scholarly journals Implementation of a novel rehabilitation model of care across Alberta, Canada: a focused ethnography

2021 ◽  
Vol 10 (1) ◽  
pp. e001261
Author(s):  
Kiran Pohar Manhas ◽  
Karin Olson ◽  
Katie Churchill ◽  
Sunita Vohra ◽  
Tracy Wasylak
Keyword(s):  
Focus Groups ◽  
Data Access ◽  
Successful Implementation ◽  
Early Adopter ◽  
Model Of Care ◽  
Focused Ethnography ◽  
Learning Collaborative ◽  
Community Rehabilitation ◽  
Negative Case ◽  
Rehabilitation Model

BackgroundIn 2017, a provincial health-system released a Rehabilitation Model of Care (RMoC) to promote patient-centred care, provincial standardisation and data-driven innovation. Eighteen early-adopter community-rehabilitation teams implemented the RMoC using a 1.5-year-long Innovation Learning Collaborative (in-person learning sessions; balanced scorecards). More research is required on developing, implementing and evaluating models of care. We aimed to explore experiences of early-adopter providers and provincial consultants involved in the community-rehabilitation RMoC implementation in Alberta, Canada.MethodsUsing focused ethnography, we used focus groups (or interviews for feasibility/confidentiality) and aggregate, site-level data analysis of RMoC standardised metrics. Purposive sampling ensured representation across geography, service types and patient populations. Team-specific focus groups were onsite and led by a researcher-moderator and cofacilitator. A semistructured question guide promoted discussions on interesting/challenging occurrences; perceptions of RMoC impact and perceptions of successful implementation. Focus groups and interviews were audio-recorded and transcribed alongside field notes. Data collection and analysis were concurrent to saturation. Transcripts coding involves collapsing similar ideas into themes, with intertheme relationships identified. Rigour tactics included negative case analysis, thick description and audit trail.ResultsWe completed 11 focus groups and seven interviews (03/2018 to 01/2019) (n=45). Participants were 89.6% women, mostly Canadian trained and represented diverse rehabilitation professions. The implementation experience involved navigating emotions, operating among dynamics and integrating the RMoC details. Confident, satisfied early-adopter teams demonstrated traits including strong coping strategies; management support and being opportunistic and candid about failure. Teams faced common challenges (eg, emotions of change; delayed data access and lack of efficient, memorable communication across team and site). Implementation success targeted patient, team and system levels.ConclusionsWe recommend training priorities for future teams including evaluation training for novice teams; timelines for stepwise implementation; on-site, in-person time with a facilitator and full-team present and prolonged facilitated introductions between similar teams for long-term mentorship.

scholarly journals Professional Early-Adopter Experiences of Implementing a Novel Rehabilitation Model of Care across Alberta, Canada: A Focused Ethnography

2019 ◽  
Author(s):  
Kiran Pohar Manhas ◽  
Karin Olson ◽  
Katie Churchill ◽  
Sunita Vohra ◽  
Tracy Wasylak
Keyword(s):  
Focus Groups ◽  
Data Access ◽  
Successful Implementation ◽  
Early Adopter ◽  
Model Of Care ◽  
Focused Ethnography ◽  
Learning Collaborative ◽  
Community Rehabilitation ◽  
Negative Case ◽  
Rehabilitation Model

Abstract Background In 2017, a provincial health-system released a Rehabilitation Model of Care (RMoC) to promote patient-centred care, provincial standardization, and data-driven innovation. Eighteen early-adopter community-rehabilitation teams implemented the RMoC using a 1.5-year long Innovation Learning Collaborative (in-person learning sessions; balanced scorecards). More research is required on developing, implementing and evaluating models of care. Understanding RMoC implementation will expand implementation science knowledge, particularly around factors influencing model-of-care outcomes and sustainability in, and between, jurisdictions. We aimed to explore experiences of early-adopter providers and provincial consultants involved in the community-rehabilitation RMoC implementation in Alberta, Canada.Methods Via focused ethnography, we used focus groups (or interviews for feasibility/confidentiality) and aggregate, site-level data analysis of RMoC standardized metrics. Purposive sampling ensured representation across geography, service types and patient populations. Team-specific focus groups were onsite, at participants’ convenience, and led by a researcher-moderator and co-facilitator. A semi-structured question guide promoted discussions on interesting/challenging occurrences; perceptions of RMoC impact; and, suggested definitions of successful implementation. Focus groups and interviews were audio-recorded and transcribed alongside field notes. Data collection and analysis were concurrent to saturation. Transcripts were coded for implementation-related phrases. Similar ideas were collapsed forming themes, with inter-theme relationships identified. Tactics for rigour included negative case analysis, use of thick description, and an audit trail.Results We completed 11 focus groups and seven interviews (03/2018 to 01/2019) (n=45). Participants were 89.6% female, mostly-Canadian trained and represented diverse rehabilitation professions. Teams varied on their focal health service and patient population. The implementation experience involved navigating emotions, operating amongst dynamics, and integrating the RMoC details. Confident, satisfied early-adopter teams demonstrated traits including strong coping strategies; management support; and, being opportunistic and candid about failure. Teams faced common challenges (e.g. emotions of change; delayed data access; and lack of efficient, memorable communication across team and site). Implementation success targeted patient-, team- and system levels.Conclusions We recommend specific training priorities for future teams including evaluation training for novice teams; timelines for step-wise implementation; on-site, in-person time with a facilitator and full-team present; and prolonged facilitated introductions between similar teams for long-term mentorship.

