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Desai M, Tardif-Douglin M, Miller I, Blitzer S, Gardner DL, Thompson T, Edmondson L, Levine DM. Implementation of Agile in healthcare: methodology for a multisite home hospital accelerator. BMJ Open Qual 2024; 13:e002764. [PMID: 38802269 PMCID: PMC11131107 DOI: 10.1136/bmjoq-2024-002764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The diffusion of innovation in healthcare is sluggish. Evidence-based care models and interventions take years to reach patients. We believe the healthcare community could deliver innovation to the bedside faster if it followed other sectors by employing an organisational framework for efficiently accomplishing work. Home hospital is an example of sluggish diffusion. This model provides hospital-level care in a patient's home instead of in a traditional hospital with equal or better outcomes. Home hospital uptake has steadily grown during the COVID-19 pandemic, yet barriers to launch remain for healthcare organisations, including access to expertise and implementation tools. The Home Hospital Early Adopters Accelerator was created to bring together a network of healthcare organisations to develop tools necessary for programme implementation. METHODS The accelerator used the Agile framework known as Scrum to rapidly coordinate work across many different specialised skill sets and blend individuals who had no experience with one another into efficient teams. Its goal was to take 40 weeks to develop 20 'knowledge products',or tools critical to the development of a home hospital programme such as workflows, inclusion criteria and protocols. We conducted a mixed-methods evaluation of the accelerator's implementation, measuring teams' productivity and experience. RESULTS 18 healthcare organisations participated in the accelerator to produce the expected 20 knowledge products in only 32 working weeks, a 20% reduction in time. Nearly all (97.4%) participants agreed or strongly agreed the Scrum teams worked well together, and 96.8% felt the teams produced a high-quality product. Participants consistently remarked that the Scrum team developed products much faster than their respective organisational teams. The accelerator was not a panacea: it was challenging for some participants to become familiar with the Scrum framework and some participants struggled with balancing participation in the Accelerator with their job duties. CONCLUSIONS Implementation of an Agile-based accelerator that joined disparate healthcare organisations into teams equipped to create knowledge products for home hospitals proved both efficient and effective. We demonstrate that implementing an organisational framework to accomplish work is a valuable approach that may be transformative for the sector.
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Affiliation(s)
| | - Miriam Tardif-Douglin
- CaraNova, Cary, North Carolina, USA
- North Carolina Healthcare Association, Cary, North Carolina, USA
| | | | | | | | | | - LaPonda Edmondson
- CaraNova, Cary, North Carolina, USA
- North Carolina Healthcare Association, Cary, North Carolina, USA
| | - David M Levine
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Quality, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Jurczuk M, Thakar R, Carroll FE, Phillips L, van der Meulen J, Gurol-Urganci I, Sevdalis N. Design and management considerations for control groups in hybrid effectiveness-implementation trials: Narrative review & case studies. FRONTIERS IN HEALTH SERVICES 2023; 3:1059015. [PMID: 36926502 PMCID: PMC10012616 DOI: 10.3389/frhs.2023.1059015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/06/2023] [Indexed: 03/12/2023]
Abstract
Hybrid effectiveness-implementation studies allow researchers to combine study of a clinical intervention's effectiveness with study of its implementation with the aim of accelerating the translation of evidence into practice. However, there currently exists limited guidance on how to design and manage such hybrid studies. This is particularly true for studies that include a comparison/control arm that, by design, receives less implementation support than the intervention arm. Lack of such guidance can present a challenge for researchers both in setting up but also in effectively managing participating sites in such trials. This paper uses a narrative review of the literature (Phase 1 of the research) and comparative case study of three studies (Phase 2 of the research) to identify common themes related to study design and management. Based on these, we comment and reflect on: (1) the balance that needs to be struck between fidelity to the study design and tailoring to emerging requests from participating sites as part of the research process, and (2) the modifications to the implementation strategies being evaluated. Hybrid trial teams should carefully consider the impact of design selection, trial management decisions, and any modifications to implementation processes and/or support on the delivery of a controlled evaluation. The rationale for these choices should be systematically reported to fill the gap in the literature.
