Organizational perspectives on implementing complex health interventions: clinical genomics in Australia

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Stephanie Best ◽  
Janet C. Long ◽  
Clara Gaff ◽  
Jeffrey Braithwaite ◽  
Natalie Taylor
Keyword(s):  
Implementation Science ◽  
Theoretical Domains Framework ◽  
Structured Interviews ◽  
Content Type ◽  
Clinical Genomics ◽  
Medical Speciality ◽  
Organizational Engagement ◽  
Organizational Barriers ◽  
Science Theory ◽  
Implementation Leadership

PurposeClinical genomics is a complex, innovative medical speciality requiring clinical and organizational engagement to fulfil the clinical reward promised to date. Focus thus far has been on gene discovery and clinicians’ perspectives. The purpose of this study was to use implementation science theory to identify organizational barriers and enablers to implementation of clinical genomics along an organizations’ implementation journey from Preadoption through to Adoption and Implementation.Design/methodology/approachWe used a deductive qualitative approach study design drawing on implementation science theory - (1) Translation Science to Population Impact Framework, to inform semi structured interviews with organizational decision-makers collaborating with Australian and Melbourne Genomics, alongside and (2) Theoretical Domains Framework (TDF), to guide data analysis.FindingsWe identified evolving organizational barriers across the implementation journey from Preadoption to Implementation. Initially the organizational focus is on understanding the value of clinical genomics (TDF code: belief about consequences) and setting the scene (TDF code: goals) before organizational (TDF codes: knowledge and belief about consequences) and clinician (TDF codes: belief about capability and intentions) willingness to adopt is apparent. Once at the stage of Implementation, leadership and clarity in organizational priorities (TDF codes: intentions, professional identity and emotion) that include clinical genomics are essential prerequisites to implementing clinical genomics in practice. Intuitive enablers were identified (e.g. ‘providing multiple opportunities for people to come on board) and mapped hypothetically to barriers.Originality/valueAttention to date has centred on the barriers facing clinicians when introducing clinical genomics into practice. This paper uses a combination of implementation science theories to begin to unravel the organizational perspectives of implementing this complex health intervention.

scholarly journals Investigating the Adoption of Clinical Genomics in Australia. An Implementation Science Case Study

Genes ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 317
Author(s):  
Stephanie Best ◽  
Janet C. Long ◽  
Clara Gaff ◽  
Jeffrey Braithwaite ◽  
Natalie Taylor
Keyword(s):  
Implementation Science ◽  
Theoretical Domains Framework ◽  
Patient Journey ◽  
Case Study Methodology ◽  
Factors Affecting ◽  
Change Models ◽  
Clinical Genomics ◽  
Medical Specialists ◽  
Study Methodology

Despite the overwhelming interest in clinical genomics, uptake has been slow. Implementation science offers a systematic approach to reveal pathways to adoption and a theory informed approach to addressing barriers presented. Using case study methodology, we undertook 16 in-depth interviews with nongenetic medical specialists to identify barriers and enablers to the uptake of clinical genomics. Data collection and analysis was guided by two evidence-based behaviour change models: the Theoretical Domains Framework (TDF), and the Capability, Opportunity Motivation Behaviour model (COM-B). Our findings revealed the use of implementation science not only provided a theoretical structure to frame the study but also facilitated uncovering of traditionally difficult to access responses from participants, e.g., “safety in feeling vulnerable” (TDF code emotion/COM-B code motivation). The most challenging phase for participants was ensuring appropriate patients were offered genomic testing. There were several consistent TDF codes: professional identity, social influences, and environmental context and resources and COM-B codes opportunity and motivation, with others varying along the patient journey. We conclude that implementation science methods can maximise the value created by the exploration of factors affecting the uptake of clinical genomics to ensure future interventions are designed to meet the needs of novice nongenetic medical specialists.