scholarly journals Context Matters: Using A Case Study Approach to Understand Implementing A Patient Centred Rehabilitation Model for Persons With Cognitive Impairment

2020 ◽  
Author(s):  
Katherine McGilton ◽  
Alexia Cumal ◽  
Dana Corsi ◽  
Shaen Gingrich ◽  
Nancy Zheng ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Contextual Factors ◽  
Rural Site ◽  
The Political ◽  
Successful Implementation ◽  
Model Of Care ◽  
Case Study Approach ◽  
Study Approach ◽  
Rehabilitation Model

Abstract Background: There is a growing number of older adults with cognitive impairment (CI) that require inpatient rehabilitation. Patient centred rehabilitation models exist, yet there is a lack of specific strategies for implementing these models into other contexts. Researchers collaborated with administrators and staff in one rural site to adapt a patient centred rehabilitation model of care in the Canadian province of Ontario. This paper reports on the contextual factors that influenced the implementation of the model of care.Methods: The study takes a case study approach. One rural facility was purposefully selected for its interest in offering rehabilitation to persons with CI. Four focus group discussions were conducted to explore healthcare professionals’ perceptions on the contextual factors that could affect the implementation of the rehabilitation model of care in this facility. Twenty-seven professionals with various backgrounds were purposively sampled using a maximum diversity sampling strategy. A hybrid inductive-deductive approach was used to analyze the data using the Context and Implementation of Complex Interventions (CICI) Framework. Results: Across the domains of the CICI framework, three domains (political, epidemiological, and geographical) and seven corresponding sub-domains were found to have a major influence on the implementation process. Key elements within the political domain included effective teamwork, facilitation, adequate resources, effective communication strategies, and a vision for change. Within the epidemiological domain, a key element was knowing how to tailor rehabilitation approaches for persons with CI. Infrastructure was a key aspect of the geographical domain, which was focused on the facility’s physical layout.Conclusions: The study identified key factors within the context that supported and hindered the implementation of the model of care in a new environment. This work suggests that when implementing a new program of care, strong consideration should be paid to the political, epidemiological, and geographical domains of the context and how these aspects interact and influence one another. The CICI Framework was a useful guide to understand which elements existed and which were still required for successful implementation of the model of care.

scholarly journals Implementering av PICC-line – en kvalitativ studie av anestesisykepleieres erfaringer

2019 ◽  
Vol 14 (2) ◽  
Author(s):  
Stine Thorvaldsen Smith ◽  
Kristin Haraldstad
Keyword(s):  
Central Venous Catheter ◽  
Focus Groups ◽  
Implementation Process ◽  
Venous Catheter ◽  
Nurse Anesthetists ◽  
Successful Implementation ◽  
Central Venous ◽  
Hermeneutic Approach ◽  
Picc Line ◽  
Good Organization

PICC-line, a peripherally inserted central venous catheter has been implemented by several Norwegian hospitals in recent years. Nurse Anesthetists play an important role in this process, and have been given new tasks as a result of PICC-line implementation. This study aimed to describe Nurse Anesthetists’ experiences with implementation of PICC-line in hospital. A qualitative design, the data are based on three focus groups interviews with fifteen nurse anesthetists. The interviews were analyzed using a hermeneutic approach. Being a PICC-line nurse led to a feeling of competence, independence, motivation and meaningfulness. The implementation required good structure and organization, as well as enthusiasm. Collaboration and support influenced the implementation process. Good organization and enough available personnel, as well as good collaboration and support from the Anesthesiologists and the management are essential for a successful implementation.

scholarly journals An inpatient rehabilitation model of care targeting patients with cognitive impairment

2012 ◽  
Vol 12 (1) ◽  
Author(s):  
Katherine S McGilton ◽  
Aileen Davis ◽  
Nizar Mahomed ◽  
John Flannery ◽  
Susan Jaglal ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Inpatient Rehabilitation ◽  
Model Of Care ◽  
Rehabilitation Model

scholarly journals What do children, parents and staff think about a healthy lifestyles intervention delivered in primary schools? a qualitative study

