scholarly journals HealthPathways implementation in a New Zealand health region: a qualitative study using the Consolidated Framework for Implementation Research

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e025094 ◽  
Author(s):  
Tim Stokes ◽  
Emma Tumilty ◽  
Fiona Doolan-Noble ◽  
Robin Gauld
Keyword(s):  
New Zealand ◽  
Implementation Research ◽  
Clinical Care ◽  
Referral System ◽  
Local Context ◽  
Successful Implementation ◽  
Care Pathways ◽  
Web Portal ◽  
Health Region ◽  
The Web

ObjectivesTo explore the process of implementation of an online health information web-based portal and referral system (HealthPathways) using implementation science theory: the Consolidated Framework for Implementation Research (CFIR).SettingSouthern Health Region of New Zealand (Otago and Southland).ParticipantsKey Informants (providers and planners of healthcare) (n=10) who were either involved in the process of implementing HealthPathways or who were intended end-users of HealthPathways.MethodsSemistructured interviews were undertaken. A deductive thematic analysis using CFIR was conducted using the framework method.ResultsCFIR postulates that for an intervention to be implemented successfully, account must be taken of the intervention’s core components and the adaptable periphery. The core component of HealthPathways—the web portal and referral system that contains a large number of localised clinical care pathways—had been addressed well by the product developers. Little attention had, however, been paid to addressing the adaptable periphery (adaptable elements, structures and systems related to HealthPathways and the organisation into which it was being implemented); it was seen as sufficient just to deliver the web portal and referral system and the set of clinical care pathways as developed to effect successful implementation. In terms of CFIR’s ‘inner setting’ corporate and professional cultures, the implementation climate and readiness for implementation were not properly addressed during implementation. There were also multiple failures of the implementation process (eg, lack of planning and engagement with clinicians). As a consequence, implementation of HealthPathways was highly problematic.ConclusionsThe use of CFIR has furthered our understanding of the factors needed for the successful implementation of a complex health intervention (HealthPathways) in the New Zealand health system. Those charged with implementing complex health interventions should always consider the local context within which they will be implemented and tailor their implementation strategy to address these.

scholarly journals Next-Generation Allergic Rhinitis Care in Singapore: 2019 ARIA Care Pathways

2020 ◽  
Vol 49 (11) ◽  
pp. 885-896
Author(s):  
Xuandao Liu ◽  
De Yun Wang ◽  
Tze Choong Charn ◽  
Leslie Timothy Koh ◽  
Neville WY Teo ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Care ◽  
Work Productivity ◽  
Suboptimal Control ◽  
Current Status ◽  
Local Context ◽  
Care Pathways ◽  
Important Health ◽  
Integrated Care Pathways ◽  
Important Health Issue

Allergic rhinitis (AR) is prevalent in Singapore, with a significant disease burden. Afflicting up to 13% of the population, AR impairs quality of life, leads to reduced work productivity and is an independent risk factor for asthma. In the last 2 decades, local studies have identified patient and physician behaviours leading to suboptimal control of the disease. Yet, there is an overall lack of attention to address this important health issue. Allergic Rhinitis and its Impact on Asthma (ARIA) is a European organisation aimed at implementing evidence-based management for AR worldwide. Recent focus in Europe has been directed towards empowering patients for self-management, exploring the complementary role of mobile health, and establishing healthcare system-based integrated care pathways. Consolidation of these ongoing efforts has led to the release of the 2019 ARIA care pathways. This review summarises the ARIA update with particular emphasis on the current status of adult AR in Singapore. In addition, we identify unmet needs and future opportunities for research and clinical care of AR in the local context. Keywords: Allergen immunotherapy, Allergic Rhinitis and its Impact on Asthma, clinical guideline

scholarly journals LO25: The development and implementation of a standardized emergency department handover tool

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S15-S15
Author(s):  
E. S. H. Kwok ◽  
G. Clapham ◽  
S. White ◽  
M. Austin ◽  
L. Calder
Keyword(s):  
Formal Education ◽  
Clinical Care ◽  
Local Context ◽  
Successful Implementation ◽  
Communication Tool ◽  
Process Measures ◽  
Communication Breakdown ◽  
Median Proportion ◽  
Stakeholder Input ◽  
Shift Change