Implementation and sustainability of upper limb constraint-induced movement therapy programs for adults with neurological conditions: an international qualitative study

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Lauren J. Christie ◽  
Annie McCluskey ◽  
Meryl Lovarini
Keyword(s):  
Program Implementation ◽  
Social Factors ◽  
Theoretical Domains Framework ◽  
Occupational Therapists ◽  
Movement Therapy ◽  
Organisational Culture ◽  
Structured Interviews ◽  
Content Type ◽  
Constraint Induced Movement Therapy ◽  
Design Behaviour

PurposeConstraint-induced movement therapy (CIMT) is an effective intervention for arm recovery following acquired brain injury; however, there is an evidence-practice gap between research and CIMT use in practice. The aim of this study was to identify individual, organisational and social factors enabling implementation and sustained delivery of CIMT programs internationally.Design/methodology/approachDescriptive qualitative design. Purposive sampling was used to recruit occupational therapists and physiotherapists with previous experience delivering CIMT. Semi- structured interviews were conducted, using an interview schedule informed by the Theoretical Domains Framework (TDF) to explore individual factors (such as knowledge, skills and beliefs), organisational factors (such as organisational culture and resources) and social factors (such as leadership) influencing CIMT implementation. Interviews were audio-recorded, transcribed and managed using NVivo. The TDF guided data analysis and identification of key influences on CIMT implementation and sustainability.FindingsEleven participants (n = 7 [63.6%] occupational therapists and n = 4 [36.4%] physiotherapists) were interviewed from six countries, working across public (n = 6, 54.6%) and private health (n = 5, 45.5%). Six key domains influenced CIMT implementation and sustainability. Clinicians needed knowledge and opportunities to apply their skills, and confidence in their ability to implement CIMT. Within their workplace, supportive social influences (including broader team support), the environmental context (including organisational culture and resources) and reinforcement from seeing positive outcomes contributed to implementation and sustainability. Other important influences included community demand and tailoring of programs to meet individual needs.Originality/valueThis is the first study to examine therapists' experiences of CIMT implementation and sustainability across multiple countries. Factors related to capacity building, social and organisational support and resources enabled CIMT program implementation and ongoing sustainability. These findings can be used to design behaviour change interventions to support CIMT use in practice.

scholarly journals User-driven efforts in creating knowledge graph information system

2020 ◽  
Vol 36 (2) ◽  
pp. 97-111
Author(s):  
Stanislava Gardasevic
Keyword(s):  
Information System ◽  
Information Seeking ◽  
Information Needs ◽  
Resource Discovery ◽  
The Body ◽  
Knowledge Graph ◽  
Structured Interviews ◽  
Community Members ◽  
Study Objective ◽  
Content Type

Purpose This paper presents the results of a qualitative study that involved students of an interdisciplinary PhD program. The study objective was to gather requirements to create a knowledge graph information system. The purpose of this study was to determine information-seeking practices and information needs of this community, to inform the functionalities of a proposed system, intended to help students with relevant resource discovery and decision-making. Design/methodology/approach The study design included semi-structured interviews with eight members of the community, followed by a website usability study with the same student participants. Findings Two main information-seeking styles are recognized and reported through user personas of international and domestic (USA) students. The findings show that the useful information resides within the community and not so much on the program website. Students rely on peer communication, although they report lack of opportunities to connect. Students’ information needs and information seeking are dependent on their progress through the program, as well as their motivation and the projected timeline. Practical implications Considering the current information needs and practices, a knowledge graph hosting both information on social networks and the knowledge produced by the activities of the community members would be useful. By recording data on their activities (for example, collaboration with professors and coursework), students would reveal further useful system functionalities and facilitate transfer of tacit knowledge. Originality/value Aside from the practical value of this research that is directly influencing the design of a system, it contributes to the body of knowledge on interdisciplinary PhD programs.

scholarly journals Unpacking the package

2015 ◽  
Vol 12 (4) ◽  
pp. 346-376 ◽  
Author(s):  
Mark Evans ◽  
Basil Phillip Tucker
Keyword(s):  
Organisational Change ◽  
Clean Energy ◽  
Management Control ◽  
Theory And Practice ◽  
Structured Interviews ◽  
Informal Control ◽  
Content Type ◽  
Energy Company ◽  
Management Controls ◽  
Control Package

Purpose – The purpose of this paper is to explore the ways in which both formal and informal control, operating as a package, are implicated in responding to organisational change arising from the introduction of the Australian Federal Government’s Clean Energy Act (2011). Design/methodology/approach – This investigation is based on a review of archival data, and semi-structured interviews conducted with 15 staff at different hierarchical levels within an Australian renewable energy company. Findings – Although formal management control systems and informal control both played important roles in the organisation’s reorientation to organisational change, it was the latter form of control that predominated over the former. The influence of the prevailing organisational culture, however, was pivotal in orchestrating both formal and informal control efforts within this organisation. Originality/value – This study contributes to management control theory and practice in two ways: first, it provides much needed empirical evidence about the ways in which management controls act as a package; second, it offers insights into the relative importance of the components of a management control package in the context of a particular organisational change. In addition, it responds to Laughlin’s (1991) call for empirical “flesh” to be added to the skeletal framework he advocates to make this conceptualisation of organisational change, “more meaningful”.

