Abstract WP333: The Impact of External Facilitation on Implementation: Findings From the Protocol-Guided Rapid Evaluation of Veterans PREVENT Quality Improvement Program

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Teresa M Damush ◽  
Barbara Homoya ◽  
Lauren Penney ◽  
Edward Miech ◽  
Nicholas Rattray ◽  
...  
Keyword(s):  
Implementation Process ◽  
Team Cohesion ◽  
Veterans Administration ◽  
Improvement Program ◽  
Team Members ◽  
Education Planning ◽  
Medical Facilities ◽  
Facility Level ◽  
The Impact ◽  
External Facilitation

Background and Aims: In the Veterans Administration, we found an absence of acute TIA care protocols and broad clinician uncertainty. To address these gaps, the PREVENT program was implemented in a stepped-wedge trial involving 6 medical facilities. To promote local adaptation, we employed external facilitation (EF) delivered by nurse as a key implementation strategy. The specific aim of this evaluation was to examine the effect of EF strategy on PREVENT implementation. Methods: We adapted an EF tracking template to prospectively monitor facilitation type, dose and temporality. We defined 17 apriori facilitation EF activity codes based upon the PREVENT protocol, and Consolidated Framework for Implementation Research (CFIR). We evaluated the EF activities delivered at each site over a 1 year and how the EF dose corresponded to the number of implementation activities completed and the level of team cohesion (beginning, developing, basic, intermediate, advanced) for providing and improving TIA care. Results: A total of 1209 EF activities delivered were delivered to QI teams and most frequently to the clinical champions; with a mean number of 242 EF activities per facility (range 182-295). Facility-level clinical champions were most likely to participate in EF activities compared to other team members. The most common EF activities delivered were: education (mean=34.3); planning (mean=27.8); overcoming barriers (mean=22.2) and ongoing quality process monitoring (mean=32.3). Teams with high initial team cohesion, &gt intermediate level, used EF early in the implementation process while teams that gradually developed cohesion over time, developing to basic levels of team cohesion, utilized EF later. QI teams with greater success in implementation activities had far more implementation activities completed (IA= 29-39) than EF activities related to barriers (B=18-28). However, QI teams with the least success in implementation activities (IA=11-25) had similar levels of EF activities related to barriers or higher (B=18-25). Conclusions: EF impacts real-world implementation by facilitating team education; planning; navigating the barriers; and enhancing the champions' skills. Early team cohesion was related to greater implementation success.

scholarly journals Understanding Low-value Care and Associated De-implementation Processes: A Qualitative Study of Choosing Wisely Interventions Across Canadian Hospitals

2021 ◽  
Author(s):  
Gillian Parker ◽  
Monika Kastner ◽  
Karen Born ◽  
Nida Shahid ◽  
Whitney Berta
Keyword(s):  
Process Model ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Choosing Wisely ◽  
Structured Interviews ◽  
Team Members ◽  
Implementation Processes ◽  
Healthcare Settings ◽  
National Campaigns ◽  
The Impact

