scholarly journals Race and Equity in Statewide Implementation Programs: An Application of the Policy Ecology of Implementation Framework

2020 ◽  
Vol 47 (6) ◽  
pp. 946-960
Author(s):  
Martha J. Aby
Keyword(s):  
Implementation Framework ◽  
Policy Ecology

How multidisciplinary are multidisciplinary case reviews in cancer care? Feasibility analysis of a theory-driven team decision-making fidelity framework

2019 ◽  
Author(s):  
Tayana Soukup ◽  
Ged Murtagh ◽  
Ben W Lamb ◽  
James Green ◽  
Nick Sevdalis
Keyword(s):  
Decision Making ◽  
Cancer Care ◽  
Recent Decade ◽  
Individual Case ◽  
Multidisciplinary Teams ◽  
Final Decision ◽  
Political Climate ◽  
Implementation Framework ◽  
Feasibility Evaluation ◽  
The Uk

Background Multidisciplinary teams (MDTs) are a standard cancer care policy in many countries worldwide. Despite an increase in research in a recent decade on MDTs and their care planning meetings, the implementation of MDT-driven decision-making (fidelity) remains unstudied. We report a feasibility evaluation of a novel method for assessing cancer MDT decision-making fidelity. We used an observational protocol to assess (1) the degree to which MDTs adhere to the stages of group decision-making as per the ‘Orientation-Discussion-Decision-Implementation’ framework, and (2) the degree of multidisciplinarity underpinning individual case reviews in the meetings. MethodsThis is a prospective observational study. Breast, colorectal and gynaecological cancer MDTs in the Greater London and Derbyshire (United Kingdom) areas were video recorded over 12-weekly meetings encompassing 822 case reviews. Data were coded and analysed using frequency counts.Results Eight interaction formats during case reviews were identified. case reviews were not always multi-disciplinary: only 8% of overall reviews involved all five clinical disciplines present, and 38% included four of five. The majority of case reviews (i.e. 54%) took place between two (25%) or three (29%) disciplines only. Surgeons (83%) and oncologists (8%) most consistently engaged in all stages of decision-making. While all patients put forward for MDT review were actually reviewed, a small percentage of them (4%) either bypassed the orientation (case presentation) and went straight into discussing the patient, or they did not articulate the final decision to the entire team (8%). Conclusions Assessing fidelity of MDT decision-making at the point of their weekly meetings is feasible. We found that despite being a set policy, case reviews are not entirely MDT-driven. We discuss implications in relation to the current eco-political climate, and the quality and safety of care. Our findings are in line with the current national initiatives in the UK on streamlining MDT meetings, and could help decide how to re-organise them to be most efficient.

scholarly journals Exploring the implementation of the Community for Successful Ageing (ComSA)program in Singapore: lessons learnt on program delivery for improving BioPsychoSocial health

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Su Aw ◽  
Gerald C. H. Koh ◽  
Chuen Seng Tan ◽  
Mee Lian Wong ◽  
Hubertus J. M. Vrijhoef ◽  
...  
Keyword(s):  
Organizational Factors ◽  
Dropout Rate ◽  
List Type ◽  
Successful Ageing ◽  
Implementation Framework ◽  
Organizational Contexts ◽  
Lessons Learnt ◽  
Implementation Stages ◽  
Program Characteristics ◽  
Interpretative Approach