Experience and expression of social isolation by inner-city high-rise residents

2014 ◽  
Vol 17 (3) ◽  
pp. 151-166 ◽  
Author(s):  
Love M. Chile ◽  
Xavier M. Black ◽  
Carol Neill
Keyword(s):  
Older Adults ◽  
Inner City ◽  
Social Isolation ◽  
Age Groups ◽  
Evidence Base ◽  
Structured Interviews ◽  
Content Type ◽  
High Rise ◽  
Starting Point ◽  
Health And Social Care

Purpose – The purpose of this paper is to examine the significance of social isolation and the factors that create social isolation for residents of inner-city high-rise apartment communities. We critically examine how the physical environment and perceptions of safety in apartment buildings and the inner-city implicate the quality of interactions between residents and with their neighbourhood community. Design/methodology/approach – The authors used mixed-methods consisting of survey questionnaires supplemented by semi-structured interviews and focus group discussions using stratified random sampling to access predetermined key strata of inner-city high-rise resident population. Using coefficient of correlation we examine the significance of the association between social isolation, age and ethnicity amongst Auckland's inner-city high-rise residents. Findings – The authors found the experience and expression of social isolation consistent across all age groups, with highest correlation between functional social isolation and “being student”, and older adults (60+ years), length of tenure in current apartment and length of time residents have lived in the inner-city. Research limitations/implications – As a case study, we did not seek in this research to compare the experience and expressions of social isolation in different inner-city contexts, nor of inner-city high-rise residents in New Zealand and other countries, although these will be useful areas to explore in future studies. Practical implications – This study is a useful starting point to build evidence base for professionals working in health and social care services to develop interventions that will help reduce functional social isolation amongst young adults and older adults in inner-city high-rise apartments. This is particularly important as the inner-city population of older adults grow due to international migration, and sub-national shifts from suburbs to the inner-cities in response to governmental policies of urban consolidation. Originality/value – By identifying two forms of social isolation, namely functional and structural social isolation, we have extended previous analysis of social isolation and found that “living alone” or structural social isolation did not necessarily lead to functional social isolation. It also touched on the links between functional social isolation and self-efficacy of older adults, particularly those from immigrant backgrounds.

scholarly journals Teaching innovations in Asian higher education: perspectives of educators

2018 ◽  
Vol 13 (2) ◽  
pp. 179-190 ◽  
Author(s):  
T.M. Wong
Keyword(s):  
Higher Education ◽  
Design Methodology ◽  
Higher Education Institutions ◽  
The Other ◽  
Asian Countries ◽  
Structured Interviews ◽  
Content Type ◽  
Advanced Technologies ◽  
The Many

Purpose The purpose of this paper is to identify the teaching innovations that have been implemented in higher education institutions in Asia and the perspectives of educators on them. Design/methodology/approach Semi-structured interviews were conducted with 28 educators who were affiliated with 23 higher education institutions in ten Asian countries/regions. The interviews covered information about the teaching innovations of the participants’ institutions, the characteristics of the innovative practices and the participants’ views on them. The relationships between the characteristics of institutions and their teaching innovations were also examined. Findings The results showed that the teaching innovations included two main categories, namely, those which involved the use of advanced technologies and those which did not. The innovations that involved the use of advanced technologies were mainly from larger institutions, while the other category was mainly from smaller ones and had been practised for less than 1.5 years. Differences were also identified between the two categories in terms of the aims and importance of innovations, innovative features, the evaluation of innovations and improvements needed for them. Originality/value The results highlighted that technology is only one of the many aspects of teaching innovations, which is different from the view prevailing in the literature. They also suggested that differences in the scale of institutions (in terms of number of students) possibly influences the kind of teaching innovations adopted.

scholarly journals “What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anh Ly ◽  
Roger Zemek ◽  
Bruce Wright ◽  
Jennifer Zwicker ◽  
Kathryn Schneider ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Clinical Pathways ◽  
Theoretical Domains Framework ◽  
Local Context ◽  
Emergency Department Physician ◽  
Evidence Based ◽  
Care Providers ◽  
Structured Interviews ◽  
Pediatric Concussion

Abstract Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.

scholarly journals Exploring producers' motivations and challenges within a farmers' market