Introduction: There is a high risk for communication breakdown, discontinuity of clinical care, and medical errors during ED physician handover. Locally, there is no standardized handover process to ensure adequate communication of critical information. Our aim was to use a locally developed handover tool to increase frequency of adequate physician handover during overnight shift change by 50% in 4 months. Methods: Using published best practices, local observational data, and stakeholder input, we determined critical components of ED handovers. We developed a structured communication tool for two unique populations in our ED: ED-VITAL for patients receiving active ED care; ED-VSA for patients who are admitted/referred. Strategies used to implement the tool included: engagement of staff physicians to introduce & modify the tool; formal education and training to ED residents; and provision of cognitive aids. A QI coordinator conducted direct observations of handovers using convenience sampling. We provided feedback to staff and resident physicians, and used their input to continuously modify the tool. The main outcome measure was adequate patient handover, defined as verbal communication of 50% of critical handover components, or documentation of key information on an electronic note. Process measures included tool utilization characteristics. Balance measures included time metrics such as handover duration. We present run charts and qualitative statistics. Results: We assessed 368 individual patient handovers (93 pre- & 275 post-implementation). The median proportion of patients in active ED care who were verbally handed over increased from 75% to 100%. The median proportion of adequate handovers improved from 50% to 72%. The time to deliver handover increased by 13 seconds per patient. Qualitative feedback from end users was positive overall, particularly for communication quality and resident educational value. Conclusion: Use of a standardized handover tool improved both verbal and documented communication during shift change. A customized approach, sensitive to local context, was important to successful implementation. Residents play a large role in handovers; strategies to improve handover processes that emphasize medical education appear to enhance success. Future PDSA cycles will focus on interventions to further enhance the utilization of the tool, and to measure direct impact on clinical outcomes.

Future Issues in Dissemination and Implementation Research

2017 ◽  
Author(s):  
Ross C. Brownson ◽  
Graham A. Colditz ◽  
Enola K. Proctor
Keyword(s):  
Public Health ◽  
Health Services ◽  
Implementation Research ◽  
Clinical Care ◽  
Dissemination And Implementation ◽  
Public Health Services ◽  
Middle Income ◽  
Middle Income Countries ◽  
Dissemination And Implementation Research ◽  
The Many

This chapter highlights just a sample of the many rich areas for dissemination and implementation research that will assist us in shortening the gap between discovery and practice, thus beginning to realize the benefits of research for patients, families, and communities. Greater emphasis on implementation in challenging settings, including lower and middle-income countries and underresourced communities in higher income countries will add to the lessons we must learn to fully reap the benefit of our advances in dissemination and implementation research methods. Moreover, collaboration and multidisciplinary approaches to dissemination and implementation research will help to make efforts more consistent and more effective moving forward. Thus, we will be better able to identify knowledge gaps that need to be addressed in future dissemination and implementation research, ultimately informing the practice and policies of clinical care and public health services.

scholarly journals Diagnosis and Management of Osteoporosis During COVID-19: Systematic Review and Practical Guidance

2021 ◽  
Author(s):  
G. Hampson ◽  
M. Stone ◽  
J. R. Lindsay ◽  
R. K. Crowley ◽  
S. H. Ralston
Keyword(s):  
Clinical Care ◽  
Fragility Fractures ◽  
Osteoporosis Treatment ◽  
Healthcare Services ◽  
Urgent Care ◽  
Health Concern ◽  
Care Pathways ◽  
Long Term Conditions ◽  
Treatment Pathways ◽  
Diagnosis And Management

AbstractIt is acknowledged that the COVID-19 pandemic has caused profound disruption to the delivery of healthcare services globally. This has affected the management of many long-term conditions including osteoporosis as resources are diverted to cover urgent care. Osteoporosis is a public health concern worldwide and treatment is required for the prevention of further bone loss, deterioration of skeletal micro-architecture, and fragility fractures. This review provides information on how the COVID-19 pandemic has impacted the diagnosis and management of osteoporosis. We also provide clinical recommendations on the adaptation of care pathways based on experience from five referral centres to ensure that patients with osteoporosis are still treated and to reduce the risk of fractures both for the individual patient and on a societal basis. We address the use of the FRAX tool for risk stratification and initiation of osteoporosis treatment and discuss the potential adaptations to treatment pathways in view of limitations on the availability of DXA. We focus on the issues surrounding initiation and maintenance of treatment for patients on parenteral therapies such as zoledronate, denosumab, teriparatide, and romosozumab during the pandemic. The design of these innovative care pathways for the management of patients with osteoporosis may also provide a platform for future improvement to osteoporosis services when routine clinical care resumes.

scholarly journals Coping with COVID-19: medical students as strong and responsible stewards of their education

2021 ◽  
Author(s):  
Jacquelyn B. Kercheval ◽  
Deena Khamees ◽  
Charles A. Keilin ◽  
Netana H. Markovitz ◽  
Eve D. Losman
Keyword(s):  
Medical Students ◽  
Curriculum Development ◽  
De Novo ◽  
Traditional Approach ◽  
Clinical Care ◽  
Successful Implementation ◽  
Discussion Boards ◽  
Multiple Choice Questions ◽  
Continued Learning ◽  
Comprehensive Curriculum

