate the micro-politics of major system change (MSC) as manifest in the formulation and implementation of Sustainability and Transformation Partnerships (STPs) in the English National Health Service (NHS). METHODS A comparative qualitative case study of three STPs carried out between 2018-2021. Data collection comprised 72 semi-structured interviews with STP leaders and stakeholders; 49h of observations of STP executive meetings, management teams and thematic committees, and documentary sources. Interpretative analysis involved developing individual and cross case reports to understand the 'disagreements, 'people and interests' and the 'skills, behaviours and practice'. FINDINGS Three linked political fault-lines underpinned the micro-politics of formulating and implementing STPs: differences in meaning and value, perceptions of winners and losers, and structural differences in power and influence. In managing these issues, STP leaders engaged in a range of complementary strategies to understand and reconcile meanings, appraise and manage risks and benefits, and to redress longstanding power imbalances, as well as those related to their own ambiguous position. CONCLUSION Given the lack of formal authority and breadth of system change, navigating the micro-politics of MSC requires political skills in listening and engagement, strategic appraisal of the political landscape and effective negotiation and consensus-building.
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Affiliation(s)
- Justin Waring
- Health Services Management Centre, University of Birmingham, UK
| | | | - Georgia Black
- Wolfson Centre for Population Health, Queen Mary, University of London, London, UK
| | | | - Mark Exworthy
- Health Services Management Centre, University of Birmingham, UK
| | - Naomi J Fulop
- Dept of Applied Health Research, University College, London, UK
| | - Jean Hartley
- School of Social Policy, Sociology and Social Research University of Kent, UK
| | - Angus Ramsay
- Dept of Applied Health Research, University College, London, UK
| | - Bridget Roe
- Health Services Management Centre, University of Birmingham, UK
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Barlow M, Watson B, Morse K, Jones E, Maccallum F. React, reframe and engage. Establishing a receiver mindset for more effective safety negotiations. J Health Organ Manag 2023; ahead-of-print. [PMID: 37749761 DOI: 10.1108/jhom-06-2023-0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
PURPOSE The response of the receiver to a voiced patient safety concern is frequently cited as a barrier to health professionals speaking up. The authors describe a novel Receiver Mindset Framework (RMF) to help health professionals understand the importance of their response when spoken up to. DESIGN/METHODOLOGY/APPROACH The framework draws on the broader receiver-focussed literature and integrates innovative findings from a series of empirical studies. These studies examined different receiver behaviour within vignettes, retrospective descriptions of real interactions and behaviour in a simulated interaction. FINDINGS The authors' findings indicated that speaking up is an intergroup interaction where social identities, context and speaker stance intersect, directly influencing both perceptions of and responses to the message. The authors' studies demonstrated that when spoken up to, health professionals poorly manage their emotions and ineffectively clarify the speaker's concerns. Currently, targeted training for receivers is overwhelmingly absent from speaking-up programmes. The receiver mindset framework provides an evidence-based, healthcare specific, receiver-focussed framework to inform programmes. ORIGINALITY/VALUE Grounded in communication accommodation theory (CAT), the resulting framework shifts speaking up training from being only speaker skill focussed, to training that recognises speaking up as a mutual negotiation between the healthcare speaker and receiver. This framework provides healthcare professionals with a novel approach to use in response to speaking up that enhances their ability to listen, understand and engage in point-of-care negotiations to ensure the physical and psychological safety of patients and staff.
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Affiliation(s)
- Melanie Barlow
- Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- School of Psychology, University of Queensland, St Lucia, Australia
| | - Bernadette Watson
- Department of English and Communication, The Hong Kong Polytechnic University, Hung Hom, China
| | - Kate Morse
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Elizabeth Jones
- School of Psychology, Monash University Malaysia, Subang Jaya, Malaysia
| | - Fiona Maccallum
- School of Psychology, University of Queensland, St Lucia, Australia
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11
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Seelandt JC, Boos M, Kolbe M, Kämmer JE. How to enrich team research in healthcare by considering five theoretical perspectives. Front Psychol 2023; 14:1232331. [PMID: 37637888 PMCID: PMC10448055 DOI: 10.3389/fpsyg.2023.1232331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
The aim of this paper is to inspire team research to apply diverse and unconventional perspectives to study team dynamics and performance in healthcare settings. To illustrate that using multiple perspectives can yield valuable insights, we examine a segment of a team interaction during a heart-surgery, using five distinct interdisciplinary perspectives known from small group research: the psychodynamic, functional, conflict-power-status, temporal, and social identity perspectives. We briefly describe each theoretical perspective, discuss its application to study healthcare teams, and present possible research questions for the segment at hand using the respective perspective. We also highlight the benefits and challenges associated with employing these diverse approaches and explore how they can be integrated to analyze team processes in health care. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses. We also point to further research avenues and highlight the benefits associated with employing these diverse approaches. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses.
