scholarly journals Implementing infection prevention practices across European hospitals: an in-depth qualitative assessment

2018 ◽  
Vol 27 (10) ◽  
pp. 771-780 ◽  
Author(s):  
Lauren Clack ◽  
Walter Zingg ◽  
Sanjay Saint ◽  
Alejandra Casillas ◽  
Sylvie Touveneau ◽  
...  
Keyword(s):  
Qualitative Assessment ◽  
Local Context ◽  
Comparative Case Study ◽  
Controlled Study ◽  
Successful Implementation ◽  
Implementation Success ◽  
Intervention Programme ◽  
Multiple Strategies ◽  
Key Stakeholders ◽  
Intervention Context

ObjectiveThe Prevention of Hospital Infections by Intervention and Training (PROHIBIT) project included a cluster-randomised, stepped wedge, controlled study to evaluate multiple strategies to prevent catheter-related bloodstream infection. We report an in-depth investigation of the main barriers, facilitators and contextual factors relevant to successfully implementing these strategies in European acute care hospitals.MethodsQualitative comparative case study in 6 of the 14 European PROHIBIT hospitals. Data were collected through interviews with key stakeholders and ethnographic observations conducted during 2-day site visits, before and 1 year into the PROHIBIT intervention. Qualitative measures of implementation success included intervention fidelity, adaptation to local context and satisfaction with the intervention programme.ResultsThree meta-themes emerged related to implementation success: ‘implementation agendas’, ‘resources’ and ‘boundary-spanning’. Hospitals established unique implementation agendas that, while not always aligned with the project goals, shaped subsequent actions. Successful implementation required having sufficient human and material resources and dedicated change agents who helped make the intervention an institutional priority. The salary provided for a dedicated study nurse was a key facilitator. Personal commitment of influential individuals and boundary spanners helped overcome resource restrictions and intrainstitutional segregation.ConclusionThis qualitative study revealed patterns across cases that were associated with successful implementation. Consideration of the intervention–context relation was indispensable to understanding the observed outcomes.

scholarly journals Implementing immediate postpartum contraception: a comparative case study at 11 hospitals

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Michelle H. Moniz ◽  
Kirsten Bonawitz ◽  
Marisa K. Wetmore ◽  
Vanessa K. Dalton ◽  
Laura J. Damschroder ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Organizational Context ◽  
Implementation Strategies ◽  
Comparative Case Study ◽  
Successful Implementation ◽  
Implementation Success ◽  
Local Conditions ◽  
Maternity Hospitals ◽  
Financial Environment

Abstract Background Immediate postpartum long-acting reversible contraception (LARC) is an evidence-based practice, but hospitals face significant barriers to its adoption. Our objective was to examine how organizational context (e.g., size, employee attitudes toward the clinical practice) and implementation strategies (i.e., the actions taken to routinize a clinical practice) drive successful implementation of immediate postpartum LARC services, with a goal of informing the design of future implementation interventions. Methods We conducted a comparative case study of the implementation of inpatient postpartum contraceptive care at 11 US maternity hospitals. In 2017–2018, we conducted site visits that included semi-structured key informant interviews informed by the Consolidated Framework for Implementation Research. Qualitative measures of implementation success included stakeholder satisfaction, routinization, and sustainability of immediate postpartum LARC services. Qualitative content analysis and cross-case synthesis explored relationships among organizational context, implementation strategies, and implementation success. Results We completed semi-structured interviews with 78 clinicians, nurses, residents, pharmacy and revenue cycle staff, and hospital administrators. Successful implementation required three essential conditions: effective implementation champions, an enabling financial environment, and hospital administrator engagement. Six other contextual conditions were influential: trust and effective communication, alignment with stakeholders’ professional values, perception of meeting patients’ needs, robust learning climate, compatibility with workflow, and positive attitudes and adequate knowledge about the clinical practice. On average, sites used 18 (range 11-22) strategies. Strategies to optimize the financial environment and train clinicians and staff were commonly used. Strategies to plan and evaluate implementation and to engage patients emerged as promising to address barriers to practice change, yet were often underused. Conclusions Implementation efforts in maternity settings may be more successful if they select strategies to optimize local conditions for success. Our findings elucidate key contextual conditions to target and provide a menu of promising implementation strategies for incorporating recommended contraceptive services into routine maternity practice. Additional prospective research should evaluate whether these strategies effectively optimize local conditions for successful implementation in a variety of settings.