Abstract Background The Community for Successful Ageing (ComSA) program has implemented overlapping BioPsychoSocial (BPS) components as part of a Community Development (CD) grassroots and volunteer-led initiative. Implementation of such multi-component programming is influenced by known program characteristics including novelty, complexity and observability as well as related organizational factors. As such, we explored ComSA CD’s implementation from the organizational perspective, seeking to inform program improvements. Methods We conducted four focus groups with program staff, partners and trainers (total N = 21 participants). Findings were analysed using an interpretative approach and synthesized into a line of argument informing lessons learnt. Results An implementation framework was identified. It is guided by considering the influence of known program characteristics across major themes, representing three core implementation stages. These and supporting sub-themes are elaborated in turn: Creating commitment toward the program was challenged by novelty and at times a lack of shared understanding of ComSA CD, particularly relating to the S component. Overall, cohesion within organizational contexts and having a strong rapport with the community (ability to engage) were needed to persuade volunteers and participants to commit to the program. Coordination and resource allocation were influenced by the complexity of interconnecting BPS components - requiring aligning communication between partners and adapting the BPS sequence, given the separated management structure of program trainers. Efficiency of resource utilization was constrained by the ability to pool and match resources given the limited manpower and community partners who worked-in-silo due to a KPI-centric culture. Collaborative program monitoring and appraisal increased observability of the program’s benefits, but depended on partners’ prior commitment. Despite appreciating its holistic BPS programming, dropout rate was used as a way to gauge program success, which has limited interpretability. Occasional uncertainty about the program value contributed to concerns about duplicating existing ageing programs, particularly those related to the B component. Conclusion Lessons learnt for improving BPS programming include (1) eliciting better participants’ buy-in and shared program vision, (2) increasing adaptability of BPS sequence and building a culture of shared values for working together (3) and developing comprehensive monitoring systems for program appraisal.

Implementation of the Australasian Teletrial Model: Translating idea into action using implementation science frameworks

2021 ◽  
pp. 1357633X2110178
Author(s):  
Sabe Sabesan ◽  
Marie Malica ◽  
Chantal Gebbie ◽  
Clare Scott ◽  
David Thomas ◽  
...  
Keyword(s):  
Implementation Science ◽  
Pilot Project ◽  
Final Report ◽  
Rare Cancer ◽  
Government Investment ◽  
Implementation Framework ◽  
Advisory Groups ◽  
Regulatory Systems ◽  
Key Stakeholders ◽  
Strategic Implementation

Background: Despite Government investment, disparity in access to clinical trials continue between metropolitan and regional & rural sectors (RRR) in Australia and around the world. To improve trial access closer to home for RRR communities and rare cancer patients even in metro settings, the Australasian Teletrial Model (ATM) was developed by Clinical Oncology Society of Australia and implemented in four states. Aim of this paper is to describe the steps and processes involved in the development and implementation of ATM guided by implementation science frameworks. Method: Two implementation science frameworks namely iPARIHS and Strategic Implementation Framework were chosen to guide the project. Details of steps and processes were extracted from COSA final report. Results: ATM met the criteria for worthy innovation. For the development and implementation of the ATM, stakeholders were at national, statewide and clinical levels. A co-design with end-users and inclusion of key stakeholders in steering committees and advisory groups made the implementation smoother. Clinician levers including advocacy were useful to overcome system barriers. During the project, more patients, and clinicians at RRR participated in trials, more primary sites collaborated with RRR sites and more RRR sites gained trial capabilities. Conclusion: Pilot project achieved its objectives including improved access to patients locally, creation of linkages between metro and RRR sites and enhanced capabilities of and access to RRR sites. Implementation science frameworks were useful for identifying the necessary steps and processes at the outset. Ownership by governments and creation of streamlined regulatory systems would enable broader adoption.

scholarly journals Behaviour change practices in exercise referral schemes: developing realist programme theory of implementation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John Downey ◽  
Katie Shearn ◽  
Nicola Brown ◽  
Ross Wadey ◽  
Jeff Breckon
Keyword(s):  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Developed Countries ◽  
Realist Evaluation ◽  
Service Planning ◽  
Service Development ◽  
Activity Levels ◽  
Programme Theory ◽  
Implementation Framework ◽  
Exercise Referral

Abstract Background Exercise Referral Schemes have been delivered worldwide in developed countries to augment physical activity levels in sedentary patients with a range of health issues, despite their utility being questioned. Understanding the implementation mechanisms of behaviour change practices is important to avoid inappropriate decommissioning and support future service planning. The aim of this study was to develop initial theories to understand what influences the behaviour change practices of Exercise Referral practitioners within the United Kingdom. Methods An eight-month focused ethnography was undertaken, to carry out the first phase of a realist evaluation, which included participant observation, interviews, document analysis, and reflexive journaling. A comprehensive implementation framework (Consolidated Framework for Implementation Research) was adopted providing an extensive menu of determinants. Mechanisms were categorised based on the Theoretical Domains Framework (within the Capability, Opportunity, Motivation, Behaviour model) providing an explanatory tool linking the levels of the framework. Results Three programme theories are proposed. Firstly, motivation and capability are influenced when behaviour change oriented planning and training are in place. Secondly, motivation is influenced if leadership is supportive of behaviour change practice. Lastly, integration between health professionals and practitioners will influence motivation and capability. The conditions necessary to influence motivation and capability include a person-centred climate, cognizant practitioners, and established communities of practice. Conclusions The findings are the first to articulate the necessary elements for the implementation of behaviour change practices in Exercise Referral services. These results outline emerging theories about the conditions, resources, and explanations of behaviour change implementation that can inform service development.