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Affiliation(s)
- Magdalena Jurczuk
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Ranee Thakar
- Obstetrics & Gynaecology, Croydon University Hospitals NHS Trust, London, United Kingdom
| | - Fran E Carroll
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Lizzie Phillips
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom.,Maternity Services, University Hospital Plymouth NHS Trust, Plymouth, United Kingdom
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ipek Gurol-Urganci
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
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Gotham HJ, Paris M, Hoge MA. Learning Collaboratives: a Strategy for Quality Improvement and Implementation in Behavioral Health. J Behav Health Serv Res 2023; 50:263-278. [PMID: 36539679 PMCID: PMC9935679 DOI: 10.1007/s11414-022-09826-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Abstract
Learning collaboratives are increasingly used in behavioral health. They generally involve bringing together teams from different organizations and using experts to educate and coach the teams in quality improvement, implementing evidence-based practices, and measuring the effects. Although learning collaboratives have demonstrated some effectiveness in general health care, the evidence is less clear in behavioral health and more rigorous studies are needed. Learning collaboratives may contain a range of elements, and which elements are included in any one learning collaborative varies widely; the unique contribution of each element has not been established. This commentary seeks to clarify the concept of a learning collaborative, highlight its common elements, review evidence of its effectiveness, identify its application in behavioral health, and highlight recommendations to guide technical assistance purveyors and behavioral health providers as they employ learning collaboratives to improve behavioral health access and quality.
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Affiliation(s)
- Heather J. Gotham
- Mental Health Technology Transfer Center Network Coordinating Office, Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA 94304 USA
| | - Manuel Paris
- The Annapolis Coalition on the Behavioral Health Workforce & Yale University School of Medicine, 34 Park Street, New Haven, CT 06511 USA
| | - Michael A. Hoge
- The Annapolis Coalition On the Behavioral Health Workforce, & Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511 USA
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Feasibility and Application of Cluster Nursing to the Care of Patients with Acute Oncology. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:8973449. [PMID: 35958913 PMCID: PMC9357692 DOI: 10.1155/2022/8973449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022]
Abstract
Objective To probe the utility of cluster nursing for the care of acute oncology clients. Methods One hundred fourteen cases of acute oncology pioneers undergoing therapy in our clinic from April 2019 to February 2021 were randomly assigned into two consecutive arms, conventional care and cluster care, in accordance with the nursing modality. Complications, satisfaction, quality of survival, and negative emotions were compared across the two parties. Results The comorbidity incidence rate of the subject matter in the research cohort was 7.02%, which was below the comorbidity rate of 17.54% in the reaction cohort (P < 0.05); the percentage of satisfaction in the research cohort was 96.49%, which was higher than the satisfaction rate of 78.95% in the reaction cohort (P < 0.05); aftercare, the quality of survival was significantly higher in both groups, and the SAS and SDS scores were significantly lower, with a more pronounced trend of change in the research cohort than in the reaction cohort (P < 0.05). Conclusion Bundled care for casualty oncology is of major value, with a marked reduction in the incidence of postoperative complications, high quality of survival, an excellent prognosis and negative mood, high patient morale and satisfaction and compliance with curative treatment, and good support for subsequent care.