scholarly journals Diffusion of process improvement methods in European SMEs

2017 ◽  
Vol 37 (5) ◽  
pp. 607-629 ◽  
Author(s):  
Tom McGovern ◽  
Adrian Small ◽  
Christian Hicks
Keyword(s):  
Process Improvement ◽  
Secondary Data ◽  
Local Context ◽  
Comparative Case Study ◽  
Institutional Pressures ◽  
Content Type ◽  
The North ◽  
Intervention Context ◽  
Improvement Interventions ◽  
Field Notes

Purpose The purpose of this paper is to evaluate the European Regions for Innovative Productivity project that established Innovative Productivity Centres (IPCs) to assist SMEs in the North Sea Region of Europe to develop a process improvement capability. A conceptual framework explains how a process improvement methodology developed for large firms was adapted and shaped to meet the needs of SMEs. Design/methodology/approach A comparative case study of 23 SMEs within six European countries. A protocol was developed to collect financial and operational data. This was supplemented by observations, secondary data and field notes. An established research model was used to evaluate the effectiveness and impact of the process improvement interventions. Findings The intervention context and structure of the IPCs varied by country which shaped process improvement interventions at two levels: the country and the firm. During diffusion three process improvement variants emerged that were tailored to fit the local context. Developing a process improvement capability depended upon the availability of company resources, establishing KPIs and change agent support. Originality/value The research contributes to knowledge and theory on diffusion and institutionalization by examining how SMEs responded to institutional pressures by implementing process improvement practices in different ways. Heterogeneity of both the IPCs and the external change agents were the drivers in shaping the improvement practices.

Moving From Interprofessional Education Toward Interprofessional Practice: Bridging the Translation Gap

2019 ◽  
Vol 4 (5) ◽  
pp. 971-976
Author(s):  
Imran Musaji ◽  
Trisha Self ◽  
Karissa Marble-Flint ◽  
Ashwini Kanade
Keyword(s):  
Interprofessional Education ◽  
Interprofessional Collaboration ◽  
Evaluation Model ◽  
Implementation Strategies ◽  
Future Research ◽  
Successful Implementation ◽  
Interprofessional Practice ◽  
Translational Model ◽  
Key Stakeholders ◽  
Clear Identification

Purpose The purpose of this article was to propose the use of a translational model as a tool for identifying limitations of current interprofessional education (IPE) research. Translational models allow researchers to clearly define next-step research needed to translate IPE to interprofessional practice (IPP). Method Key principles, goals, and limitations of current IPE research are reviewed. A popular IPE evaluation model is examined through the lens of implementation research. The authors propose a new translational model that more clearly illustrates translational gaps that can be used to direct future research. Next steps for translating IPE to IPP are discussed. Conclusion Comprehensive reviews of the literature show that the implementation strategies adopted to date have fostered improved buy-in from key stakeholders, as evidenced by improved attitudes and perceptions toward interprofessional collaboration/practice. However, there is little evidence regarding successful implementation outcomes, such as changed clinician behaviors, changed organizational practices, or improved patient outcomes. The authors propose the use of an IPE to IPP translational model to facilitate clear identification of research gaps and to better identify future research targets.

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.

