2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Liana Zucco ◽  
Nadav Levy ◽  
Yunping Li ◽  
Toni Golen ◽  
Scott A. Shainker ◽  
...  

Abstract Background Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe factors which influenced rapid cycle implementation of a novel comprehensive checklist for the perioperative care of the COVID-19 parturient. Methods Within our labour and delivery unit, implementation of a novel checklist for the COVID-19 parturient requiring perioperative care was accomplished through rapid cycling, debriefing and on-site walkthroughs. Post-implementation, consistent use of the checklist was reported for all obstetric COVID-19 perioperative cases (100% workflow checklist utilization). Retrospective analysis of the factors influencing implementation was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results Analysis of factors influencing implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting, and characteristic of individuals (external pressures, baseline culture, and personal attributes) were perceived to act as early barriers. Constructs such as communication culture and learning climate, shifted in influence over time. Conclusion We describe the influential factors of implementing a novel comprehensive obstetric workflow for care of the COVID-19 perioperative parturient during the first surge of the pandemic using the CFIR framework. Early workflow adoption was facilitated primarily by two domains, namely thoughtful innovation design and careful implementation planning in the setting of a long-standing culture of improvement. Factors initially assessed as barriers such as communication, culture and learning climate, transitioned into facilitators once a perceived benefit was experienced by healthcare teams. These results provide important information for the implementation of rapid change during a time of crisis.


2000 ◽  
Vol 34 (2) ◽  
pp. 223
Author(s):  
Mutsuko Endo Hudson ◽  
Seiichi Makino ◽  
Yukiko Abe Hatasa ◽  
Kazumi Hatasa

1997 ◽  
Vol 27 (1-4) ◽  
pp. 59-95
Author(s):  
David A. Shank

AbstractWe have looked at illustrations from a process going from a culture gap in inter-personal contacts, to rapidly scrawled notes—sometimes in a French transcription of heard English, edited in a filled-out synthesis in French, then translated and edited in English, then re-edited and published as a 'full account.' At every stage of the process, one may observe mutations, governed no doubt in large part by the major preoccupation of legitimation of the Wesleyan mission, in all good faith. And it produced the dominant interpretation of the Prophet Harris. The reconstructed message did greatly profit Methodist developments, even though many Harrists could not accept the Wesleyan claim to Harris's authorization of their mission. More important, the Methodists did not stand up as his spokesperson for 'Ethiopian' ways of conjugality ; on the contrary, they used his legitimation to sanction a monogamous discipline. An inherent contradiction was present in that a ministry which they could accept but not fully approve, was used to validate their own. But even more, the Wesleyan Mission clearly did not become a spokesperson for Harris's warnings to the colonial authorities, nor did they wish to seek legitimate authorization for Harris's return ministry in the French colony.37 The consequences of these differences were to have all kinds of implications for the future relationships between Methodists and the Harrists, for whom even today the name and reputation of the white 'Pasteur Benoit' have become ignominious. But in the process, important information was also recorded to permit us to enter into a better understanding of the phenomenal prophet on his own terms, and recognizing—in his own language—that 'God moves in mysterious ways... and uses the foolish things in the world to confound the wise.'38


Author(s):  
Saba Farzi ◽  
Fariba Taleghani ◽  
Ahmadreza Yazdannik ◽  
Mehran Sharifi Esfahani

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