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Affiliation(s)
| | - Margarete Boos
- Department of Social and Communication Psychology, Institute for Psychology, University of Göttingen, Göttingen, Germany
| | - Michaela Kolbe
- Simulation Center, University Hospital Zürich, Zürich, Switzerland
- ETH Zurich, Zürich, Switzerland
| | - Juliane E. Kämmer
- Department of Social and Communication Psychology, Institute for Psychology, University of Göttingen, Göttingen, Germany
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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12
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Fulop NJ, Walton H, Crellin N, Georghiou T, Herlitz L, Litchfield I, Massou E, Sherlaw-Johnson C, Sidhu M, Tomini SM, Vindrola-Padros C, Ellins J, Morris S, Ng PL. A rapid mixed-methods evaluation of remote home monitoring models during the COVID-19 pandemic in England. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-151. [PMID: 37800997 DOI: 10.3310/fvqw4410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Background Remote home monitoring services were developed and implemented for patients with COVID-19 during the pandemic. Patients monitored blood oxygen saturation and other readings (e.g. temperature) at home and were escalated as necessary. Objective To evaluate effectiveness, costs, implementation, and staff and patient experiences (including disparities and mode) of COVID-19 remote home monitoring services in England during the COVID-19 pandemic (waves 1 and 2). Methods A rapid mixed-methods evaluation, conducted in two phases. Phase 1 (July-August 2020) comprised a rapid systematic review, implementation and economic analysis study (in eight sites). Phase 2 (January-June 2021) comprised a large-scale, multisite, mixed-methods study of effectiveness, costs, implementation and patient/staff experience, using national data sets, surveys (28 sites) and interviews (17 sites). Results Phase 1 Findings from the review and empirical study indicated that these services have been implemented worldwide and vary substantially. Empirical findings highlighted that communication, appropriate information and multiple modes of monitoring facilitated implementation; barriers included unclear referral processes, workforce availability and lack of administrative support. Phase 2 We received surveys from 292 staff (39% response rate) and 1069 patients/carers (18% response rate). We conducted interviews with 58 staff, 62 patients/carers and 5 national leads. Despite national roll-out, enrolment to services was lower than expected (average enrolment across 37 clinical commissioning groups judged to have completed data was 8.7%). There was large variability in implementation of services, influenced by patient (e.g. local population needs), workforce (e.g. workload), organisational (e.g. collaboration) and resource (e.g. software) factors. We found that for every 10% increase in enrolment to the programme, mortality was reduced by 2% (95% confidence interval: 4% reduction to 1% increase), admissions increased by 3% (-1% to 7%), in-hospital mortality fell by 3% (-8% to 3%) and lengths of stay increased by 1.8% (-1.2% to 4.9%). None of these results are statistically significant. We found slightly longer hospital lengths of stay associated with virtual ward services (adjusted incidence rate ratio 1.05, 95% confidence interval 1.01 to 1.09), and no statistically significant impact on subsequent COVID-19 readmissions (adjusted odds ratio 0.95, 95% confidence interval 0.89 to 1.02). Low patient enrolment rates and incomplete data may have affected chances of detecting possible impact. The mean running cost per patient varied for different types of service and mode; and was driven by the number and grade of staff. Staff, patients and carers generally reported positive experiences of services. Services were easy to deliver but staff needed additional training. Staff knowledge/confidence, NHS resources/workload, dynamics between multidisciplinary team members and patients' engagement with the service (e.g. using the oximeter to record and submit readings) influenced delivery. Patients and carers felt services and human contact received reassured them and were easy to engage with. Engagement was conditional on patient, support, resource and service factors. Many sites designed services to suit the needs of their local population. Despite adaptations, disparities were reported across some patient groups. For example, older adults and patients from ethnic minorities reported more difficulties engaging with the service. Tech-enabled models helped to manage large patient groups but did not completely replace phone calls. Limitations Limitations included data completeness, inability to link data on service use to outcomes at a patient level, low survey response rates and under-representation of some patient groups. Future work Further research should consider the long-term impact and cost-effectiveness of these services and the appropriateness of different models for different groups of patients. Conclusions We were not able to find quantitative evidence that COVID-19 remote home monitoring services have been effective. However, low enrolment rates, incomplete data and varied implementation reduced our chances of detecting any impact that may have existed. While services were viewed positively by staff and patients, barriers to implementation, delivery and engagement should be considered. Study registration This study is registered with the ISRCTN (14962466). Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (RSET: 16/138/17; BRACE: 16/138/31) and NHSEI and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 13. See the NIHR Journals Library website for further project information. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care.
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Affiliation(s)
- Naomi J Fulop
- Department of Applied Health Research, University College London, UK
| | - Holly Walton
- Department of Applied Health Research, University College London, UK
| | | | | | - Lauren Herlitz
- Department of Applied Health Research, University College London, UK
| | - Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Efthalia Massou
- Department of Public Health and Primary Care, University of Cambridge, UK
| | | | - Manbinder Sidhu
- Health Services Management Centre, School of Social Policy, University of Birmingham, UK
| | - Sonila M Tomini
- Department of Applied Health Research, University College London, UK
| | | | - Jo Ellins
- Health Services Management Centre, School of Social Policy, University of Birmingham, UK
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Pei Li Ng
- Department of Applied Health Research, University College London, UK
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13
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MacLeod MLP, McCaffrey G, Wilson E, Zimmer LV, Snadden D, Zimmer P, Jónatansdóttir S, Fyfe TM, Koopmans E, Ulrich C, Graham ID. Exploring the intersection of hermeneutics and implementation: a scoping review. Syst Rev 2023; 12:30. [PMID: 36864488 PMCID: PMC9979573 DOI: 10.1186/s13643-023-02176-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 01/24/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND An enduring challenge remains about how to effectively implement programs, services, or practices. Too often, implementation does not achieve its intended effectiveness, fidelity, and sustainability, even when frameworks or theories determine implementation strategies and actions. A different approach is needed. This scoping review joined two markedly different bodies of literature: implementation and hermeneutics. Implementation is usually depicted as focused, direct, and somewhat linear, while hermeneutics attends to the messiness of everyday experience and human interaction. Both, however, are concerned with practical solutions to real-life problems. The purpose of the scoping review was to summarize existing knowledge on how a hermeneutic approach has informed the process of implementing health programs, services, or practices. METHODS We completed a scoping review by taking a Gadamerian hermeneutic approach to the JBI scoping review method. Following a pilot search, we searched eight health-related electronic databases using broadly stated terms such as implementation and hermeneutics. A diverse research team that included a patient and healthcare leader, working in pairs, independently screened titles/abstracts and full-text articles. Through the use of inclusion criteria and full-team dialogue, we selected the final articles and identified their characteristics, hermeneutic features, and implementation components. RESULTS Electronic searches resulted in 2871 unique studies. After full-text screening, we retained six articles that addressed both hermeneutics and implementing a program, service, or practice. The studies varied widely in location, topic, implementation strategies, and hermeneutic approach. All addressed assumptions underpinning implementation, the human dimensions of implementing, power differentials, and knowledge creation during implementation. All studies addressed issues foundational to implementing such as cross-cultural communication and surfacing and addressing tensions during processes of change. The studies showed how creating conceptual knowledge was a precursor to concrete, instrumental knowledge for action and behavioral change. Finally, each study demonstrated how the hermeneutic process of the fusion of horizons created new understandings needed for implementation. CONCLUSIONS Hermeneutics and implementation have rarely been combined. The studies reveal important features that can contribute to implementation success. Implementers and implementation research may benefit from understanding, articulating, and communicating hermeneutic approaches that foster the relational and contextual foundations necessary for successful implementation. TRIAL REGISTRATION The protocol was registered at the Centre for Open Science on September 10, 2019. MacLeod M, Snadden D, McCaffrey G, Zimmer L, Wilson E, Graham I, et al. A hermeneutic approach to advancing implementation science: a scoping review protocol 2019. Accessed at osf.io/eac37.