scholarly journals Implementation Framework for a Blockchain-Based Federated Learning Model for Classification Problems

Symmetry ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1116
Author(s):  
Zeba Mahmood ◽  
Vacius Jusas
Keyword(s):  
Machine Learning ◽  
Learning Model ◽  
Global Perspective ◽  
Learning Technology ◽  
Classification Problems ◽  
Zero Knowledge ◽  
Privacy And Security ◽  
Implementation Framework ◽  
The Past

This paper introduces a blockchain-based federated learning (FL) framework with incentives for participating nodes to enhance the accuracy of classification problems. Machine learning technology has been rapidly developed and changed from a global perspective for the past few years. The FL framework is based on the Ethereum blockchain and creates an autonomous ecosystem, where nodes compete to improve the accuracy of classification problems. With privacy being one of the biggest concerns, FL makes use of the blockchain-based approach to ensure privacy and security. Another important technology that underlies the FL framework is zero-knowledge proofs (ZKPs), which ensure that data uploaded to the network are accurate and private. Basically, ZKPs allow nodes to compete fairly by only submitting accurate models to the parameter server and get rewarded for that. We have conducted an analysis and found that ZKPs can help improve the accuracy of models submitted to the parameter server and facilitate the honest participation of all nodes in FL.

scholarly journals Application of a Preventive Training Program Implementation Framework to Youth Soccer and Basketball Organizations

2019 ◽  
Vol 54 (2) ◽  
pp. 182-191 ◽  
Author(s):  
Hayley J. Root ◽  
Barnett S. Frank ◽  
Craig R. Denegar ◽  
Douglas J. Casa ◽  
David I. Gregorio ◽  
...  
Keyword(s):  
Program Implementation ◽  
Administrative Support ◽  
Neuromuscular Control ◽  
Initial Step ◽  
Sport Performance ◽  
Implementation Framework ◽  
Injury Rates ◽  
Youth Soccer ◽  
Youth Athletes ◽  
Education Workshop

Context Preventive training programs (PTPs) can reduce injury rates and improve neuromuscular control and sport performance. However, PTPs must be implemented correctly and consistently over time for athletes to benefit. Coaches represent the best long-term option for implementing PTPs. Youth athletes are at the optimal age for developing good habits before maturation. Although frameworks have been proposed to guide implementation efforts, little is known regarding the feasibility and real-world context of PTP implementation at the youth sport level. Objective To evaluate the application of the 7-Step framework for promoting implementation of a preseason PTP workshop. Design Descriptive epidemiology study. Setting Youth soccer and basketball organizations. Patients or Other Participants Organizations with at least 1 team of athletes aged 8 to 14 years were invited to participate in a free preseason coaches' education workshop on PTP implementation. Intervention(s) The 7-Step framework was used to guide PTP education and implementation for each organization. Personnel at organizations that agreed to participate attended a single preseason workshop for coaches. Research staff were available as a resource throughout the season but did not actively implement or monitor the PTPs. Main Outcome Measure(s) Retrospective evaluation of each organization's completion of steps 1 through 5 of the 7-Step framework. Results A total of 62 youth soccer (n = 40) and basketball (n = 22) organizations were invited to participate. Twelve organizations completed steps 1 through 4 and steps 5a through 5d. The highest drop-off rate occurred during step 1, “Establishing Administrative Support.” No organization completed all components of steps 1 through 5. Conclusions To better understand how to successfully promote PTP adoption, we must identify the implementation steps that may present the most challenges. Because the highest drop-off rate was seen during the initial step, establishing administrative support and strengthening initial engagement are necessary to improve PTP implementation.

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