scholarly journals Implementation of artificial intelligence (AI) applications in radiology: hindering and facilitating factors

2020 ◽  
Vol 30 (10) ◽  
pp. 5525-5532
Author(s):  
Lea Strohm ◽  
Charisma Hehakaya ◽  
Erik R. Ranschaert ◽  
Wouter P. C. Boon ◽  
Ellen H. M. Moors
Keyword(s):  
Artificial Intelligence ◽  
Scale Up ◽  
Barriers And Facilitators ◽  
Added Value ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Implementation Processes ◽  
Technical Performance ◽  
Facilitating Factors ◽  
Clinical Radiology

Abstract Objective The objective was to identify barriers and facilitators to the implementation of artificial intelligence (AI) applications in clinical radiology in The Netherlands. Materials and methods Using an embedded multiple case study, an exploratory, qualitative research design was followed. Data collection consisted of 24 semi-structured interviews from seven Dutch hospitals. The analysis of barriers and facilitators was guided by the recently published Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework for new medical technologies in healthcare organizations. Results Among the most important facilitating factors for implementation were the following: (i) pressure for cost containment in the Dutch healthcare system, (ii) high expectations of AI’s potential added value, (iii) presence of hospital-wide innovation strategies, and (iv) presence of a “local champion.” Among the most prominent hindering factors were the following: (i) inconsistent technical performance of AI applications, (ii) unstructured implementation processes, (iii) uncertain added value for clinical practice of AI applications, and (iv) large variance in acceptance and trust of direct (the radiologists) and indirect (the referring clinicians) adopters. Conclusion In order for AI applications to contribute to the improvement of the quality and efficiency of clinical radiology, implementation processes need to be carried out in a structured manner, thereby providing evidence on the clinical added value of AI applications. Key Points • Successful implementation of AI in radiology requires collaboration between radiologists and referring clinicians. • Implementation of AI in radiology is facilitated by the presence of a local champion. • Evidence on the clinical added value of AI in radiology is needed for successful implementation.

scholarly journals Investigating the barriers and facilitators to implementing mental health first aid in the workplace: a qualitative study

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Melanie Jay Narayanasamy ◽  
Louise Thomson ◽  
Carol Coole ◽  
Fiona Nouri ◽  
Avril Drummond
Keyword(s):  
Mental Health ◽  
Good Practice ◽  
First Aid ◽  
Barriers And Facilitators ◽  
Successful Implementation ◽  
Mental Health First Aid ◽  
Structured Interviews ◽  
Content Type ◽  
Factors Affecting ◽  
Employee Characteristics

Purpose There has been little research into the use and efficacy of Mental Health First Aid (MHFA) across UK workplaces. This paper aims to investigate the implementation of MHFA across six UK organisations, identifying key barriers and facilitators. Design/methodology/approach Twenty-seven workplace representatives were recruited from six organisations through purposive sampling and took part in semi-structured interviews exploring their experiences of workplace MHFA. The data underwent thematic analysis, identifying key themes around implementation. Findings Implementation varied across organisations, including different reasons for initial interest in the programme, and variable ways that MHFA-trained employees operated post-training. Key barriers to successful implementation included negative attitudes around mental health, the perception that MHFA roles were onerous, and employees’ reluctance to engage in the MHFA programme. Successful implementation was perceived to be based on individual qualities of MHFA instructors and good practice demonstrated by trained individuals in the workplace. The role of the inner organisational setting and employee characteristics were further highlighted as barriers and facilitators to effective implementation. Research limitations/implications MHFA is a complex intervention, presenting in different ways when implemented into complex workplace settings. As such, traditional evaluation methods may not be appropriate for gaining insights into its effectiveness. Future evaluations of workplace MHFA must consider the complexity of implementing and operationalising this intervention in the workplace. Originality/value This study is the first to highlight the factors affecting successful implementation of MHFA across a range of UK workplaces.

scholarly journals What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review

2020 ◽  
Author(s):  
Melanie Karrer ◽  
Julian Hirt ◽  
Adelheid Zeller ◽  
Susi Saxer
Keyword(s):  
Scoping Review ◽  
Implementation Process ◽  
Dementia Care ◽  
Barriers And Facilitators ◽  
Successful Implementation ◽  
Evidence Based ◽  
Management Support ◽  
Implementation Processes ◽  
Culture Of Care ◽  
People With Dementia