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Affiliation(s)
- Martha L P MacLeod
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada. .,Health Research Institute, University of Northern British Columbia, Prince George, British Columbia, Canada.
| | - Graham McCaffrey
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Erin Wilson
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Lela V Zimmer
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - David Snadden
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Prince George, British Columbia, Canada.,Northern Medical Program, Division of Medical Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Peter Zimmer
- University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Steinunn Jónatansdóttir
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Trina M Fyfe
- Division of Medical Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada.,Geoffrey R. Weller Library, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Erica Koopmans
- Health Research Institute, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Cathy Ulrich
- Northern Health Authority, Prince George, British Columbia, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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14
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Barlow M, Watson B, Jones E, Maccallum F, Morse KJ. The influence of professional identity on how the receiver receives and responds to a speaking up message: a cross-sectional study. BMC Nurs 2023; 22:26. [PMID: 36710343 PMCID: PMC9884599 DOI: 10.1186/s12912-023-01178-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Research focused on understanding what enables or hinders health professionals to speak up about a safety concern has been to date predominately atheoretical and speaker focused. However, the role the receiver of the message plays in these often-difficult encounters is highly influential. To date, speaking up programs have created conversational mnemonics that technically should respectfully engage the receiver, yet speaking up remains challenging. This paper utilises Communication Accommodation Theory to explore the impact the communication behaviour and speaker characteristics has on the receiver of a speaking up message, and if these impacts differ between receiver groups (clinical disciplines). METHOD Clinicians (N = 208) from varying disciplines responded to two hypothetical speaking up vignettes, where participants were the receivers of speaking up messages. Analysis of variance was used to explore any potential differences between receiver groups. RESULTS Findings indicated that the level of perceived accommodation and group membership, whether defined by speaker discipline or seniority, collectively influenced how the receiver of a speaking up message evaluated the interaction, which influenced their anticipated response to the speaker. CONCLUSIONS The receiver's perceptions and evaluations of the message, their own professional identity and the presence of others, influenced receivers' anticipated responses. This has direct implications on healthcare speaking up training and provision of care, as the varying clinical disciplines received and responded to the same messages differently.
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Affiliation(s)
- Melanie Barlow
- grid.411958.00000 0001 2194 1270 Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, QLD Australia ,grid.1003.20000 0000 9320 7537School of Psychology, University of Queensland, St Lucia, QLD Australia
| | - Bernadette Watson
- grid.1003.20000 0000 9320 7537School of Psychology, University of Queensland, St Lucia, QLD Australia ,grid.16890.360000 0004 1764 6123 Department of English and Communication, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Elizabeth Jones
- grid.440425.30000 0004 1798 0746 School of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Darul Ehsan Malaysia
| | - Fiona Maccallum
- grid.1003.20000 0000 9320 7537School of Psychology, University of Queensland, St Lucia, QLD Australia
| | - Kate J. Morse
- grid.166341.70000 0001 2181 3113 College of Nursing & Health Professions, Drexel University, 245 N 15th Street, Mail Stop 501, 4th Floor, Room 4606, Philadelphia, PA 19102 USA
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15
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Anderson LA, Kildea S, Kynoch K, Gao Y, Lee N. Midwives experiences of interventions to improve breast expression following preterm birth: A qualitative study. Midwifery 2023; 116:103530. [PMID: 36334529 DOI: 10.1016/j.midw.2022.103530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Preterm birth impacts approximately 10% of women globally. Midwives are often the first point of care after the birth of a preterm infant providing mothers with information and support for breast expression. However, despite guidelines that suggest expression within the first hour of birth, most first expressions occur much later. This study aimed to seek an understanding of midwives' experiences with the first expression for mothers of preterm infants, including the barriers and facilitators that midwives may face. DESIGN A qualitative design using semi-structured interviews via focus groups. Thematic analysis was used to identify relevant themes and sub-themes. PARTICIPANTS Participants included midwives providing care to women in preterm labour and birth at a tertiary maternity hospital in Australia (N=12). All participating midwives cared for mothers of preterm infants between 28 and 35 weeks' gestation up to six hours following birth. FINDINGS Two major themes resulted from the data, including the changing expectations of infant feeding and the responsibility versus expectation to support a woman to express in the first hour of birth with other competing clinical and organisational tasks. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Whilst individual philosophies on the benefits of human milk were positive, expressing in the birth suite was dictated by essential clinical tasks and by the institutions value placed on expressing in the first hour. Clear objectives to undertake expressing within the first hour or within the birth suite stay, need to be included in policy and supported by management and team leaders, to increase early expressing rates.
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Affiliation(s)
- Loretta A Anderson
- School of Nursing, Midwifery and Social Work, University of Queensland, Level 3 Chamberlain Building, St Lucia, Australia.
