scholarly journals Lessons learned on the experienced facilitators and barriers of implementing a tailored VBHC model in a Dutch university hospital from a perspective of physicians and nurses

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e051764
Author(s):  
Dane Lansdaal ◽  
Femke van Nassau ◽  
Marije van der Steen ◽  
Martine de Bruijne ◽  
Marian Smeulers
Keyword(s):  
Patient Involvement ◽  
Implementation Process ◽  
Lessons Learned ◽  
University Hospital ◽  
Care Process ◽  
External Information ◽  
Health Records ◽  
Facilitators And Barriers ◽  
Implementation Methodology ◽  
Insight Into

ObjectiveThis study aims to obtain insight into experienced facilitators and barriers of implementing a tailored value-based healthcare (VBHC) model in a Dutch university hospital from a perspective of physicians and nurses.MethodA descriptive qualitative study with 12 physicians, nurses and managers of seven different care pathways who were involved in the implementation of a tailored VBHC methodology was conducted. Thematic content analysis was used to analyse the data guided by all factors of the Consolidated Framework for Implementation Research (CFIR).FindingsThe method designed for the implementation of a tailored VBHC methodology was appointed as a structured guide for the process. Throughout the implementation process, leadership and team dynamics were considered as important for the implementation to succeed. Also, sharing experiences with other value teams and the cooperation with external Information Technology (IT) teams in the hospital was mentioned as desirable. The involvement of patients, that is part of the VBHC methodology, was considered useful in the decision-making and improvement of the care process because it gave better insights in topics that are important for patients. The time-consuming nature of the implementation process was named as barrier to the VBHC methodology. On top of that, the shaping of the involvement of patients and the ongoing changes in departments were established as difficult. Finally, working with the Electronic Health Records and acquiring the necessary digital skills were considered to be often forgotten and, thus, hindering implementation.ConclusionClinical Healthcare organisations implementing a tailored VBHC methodology will benefit from the use of a structured implementation methodology, a well-led strong team and cooperation with (external) teams and patients. However, shaping patient involvement, alignment with other departments and attention to digitisation were seen as a most important concerns in implementation and require further attention.

scholarly journals Leadership assumptions on implementation of patient involvement methods

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathrine Håland Jeppesen ◽  
Kirsten Frederiksen ◽  
Marianne Johansson Joergensen ◽  
Kirsten Beedholm
Keyword(s):  
Health Care ◽  
Organizational Learning ◽  
Health Care Professionals ◽  
Large Scale ◽  
Patient Involvement ◽  
Hospital Setting ◽  
Implementation Process ◽  
University Hospital ◽  
Structured Interviews ◽  
Implementation Processes

Abstract Background From 2014 to 17, a large-scale project, ‘The User-involving Hospital’, was implemented at a Danish university hospital. Research highlights leadership as crucial for the outcome of change processes in general and for implementation processes in particular. According to the theory on organizational learning by Agyris and Schön, successful change requires organizational learning. Argyris and Schön consider that the assumptions of involved participants play an important role in organizational learning and processes. The purpose was to explore leaders’ assumptions concerning implementation of patient involvement methods in a hospital setting. Methods Qualitative explorative interview study with the six top leaders in the implementation project. The semi-structured interviews were conducted and analyzed in accordance with Kvale and Brinkmanns’ seven stages of interview research. Result The main leadership assumptions on what is needed in the implementation process are in line with the perceived elements in organizational learning according to the theory of Argyris and Schön. Hence, they argued that implementation of patient involvement requires a culture change among health care professionals. Two aspects on how to obtain success in the implementation process were identified based on leadership assumptions: “The health care professionals’ roles in the implementation process” and “The leaders’ own roles in the implementation process”. Conclusion The top leaders considered implementation of patient involvement a change process that necessitates a change in culture with health care professionals as crucial actors. Furthermore, the top leaders considered themselves important facilitators of this implementation process.

scholarly journals Facilitators and Barriers to Recruiting Ambulatory Oncology Practices Into a Large Multisite Study: Mixed Methods Study

JMIR Cancer ◽  
10.2196/14476 ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. e14476 ◽  
Author(s):  
Milisa Manojlovich ◽  
Louise Bedard ◽  
Jennifer J Griggs ◽  
Michaella McBratnie ◽  
Kari Mendelsohn-Victor ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
Data Collection ◽  
Human Subjects ◽  
Implementation Process ◽  
Lessons Learned ◽  
Quality Improvement Collaborative ◽  
Ambulatory Oncology ◽  
Oncology Care ◽  
Facilitators And Barriers