2020 ◽  
Vol 122 (7) ◽  
pp. 2089-2103
Author(s):  
Rosario Michel-Villarreal ◽  
Eliseo Luis Vilalta-Perdomo ◽  
Martin Hingley
Keyword(s):  
Design Methodology ◽  
Farmers Markets ◽  
Full Time ◽  
Structured Interviews ◽  
Farmers Market ◽  
Content Type ◽  
Food Supply Chains ◽  
Part Time ◽  
Short Food Supply Chains

PurposeThe purpose of this study is to explore food producers' motivations and challenges whilst participating in short food supply chains (SFSCs). This paper compares findings with previous literature and investigates the topic in the context of producers' motivations.Design/methodology/approachThe paper includes a literature review concerning producers' motivations to engage in SFSCs. A case study was designed to investigate motivations underlying producers' engagement in SFSCs, as well as the challenges that they face. Semi-structured interviews were conducted in a farmers' market located in Mexico. Thematic analysis is used to identify the principal issues for producers'. Propositions based on findings are presented.FindingsFindings suggest that small, large, part-time and full-time producers are willing to engage with farmers' markets for diverse primary economic and non-economic motivations. Individual and collective challenges were also identified.Originality/valueThis research helps to explain producers' motivations and challenges within SFSCs in an under-researched context, namely a focus on producers' and in the Global South.

Collaborative design in public services: a wicked problem-reframing case

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Patrícia Moura e Sá ◽  
Catarina Frade ◽  
Fernanda Jesus ◽  
Mónica Lopes ◽  
Teresa Maneca Lima ◽  
...  
Keyword(s):  
Collaborative Design ◽  
Success Factors ◽  
Central Government ◽  
Wicked Problem ◽  
Low Density ◽  
Structured Interviews ◽  
Content Type ◽  
Critical Success ◽  
Definition Of ◽  
The Right

PurposeWicked problems require collaborative innovation approaches. Understanding the problem from the users' perspective is essential. Based on a complex and ill-defined case, the purpose of the current paper is to identify some critical success factors in defining the “right problem” to be addressed.Design/methodology/approachAn empirical research study was carried out in a low-density municipality (case study). Extensive data were collected from official databases, individual semi-structured interviews and a focus group involving citizens, local authorities, civil servants and other relevant stakeholders.FindingsAs defined by the central government, the problem to be addressed by the research team was to identify which justice services should be made available locally to a small- and low-density community. The problem was initially formulated using top-down reasoning. In-depth contact with citizens and key local players revealed that the lack of justice services was not “the issue” for that community. Mobility constraints and the shortage of economic opportunities had a considerable impact on the lack of demand for justice services. By using a bottom-up perspective, it was possible to reframe the problem to be addressed and suggest a new concept to be tested at later stages.Social implicationsThe approach followed called attention to the importance of listening to citizens and local organisations with a profound knowledge of the territory to effectively identify and circumscribe a local problem in the justice field.Originality/valueThe paper highlights the limitations of traditional rational problem-solving approaches and contributes to expanding the voice-of-the-customer principle showing how it can lead to a substantially new definition of the problem to be addressed.

scholarly journals Sinabung volcano: how culture shapes community resilience

2019 ◽  
Vol 28 (3) ◽  
pp. 290-303
Author(s):  
Marta Mori ◽  
Ronan McDermott ◽  
Saut Sagala ◽  
Yasmina Wulandari
Keyword(s):  
Structured Interviews ◽  
Content Type ◽  
Aid Dependency ◽  
Relief Operations ◽  
Long Term Impact ◽  
Cultural Experts ◽  
Practical Implications

Purpose The purpose of this paper is to explore how culture, including traditions and social structures, can influence resilience and how culturally sensitive relief operations can put affected people and their context at the core of any interventions. Design/methodology/approach A case study of the Mt Sinabung volcano area in Indonesia was undertaken. As part of the case study, an analysis of interventions was conducted, which was complemented by semi-structured interviews with Karo cultural experts and humanitarian organisations. Findings Culture influences the manner in which the Karo people react to volcano eruptions with varying implications for recovery. In addition, relief organisations which understand people’s actions through a cultural lens have better managed to tailor programs with long-term impact, thereby avoiding aid dependency. Practical implications Practical examples of disaster management activities that adequately account for the beneficiaries’ way of living prior to the eruptions are provided. Aid actors are provided with guidance concerning how to better tailor their activities in line with a cultural lens. Originality/value The study provides empirical grounding for claims concerning the role of culture in planning interventions in Indonesia and other similar contexts.

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