| | - Sue Kildea
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Alice Springs Campus, NT, Australia
| | - Kathryn Kynoch
- Mater Health and QLD Centre for Evidence Based Nursing and Midwifery: A JBI Centre of Excellence, South Brisbane, QLD, Australia; Australian Centre for Health Services Innovation (AusHSI) and School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Yu Gao
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane Campus, Brisbane, Australia
| | - Nigel Lee
- School of Nursing, Midwifery and Social Work, University of Queensland, Level 3 Chamberlain Building, St Lucia, Australia
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Sharp A, Carlson M, Vroom EB, Rigg K, Hills H, Harding C, Moore K, Schuman-Olivier Z. When a pandemic and epidemic collide: Lessons learned about how system barriers can interrupt implementation of addiction research. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231205890. [PMID: 37936966 PMCID: PMC10572032 DOI: 10.1177/26334895231205890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Telehealth technologies are now featured more prominently in addiction treatment services than prior to the COVID-19 pandemic, but system barriers should be carefully considered for the successful implementation of innovative remote solutions for medication management and recovery coaching support for people with opioid use disorder (OUD). Method The Centers for Disease Control and Prevention funded a telehealth trial prior to the COVID-19 pandemic with a multi-institution team who attempted to implement an innovative protocol during the height of the pandemic in 2020 in Tampa, Florida. The study evaluated the effectiveness of a mobile device application, called MySafeRx, which integrated remote motivational recovery coaching with daily supervised dosing from secure pill dispensers via videoconference, on medication adherence during buprenorphine treatment. This paper provides a participant case example followed by a reflective evaluation of how the pandemic amplified both an existing research-to-practice gap and clinical system barriers during the implementation of telehealth clinical research intervention for patients with OUD. Findings Implementation challenges arose from academic institutional requirements, boundaries and role identity, clinical staff burnout and lack of buy-in, rigid clinical protocols, and limited clinical resources, which hampered recruitment and intervention engagement. Conclusions As the urgency for feasible and effective telehealth solutions continues to rise in response to the growing numbers of opioid-related deaths, the scientific community may use these lessons learned to re-envision the relationship between intervention implementation and the role of clinical research toward mitigating the opioid overdose epidemic.
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Affiliation(s)
- Amanda Sharp
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, USA
| | - Melissa Carlson
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Enya B. Vroom
- School of Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Khary Rigg
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Holly Hills
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Cassandra Harding
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, USA
| | - Kathleen Moore
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Zev Schuman-Olivier
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, USA
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Waring J, Bishop S, Black G, Clarke JM, Exworthy M, Fulop NJ, Hartley J, Ramsay A, Roe B. Understanding the Political Skills and Behaviours for Leading the Implementation of Health Services Change: A Qualitative Interview Study. Int J Health Policy Manag 2022; 11:2686-2697. [PMID: 35297229 PMCID: PMC9818121 DOI: 10.34172/ijhpm.2022.6564] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/07/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The implementation of change in health and care services is often complicated by organisational micro-politics. There are calls for those leading change to develop and utilise political skills and behaviours to understand and mediate such politics, but to date only limited research offers a developed empirical conceptualisation of the political skills and behaviours for leading health services change. METHODS A qualitative interview study was undertaken with 66 healthcare leaders from the English National Health Service (NHS). Participants were sampled on the basis of their variable involvement in leading change processes, taking into account anticipated differences in career stage, leadership level and role, care sector, and professional backgrounds. Interpretative data analysis led to the development of five themes. RESULTS Participants' accounts highlighted five overarching sets of political skills and behaviours: personal and inter-personal qualities relating to self-belief, resilience and the ability to adapt to different audiences; strategic thinking relating to the ability to understand the wider and local political landscape from which to develop realistic plans for change; communication skills for engaging and influencing stakeholders, especially for understanding and mediating stakeholders' competing interests; networks and networking in terms of access to resources, and building connections between stakeholders; and relational tactics for dealing with difficult individuals through more direct forms of negotiation and persuasion. CONCLUSION The study offers further empirical insight the existing literature on healthcare organisational politics by describing and conceptualising the political skills and behaviours of implementing health services change.
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18
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King OA, Pinson J, Dennett A, Williams C, Davis A, Snowdon DA. Allied health assistants' perspectives of their role in healthcare settings: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4684-e4693. [PMID: 35689419 PMCID: PMC10084421 DOI: 10.1111/hsc.13874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/05/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Allied health assistants (AHAs) are important members of the health workforce and key to meeting population health needs. Previous studies exploring the role and utility of AHAs from multiple stakeholder perspectives suggest AHAs remain poorly utilised in many healthcare settings. This qualitative study explores the experiences and perspectives of AHAs working in healthcare settings to determine the contextual factors influencing their role, and mechanisms to maximise their utility. We conducted semi-structured interviews using purposive sampling with 21 AHAs, from one regional and three metropolitan health services in Australia, between February and July 2021. We used a team-based framework approach to analyse the data. Four major themes were identified: 1) AHAs' interpersonal relationships, 2), clarity and recognition of AHA roles and role boundaries, 3) AHAs accessing education and professional development, and 4) the professional identity of the AHA workforce. Underpinning each of these themes were relationships between AHAs and other healthcare professionals, their patients, health services, and the wider AHA workforce. This study may inform initiatives to optimise the utility of AHAs and increase their role in, and impact on, patient care. Such initiatives include the development and implementation of guidelines and competencies to enhance the clarity of AHAs' scope of practice, the establishment of standardised educational pathways for AHAs, and increased engagement with the AHA workforce to make decisions about their scope of practice. These initiatives may precede strategies to advance the AHA career structure.
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Affiliation(s)
- Olivia A. King
- Barwon HealthGeelongVicAustralia
- Monash Centre for Scholarship in Health EducationMonash UniversityClaytonVicAustralia
| | - Jo‐Anne Pinson
- Monash Health, Department of Medical ImagingClaytonVicAustralia
- Peninsula Health, Department of Medical ImagingFrankstonVicAustralia
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonVicAustralia
| | - Amy Dennett
- Allied Health Clinical Research OfficeEastern HealthBox HillVicAustralia
- School of Allied Health Human Services and SportLa Trobe UniversityBundooraVicAustralia
| | - Cylie Williams
- School of Primary and Allied Health CareMonash UniversityFrankstonVicAustralia
- Academic Unit, Peninsula HealthFrankstonVicAustralia
| | - Annette Davis
- Allied Health Workforce Innovation Strategy Education Research (WISER) UnitMonash HealthClaytonVicAustralia
| | - David A. Snowdon
- Academic Unit, Peninsula HealthFrankstonVicAustralia
- Peninsula Clinical School, Central Clinical SchoolMonash UniversityFrankstonVicAustralia
- National Centre for Healthy AgeingFrankstonVicAustralia
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19
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Steinmann G, Daniels K, Mieris F, Delnoij D, van de Bovenkamp H, van der Nat P. Redesigning value-based hospital structures: a qualitative study on value-based health care in the Netherlands. BMC Health Serv Res 2022; 22:1193. [PMID: 36138382 PMCID: PMC9502905 DOI: 10.1186/s12913-022-08564-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 09/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background A crucial component of value-based health care concerns the redesign of organizational structures. In theory, hospital structures should follow value creation: addressing medical conditions for specific groups of patients over full cycles of care. In practice, however, it remains unclear how hospitals can reorganize themselves into value-based structures. The purpose of this study is to explore the ways in which Dutch hospitals are currently implementing and pursuing value-based redesign. Methods This qualitative exploratory study used semi-structured interviews and a focus group for data collection. Transcripts were analyzed through deductive coding, for which we used Mintzberg’s theory on organizational structures, particularly his work on design parameters. Results In their efforts to create more value-based structures, Dutch hospitals often employ a variety of liaison devices, such as project teams and committees. By contrast, the actual formation of units around medical conditions is much rarer. Outcome data are widely used within planning and control systems, and some hospitals partake in external benchmarking. Not all hospitals use cost indicators for monitoring performance. Conclusions Value-based redesign is not necessarily a matter of radical changes or binary choices. Instead, as Dutch hospitals show, it can be an incremental process, with a variety of potential knobs to turn to various degrees. Health care executives, managers, and professionals thus have a wide range of options when they aim for more value-based structures. Our conceptualization of “value-based design parameters” can help guide the selection and implementation of strategies and mechanisms for further coordination around medical conditions over full cycles of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08564-4.