Background Practice-based research is essential to generate the data necessary to understand outcomes in ambulatory oncology care. Although there is an increased interest in studying ambulatory oncology care, given the rising patient volumes and complexity in those settings, little guidance is available on how best to recruit ambulatory oncology practices for research. Objective This paper aimed to describe the facilitators and barriers to recruiting ambulatory oncology practices into a large multisite study. Methods Using a mixed methods design, we sought to recruit 52 ambulatory oncology practices that have participated in a state-wide quality improvement collaborative for the quantitative phase. We used 4 domains of the Consolidated Framework for Implementation Research (CFIR) to describe facilitators and barriers to recruitment. Results We successfully recruited 28 of the 52 collaborative-affiliated practices, collecting survey data from 2223 patients and 297 clinicians. Intervention attributes included multimodal outreach and training activities to assure high fidelity to the data collection protocol. The implementation process was enhanced through interactive training and practice-assigned champions responsible for data collection. External context attributes that facilitated practice recruitment included partnership with a quality improvement collaborative and the inclusion of a staff member from the collaborative in our team. Key opinion leaders within each practice who could identify challenges to participation and propose flexible solutions represented internal context attributes. We also reported lessons learned during the recruitment process, which included navigating diverse approaches to human subjects protection policies and understanding that recruitment could be a negotiated process that took longer than anticipated, among others. Conclusions Our experience provides other researchers with challenges to anticipate and possible solutions for common issues. Using the CFIR as a guide, we identified numerous recruitment barriers and facilitators and devised strategies to enhance recruitment efforts. In conclusion, researchers and clinicians can partner effectively to design and implement research protocols that ultimately benefit patients who are increasingly seeking care in ambulatory practices.

scholarly journals Implementation of the First US Sugar-Sweetened Beverage Tax in Berkeley, CA, 2015–2019

2020 ◽  
Vol 110 (9) ◽  
pp. 1429-1437 ◽  
Author(s):  
Jennifer Falbe ◽  
Anna H. Grummon ◽  
Nadia Rojas ◽  
Suzanne Ryan-Ibarra ◽  
Lynn D. Silver ◽  
...  
Keyword(s):  
Public Health ◽  
Public Support ◽  
Implementation Process ◽  
Food Prices ◽  
Lessons Learned ◽  
Sugar Sweetened Beverage ◽  
Excise Tax ◽  
Sweetened Beverage ◽  
Advisory Commissions ◽  
Facilitators And Barriers

Objectives. To identify lessons learned from implementation of the nation’s first sugar-sweetened beverage (SSB) excise tax in 2015 in Berkeley, California. Methods. We interviewed city stakeholders and SSB distributors and retailers (n = 48) from June 2015 to April 2017 and analyzed records through January 2019. Results. Lessons included the importance of thorough and timely communications with distributors and retailers, adequate lead time for implementation, advisory commissions for revenue allocations, and funding of staff, communications, and evaluation before tax collection begins. Early and robust outreach about the tax and programs funded can promote and sustain public support, reduce friction, and facilitate beverage price increases on SSBs only. No retailer reported raising food prices, indicating that Berkeley’s SSB tax did not function as a “grocery tax,” as industry claimed. Revenue allocations totaled more than $9 million for public health, nutrition, and health equity through 2021. Conclusions. The policy package, context, and implementation process facilitated translating policy into public health outcomes. Further research is needed to understand long-term facilitators and barriers to sustaining public health benefits of Berkeley’s tax and how those differ from facilitators and barriers in jurisdictions facing significant industry-funded repeal efforts.

scholarly journals Facilitators and Barriers to Recruiting Ambulatory Oncology Practices Into a Large Multisite Study: Mixed Methods Study (Preprint)

2019 ◽  
Author(s):  
Milisa Manojlovich ◽  
Louise Bedard ◽  
Jennifer J Griggs ◽  
Michaella McBratnie ◽  
Kari Mendelsohn-Victor ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
Data Collection ◽  
Human Subjects ◽  
Implementation Process ◽  
Lessons Learned ◽  
Quality Improvement Collaborative ◽  
Ambulatory Oncology ◽  
Oncology Care ◽  
Facilitators And Barriers