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Uneno Y, Iwai M, Morikawa N, Tagami K, Matsumoto Y, Nozato J, Kessoku T, Shimoi T, Yoshida M, Miyoshi A, Sugiyama I, Mantani K, Itagaki M, Yamagishi A, Morita T, Inoue A, Muto M. Development of a national health policy logic model to accelerate the integration of oncology and palliative care: a nationwide Delphi survey in Japan. Int J Clin Oncol 2022; 27:1529-1542. [PMID: 35713754 DOI: 10.1007/s10147-022-02201-0] [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: 03/07/2022] [Accepted: 05/24/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite recommendations to deliver palliative care to cancer patients and their caregivers, their distress has not been alleviated satisfactorily. National health policies play a pivotal role in achieving a comprehensive range of quality palliative care delivery for the public. However, there is no standardised logic model to appraise the efficacy of these policies. This study aimed to develop a logic model of a national health policy to deliver cancer palliative care and to reach consensus towards specific policy proposals. METHODS A draft version of the logic model and specific policy proposals were formulated by the research team and the internal expert panel, and the independent external expert panel evaluated the policy proposals based on the Delphi survey to reach consensus. RESULTS The logic model was divided into three major conceptual categories: 'care-delivery at cancer hospitals', 'community care coordination', and 'social awareness of palliative care'. There were 18 and 45 major and minor policy proposals, which were categorised into four groups: requirement of government-designated cancer hospitals; financial support; Basic Plan to Promote Cancer Control Programs; and others. These policy proposals were independently evaluated by 64 external experts and the first to third Delphi round response rates were 96.9-98.4%. Finally, 47 policy proposals reached consensus. The priority of each proposal was evaluated within the four policy groups. CONCLUSIONS A national health policy logic model was developed to accelerate the provision of cancer palliative care. Further research is warranted to verify the study design to investigate the efficacy of the logic model.
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Affiliation(s)
- Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Maki Iwai
- Former Non-Profit Organization, Cancer Policy Summit, Tokyo, 155-0032, Japan
| | - Naoto Morikawa
- Department of Clinical Oncology, Tohoku Rosai Hospital, Sendai, 981-8563, Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, 980-8575, Japan
| | - Yoko Matsumoto
- Specified Non-Profit Organization, Ehime Cancer Support Association Orange, Matsuyama, 790-0023, Japan
| | - Junko Nozato
- Department of Internal Medicine, Palliative Care, Tokyo Medical and Dental University Hospital, Tokyo, 113-8519, Japan
| | - Takaomi Kessoku
- Department of Palliative Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.,Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tatsunori Shimoi
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, 104-0045, Japan
| | - Miyuki Yoshida
- Program for Nursing and Health Sciences, Graduate School of Medicine, Ehime University, Ehime, 791-0295, Japan
| | - Aya Miyoshi
- Specified Non-Profit Organization, Cancer Support Kagoshima, Kagoshima, 890-8511, Japan
| | - Ikuko Sugiyama
- Division of Nursing, Tohoku University Hospital, Sendai, 980-8574, Japan
| | - Kazuhiro Mantani
- Cancer Support Centre, National Hospital Organization, Osaka-Minami Medical Center, Osaka, 586-8521, Japan
| | - Mai Itagaki
- Section of Research Administration, National Cancer Center Hospital East, Chiba, 277-8577, Japan
| | - Akemi Yamagishi
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, 160-8582, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, 433-8558, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, 980-8575, Japan.
| | - Manabu Muto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
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Bakhshaie J, Doorley J, Reichman M, Mace R, Laverty D, Matuszewski PE, Elwy AR, Fatehi A, Bowers LC, Ly T, Vranceanu AM. Optimizing the implementation of a multisite feasibility trial of a mind-body program in acute orthopedic trauma. Transl Behav Med 2022; 12:642-653. [PMID: 35195266 PMCID: PMC9154268 DOI: 10.1093/tbm/ibac004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Toolkit for Optimal Recovery (TOR) is a mind-body program for patients with acute orthopedic injuries who are at risk for persistent pain/disability. In preparation for a multisite feasibility trial of TOR at three orthopedic trauma centers, we aim to qualitatively identify barriers and facilitators to study implementation and strategies to mitigate the implementation barriers and leverage facilitators.We conducted 18 live video focus groups among providers and three one-on-one interviews with department chiefs at Level 1 trauma centers in three geographically diverse sites (N = 79 participants). Using a content analysis approach, we detected the site-specific barriers and facilitators of implementation of TOR clinical trial. We organized the data according to 26 constructs of the Consolidated Framework for Implementation Research (CFIR), mapped to three Proctor implementation outcomes relevant to the desired study outcomes (acceptability, appropriateness, and feasibility). Across the three sites, we mapped six of the CFIR constructs to acceptability, eight to appropriateness, and three to feasibility. Prominent perceived barriers across all three sites were related to providers' lack of knowledge/comfort addressing psychosocial factors, and organizational cultures of prioritizing workflow efficiency over patients' psychosocial needs (acceptability), poor fit between TOR clinical trial and the fast-paced clinic structure as well as basic needs of some patients (appropriateness), and limited resources (feasibility). Suggestions to maximize the implementation of the TOR trial included provision of knowledge/tools to improve providers' confidence, streamlining study recruitment procedures, creating a learning collaborative, tailoring the study protocol based on local needs assessments, exercising flexibility in conducting research, dedicating research staff, and identifying/promoting champions and using novel incentive structures with regular check-ins, while keeping study procedures as nonobtrusive and language as de-stigmatizing as possible. These data could serve as a blueprint for implementation of clinical research and innovations in orthopedic and other medical settings.