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Affiliation(s)
- Gijs Steinmann
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, Rotterdam, 3000 DR, The Netherlands.
| | - K Daniels
- Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands.,Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Fabio Mieris
- Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Diana Delnoij
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, Rotterdam, 3000 DR, The Netherlands.,National Health Care Institute (Zorginstituut Nederland), Diemen, the Netherlands
| | - Hester van de Bovenkamp
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, Rotterdam, 3000 DR, The Netherlands
| | - Paul van der Nat
- Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands.,Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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20
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Mielke J, De Geest S, Zúñiga F, Brunkert T, Zullig LL, Pfadenhauer LM, Staudacher S. Understanding dynamic complexity in context-Enriching contextual analysis in implementation science from a constructivist perspective. FRONTIERS IN HEALTH SERVICES 2022; 2:953731. [PMID: 36925847 PMCID: PMC10012673 DOI: 10.3389/frhs.2022.953731] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/01/2022] [Indexed: 01/24/2023]
Abstract
Context in implementation science includes not only characteristics of a setting in which an intervention will be delivered, but also social systems (e.g., interrelationships). Context is dynamic and interacts with both, the intervention and its implementation. Therefore, contextual analysis is recognized as an indispensable part of implementation science methodology: it provides the foundation for successful and sustainable implementation projects. Yet, driven by the prevailing post-positivist understanding of context, contextual analysis typically focuses on individual characteristics of context i.e., contextual dynamics and interactions go unnoticed. Conducting contextual analysis from a constructivist perspective promotes a multilayered approach, building a more comprehensive understanding of context, and thus facilitating successful implementation. In this article, we highlight the limitations of prevailing perspectives on context and approaches to contextual analysis. We then describe how contextual analysis can be enriched by working from a constructivist perspective. We finish with a discussion of the methodological and practical implications the proposed changes would entail. Emerging literature attempts to address both the concept of context and methods for contextual analysis. Various theories, models and frameworks consider context, however, many of these are reductionistic and do not acknowledge the dynamic nature of context or interactions within it. To complement recent conceptualizations of context, we suggest consider the following five constructivist concepts: 1) social space; 2) social place; 3) agency; 4) sensation; and 5) embodiment. We demonstrate the value of these concepts using COVID-19 vaccination uptake as an example and integrate the concepts in the Context and Implementation of Complex Interventions (CICI) framework-an implementation science framework that pays ample attention to context. To study context from a constructivist perspective, we also suggest additional considerations in view of methodologies for data collection and analysis, e.g., rapid ethnographic methods. A constructivist perspective contributes to a stronger conceptualization of contextual analysis. Considering the five constructivist concepts helps to overcome contextual analysis' current shortcomings, while revealing complex dynamics that usually go unnoticed. Thus, more comprehensive understanding of context can be developed to inform subsequent phases of an implementation project, thereby maximizing an intervention's uptake and sustainability.
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Affiliation(s)
- Juliane Mielke
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Franziska Zúñiga
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
| | - Thekla Brunkert
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
| | - Leah L. Zullig
- Center for Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care, Durham, NC, United States
- System and Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, United States
| | - Lisa M. Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
- Pettenkofer School of Public Health, Ludwig Maximilian University of Munich, Munich, Germany
| | - Sandra Staudacher
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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21
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Khurshid Z, De Brún A, McAuliffe E. Factors influencing measurement for improvement skills in healthcare staff: trainee, and trainer perspectives. BMC MEDICAL EDUCATION 2022; 22:236. [PMID: 35365138 PMCID: PMC8975706 DOI: 10.1186/s12909-022-03282-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Measurement for improvement is an integral component of quality improvement (QI) trainings and demonstrates whether a change resulted in an improvement. Despite its critical role, the development of measurement for improvement skills for QI is relatively under-explored. PURPOSE To explore the training, curricular and contextual factors that influence the development of measurement for improvement skills in healthcare professionals. METHODS This is a retrospective, qualitative, multiple case study design, based on two QI collaboratives. Trainees and trainers from these programmes participated in semi-structured interviews. A framework drawing on the Kirkpatrick's evaluation model and the Model for Understanding Success in Quality (MUSIQ) model was developed. The interviews were analysed based on a three-step qualitative thematic analysis method. RESULTS A total of 21 participants were interviewed (15 trainees and 6 trainers). Six themes emerged in the analysis of trainee interviewees: impact of differences in job role and hierarchical levels, narrow conception of QI, knowledge disparity between trained and untrained staff, balancing the benefits and burdens of measurement, early adopters of QI driving change and supportive and engaged leadership. Themes in trainer perspectives were knowledge and understanding of measurement, application of PDSA approach to programme design, balancing consistency with adaptation to context, and attributes of sites receptive to change as predictors of development of measurement for improvement skills in staff. CONCLUSION Training alone does not determine the development, sustainability and spread of measurement and QI skills. Instead, it is influenced by a combination of curricular, training, and contextual support structures. Training programmes should be aware of the impact of job role and hierarchy, increased knowledge disparity between trained and untrained staff and trainees equating QI to bundle implementation while designing programmes. Similarly, organisational support through leaders, encouraging staff who have an interest in measurement and a culture receptive to QI also supports development of measurement skills. The study highlights the need for trainees, trainers, and organisations to work together in balancing the benefits and burdens of measurement, leading to sustainable skill development in line with international best practices.