Abstract Background The implementation of evidence-based interventions for people with dementia is complex and challenging. However, successful implementation might be a key element to ensure evidence-based practice and high quality of care. There is a need to improve implementation processes in dementia care by better understanding the arising challenges. Thus, the aim of this study was to identify recent knowledge concerning barriers and facilitators to implementing nurse-led interventions in dementia care. Methods We performed a scoping review using the methodological framework of Arksey and O’Malley. Studies explicitly reporting on the implementation process and factors influencing the implementation of a nurse-led intervention in dementia care in all settings were included. We searched eight databases from January 2015 until January 2019. Two authors independently selected the studies. For data analysis, we used an inductive approach to build domains and categories. Results We included 26 studies in the review and identified barriers as well as facilitators in five domains: policy (e.g. financing issues, health insurance), organisation (e.g. organisational culture and vision, resources, management support), intervention/implementation (e.g. complexity of the intervention, perceived value of the intervention), staff (e.g. knowledge, experience and skills, attitude towards the intervention), and person with dementia/family (e.g. nature and stage of dementia, response of persons with dementia and their families). Conclusions Besides general influencing factors for implementing nursing interventions, we identified dementia-specific factors reaching beyond already known barriers and facilitators. A pre-existing person-centred culture of care as well as consistent team cultures and attitudes have a facilitating effect on implementation processes. Furthermore, there is a need for interventions that are highly flexible and sensitive to patients’ condition, needs and behaviour.

scholarly journals The right to smoke and the right to smoke-free surroundings: international comparison of smoke-free psychiatric clinic implementation experiences

BJPsych Open ◽  
2021 ◽  
Vol 7 (3) ◽  
Author(s):  
Tove Freiburghaus ◽  
Rie Raffing ◽  
Montse Ballbè ◽  
Antoni Gual ◽  
Hanne Tönnesen
Keyword(s):  
Qualitative Methodology ◽  
Smoking Ban ◽  
Psychiatric Clinic ◽  
Successful Implementation ◽  
Management Support ◽  
Staff Education ◽  
Structured Interviews ◽  
Implementation Processes ◽  
Compulsory Care ◽  
The Right

Background In Scandinavia, people with a severe mental disorder have a reduced life expectancy of 15–20 years compared with the general public. Smoking is a major contributor, and smoke-free policies are increasingly adopted in psychiatric clinics around the world. We compared potential facilitators and barriers among staff and management, for the implementation of smoke-free psychiatric clinics. Aims To investigate the attitudes and experiences regarding smoke-free policies among managers and staff involved in the implementation processes of smoke-free psychiatric clinics at hospitals in Malmö (Sweden) and Barcelona (Spain). Method We used a qualitative methodology, with 15 semi-structured interviews. The interviews were conducted with each participant individually, and were subsequently transcribed. The data were analysed with systematic text condensation. Results There were notable differences in how the smoke-free policies were carried out and experienced, and attitudes regarding the policy changes differed in the two settings. Key differences were the views on the right to smoke in compulsory care and to stay in smoke-free surroundings supported by smoking cessation intervention; the prioritisation of staff facilitation of smoking breaks; and views on smoking and smoke-free psychiatry. In contrast, participants agreed on the importance of staff education and management support. A smoking ban by law and belonging to a network of smoke-free hospitals were also relevant. Conclusions Staff education, and support from staff and management for the patients’ right to stay in smoke-free surroundings, facilitated successful implementation of smoke-free policies in the psychiatric clinics, whereas supporting the right to smoke was a barrier.

scholarly journals Evaluating factors that influenced the successful implementation of an evidence-based neonatal care intervention in Chinese hospitals using the PARIHS framework

2021 ◽  
Author(s):  
Jieya Yue ◽  
Jun Liu ◽  
Yingxi Zhao ◽  
Sarah Williams ◽  
Bo Zhang ◽  
...  
Keyword(s):  
Scale Up ◽  
Improve Patient Care ◽  
Successful Implementation ◽  
Evidence Based ◽  
Hospital Level ◽  
Structured Interviews ◽  
Knowledge And Beliefs ◽  
Tertiary Hospitals ◽  
Parihs Framework ◽  
Study Participants

