Successful Implementation of an All-or-None Diabetes Measure in 10 U.S. Health Systems

Abstract Domestic violence (DV) against women is a widespread violation of human rights. Adoption of effective interventions to address DV by health systems may fail if there is no readiness among organizations, institutions, providers and communities. There is, however, a research gap in our understanding of health systems’ readiness to respond to DV. This article describes the use of a health system’s readiness assessment to identify system obstacles to enable successful implementation of a primary health-care (PHC) intervention to address DV in the occupied Palestinian Territory (oPT). This article describes a case study where qualitative methods were used, namely 23 interviews with PHC providers and key informants, one stakeholder meeting with 19 stakeholders, two health facility observations and a document review of legal and policy materials on DV in oPT. We present data on seven dimensions of health systems. Our findings highlight the partial readiness of health systems and services to adopt a new DV intervention. Gaps were identified in: governance (no DV legislation), financial resources (no public funding and limited staff and infrastructure) and information systems (no uniform system), co-ordination (disjointed referral network) and to some extent around the values system (tension between patriarchal views on DV and more gender equal norms). Additional service-level barriers included unclear leadership structure at district level, uncertain roles for front-line staff, limited staff protection and the lack of a private space for identification and counselling. Findings also pointed to concrete actions in each system dimension that were important for effective delivery. This is the first study to use an adapted framework to assess health system readiness (HSR) for implementing an intervention to address DV in low- and middle-income countries. More research is needed on HSR to inform effective implementation and scale up of health-care-based DV interventions.

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Studer Group® ' s evidence-based leadership initiatives

Journal of Health Organization and Management ◽

10.1108/jhom-10-2013-0211 ◽

2015 ◽

Vol 29 (6) ◽

pp. 684-700 ◽

Cited By ~ 4

Author(s):

Kristin A. Schuller ◽

Bita A. Kash ◽

Larry D. Gamm

Keyword(s):

Health Systems ◽

Success Factors ◽

Driving Forces ◽

Qualitative Content Analysis ◽

Critical Factor ◽

Comparative Case Study ◽

Successful Implementation ◽

Evidence Based ◽

Content Type ◽

Systems Leadership

Purpose – The purpose of this paper is to analyze the implementation of an organizational change initiative – Studer Group®’s Evidence-Based Leadership (EBL) – in two large, US health systems by comparing and contrasting the factors associated with successful implementation and sustainability of the EBL initiative. Design/methodology/approach – This comparative case study assesses the responses to two pairs of open-ended questions during in-depth qualitative interviews of leaders and managers at both health systems. Qualitative content analysis was employed to identify major themes. Findings – Three themes associated with success and sustainability of EBL emerged at both health systems: leadership; culture; and organizational processes. The theme most frequently identified for both success and sustainability of EBL was culture. In contrast, there was a significant decline in salience of the leadership theme as attention shifts from success in implementation of EBL to sustaining EBL long term. Within the culture theme, accountability, and buy-in were most often cited by interviewees as success factors, while sense of accountability, buy-in, and communication were the most reported factors for sustainability. Originality/value – Cultural factors, such as accountability, staff support, and communication are driving forces of success and sustainability of EBL across both health systems. Leadership, a critical factor in several stages of implementation, appears to be less salient as among factors identified as important to longer term sustainability of EBL.

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Successful implementation of a trans-jurisdictional, primary care, anticipatory care planning intervention for older adults at risk of functional decline: interviews with key health professionals

BMC Health Services Research ◽

10.1186/s12913-021-06896-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dagmar Anna S. Corry ◽

Gillian Carter ◽

Frank Doyle ◽

Tom Fahey ◽

Patrick Gillespie ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Health Systems ◽