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Affiliation(s)
- Zuneera Khurshid
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
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22
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Vroom EB, Massey OT, Akbari Z, Bristol SC, Cook B, Green AL, Levin BL, Tyson DM, Johnson ME. Exploring perceptions of implementation practice capacity in community-based behavioral health organizations. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1700-1716. [PMID: 34797922 PMCID: PMC8917074 DOI: 10.1002/jcop.22749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 06/13/2023]
Abstract
Community-based organizations (CBOs) must have the capacity to adopt, implement, and sustain evidence-based practices (EBPs). However, limited research exists examining CBOs' ability/capacity to implement EBPs. The purpose of this preliminary study was to investigate how staff of CBOs perceive implementation practice capacity, determine factors needed for adequate capacity for implementing EBPs, and examine which perspectives of capacity are shared across organizational levels. Ninety-seven administrators and practitioners of CBOs were surveyed using the Implementation Capacity Survey, which examines perceived importance, presence, and organizational capacity of the CBO in nine implementation practice areas (IPAs) (e.g., leadership). Results revealed participants rated IPAs on the importance scale higher than IPAs on the present scale. Presence and organizational capacity scales were strongly correlated, and results showed significant differences between administrators and practitioners on ratings of presence and organizational capacity. Implications for future research aimed at examining/building implementation practice capacity in community settings will be discussed.
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Affiliation(s)
- Enya B Vroom
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Oliver T Massey
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Zahra Akbari
- Department of Economics, College of Arts and Sciences, University of South Florida, Tampa, Florida, USA
| | - Skye C Bristol
- Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Brandi Cook
- Department of Chemistry, Cell Biology, Microbiology, and Molecular Biology, College of Arts and Sciences, University of South Florida, Tampa, Florida, USA
| | - Amy L Green
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Bruce L Levin
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Dinorah M Tyson
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Micah E Johnson
- Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
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23
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Abstract
Elvin Hsing Geng and colleagues discuss mechanism mapping and its utility in conceptualizing and understanding how implementation strategies produce desired effects.
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Affiliation(s)
- Elvin H. Geng
- Center for Dissemination and Implementation, Institute for Public Health and Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
| | - Ana A. Baumann
- Division of Prevention Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Byron J. Powell
- Center for Dissemination and Implementation, Institute for Public Health and Brown School, Washington University, St. Louis, Missouri, United States of America
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24
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Metz A, Kainz K, Boaz A. Intervening for sustainable change: Tailoring strategies to align with values and principles of communities. FRONTIERS IN HEALTH SERVICES 2022; 2:959386. [PMID: 36925846 PMCID: PMC10012724 DOI: 10.3389/frhs.2022.959386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/05/2022] [Indexed: 01/19/2023]
Abstract
This paper presents a rationale for tailoring implementation strategies within a values-driven implementation approach. Values-driven implementation seeks to organize implementers around clarifying statements of their shared values in ways that harmonize implementation dynamics related to individual and group mental models, relationships among implementers, and the implementation climate. The proposed approach to tailoring strategies is informed by systems theory and emphasizes the need to focus on both tangible events and behaviors, as well deeper patterns, structures, relationships, and mental models, in order to increase the likelihood of sustaining implementation efforts and improving outcomes for people and communities. We offer for consideration three specific sets of context determinants that are under-represented in the implementation literature and that emerge as especially relevant within a systems approach to identifying and successfully tailoring implementation strategies in the implementation setting including relationships, mental models, and implementation climate.
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Affiliation(s)
- Allison Metz
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kirsten Kainz
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Annette Boaz
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England
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25
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Curtis K, Sivabalan P, Bedford DS, Considine J, D'Amato A, Shepherd N, Fry M, Munroe B, Shaban RZ. Implementation of a structured emergency nursing framework results in significant cost benefit. BMC Health Serv Res 2021; 21:1318. [PMID: 34886873 PMCID: PMC8655998 DOI: 10.1186/s12913-021-07326-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background Patients are at risk of deterioration on discharge from an emergency department (ED) to a ward, particularly in the first 72 h. The implementation of a structured emergency nursing framework (HIRAID) in regional New South Wales (NSW), Australia, resulted in a 50% reduction of clinical deterioration related to emergency nursing care. To date the cost implications of this are unknown. The aim of this study was to determine any net financial benefits arising from the implementation of the HIRAID emergency nursing framework. Methods This retrospective cohort study was conducted between March 2018 and February 2019 across two hospitals in regional NSW, Australia. Costs associated with the implementation of HIRAID at the study sites were calculated using an estimate of initial HIRAID implementation costs (AUD) ($492,917) and ongoing HIRAID implementation costs ($134,077). Equivalent savings per annum (i.e. in less patient deterioration) were calculated using projected estimates of ED admission and patient deterioration episodes via OLS regression with confidence intervals for incremental additional deterioration costs per episode used as the basis for scenario analysis. Results The HIRAID-equivalent savings per annum exceed the costs of implementation under all scenarios (Conservative, Expected and Optimistic). The estimated preliminary savings to the study sites per annum was $1,914,252 with a payback period of 75 days. Conservative projections estimated a net benefit of $1,813,760 per annum by 2022–23. The state-wide projected equivalent savings benefits of HIRAID equalled $227,585,008 per annum, by 2022–23. Conclusions The implementation of HIRAID reduced costs associated with resources consumed from patient deterioration episodes. The HIRAID-equivalent savings per annum to the hospital exceed the costs of implementation across a range of scenarios, and upscaling would result in significant patient and cost benefit.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Office 169, RC Mills Building, Camperdown, NSW, Australia. .,Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia. .,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia. .,George Institute for Global Health, University of NSW, Kensington, Australia. .,Faculty of Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
| | - Prabhu Sivabalan
- Business School, University of Technology Sydney, Sydney, NSW, Australia
| | - David S Bedford