BACKGROUND Practice-based research is essential to generate the data necessary to understand outcomes in ambulatory oncology care. Although there is an increased interest in studying ambulatory oncology care, given the rising patient volumes and complexity in those settings, little guidance is available on how best to recruit ambulatory oncology practices for research. OBJECTIVE This paper aimed to describe the facilitators and barriers to recruiting ambulatory oncology practices into a large multisite study. METHODS Using a mixed methods design, we sought to recruit 52 ambulatory oncology practices that have participated in a state-wide quality improvement collaborative for the quantitative phase. We used 4 domains of the Consolidated Framework for Implementation Research (CFIR) to describe facilitators and barriers to recruitment. RESULTS We successfully recruited 28 of the 52 collaborative-affiliated practices, collecting survey data from 2223 patients and 297 clinicians. <i>Intervention attributes</i> included multimodal outreach and training activities to assure high fidelity to the data collection protocol. The <i>implementation process</i> was enhanced through interactive training and practice-assigned champions responsible for data collection. <i>External context</i> attributes that facilitated practice recruitment included partnership with a quality improvement collaborative and the inclusion of a staff member from the collaborative in our team. Key opinion leaders within each practice who could identify challenges to participation and propose flexible solutions represented <i>internal context</i> attributes. We also reported lessons learned during the recruitment process, which included navigating diverse approaches to human subjects protection policies and understanding that recruitment could be a negotiated process that took longer than anticipated, among others. CONCLUSIONS Our experience provides other researchers with challenges to anticipate and possible solutions for common issues. Using the CFIR as a guide, we identified numerous recruitment barriers and facilitators and devised strategies to enhance recruitment efforts. In conclusion, researchers and clinicians can partner effectively to design and implement research protocols that ultimately benefit patients who are increasingly seeking care in ambulatory practices.

Implementation of Automated Network-Level Crack Detection Processes in Maryland

2003 ◽  
Vol 1860 (1) ◽  
pp. 109-116 ◽  
Author(s):  
Jonathan L. Groeger ◽  
Peter Stephanos ◽  
Paul Dorsey ◽  
Mark Chapman
Keyword(s):  
Data Collection ◽  
Crack Detection ◽  
Implementation Process ◽  
Lessons Learned ◽  
Pavement Management ◽  
Pavement Management System ◽  
State Highway ◽  
Management Group ◽  
Detection Software ◽  
Insight Into

The Maryland State Highway Administration (MDSHA) has collected cracking data on its roadways for use in its pavement management system since 1984. Through much of this history the pavement cracking survey was performed yearly by teams of inspectors riding in vans. With the reengineering of the administration over the years, this process began to present serious resource and logistical problems. During the past 3 years, the MDSHA pavement management group has developed and implemented a state-of-the-art automated network-level crack detection process that is showing promising results. This process is based upon the use of the automated road analyzer (ARAN) data collection vehicle, Wisecrax crack detection software, and an intensive quality-control (QC) and quality-assurance (QA) procedure. The data collection and data processing tasks are all performed in house with MDSHA resources. An overview of the processes developed and implemented by MDSHA to conduct these surveys is provided. Also discussed are challenges and lessons learned during the implementation process. Presentation of this information will allow others to gain insight into the strengths and weaknesses of adopting such a system and promote information sharing among pavement data collection organizations. Overall, it is concluded that automated network-level crack detection is a workable and efficient tool. However, a strict QC-QA regime must be instituted in order to achieve consistent and repeatable results.

Radical Subject Acceleration for Gifted Students: One School's Response

2019 ◽  
pp. 29-46
Author(s):  
Kaye Chalwell ◽  
Therese Cumming
Keyword(s):  
Gifted And Talented ◽  
Gifted Students ◽  
Subject Area ◽  
Lessons Learned ◽  
Gifted Student ◽  
Learning Needs ◽  
Mathematically Gifted ◽  
Support Students ◽  
Insight Into

Radical subject acceleration, or moving students through a subject area faster than is typical, including skipping grades, is a widely accepted approach to support students who are gifted and talented. This is done in order to match the student’s cognitive level and learning needs. This case study explored radical subject acceleration for gifted students by focusing on one school’s response to the learning needs of a ten year old mathematically gifted student. It provides insight into the challenges, accommodations and approach to radical subject acceleration in an Australian school. It explored the processes and decisions made to ensure that a gifted student’s learning needs were met and identified salient issues for radical subject acceleration. Lessons learned from this case study may be helpful for schools considering radical acceleration.

scholarly journals Patient-reported recovery in upper abdominal cancer surgery care: A prospective study

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110169
Author(s):  
Anna Johansson ◽  
Jessica Karlsson ◽  
Victoria Fomichov ◽  
Anna Lindhoff Larsson ◽  
Per Sandström ◽  
...  
Keyword(s):  
Physical Symptoms ◽  
Postoperative Recovery ◽  
Cancer Surgery ◽  
Social Dimension ◽  
University Hospital ◽  
Care Process ◽  
Five Dimensions ◽  
Patient Reported ◽  
Upper Abdominal ◽  
A Prospective Study

The study aimed to describe and analyse patient-reported recovery in patients after upper abdominal cancer surgery. This study had a quantitative design and patients were consecutively included in a university hospital in southern Sweden. Twenty-four patients answered the Postoperative Recovery Profile (PRP) questionnaire at three measurement points. All five dimensions were affected. In the physical symptoms dimension, the majority of patients reported a lack of energy upon discharge. High levels of anxiety were reported. Over 50% of patients reported some degree of depressed mood at all three measurement points. In the social dimension, the majority of patients reported some degree of being dependent on help from others in everyday life at 4 weeks after discharge. Few patients are fully recovered at 4 weeks after discharge. Individual patient-reported recovery estimates may be valuable in identifying and planning interventions tailored to each patient’s needs throughout the care process.