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e038625
Author(s):  
Joanna Goldthorpe ◽  
Tracy Epton ◽  
Chris Keyworth ◽  
Rachel Calam ◽  
Joanna Brooks ◽  
...  
Keyword(s):  
Physical Activity ◽  
Qualitative Study ◽  
Focus Groups ◽  
Primary Schools ◽  
Health Behaviours ◽  
Research Approach ◽  
Successful Implementation ◽  
Management Interventions ◽  
Diet And Physical Activity ◽  
Home And School

ObjectivePrimary schools are crucial settings for early weight management interventions but effects on children’s weight are small and evidence shows that deficiencies in intervention implementation may be responsible. Very little is known about the roles of multiple stakeholders in the process of implementation. We used a multiple-stakeholder qualitative research approach to explore the implementation of an intervention developed to improve the diet and increase the levels of physical activity for children living in some of the most deprived areas of England.DesignFor this qualitative study, interviews and focus groups were carried out using semi-structured topic guides. Data were analysed thematically.SettingSeven primary schools (pupils aged 4 to 11) in Manchester, England.ParticipantsWe conducted 14 focus groups with children aged 5 to 10 years and interviews with 19 staff members and 17 parents.InterventionManchester Healthy Schools (MHS) is a multicomponent intervention, developed to improve diet and physical activity in schools with the aim of reducing and preventing childhood obesity.ResultsThree themes were developed from the data: common understandings of health and health behaviours; congruence and consistency of messages; negotiations of responsibility.ConclusionAll participant groups had a common conceptualisation of health as having physical and psychological components and that action could be taken in childhood to change behaviours that protect long-term health. When parents and staff felt a shared sense of responsibility for children’s health and levels of congruence between home and school norms around diet and physical activity were high, parents and children were more likely to accept the policies implemented as part of MHS. Effective two-way communication between home and school is therefore vital for successful implementation of this intervention.

Developing a nursing model of care? Try focus groups

2011 ◽  
Vol 42 (8) ◽  
pp. 24-26 ◽  
Author(s):  
Susan L. Dunn ◽  
Susan R. Shattuck ◽  
Lindsey Baird ◽  
Jean Mau ◽  
Denise Bakker
Keyword(s):  
Focus Groups ◽  
Model Of Care

scholarly journals Midwifery-led care embedded within primary care: consumer satisfaction with a model in New Zealand

2014 ◽  
Vol 6 (4) ◽  
pp. 319
Author(s):  
Susan Pullon ◽  
Ben Gray ◽  
Monika Steinmetz ◽  
Claire Molineux
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Pilot Study ◽  
Focus Group ◽  
Focus Groups ◽  
Maternity Care ◽  
Consumer Satisfaction ◽  
Service Providers ◽  
Analytic Approach ◽  
Model Of Care

INTRODUCTION: Providing quality maternity care for high-needs, socially deprived women from ethnic minority groups is challenging. Consumer satisfaction with maternity services is an important aspect of service evaluation for this group. This pilot study aimed to investigate the feasibility of using focus groups and interviews to gauge consumer satisfaction of maternity care by high-needs women, and to explore their perceptions of the Newtown Union Health Service (NUHS) model of a midwifery-led service embedded in primary care in Wellington, New Zealand (NZ). METHODS: Following a previous audit of consumer satisfaction surveys collected over a six-year period, a qualitative pilot study using a thematic analytic approach was conducted at the NUHS in late 2011. The study assessed use of focus groups and interviews, interpreted where necessary, and considered the experiences reported by women about the model of care. FINDINGS: Interviews and focus groups were successfully conducted with 11 women: two NZ European (individual interviews), six Cambodian (five in a focus group, one interview), and three Samoan (focus group). Using a thematic analytic approach, key themes identified from the focus group and interviews were: issues with survey form-filling; importance of accessibility and information; and relationships and communication with the midwifery team. CONCLUSION: Interviews and focus groups were well received, and indicated positive endorsement of the model of care. They also revealed some hitherto unknown concerns. Good quality feedback about satisfaction with a range of maternal and child health services helps service providers to provide the best possible start in life for children in high-needs families. KEYWORDS: Interprofessional; maternity care; New Zealand; patient care team; primary health care

scholarly journals Architecture of the Platform for the E-Government Open Data

2019 ◽  
pp. 70-76
Author(s):  
M. Alhawawsha
Keyword(s):  
Detailed Analysis ◽  
Crucial Role ◽  
Open Data ◽  
Data Access ◽  
Successful Implementation ◽  
Systems Implementation ◽  
Data Platform ◽  
Automated Processes