- Performance Analysis for Transformation in Healthcare (PATH) Group, UTS Business School, Ultimo, NSW, Australia
| | - Julie Considine
- Deakin University, School of Nursing and Midwifery, Geelong, NSW, Australia.,Deakin University, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Alfa D'Amato
- Performance Analysis for Transformation in Healthcare (PATH) Group, UTS Business School, Ultimo, NSW, Australia.,System Financial Performance, NSW Ministry of Health, North Sydney, NSW, Australia
| | - Nada Shepherd
- Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
| | - Margaret Fry
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Office 169, RC Mills Building, Camperdown, NSW, Australia.,School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia.,Research & Practice Development Unit, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - Belinda Munroe
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
| | - Ramon Z Shaban
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Office 169, RC Mills Building, Camperdown, NSW, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead, NSW, Australia.,Division of Infectious Diseases and Sexual Health, Westmead Hospital and the New South Wales Biocontainment Centre, Western Sydney Local Heath District and New South Wales Ministry of Health, Westmead, NSW, Australia
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26
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Curtis K, Moules P, McKenzie J, Weidl L, Selak T, Binks S, Hernandez D, Rijsdijk J, Risi D, Wright J, O'Rourke L, Knapman M, Ristevski M, Stephens T, Harris I, Close JCT. Development of an Early Activation Hip Fracture Care Bundle and Implementation Strategy to Improve Adherence to the National Hip Fracture Clinical Care Standard. J Multidiscip Healthc 2021; 14:2891-2903. [PMID: 34703242 PMCID: PMC8524060 DOI: 10.2147/jmdh.s323678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To develop and implement a multidisciplinary early activation mechanism and bundle of care (eHIP) to improve adherence to ACSQHC standards in a regional trauma centre. Methods Barriers to implementation were categorised using the Theoretical Domains Framework, then linked to specific strategies guided by the Behaviour Change Wheel and Behaviour Change Technique Taxonomy (BCTT). The resulting implementation strategies were assessed using Affordable, Practical, Effective, Acceptable, had Side-effects (APEASE) criteria. Results Eighty-three barriers to implementation of the hip fracture care bundle were identified. The behaviour change wheel process resulted in the identification of 41 techniques to address these barriers. The predominant mechanisms to achieve this were development and implementation of 1) formal policy that outlines eHIP roles; 2) video promotion; 3) pager group; 4) fascia iliaca block enabling; 5) eMR modifications; 6) face-to-face reinforcement and modelling; 7) communication and prompts; 8) environmental restructuring. Conclusion We applied behaviour change theory through a pragmatic evidence-based process. This resulted in a codesigned strategy to overcome staff and organisational barriers to the implementation of a multidisciplinary early activation mechanism and bundle of care (eHIP). Future work will include evaluation of the uptake and clinical impact of the care bundle.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,George Institute for Global Health, Newtown, NSW, Australia
| | - Peter Moules
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - John McKenzie
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Lauren Weidl
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Tanya Selak
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Simon Binks
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Daniel Hernandez
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Joshua Rijsdijk
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Dante Risi
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - James Wright
- Agency for Clinical Innovation, St Leonards, NSW, Australia
| | - Lauren O'Rourke
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Myles Knapman
- Western NSW LHD, Department of Surgery, Dubbo, NSW, Australia
| | - Meagan Ristevski
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Teala Stephens
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Ian Harris
- Ingham Institute of Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia
| | - Jacqueline C T Close
- Prince Wales Clinical School, UNSW, Sydney, NSW, Australia.,Neuroscience Research Australia, UNSW, Sydney, NSW, Australia
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27
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Curtis K, Kourouche S, Asha S, Considine J, Fry M, Middleton S, Mitchell R, Munroe B, Shaban RZ, D’Amato A, Skinner C, Wiseman G, Buckley T. Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation. PLoS One 2021; 16:e0256027. [PMID: 34618825 PMCID: PMC8496821 DOI: 10.1371/journal.pone.0256027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/28/2021] [Indexed: 12/03/2022] Open
Abstract
Background Blunt chest injury leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes. ChIP provides guidance in three key pillars of care for blunt chest injury—respiratory support, analgesia and complication prevention. ChIP was implemented using a multi-faceted implementation plan developed using the Behaviour Change Wheel. Methods This controlled pre-and post-test study (two intervention and two non-intervention sites) was conducted from July 2015 to June 2019. The primary outcome measures were unplanned Intensive Care Unit (ICU) admissions, non-invasive ventilation use and mortality. Results There were 1790 patients included. The intervention sites had a 58% decrease in non-invasive ventilation use in the post- period compared to the pre-period (95% CI 0.18–0.96). ChIP was associated with 90% decreased odds of unplanned ICU admissions (95% CI 0.04–0.29) at the intervention sites compared to the control groups in the post- period. There was no significant change in mortality. There were higher odds of health service team reviews (surgical OR 6.6 (95% CI 4.61–9.45), physiotherapy OR 2.17 (95% CI 1.52–3.11), ICU doctor OR 6.13 (95% CI 3.94–9.55), ICU liaison OR 55.75 (95% CI 17.48–177.75), pain team OR 8.15 (95% CI 5.52 –-12.03), analgesia (e.g. patient controlled analgesia OR 2.6 (95% CI 1.64–3.94) and regional analgesia OR 8.8 (95% CI 3.39–22.79), incentive spirometry OR 8.3 (95% CI 4.49–15.37) and, high flow nasal oxygen OR 22.1 (95% CI 12.43–39.2) in the intervention group compared to the control group in the post- period. Conclusion The implementation of a chest injury care bundle using behaviour change theory was associated with a sustained improvement in evidence-based practice resulting in reduced unplanned ICU admissions and non-invasive ventilation requirement. Trial registration ANZCTR: ACTRN12618001548224, approved 17/09/2018
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
- * E-mail:
| | - Sarah Kourouche
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Stephen Asha
- Emergency Department, St George Hospital, Kogarah, NSW, Australia
- St George Clinical School, Faculty of Medicine, University of New South Wales, Kogarah, NSW, Australia
| | - Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Experience in the Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Experience–Eastern Health Partnership, Box Hill, VIC, Australia
| | - Margaret Fry
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
- Northern Sydney Local Health District, Hornsby, NSW, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- Australian Catholic University, Sydney, NSW, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Belinda Munroe
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, Australia
| | - Ramon Z. Shaban
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Camperdown, NSW, Australia
- Division of Infectious Diseases and Sexual Health, Department of Infection Prevention and Control, Westmead Hospital and Western Sydney Local Health District, Westmead, NSW, Australia
- New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, Warwick Farm, NSW, Australia