Learnings from the Field Implementation of a Novel Ultra-High Performance Concrete Beam End Repair on a Corroded Steel Girder Bridge in Connecticut

2021 ◽  
pp. 036119812110041
Author(s):  
Alexandra Hain ◽  
Arash E. Zaghi
Keyword(s):  
High Performance ◽  
High Performance Concrete ◽  
Implementation Process ◽  
Lessons Learned ◽  
Load Path ◽  
Ultra High Performance Concrete ◽  
Steel Girder Bridge ◽  
Aging Steel ◽  
Girder Bridge ◽  
The University

Corrosion at steel beam ends is one of the most pressing challenges in the maintenance of aging bridges. To tackle this challenge, the Connecticut Department of Transportation (DOT) has partnered with the University of Connecticut to develop a repair method that benefits from the superior mechanical and durability characteristics of ultra-high performance concrete (UHPC) material. The repair involves welding shear studs to the intact portions of the web and encasing the beam end with UHPC. This provides an alternate load path for bearing forces that bypasses the corroded regions of the beam. The structural viability of the repair has been extensively proven through small- and full-scale experiments and comprehensive finite element simulations. Connecticut DOT implemented the repair for the first time in the field on a heavily trafficked four-span bridge in 2019. The UHPC beam end repair was chosen because of the access constraints and geometric complexities of the bridge that limited the viable repair options. Four of the repaired beam ends were fully instrumented to collect data on the performance of the repaired locations before casting, during curing, and for approximately 6 months following the application of the repair. This paper provides an overview of the successful repair implementation and presents the lessons learned during construction. Select data from the monitored beam ends are presented. It is expected that this information will provide engineers with a better understanding of the repair implementation process, and thus provide an additional repair option for states to enhance the safety of aging steel bridges.

Bulego Judizial Berria Euskadin

2011 ◽  
pp. 259-281
Author(s):  
Izaskun IRIARTE IRURETA
Keyword(s):  
Basque Country ◽  
Implementation Process ◽  
Lessons Learned ◽  
Implementation Plan ◽  
Whole Process ◽  
Administration Of Justice ◽  
El Sistema

LABURPENA: Gaur egun Bulego Judizial Berriaren (BJB) ezarpenaren prozesua abian da Euskal Autonomia Erkidegoko barruti judizialetan. «Bulego Judizial Berria»-tzat ezagutzen den Justizia Administrazioaren eraldaketa sakona dakarrenez, berrantolaketa hau gradualki egingo da Euskadin. Testu honen helburua da aurkeztea Bulego Judizial Berria zer den eta zer suposatzen duen, nola antolatu eta gauzatu den Euskadin Bulego Judizial Berriaren ezarpena horretarako propio Eusko Jaurlaritzak onartu zuen planaren eremuan, aurreikusita duen kalitate-sistema, lehen Bulegoen ezarpenaren ondorioak zeintzuk izan diren eta prozesu osoaren erronkak. RESUMEN: En estos momentos está en marcha el proceso implantación de la Oficina Judicial en los partidos judiciales de Euskadi. Dado que lo que se conoce como «Nueva Oficina Judicial» supone una profunda reforma en la Administración de Justicia, esta reestructuración, en Euskadi, se llevará a cabo de forma gradual. Este texto pretende presentar el alcance de la Nueva Oficina Judicial y en qué consiste, cómo se ha organizado y se está llevando a cabo la implantación de la Nueva Oficina Judicial en Euskadi en el marco del plan que aprobó el Gobierno Vasco con ese fin, el sistema de calidad que se ha previsto, las conclusiones extraídas de las primeras Oficinas Judiciales implantadas y los retos del conjunto del proceso. ABSTRACT: Nowadays the implementation process of the Judicial Office in the Judicial Districts of the Basque Country is taking place. This new «Judicial Office» brings about a deep and thorough reform in the Administration of Justice and its functioning. Therefore this reorganisation process will be implemented gradually. This article aims to discuss the meaning and the implications of the New Judicial Office, to describe how the implementation of the New Judicial Office in the Basque Country has been organized and applied within the framework of the Implementation Plan adopted by the Basque Government, including the qualitysystem for the Judicial Office, and finally to draw the lessons learned from the process of implementation as it has been taking place within the first Judicial Offices. The challenges of the whole process are thus brought to the fore.

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