Abstract Background Evidence based interventions (EBIs) can improve patient care and outcomes. Understanding the process for successfully introducing and implementing EBIs can inform effective roll-out and scale up. The Promoting Action on Research Implementation in Health Services (PARIHS) framework can be used to evaluate and guide the introduction and implementation of EBIs. To gain an understanding of the utility of the PARIHS framework in China and investigate how important each of its constructs (evidence, context and facilitation) and sub-elements are perceived to be to successful implementation of EBIs in a Chinese setting, we used the framework to assess the implementation of an evidence-based neonatal intervention (kangaroo mother care, KMC) recently introduced in selected Chinese hospitals. Method We conducted clinical observations and semi-structured interviews with 10 physicians and 18 nurses in five tertiary hospitals implementing KMC. Interview questions were organized around issues including knowledge and beliefs, resources, culture, implementation readiness and climate. We used directed content analysis to analyze the interview transcript, amending the PARIHS framework to incorporate emerging sub-themes. We also rated the constructs and sub-elements on a continuum from “low (weak)”, “moderate” or “high (strong)” highlighting the ones considered most influential for hospital level implementation by study participants. Results Our finding suggest that clinical experience, culture, leadership, evaluation, and facilitation are highly influential sub-elements for EBI implementation in China. External evidence had a moderate impact, especially in the initial awareness raising stages of implementation and resources were also considered to be of moderate importance, although this may change as implementation progresses. Patient experience was not seen as a driver for implementation at hospital level. Conclusion The PHARIS framework can be a useful tool for planning and evaluating EBI implementation in China. However, it’s sub-elements should be assessed and adapted to the implementation setting.

scholarly journals Perceived barriers and facilitators of the implementation of a combined lifestyle intervention with a financial incentive for chronically ill patients

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
C. C. M. Molema ◽  
G. C. W. Wendel-Vos ◽  
S. ter Schegget ◽  
A. J. Schuit ◽  
L. A. M. van de Goor
Keyword(s):  
Health Care ◽  
Lifestyle Intervention ◽  
Health Care Professionals ◽  
Healthy Lifestyle ◽  
Financial Incentive ◽  
Chronically Ill ◽  
Barriers And Facilitators ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Care Groups

Abstract Background This study aims to describe barriers and facilitators of the implementation of a combined lifestyle intervention (CLI) in primary care for patients with chronic disease. The aim of CLI to help patients to create a healthy lifestyle and to maintain this healthy lifestyle. During a CLI a patient receives advice and counselling to improve health-related behavior such as physical activity and diet. Special attention was given to the influence of adding a health promoting financial incentive (HPFI) for the participants to the CLI. Methods Twenty-four semi-structured interviews within six care groups were performed between July and October 2017. The interviews were transcribed verbatim and coded by two researchers independently. Results Respondents mentioned several preferred characteristics of the CLI such as easy accessibility of the intervention site and the presence of health care professionals during exercise sessions. Moreover, factors that could influence implementation (such as attitude of the health care professionals) and preconditions for a successful implementation of a CLI (such as structural funding and good infrastructure) were identified. Overall, positive HPFIs (e.g. a reward) were preferred over negative HPFIs (e.g. a fine). According to the respondents, HPFIs could positively influence the degree of participation, and break down barriers for participating in and finishing the CLI. Conclusions Multiple barriers and facilitators for successful implementation of a CLI were identified. For successful implementing CLIs, a positive attitude of all stakeholders is essential and specific preconditions should be fulfilled. With regard to adding a HPFI, more research is needed to identify the attitude of specific target groups towards an HPFI.

scholarly journals Training registered nurses to conduct pre-implementation assessment to inform program scale-up: an example from the rural Transitions Nurse Program

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Chelsea Leonard ◽  
Heather Gilmartin ◽  
Marina McCreight ◽  
Lynette Kelley ◽  
Ashlea Mayberry ◽  
...  
Keyword(s):  
Data Collection ◽  
Implementation Strategy ◽  
Care Transitions ◽  
Scale Up ◽  
Barriers And Facilitators ◽  
Local Context ◽  
Successful Implementation ◽  
Evidence Based ◽  
Local Contexts ◽  
Implementation Assessment