| | - Alfa D’Amato
- NSW Activity Based Funding Taskforce, NSW Ministry of Health, Sydney, Australia
| | - Clare Skinner
- Emergency Department, Hornsby Ku-ring-ai Hospital, Hornsby, NSW, Australia
| | - Glen Wiseman
- Emergency Services, Canterbury Hospital, Campsie, NSW, Australia
| | - Thomas Buckley
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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Ní Shé É, Harrison R. Mitigating unintended consequences of co-design in health care. Health Expect 2021; 24:1551-1556. [PMID: 34339528 PMCID: PMC8483209 DOI: 10.1111/hex.13308] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 12/22/2022] Open
Abstract
Background Co‐design and associated terms are increasingly being used to facilitate values‐based approaches to health‐care improvement. It is messy and complex, involving diverse actors. Methods We explore the notion that initiatives have outcomes other than initially planned is neither new nor novel but is overlooked when thinking about co‐design. We explore some of the unintended consequences and outline some optimal conditions that can mitigate challenges. Discussion Although co‐design approaches are being applied in health care, questions remain regarding its ability to produce gains in health outcomes. Little is known about determining whether co‐design is the most suitable approach to achieve the given project goals, the levels of involvement required to realize the benefits of co‐design or the potential unintended consequences. There is a risk of further marginalizing or adding burden to under‐represented populations and/or over‐researched populations. Conclusion Undertaking a co‐design approach without the optimal conditions for inclusive involvement by all may not result in an equal partnership or improve health or care quality outcomes. Co‐design requires on‐going reflective discussions and deliberative thinking to remove any power imbalances. However, without adequate resources, a focus on implementation and support from senior leaders, it is a tough ask to achieve. Patient or Public Contribution This viewpoint article was written by two academics who have undertaken a significant amount of PPI and co‐design work with members of the public and patient's right across the health system. Our work guided the focus of this viewpoint as we reflected on our experiences.
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Affiliation(s)
- Éidín Ní Shé
- School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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29
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Miller CJ, Barnett ML, Baumann AA, Gutner CA, Wiltsey-Stirman S. The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare. Implement Sci 2021; 16:36. [PMID: 33827716 PMCID: PMC8024675 DOI: 10.1186/s13012-021-01105-3] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/22/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Implementation strategies are necessary to ensure that evidence-based practices are successfully incorporated into routine clinical practice. Such strategies, however, are frequently modified to fit local populations, settings, and contexts. While such modifications can be crucial to implementation success, the literature on documenting and evaluating them is virtually nonexistent. In this paper, we therefore describe the development of a new framework for documenting modifications to implementation strategies. DISCUSSION We employed a multifaceted approach to developing the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS), incorporating multiple stakeholder perspectives. Development steps included presentations of initial versions of the FRAME-IS to solicit structured feedback from individual implementation scientists ("think-aloud" exercises) and larger, international groups of researchers. The FRAME-IS includes core and supplementary modules to document modifications to implementation strategies: what is modified, the nature of the modification (including the relationship to core elements or functions), the primary goal and rationale for the modification, timing of the modification, participants in the modification decision-making process, and how widespread the modification is. We provide an example of application of the FRAME-IS to an implementation project and provide guidance on how it may be used in future work. CONCLUSION Increasing attention is being given to modifications to evidence-based practices, but little work has investigated modifications to the implementation strategies used to implement such practices. To fill this gap, the FRAME-IS is meant to be a flexible, practical tool for documenting modifications to implementation strategies. Its use may help illuminate the pivotal processes and mechanisms by which implementation strategies exert their effects.
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Affiliation(s)
- Christopher J Miller
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Miya L Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Ana A Baumann
- Washington University at St. Louis, St. Louis, MO, USA
| | - Cassidy A Gutner
- ViiV Healthcare, Innovation & Implementation Science, Research Triangle, NC, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Shannon Wiltsey-Stirman
- National Center for PTSD Dissemination and Training Division, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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Rogers L, De Brún A, Birken SA, Davies C, McAuliffe E. Context counts: a qualitative study exploring the interplay between context and implementation success. J Health Organ Manag 2021; ahead-of-print. [PMID: 33682395 PMCID: PMC9073593 DOI: 10.1108/jhom-07-2020-0296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Implementing change in healthcare is difficult to accomplish due to the unpredictability associated with challenging the status quo. Adapting the intervention/practice/program being implemented to better fit the complex context is an important aspect of implementation success. Despite the acknowledged influence of context, the concept continues to receive insufficient attention at the team-level within implementation research. Using two heterogeneous multidisciplinary healthcare teams as implementation case studies, this study evaluates the interplay between context and implementation and highlights the ways in which context influences the introduction of a collective leadership intervention in routine practice. DESIGN/METHODOLOGY/APPROACH The multiple case study design adopted, employed a triangulation of qualitative research methods which involved observation (Case A = 16 h, Case B = 15 h) and interview data (Case A = 13 participants, Case B = 12 participants). Using an inductive approach, an in-depth thematic analysis of the data outlined the relationship between team-level contextual factors and implementation success. FINDINGS Themes are presented under the headings: (1) adapting to the everyday realities, a key determinant for implementation success and (2) implementation stimulating change in context. The findings demonstrate a dynamic relationship between context and implementation. The challenges of engaging busy healthcare professionals emphasised that mapping the contextual complexity of a site and adapting implementation accordingly is essential to enhance the likelihood of successful implementation. However, implementation also altered the surrounding context, stimulating changes within both teams. ORIGINALITY/VALUE By exposing the reciprocal relationship between team-level contextual factors and implementation, this research supports the improved design of implementation strategies through better understanding the interplay and mutual evolution of evidence-based healthcare interventions within different contexts.
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Affiliation(s)
- Lisa Rogers
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Sarah A Birken
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carmel Davies
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
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