E-Government is a set of pervasive technologies and automated processes now. The open data plays a crucial role in the successful implementation of this concept. The Open Data Platform (ODP) architecture is described here as the framework for the open data access systems implementation, including specific requirements. The proposed architecture and its components were discussed in this paper in detail for its availability, productivity, and reliability. The open data subsystem based on the architecture presented here was developed for the Jordan Government and was successfully implemented and tested. Thus, this architecture showed its viability. The focus of the paper is the detailed analysis of the proposed ODP architecture and its characteristics. The ODP is a significant system for the mature e-Government. We propose here the architecture for it with usage-proven characteristics. This fact adds the value to the e-Government framework stability, and significant characteristics and improves the overall quality of the system.

scholarly journals An assessment of implementation of Community Oriented Primary Care in Kenyan family medicine postgraduate medical education programmes

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Ian J. Nelligan ◽  
Jacob Shabani ◽  
Stephanie Taché ◽  
Gulnaz Mohamoud ◽  
Megan Mahoney
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Focus Groups ◽  
Learning Outcomes ◽  
Care Delivery ◽  
The United States ◽  
Community Empowerment ◽  
Successful Implementation ◽  
Community Based ◽  
Postgraduate Students

Background and objectives: Family medicine postgraduate programmes in Kenya are examining the benefits of Community-Oriented Primary Care (COPC) curriculum, as a method to train residents in population-based approaches to health care delivery. Whilst COPC is an established part of family medicine training in the United States, little is known about its application in Kenya. We sought to conduct a qualitative study to explore the development and implementation of COPC curriculum in the first two family medicine postgraduate programmes in Kenya. Method: Semi-structured interviews of COPC educators, practitioners, and academic stakeholders and focus groups of postgraduate students were conducted with COPC educators, practitioners and academic stakeholders in two family medicine postgraduate programmes in Kenya. Discussions were transcribed, inductively coded and thematically analysed. Results: Two focus groups with eight family medicine postgraduate students and interviews with five faculty members at two universities were conducted. Two broad themes emerged from the analysis: expected learning outcomes and important community-based enablers. Three learning outcomes were (1) making a community diagnosis, (2) understanding social determinants of health and (3) training in participatory research. Three community-based enablers for sustainability of COPC were (1) partnerships with community health workers, (2) community empowerment and engagement and (3) institutional financial support. Conclusions: Our findings illustrate the expected learning outcomes and important communitybased enablers associated with the successful implementation of COPC projects in Kenya and will help to inform future curriculum development in Kenya.

Cancer survivorship care in rural community: Provider perspective.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 50-50
Author(s):  
Katia Noyes ◽  
David Holub ◽  
Irfan Rizvi ◽  
Alex Swanger ◽  
Coty Reisdorf ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Group ◽  
Focus Groups ◽  
Multidisciplinary Team ◽  
Cancer Care ◽  
Financial Incentives ◽  
Primary Care Physicians ◽  
Performance Metrics ◽  
Care Delivery ◽  
Successful Implementation

50 Background: Advances in oncologic sciences have resulted in successful treatments for many cancers with improved survival for millions of patients. Efficient delivery of cancer care now requires not only skills and professionalism of each provider but also well-orchestrated performances of multiple oncology, primary care and social services providers acting as one multidisciplinary team. It is unknown, however, whether providers are prepared for and accept their new roles in patient cancer care teams across region. This study assessed perspectives of providers involved in care for patients with cancer about their changing roles. Methods: We conducted a focus group with a diverse group of stakeholders involved in cancer care (2 primary care physicians, 1 rural surgeon, 2 rural oncologists, 2 oncology nurses, 2 cancer patients and a caregiver). The focus group was conducted using ThinkTank software, a collaborative tool that allows participants to communicate virtually in real time, screen share, express preferences and confidentially rank each other responses. We also conducted two traditional focus groups with rural care managers, nurses, social workers and public health providers. Results: The focus groups identified significant differences in attitudes and beliefs toward regional team-based cancer care between various providers. PCPs ranked oncology issues as less important to their practices compared to other chronic conditions associated with performance metrics and financial incentives. APPs ranked care coordination issues as more important compared to PCP rankings from the same practices. Rural providers identified limited staffing, outdated health IT systems, and lack of expertise as major barriers to multidisciplinary team care. Both patients and providers highlighted importance of trust and face-to-face communication in treatment adherence and choice of care setting. Conclusions: Current health information systems, performance metrics and payment models represent significant barriers to integrated care delivery in oncology and survivorship. Successful implementation of efficient and sustainable regional oncology program will require a multi-dimensional intervention to address each of these barriers.

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