Health Professionals ◽

Functional Decline ◽

Successful Implementation ◽

Care Planning ◽

Nurse Training ◽

Sustainable Implementation ◽

Patient Health

Abstract Background Aging populations present a challenge to health systems internationally, due to the increasing complexity of care for older adults living with functional decline. This study aimed to elicit expert views of key health professionals on effective and sustainable implementation of a nurse-led, person-centred anticipatory care planning (ACP) intervention for older adults at risk of functional decline in a primary care setting. Methods We examined the feasibility of an ACP intervention in a trans-jurisdictional feasibility cluster randomized controlled trial consisting of home visits by research nurses who assessed participants’ health, discussed their health goals and devised an anticipatory care plan following consultation with participants’ GPs and adjunct clinical pharmacist. As part of the project, we elicited the views and recommendations of experienced key health professionals working with the target population who were recruited using a ‘snowballing technique’ in cooperation with older people health networks in the Republic of Ireland (ROI) and Northern Ireland (NI), United Kingdom [n = 16: 7 ROI, 9 NI]. Following receipt of written information about the intervention and the provision of informed consent, the health professionals were interviewed to determine their expert views on the feasibility of the ACP intervention and recommendations for successful implementation. Data were analyzed using thematic analysis. Results The ACP intervention was perceived to be beneficial for most older patients with multimorbidity. Effective and sustainable implementation was said to be facilitated by accurate and timely patient selection, GP buy-in, use of existing structures within health systems, multidisciplinary and integrated working, ACP nurse training, as well as patient health literacy. Barriers emerged as significant work already undertaken, increasing workload, lack of time, funding and resources, fragmented services, and geographical inequalities. Conclusions The key health professionals perceived the ACP intervention to be highly beneficial to patients, with significant potential to prevent or avoid functional decline and hospital admissions. They suggested that successful implementation of this primary care based, whole-person approach would involve integrated and multi-disciplinary working, GP buy in, patient health education, and ACP nurse training. The findings have potential implications for a full trial, and patient care and health policy. Trial registration Clinicaltrials.gov, ID: NCT03902743. Registered on 4 April 2019.

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Leadership in Healthcare System

Kwartalnik Ekonomistów i Menedżerów ◽

10.5604/01.3001.0013.2361 ◽

2019 ◽

Vol 51 (1) ◽

pp. 133-144

Author(s):

Tomasz Rostkowski ◽

Jan Strzemiński

Keyword(s):

Healthcare System ◽

Health Systems ◽

Successful Implementation ◽

Special Role ◽

Health Security ◽

Starting Point ◽

Leadership In Healthcare

Health plays a special role both for societies and economies. Regardless of the level of development of health systems and respective expenditures, they are struggling with shortage of resources. In case of Poland, this phenomenon also concerns significant deficiencies in other areas, including personnel. In the light of inevitable and necessary changes, this poses a serious risk both to the health security of Poles and successful implementation of modernization plans. Research carried out by employees of the Warsaw School of Economics highlighted the possibility of solving this problem through the use and development of leadership competences. This article is a starting point for a discussion on the role of the leadership in the process of changes in healthcare system.

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Human Factors in Dynamic E-Health Systems and Digital Libraries

Biomedical Knowledge Management ◽

10.4018/978-1-60566-266-4.ch013 ◽

2010 ◽

pp. 192-203 ◽

Cited By ~ 1

Author(s):

Arash Shaban-Nejad ◽

Volker Haarslev

Keyword(s):

Health Systems ◽

Digital Libraries ◽

Intelligent Agents ◽

Health Knowledge ◽

Deep Understanding ◽

Successful Implementation ◽

Biomedical Systems ◽

Machine Communication ◽

Whole Life Cycle ◽

Machine Interaction

E-health systems and digital libraries deal with human health, requiring fast responses and real-time decision-making. Human intervention can be seen in the whole life cycle of biomedical systems. In fact, relations between patients, nurses, lab technicians, health insurers, and physicians are crucial in such systems, and should be encouraged when necessary. However, there are some issues that affect the successful implementation of such infrastructures. Man-machine interaction problems are not purely computational and need a deep understanding of human behavior. Many integrated health knowledge management systems, have employed various knowledgebases and ontologies as their conceptual backbone to facilitate human-machine communication. Ontologies facilitate sharing knowledge between human and machine; they try to capture knowledge from a domain of interest; when the knowledge changes, the definitions will be altered to provide meaningful and valid information. In this chapter, we review and survey the potential issues related to the human factor in an integrated dynamic e-health system composed of several interrelated knowledgebases, bio-ontologies and digital libraries by looking at different theories in social science, psychology, and cognitive science. We also investigate the potential of some advanced formalisms in the semantic web context such as employing intelligent agents to assist the human user in dealing with changes.

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Implementation research and human-centred design: how theory driven human-centred design can sustain trust in complex health systems, support measurement and drive sustained community health volunteer engagement

Health Policy and Planning ◽

10.1093/heapol/czaa129 ◽

2020 ◽

Vol 35 (Supplement_2) ◽

pp. ii150-ii162

Author(s):

Mary B Adam ◽

Joy Minyenya-Njuguna ◽

Wilson Karuri Kamiru ◽

Simon Mbugua ◽

Naomi Wambui Makobu ◽

...