Abstract Background Due to the COVID-19 pandemic, clinical rotations at the University of Michigan Medical School (UMMS) were suspended on March 17, 2020, per the Association of American Medical Colleges’ recommendations. No alternative curriculum existed to fill the educational void for clinical students. The traditional approach to curriculum development was not feasible during the pandemic as faculty were redeployed to clinical care, and the immediate need for continued learning necessitated a new model. Approach One student developed an outline for an online course on pandemics based on peer-to-peer conversations regarding learners’ interests and needs, and she proposed that students author the content given the immediate need for a curriculum. Fifteen student volunteers developed content to fill knowledge gaps, and expert faculty reviewers confirmed that the student authors had successfully curated a comprehensive curriculum. Evaluation The crowdsourced student content coalesced into a 40-hour curriculum required for all 371 clinical-level students at UMMS. This student-driven effort took just 17 days from outline to implementation, and the final product is a full course comprising five modules, multiple choice questions, discussion boards, and assignments. Learners were surveyed to gauge success, and 93% rated this content as relevant to all medical students. Reflection The successful implementation of this model for curriculum development, grounded in the Master Adaptive Learner framework, suggests that medical students can be entrusted as stewards of their own education. As we return to a post-pandemic “normal,” this approach could be applied to the maintenance and de novo development of future curricula.

scholarly journals Developing implementation strategies to adopt Enhanced Recovery After Surgery (ERAS®) guidelines

BJS Open ◽  
2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Jennifer Y Lam ◽  
Alexandra Howlett ◽  
Duncan McLuckie ◽  
Lori M Stephen ◽  
Scott D N Else ◽  
...  
Keyword(s):  
Implementation Strategy ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Healthcare Providers ◽  
Implementation Strategies ◽  
Multidisciplinary Teams ◽  
Successful Implementation ◽  
Care Pathways ◽  
Audit System ◽  
Local Contexts

Abstract Background Strong implementation strategies are critical to the success of Enhanced Recovery after Surgery (ERAS®) guidelines, though little documentation exists on effective strategies, especially in complex clinical situations and unfamiliar contexts. This study outlines the process taken to adopt a novel neonatal ERAS® guideline. Methods The implementation strategy was approached in a multi-pronged, concurrent but asynchronous fashion. Between September 2019 and January 2020, healthcare providers from various disciplines and different specialties as well as parents participated in the strategy. Multidisciplinary teams were created to consider existing literature and local contexts including potential facilitators and/or barriers. Task forces worked collaboratively to develop new care pathways. An audit system was developed to record outcomes and elicit feedback for revision. Results 32 healthcare providers representing 9 disciplines and 5 specialties as well as 8 parents participated. Care pathways and resources were created. Elements recommended for a successful implementation strategy included identification of champions, multidisciplinary stakeholder involvement, consideration of local contexts and insights, patient/family engagement, education, and creation of an audit system. Conclusion A multidisciplinary and structured process following principles of implementation science was used to develop an effective implementation strategy for initiating ERAS® guidelines.

Overcoming the White Knight Complex: Social License and Internationalization for Society

2021 ◽  
pp. 102831532110162
Author(s):  
Svetlana Kostrykina
Keyword(s):  
Higher Education ◽  
New Zealand ◽  
International Education ◽  
Service Industries ◽  
Local Context ◽  
Social License To Operate ◽  
Education Industry ◽  
Social License ◽  
Common Purpose ◽  
Internationalization In Higher Education

The article investigates the concept of internationalization in higher education for society (IHES) and discusses the role of social license to internationalize, its contextual variations, and implications for internationalization practices in New Zealand and Indonesia. The notion of social license to operate is common in the extraction and some service industries; however, the concept of social license to internationalize constitutes an innovative direction for research concerned with IHES and the global international education industry. Social license to internationalize emerged as a pivotal feature of internationalization practices in New Zealand and Indonesia. It reflected the public recognition of IHES, manifested in the cultural and social value of internationalization. The construction of social license to internationalize presented itself as a strategic priority for the governments and higher education institutions (HEIs) in both research settings. The conceptual underpinnings of social license to internationalize, and hence the means of constructing the latter varied depending on the local context, but they served a common purpose of reification of internationalization practices. The study of social license to internationalize contributes to a broader discussion on IHES and sheds lights on the mechanisms of building meaningful and mutually beneficial connections between the stakeholders of the global international education industry and the wider public.