Abstract Objectives Adapting evidence-based practices to local settings is critical for successful implementation and dissemination. A pre-implementation assessment evaluates local context to inform implementation, but there is little published guidance for clinician-implementers. The rural Transitions Nurse Program (TNP) is a care coordination intervention that facilitates care transitions for rural veterans. In year 1 of TNP, pre-implementation assessments were conducted by a centralized project team through multi-day visits at five sites nationwide. In year 2, we tested if local site TNP nurses could conduct pre-implementation assessments using evidence-based tools and coaching from the TNP team. This required developing a multicomponent pre-implementation strategy bundle to guide data collection and synthesis. We hypothesized that (1) nurses would find the pre-implementation assessment useful for tailoring TNP to local contexts and (2) nurses would identify similar barriers and facilitators to those identified at first year sites. Methods The bundle included guides for conducting key informant interviews, brainwriting, process mapping, and reflective journaling. We evaluated TNP nurse satisfaction and perceived utility of the structure and process of the training and bundle through pre-post surveys. To assess the outcome of data collection efforts, we interviewed nurses 4 months after completion of the pre-implementation assessment to determine if and how they used pre-implementation findings to tailor implementation of TNP to local contexts. To further assess outcomes, all data that the nurses collected were analyzed thematically. Themes related to barriers and facilitators were compared across years. Findings Five nurses at different VA medical centers used the pre-implementation strategy bundle to collect site-level data and completed pre-post surveys. Findings indicated that the pre-implementation assessment was highly recommended, and the bundle provided adequate training. Nurses felt that pre-implementation work oriented them to the local context and illustrated how to integrate TNP into existing processes. Barriers and facilitators identified by nurses were similar to those collected in year 1 by the TNP research team, including communication challenges, need for buy-in, and logistical concerns. Conclusions This proof-of-concept study suggests that evidence-based tools can effectively guide clinician-implementers through the process of conducting a pre-implementation assessment. This approach positively informed TNP implementation and oriented nurses to their local context prior to implementation.

scholarly journals Tackling the scaling-up problem of digital health applications

2021 ◽  
Author(s):  
Peggy Richter ◽  
Lorenz Harst
Keyword(s):  
Digital Health ◽  
Scale Up ◽  
Implementation Process ◽  
Successful Implementation ◽  
Full Potential ◽  
Special Issue ◽  
Implementation Processes ◽  
Research Fields ◽  
Recent Developments ◽  
Health Applications

Abstract Aim The purpose of this editorial is to provide guidance for the readers concerning the broad realm of approaches towards successful implementation of digital health applications into the health care system. Recent developments due to the challenges posed by the COVID-19 pandemic are used as a current angle. Subject and Methods All contributions within the special issue were scanned for their most decisive contribution to the special issue and the field of implementation science, with a focus on digital health. Micro, meso, and macro layers of implementation processes, as well as the technological perspective itself, are used as broad categories for sorting the contributions and structuring the special issue. Results The ten contributions to this special issue cover micro (n = 1), technology (n = 1), meso (n = 4) and macro (n = 2) perspectives on the implementation process of digital health applications. Two further contributions also tackle the issue from a wider perspective when aiming to structure telemedicine application types and barriers encountered when implementing digital health. Conclusion Considering the wide array of research fields represented in this special issue, an emphasis is put on the importance of interdisciplinary work required for tackling the scale-up problem of digital health. As such, the special issue can assist in leveraging the full potential of digital health, not only when dealing with situations as out-of-the-ordinary as the current pandemic but also well beyond that, for example when dealing with the upcoming challenges of demographic change.

scholarly journals Physician perceived barriers and facilitators for self-measured blood pressure monitoring- a qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255578
Author(s):  
Saahith Gondi ◽  
Shellie Ellis ◽  
Mallika Gupta ◽  
Edward Ellerbeck ◽  
Kimber Richter ◽  
...  
Keyword(s):  
Health System ◽  
Primary Care Physicians ◽  
Blood Pressure Monitoring ◽  
Theoretical Domains Framework ◽  
Radical Change ◽  
Barriers And Facilitators ◽  
Hypertension Management ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Patient Acceptability

Introduction Improving hypertension management is a national priority that can decrease morbidity and mortality. Evidence-based hypertension management guidelines advocate self-measured BP (SMBP), but widespread implementation of SMBP is lacking. The purpose of this study was to describe the perspective of primary care physicians (PCPs) on SMBP to identify the barriers and facilitators for implementing SMBP. Methods We collected data from PCPs from a large health system using semi-structured interviews based on the Theoretical Domains Framework (TDF). Responses were recorded, transcribed, and qualitatively analyzed into three overarching TDF domains based on the Behavior Change Wheel (BCW): 1) Motivation 2) Opportunity and 3) Capabilities. The sample size was based on theme saturation. Results All 17 participating PCPs believed that SMBP is a useful, but underutilized tool. Although individual practices varied, most physicians felt that the increased data points from SMBP allowed for better hypertension management. Most felt that overcoming existing barriers would be difficult, but identified several facilitators: physician support of SMBP, the possibility of having other trained health professionals to assist with SMBP and patient education; improving patient engagement and empowerment with SMBP, and the interest of the health system in using technology to improve hypertension management. Conclusion PCPs believe that SMBP can improve hypertension management. There are numerous barriers and facilitators for implementing SMBP. Successful implementation in clinical practice will require implementation strategies targeted at increasing patient acceptability and reducing physician workload. This may need a radical change in the current methods of managing hypertension.