Factors influencing success among collaborative sage-grouse management groups in the western United States

2010 ◽  
Vol 37 (3) ◽  
pp. 250-260 ◽  
Author(s):  
LORIEN R. BELTON ◽  
DOUGLAS JACKSON-SMITH
Keyword(s):  
Early Stage ◽  
Collaborative Group ◽  
Successful Implementation ◽  
Sage Grouse ◽  
Implementation Success ◽  
Management Plans ◽  
Collaborative Conservation ◽  
Process Factors ◽  
Group Success ◽  
The Impact

SUMMARYConsiderable efforts have been put into collaborative conservation efforts across the globe. In the western USA, concern about declines of two sage-grouse species (Centrocercus urophasianus and C. minimus) has led to the creation of over 60 collaborative wildlife management partnership groups to develop and implement local sage-grouse management plans. These sage-grouse local working groups (LWGs) share a common goal, information, and policy environment, but were implemented in diverse ways. As a result, they provide a rare opportunity to study systematically the impact of contextual, organizational, institutional and process factors on local collaborative group success. Data from document reviews and an extensive survey of over 700 group participants from 53 sage-grouse LWGs were used to assess the success of this collaborative conservation effort and identify those group attributes that were related to successful implementation and funding of projects. Specifically, external, internal and emergent group characteristics were considered as likely predictors of LWG implementation success. The LWGs varied broadly in their achievements. The presence of a neutral facilitator, participants' feelings of ownership, groups whose local plans had more authority and early-stage group successes were significantly related to implementation success at the group level.

scholarly journals Planning Implementation Success of Syncope Clinical Practice Guidelines in the Emergency Department Using CFIR Framework

2021 ◽  
Author(s):  
Jing Li ◽  
Susan S. Smyth ◽  
Jessica Miller Clouser ◽  
Colleen A. McMullen ◽  
Vedant Gupta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Family Caregivers ◽  
Implementation Strategy ◽  
Care Pathway ◽  
Implementation Strategies ◽  
Mobile App ◽  
Care Plan ◽  
Local Context ◽  
Successful Implementation

Background and Objectives: Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope care, study suggested that the current clinical guidelines have not significantly impacted resource utilization surrounding emergency department (ED) evaluation of syncope. Matching implementation strategies to barriers and facilitators and tailoring strategies to local context hold significant promise for a successful implementation of clinical practice guideline (CPG). Our team applied implementation science principles to develop a stakeholder-based implementation strategy. Methods and Materials: We partnered with patients, family caregivers, frontline clinicians and staff, and health system administrators at four health systems to conduct quantitative surveys and qualitative interviews for context assessment. The identification of implementation strategies was done by applying the CFIR-ERIC Implementation Strategy Matching Tool and soliciting stakeholders’ inputs. We then co-designed with patients and frontline teams, developed and tested specific strategies. Results: 114 clinicians completed surveys and 32 clinicians and stake-holders participated in interviews. Results from the surveys and interview indicated low awareness of syncope guidelines, and communication challenges with patients, lack of CPG protocol integration into ED workflows, and organizational process to change were recognized as major barriers. Thirty-one patients and their family caregivers participated in interviews and ex-pressed their expectations: clarity regarding their diagnosis, context surrounding care plan and diagnostic testing, and a desire to feel cared about. After identifying change methods to address those barriers, the multilevel, multicomponent implementation strategy, MISSION, included pa-tient educational materials, mentored implementation, academic detailing, Syncope Optimal Care Pathway and corresponding Mobile App, and Lean quality improvement methods. The pilot of MISSION demonstrated feasibility, acceptability and initial success on appropriate testing. Con-clusions: Effect multifaceted implementation strategies that target individuals, teams, and healthcare systems can be employed to plan successful implementation and promote adherence to syncope CPGs.

scholarly journals Complexity, Evaluation and the Effectiveness of Community-based Interventions to Reduce Health Inequalities