Keyword(s):

Health System ◽

Community Health ◽

Health Systems ◽

Explanatory Power ◽

Trust Building ◽

Successful Implementation ◽

Theoretical Frameworks ◽

Intervention Protocol ◽

Implementation Problems ◽

Human Centred Design

Abstract Human-centred design (HCD) can support complex health system interventions by navigating thorny implementation problems that often derail population health efforts. HCD is a pragmatic, ‘practice framework’, not an intervention protocol. It can build empathy by bringing patient voice, user perspective and innovation to construct and repair pieces of the intervention or health system. However, its emphasis on product development and process change with fixed end points has left it as an approach lacking explanatory power and reproducible measurement. Yet when informed by theory, the tremendous innovation potential of HCD can be harnessed to drive sustainability, mediate implementation problems, frame measurement constructs and ultimately improve population-level health outcomes. In attempting to mine, the potential of HCD we move beyond the pragmatic ‘how it works’, to the theoretical question, ‘why it works’. In doing so, we explore a more fundamental human question, ‘How can participation and engagement be sustained for impact in close to the community health systems?’ In this exploration, we illustrate the power of HCD by linking it to our theory of trust building. The research method we utilize is that of a longitudinal process evaluation. We leverage the heterogeneity of five community health units from the diverse setting (rural, peri-urban slum) to better understand what works for whom and in what context by tracking 21 groups of community health volunteers (CHVs) over 12 months. We report results with a focus on the outlier case failure to illustrate the contrast with common features of sustained CHV engagement, where recurrent reciprocal cycles of trust building are demonstrated in the successful implementation of action plans in plan-do-study-act cycles for improvement. All was accomplished by CHVs with no external funding. We conclude by discussing how HCD could be unleashed if linked to theoretical frameworks, increasing ability to address implementation challenges in complex health systems.

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Selection of patient-reported outcome measures (PROMs) for use in health systems

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-021-00374-2 ◽

2021 ◽

Vol 5 (S2) ◽

Author(s):

Fatima Al Sayah ◽

Xuejing Jin ◽

Jeffrey A. Johnson

Keyword(s):

Health System ◽

Health Systems ◽

Outcome Measures ◽

Outcome Measurement ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Measurement Properties ◽

Successful Implementation ◽

Patient Reported ◽

Selection Of

AbstractMany healthcare systems around the world have been increasingly using patient-reported outcome measures (PROMs) in routine outcome measurement to enhance patient-centered care and incorporate the patient’s perspective in health system performance evaluation. One of the key steps in using PROMs in health systems is selecting the appropriate measure(s) to serve the purpose and context of measurement. However, the availability of many PROMs makes this choice rather challenging. Our aim was to provide an integrated approach for PROM(s) selection for use by end-users in health systems.The proposed approach was based on relevant literature and existing guidebooks that addressed PROMs selection in various areas and for various purposes, as well as on our experience working with many health system users of PROMs in Canada. The proposed approach includes the following steps: (1) Establish PROMs selection committee; (2) Identify the focus, scope, and type of PROM measurement; (3) Identify potential PROM(s); (4) Review practical considerations for each of the identified PROMs; (5) Review measurement properties of shortlisted PROMs; (6) Review patient acceptance of shortlisted PROMs; (7) Recommend a PROM(s); and (8) Pilot the selected PROM(s). The selection of appropriate PROMs is one step in the successful implementation of PROMs within health systems, albeit, an essential step. We provide guidance for the selection of PROMs to satisfy all potential usages at the micro (patient-clinician), meso (organization), and macro (system) levels within the health system. Selecting PROMs that satisfy all these purposes is essential to ensure continuity and standardization of measurement over time. This is an iterative process and users should consider all the available information from all presented steps in selecting PROMs. Each of these considerations has a different weight in diverse clinical contexts and settings with various types of patients and resources.

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Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems

Journal of Hospital Administration ◽

10.5430/jha.v3n6p66 ◽

2014 ◽

Vol 3 (6) ◽

pp. 66

Author(s):

Pavani Rangachari

Keyword(s):