scholarly journals What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review

2020 ◽  
Author(s):  
Melanie Karrer ◽  
Julian Hirt ◽  
Adelheid Zeller ◽  
Susi Saxer
Keyword(s):  
Scoping Review ◽  
Implementation Process ◽  
Dementia Care ◽  
Barriers And Facilitators ◽  
Successful Implementation ◽  
Evidence Based ◽  
Management Support ◽  
Implementation Processes ◽  
Culture Of Care ◽  
People With Dementia

Abstract BackgroundThe implementation of evidence-based interventions for people with dementia is complex and challenging. However, successful implementation might be a key element to ensure evidence-based practice and high quality of care. There is a need to improve implementation processes in dementia care by better understanding the arising challenges. Thus, the aim of this study was to identify recent knowledge concerning barriers and facilitators to implementing nurse-led interventions in dementia care.MethodsWe performed a scoping review using the methodological framework of Arksey and O’Malley. Studies explicitly reporting on the implementation process and factors influencing the implementation of a nurse-led intervention in dementia care were included. We searched eight databases until January 2019. Two authors independently selected the studies. For data analysis, we used an inductive approach to build domains and categories.ResultsWe included 26 studies in the review and identified barriers as well as facilitators in five domains: policy (e.g. financing issues, health insurance), organisation (e.g. organisational culture and vision, resources, management support), intervention/implementation (e.g. complexity of the intervention, perceived value of the intervention), staff (e.g. knowledge, experience and skills, attitude towards the intervention), and person with dementia/family (e.g. nature and stage of dementia, response of persons with dementia and their families). ConclusionsBesides general influencing factors for implementing nursing interventions, we identified dementia-specific factors reaching beyond already known barriers and facilitators. A pre-existing person-centred culture of care as well as consistent team cultures and attitudes have a facilitating effect on implementation processes. Furthermore, there is a need for interventions that are highly flexible and sensitive to patients’ condition, needs and behaviour.

scholarly journals Implementation of a standard outcome set in perinatal care: a qualitative analysis of barriers and facilitators from all stakeholder perspectives

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anne L. Depla ◽  
Neeltje M. Crombag ◽  
Arie Franx ◽  
Mireille N. Bekker
Keyword(s):  
Thematic Analysis ◽  
Perinatal Care ◽  
Barriers And Facilitators ◽  
Care Practice ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Policy Makers ◽  
Stakeholder Perspectives ◽  
Outcome Set ◽  
Patient Reported

Abstract Background To improve their quality, healthcare systems are increasingly focused on value delivered to patients. For perinatal care, the International Consortium for Health Outcomes Measurement (ICHOM) proposed a patient-centred outcome set with both clinical and patient-reported measures for pregnancy and childbirth (PCB set). This study aimed to identify factors that affect the implementation of the PCB set at the pre-implementation stage, using the consolidated framework for implementation research (CFIR). Methods In this qualitative study, we conducted semi-structured interviews amongst a purposive sample of key stakeholders within an obstetric care network (OCN): 1) patients, 2) perinatal care professionals involved in the full cycle of perinatal care, and 3) policy makers, including hospital managers, administrative staff and health care insurers. While the CFIR guided data capture and structuring, thematic analysis revealed overarching themes that best reflected the barriers and facilitators from different stakeholder perspectives. Within these overarching themes, the CFIR constructs were maintained. Results Interviews were conducted with 6 patients, 16 professionals and 5 policy makers. Thematic analysis supported by the CFIR framework identified four main themes: the instrument and its implementation process, use in individual patient care, use in quality improvement, and the context of the OCN. Important barriers included professional workload, data reliability, and interprofessional and interorganizational collaboration. Potential facilitators were the PCB set’s direct value in individual care, interprofessional feedback and education, and aligning with existing systems. Prominent variations between stakeholder groups included the expected patient burden, the level of use, transparency of outcomes and the degree of integrated care. Conclusions This study clarified critical factors that affect successful implementation of the PCB set in perinatal care. Practice recommendations, suggested at multiple levels, can enable structural patient-centred care improvement and may unite stakeholders towards integrated birth care.

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