scholarly journals Feasibility, usability and acceptability of paediatric lung ultrasound among healthcare providers and caregivers for the diagnosis of childhood pneumonia in resource-constrained settings: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e042547
Author(s):  
Atif Riaz ◽  
Olga Cambaco ◽  
Laura Elizabeth Ellington ◽  
Jennifer L Lenahan ◽  
Khatia Munguambe ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Low Income ◽  
Lung Ultrasound ◽  
New Technology ◽  
Healthcare Providers ◽  
Ease Of Use ◽  
Local Context ◽  
Future Research ◽  
Successful Implementation ◽  
Pneumonia Diagnosis

ObjectivesPaediatric pneumonia burden and mortality are highest in low-income and middle-income countries (LMIC). Paediatric lung ultrasound (LUS) has emerged as a promising diagnostic tool for pneumonia in LMIC. Despite a growing evidence base for LUS use in paediatric pneumonia diagnosis, little is known about its potential for successful implementation in LMIC. Our objectives were to evaluate the feasibility, usability and acceptability of LUS in the diagnosis of paediatric pneumonia.DesignProspective qualitative study using semistructured interviewsSettingTwo referral hospitals in Mozambique and PakistanParticipantsA total of 21 healthcare providers (HCPs) and 20 caregivers were enrolled.ResultsHCPs highlighted themes of limited resource availability for the feasibility of LUS implementation, including perceived high cost of equipment, maintenance demands, time constraints and limited trained staff. HCPs emphasised the importance of policymaker support and caregiver acceptance for long-term success. HCP perspectives of usability highlighted ease of use and integration into existing workflow. HCPs and caregivers had positive attitudes towards LUS with few exceptions. Both HCPs and caregivers emphasised the potential for rapid, improved diagnosis of paediatric respiratory conditions using LUS.ConclusionsThis was the first study to evaluate HCP and caregiver perspectives of paediatric LUS through qualitative analysis. Critical components impacting feasibility, usability and acceptability of LUS for paediatric pneumonia diagnosis in LMIC were identified for initial deployment. Future research should explore LUS sustainability, with a particular focus on quality control, device maintenance and functionality and adoption of the new technology within the health system. This study highlights the need to engage both users and recipients of new technology early in order to adapt future interventions to the local context for successful implementation.Trial registration numberNCT03187067.

scholarly journals Culturally competent, safe and equitable clinical care for Ma¯ori with bipolar disorder in New Zealand: The expert critique of Ma¯ori patients and Wha¯nau

2021 ◽  
pp. 000486742110314
Author(s):  
Tracy Haitana ◽  
Suzanne Pitama ◽  
Donna Cormack ◽  
Mau Te Rangimarie Clark ◽  
Cameron Lacey
Keyword(s):  
Bipolar Disorder ◽  
New Zealand ◽  
Cultural Competence ◽  
Health System ◽  
Clinical Care ◽  
Clinical Work ◽  
Culturally Competent ◽  
Structured Interviews ◽  
Clinical Culture ◽  
Competence Framework

Objective: Research designed to increase knowledge about Māori with bipolar disorder is required to understand how health services support wellbeing and respond to identified levels of community need. This paper synthesises the expert critique of Māori patients with bipolar disorder and their whānau regarding the nuances of cultural competence and safety in clinical encounters with the health system. Methods: A qualitative Kaupapa Māori Research methodology was used. A total of 24 semi-structured interviews were completed with Māori patients with bipolar disorder and members of their whānau. Structural, descriptive and pattern coding was completed using an adapted cultural competence framework to organise and analyse the data. Results: Three themes were evident from participants’ critique of clinical components of the health system. Theme 1 established that the efficacy of clinical care for bipolar disorder was dependent on Māori patients and whānau having clear pathways through care, and being able to access timely, consistent care from clinically and culturally competent staff. Theme 2 identified the influence of clinical culture in bipolar disorder services, embedded into care settings, expressed by staff, affecting the safety of clinical care for Māori. Theme 3 focused on the need for bipolar disorder services to prioritise clinical work with whānau, equip staff with skills to facilitate engagement and tailor care with resources to enhance whānau as well as patient wellbeing. Conclusion: The standard of clinical care for Māori with bipolar disorder in New Zealand does not align with practice guidelines, Māori models of health or clinical frameworks designed to inform treatment and address systemic barriers to equity. Research also needs to explore the role of structural and organisational features of the health system on Māori patient and whānau experiences of care.

The Web Portal ‘meereisportal.de’ in Context of ESKP

2018 ◽  
pp. 69-72 ◽  
Author(s):  
Klaus Grosfeld ◽  
Renate Treffeisen ◽  
Jölund Asseng ◽  
Georg Heygster
Keyword(s):  
Web Portal ◽  
The Web
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