2020 ◽  
Author(s):  
Anna Matheson ◽  
Kevin Dew ◽  
Jacqueline Cumming
Keyword(s):  
New Zealand ◽  
Health Inequalities ◽  
Comparative Case Study ◽  
Successful Implementation ◽  
Intervention Effectiveness ◽  
Community Based Interventions ◽  
Community Based ◽  
Theoretical Understanding ◽  
System Perspective

Reducing health inequalities has been part of the New Zealand government's agenda since the early 1990s. As a result, interventions have been implemented nationally with the explicit goal of reducing health inequalities. This paper describes findings from a comparative case study of two community-based interventions - carried out in different New Zealand communities. Complexity theory was used as an analytic tool to examine the case data, and provided a systematic way in which to explore 'local' issues by taking a 'whole system' perspective. The findings showed that two important influences on the successful implementation of the interventions were the existence and capacity of local organisations and their relationships with government agencies. The analysis provided a dynamic picture of shared influences on the interventions in different communities and in doing so offered insight into intervention effectiveness. It is argued in this article that, for examining intervention effectiveness, it is essential to have a theoretical understanding of the behaviour of the complex system in which they are implemented. This theoretical understanding has implications for the appropriate design of interventions to reduce health inequalities, and in turn should lead to more meaningful ways to evaluate them.

scholarly journals Complexity, Evaluation and the Effectiveness of Community-based Interventions to Reduce Health Inequalities

2020 ◽  
Author(s):  
Anna Matheson ◽  
Kevin Dew ◽  
Jacqueline Cumming
Keyword(s):  
New Zealand ◽  
Health Inequalities ◽  
Comparative Case Study ◽  
Successful Implementation ◽  
Intervention Effectiveness ◽  
Community Based Interventions ◽  
Community Based ◽  
Theoretical Understanding ◽  
System Perspective

Reducing health inequalities has been part of the New Zealand government's agenda since the early 1990s. As a result, interventions have been implemented nationally with the explicit goal of reducing health inequalities. This paper describes findings from a comparative case study of two community-based interventions - carried out in different New Zealand communities. Complexity theory was used as an analytic tool to examine the case data, and provided a systematic way in which to explore 'local' issues by taking a 'whole system' perspective. The findings showed that two important influences on the successful implementation of the interventions were the existence and capacity of local organisations and their relationships with government agencies. The analysis provided a dynamic picture of shared influences on the interventions in different communities and in doing so offered insight into intervention effectiveness. It is argued in this article that, for examining intervention effectiveness, it is essential to have a theoretical understanding of the behaviour of the complex system in which they are implemented. This theoretical understanding has implications for the appropriate design of interventions to reduce health inequalities, and in turn should lead to more meaningful ways to evaluate them.

Opportunities and Challenges of Implementing Predictive Analytics for Competitive Advantage

2019 ◽  
pp. 64-90
Author(s):  
Mohsen Attaran ◽  
Sharmin Attaran
Keyword(s):  
Competitive Advantage ◽  
Conceptual Model ◽  
Service Industry ◽  
Predictive Analytics ◽  
Successful Implementation ◽  
Implementation Success ◽  
Adoption Rate ◽  
Potential Applications ◽  
Potential Benefits ◽  
Determinants Of Implementation

Predictive analytics has become an increasingly hot topic in analytics landscape. As a result, predictive analytics deployments are gaining momentum. Yet, the adoption rate is slow, and organizations are only beginning to scratch the surface in regard to the potential applications of this technology. Implemented properly, the business benefits can be substantial. However, there are strategic pitfalls to consider. The key objective of this chapter is to propose a conceptual model for successful implementation of analytics in organizations. This chapter highlights the importance of predictive analytics, identifies determinants of implementation success, and covers some of the potential benefits of this technology. Furthermore, this study reviews key attributes of a successful predictive analytics platform and illustrates how to overcome some of the strategic pitfalls of incorporating this technology in business. Finally, this study highlights successful implementation of analytics solutions in manufacturing and service industry.

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