Information And Communication Technologies ◽

Health Systems ◽

Technology Use ◽

Meaningful Use ◽

Social Structures ◽

Social Knowledge ◽

Successful Implementation ◽

Electronic Health ◽

Practice Framework ◽

Knowledge In Practice

Despite the federal policy momentum towards “meaningful use” of Electronic Health Records (EHRs), the healthcare organizational literature remains replete with reports of unintended adverse consequences of implementing EHRs, including: increased work for clinicians, unfavorable workflow changes, and unexpected changes in communication patterns & practices. In addition to being costly and unsafe, these unintended adverse consequences may pose a formidable barrier to “meaningful use” of EHRs. Correspondingly, it is essential for hospital administrators to understand and detect the causes of unintended adverse consequences, to ensure successful implementation of EHRs. The longstanding Technology-in-Practice framework emphasizes the role of human agency in enacting structures of technology use or “technologies-in-practice”. Given a set of unintended adverse consequences from health information technology implementation, this framework could help trace them back to specific actions (types of technology-in-practice) and institutional conditions (social structures). On the other hand, the more recent Knowledge-in-Practice framework helps understand how information and communication technologies (e.g., social knowledge networking systems) could be implemented alongside existing technology systems, to create new social structures, generate new knowledge-in-practice, and transform technology-in-practice. Therefore, integrating the two literature streams could serve the dual purpose of understanding and overcoming unintended adverse consequences of EHR implementation. This paper seeks to: (1) review the theoretical literatures on technology use & implementation, and identify a framework for understanding & overcoming unintended adverse consequences of implementing EHRs; (2) outline a broad project proposal to test the applicability of the framework in enabling “meaningful use” of EHRs in a healthcare context; and (3) identify strategies for successful implementation of EHRs in hospitals & health systems, based on the literature review and application.

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Challenges in Patient Discharge Planning in the Health System of Iran: A Qualitative Study

Global Journal of Health Science ◽

10.5539/gjhs.v8n6p168 ◽

2015 ◽

Vol 8 (6) ◽

pp. 168 ◽

Cited By ~ 5

Author(s):

Masumeh Gholizadeh ◽

Bahram Delgoshaei ◽

Hasan Abulghasem Gorji ◽

Sogand Torani ◽

Ali Janati

Keyword(s):

Health System ◽

Health Systems ◽

Discharge Planning ◽

Planning System ◽

World Health ◽

Health Staff ◽

Successful Implementation ◽

Policy Makers ◽

Effective Discharge

BACKGROUND: One of the main factors relating to quality of hospitals is effective discharge planning. Discharge planning promotes the quality of inpatient care and reduces unplanned hospital readmission. The current study investigated the challenges of discharge planning observed in the health system of Iran.METHODS: This qualitative research was conducted using a thematic and framework analyses to identify the challenges under each themes defined by the World Health Organization (WHO), to understand barriers in developing an effective discharge planning system in Iran health system. The data was collected from detailed semi-structured interviews and sessions of focus group discussions. This study involved 51 participants including health policy makers, hospital and health managers, faculty members, nurses, practitioners, community medicine specialists and other professionals of the Ministry of Health and Medical Education (MOHME). To reduce the bias and to increase the credibility of the study, evaluation criteria from Lincoln and Guba were used. All interviews and FGDs were recorded and transcribed, then analyzed by the software MAXQDA-11 and also manually.RESULTS: According to the WHO health systems framework, challenges of effective hospital discharge planning were divided into six areas, leadership/governance, service delivery, information, financing, health workforce, and medical production(themes), in which there were 5,3,2,2,3,1 subthemes respectively.CONCLUSION: It is evident from the findings of this study that changes in the perspective of policy makers, health staff and managers, strengthening of systematic approach, and establishment of required infrastructures are essential for successful implementation of effective discharge planning in health systems in Iran.

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Expressions of Actor Power in Implementation: A Qualitative Case Study of a Health Service Intervention in South Africa

10.21203/rs.3.rs-720836/v1 ◽

2021 ◽

Author(s):

Helen Schneider ◽

Fidele Mukinda ◽

Hanani Tabana ◽

Asha George

Keyword(s):

South Africa ◽

Health Care ◽

Health Systems ◽

Power Relations ◽

Health Care Quality ◽

Qualitative Case Study ◽

Care Quality ◽

Successful Implementation ◽

Local Health

Abstract Background Implementation frameworks and theories acknowledge the role of power as a factor in the adoption (or not) of interventions in health services. Despite this recognition, there is a paucity of evidence on how interventions at the front line of health systems confront or shape existing power relations. This paper reports on a study of actor power in the implementation of an intervention to improve maternal, neonatal and child health care quality and outcomes in a rural district of South Africa. Methods A retrospective qualitative case study based on interviews with 34 actors in three ‘implementation units’ – a district hospital and surrounding primary health care services – of the district, selected as purposefully representing full, moderate and low implementation of the intervention some three years after it was first introduced. Data are analysed using Veneklasen and Miller’s typology of the forms of power – namely ‘power over’, ‘power to’, ‘power within’ and ‘power with’. Results Multiple expressions of actor power were evident during implementation and played a plausible role in shaping variable implementation, while the intervention itself acted to change power relations. The ability to mobilise collective action (power with) was a key dimension of successful implementation, but potentially poses a threat to hierarchical power (power over) at higher levels of the system, affecting sustainability. Conclusions A systematic approach to the analysis of power in implementation research may provide insights into the fate of interventions. Intervention designs need to consider how they shape power relations, especially where interventions seek to widen participation and responsiveness in local health systems.

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