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Affiliation(s)
- Jafar Bakhshaie
- Harvard Medical School, Boston, MA 02115, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02115, USA
| | - James Doorley
- Harvard Medical School, Boston, MA 02115, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02115, USA
| | - Mira Reichman
- Harvard Medical School, Boston, MA 02115, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02115, USA
| | - Ryan Mace
- Harvard Medical School, Boston, MA 02115, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02115, USA
| | - David Laverty
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA
| | - Paul E Matuszewski
- Department of Orthopaedic Surgery & Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY 40506, USA
| | - A Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI 02912, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
| | - Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA
| | - Lucy C Bowers
- Department of Orthopaedic Surgery & Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY 40506, USA
| | - Thuan Ly
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA 02115, USA
| | - Ana-Maria Vranceanu
- Harvard Medical School, Boston, MA 02115, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02115, USA
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Yang GM, Dionne-Odom JN, Foo YH, Chung AHM, Kamal NHA, Tan L, Yu CC, Khanh LM, Koh ARX, Teo I, Yoon S, Bakitas M. Adapting ENABLE for patients with advanced cancer and their family caregivers in Singapore: a qualitative formative evaluation. BMC Palliat Care 2021; 20:86. [PMID: 34158022 PMCID: PMC8218975 DOI: 10.1186/s12904-021-00799-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND ENABLE (Educate, Nurture, Advise, Before Life Ends) is a nurse coach-led, early palliative care model for patients with advanced cancer and their family caregivers. Content covered includes problem-solving, advance care planning, symptom management and self-care. The aim was to evaluate the cultural acceptability of ENABLE among patients with advanced cancer and their caregivers in Singapore and identify modifications for an adapted ENABLE-SG model. METHODS Qualitative formative evaluation with a thematic analysis approach in two hospitals in Singapore, involving patients (n = 10), family caregivers (n = 11) and healthcare professionals (n = 10) who care for patients with advanced cancer. Semi-structured interviews were conducted to explore (i) the main needs and challenges facing individuals with advanced cancer and their family caregivers; (ii) patient involvement in healthcare decision making; and (iii) content and delivery of ENABLE. RESULTS While physical needs were largely well met, participants expressed that psychosocial care was delivered too late in the illness trajectory. Healthcare decision making approaches varied from a patient-centred shared decision-making model to a family-centred model where patients may not know their cancer diagnosis and prognosis. The content was considered to be relevant, comprehensive and practical; financial assistance, adjustment to body image, and evaluation of complementary therapy were also recommended. Face-to-face rather than telephone sessions were preferred to facilitate rapport building. CONCLUSIONS ENABLE was broadly acceptable with some modifications, including adjusting the content to ensure it can be delivered even if the patient is not fully aware of cancer diagnosis and delivering the first session face-to-face with flexibility for subsequent sessions.
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Affiliation(s)
- Grace Meijuan Yang
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
| | | | - Yi Han Foo
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Chou Chuen Yu
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Le Mai Khanh
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Audrey Rui Xuan Koh
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Irene Teo
- Duke-NUS Medical School, Lien Centre for Palliative Care, Singapore, Singapore
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