Abstract Background:Choosing Wisely (CW) is an international movement comprised of national campaigns in more than 20 countries to reduce low-value care (LVC). Hospitals and healthcare providers are examining existing practices and putting interventions in place to reduce practices that offer little to no benefit to patients or may cause them harm. De-implementation, the reduction or removal of a healthcare practice is an emerging field of research. Little is known about the factors which (i) sustain LVC; and (ii) the magnitude of the problem of LVC. In addition, little is known about the processes of de-implementation, and if and how these processes differ from implementation endeavours. The objective of this study was to explicate the myriad factors which impact the processes and outcomes of de-implementation initiatives that are designed to address national Choosing Wisely campaign recommendations.Methods:Semi-structured interviews were conducted with individuals implementing Choosing Wisely Canada recommendations in healthcare settings in four provinces. The interview guide was developed using concepts from the literature and the Implementation Process Model (IPM) as a framework. All interviews were conducted virtually, recorded, and transcribed verbatim. Data were analysed using thematic analysis.Results:Seventeen Choosing Wisely team members were interviewed. Participants identified numerous provider factors, most notably habit, which sustain LVC. Contrary to reporting in recent studies, the majority of LVC in the sample was not ‘patient facing’; therefore, patients were not a significant driver for the LVC, nor a barrier to reducing it. Participants detailed aspects of the magnitude of the problems of LVC, specifically the impact of harm and resources. Unique factors influencing the processes of de-implementation reported were: influence of Choosing Wisely campaigns, availability of data, lack of targets and hard-coded interventions.Conclusions: This study explicates factors ranging from those which impact the maintenance of LVC to factors that impact the success of de-implementation interventions intended to reduce them. The findings draw attention to the significance of unintentional factors, highlight the importance of understanding the impact of harm and resources to reduce LVC and illuminate the overstated impact of patients in de-implementation literature. These findings illustrate the complexities of de-implementation.

scholarly journals THE IMPACT OF ALIVIADO DEMENTIA CARE HOSPICE EDITION TRAINING PROGRAM ON HOSPICE STAFF’S DEMENTIA SYMPTOM KNOWLEDGE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S851-S851
Author(s):  
Catherine E Schneider ◽  
Alycia A Bristol ◽  
Ariel Ford ◽  
Shih-Yin Lin ◽  
Abraham A Brody
Keyword(s):  
Psychological Symptoms ◽  
Daily Practice ◽  
Dementia Care ◽  
Interdisciplinary Teams ◽  
Practice Change ◽  
P Value ◽  
Evidence Based ◽  
Improvement Program ◽  
Team Members ◽  
The Impact

Abstract A lack of high quality dementia training for healthcare workers is a key barrier to effective care for persons with dementia (PWD), a vulnerable and increasing population across the care continuum. Hospice agencies in particular are underprepared to care for this population, although annually about 17% of hospice patients have a primary diagnosis of dementia and an additional 28% as a comorbidity. Aliviado Dementia Care-Hospice Edition is an interdisciplinary, evidence-based quality improvement program developed to assist hospice interdisciplinary teams in caring for PWD and their caregivers. Interdisciplinary hospice team members in two agencies were enrolled in online training modules, which addressed multiple areas including pain, behavioral and psychological symptoms of dementia (BPSD), and working with caregivers. They were also provided a toolkit to integrate training in daily practice. Changes in knowledge, confidence and attitudes were tested before and after training and paired t-tests were utilized to evaluate the program’s effect. Thirty-five individuals completed the program and pre/post tests. Paired t-tests showed clinically and statistically significant increases in knowledge, attitudes and confidence in five of 10 domains including depression knowledge and confidence and BPSD knowledge, confidence and interventions. The greatest increase was in using BPSD interventions (18.5% increase, p-value: 0.0002), depression confidence (15.9% increase, p-value: 0.006) and BPSD confidence (12.6% increase, p-value: 0.02). Aliviado is an evidence-based, systems-level intervention shown to improve clinical knowledge, attitudes and confidence in treating pain and BPSD in PWD. This training could be used to produce systems-level practice change for hospice interdisciplinary team members serving PWD.

scholarly journals Understanding low-value care and associated de-implementation processes: A qualitative study of Choosing Wisely Interventions across Canadian hospitals

2021 ◽  
Author(s):  
Gillian Parker ◽  
Monika Kastner ◽  
Karen Born ◽  
Nida Shahid ◽  
Whitney Berta
Keyword(s):  
Process Model ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Choosing Wisely ◽  
Structured Interviews ◽  
Team Members ◽  
Implementation Processes ◽  
Healthcare Settings ◽  
National Campaigns ◽  
The Impact

Abstract Background:Choosing Wisely (CW) is an international movement comprised of national campaigns in more than 20 countries to reduce low-value care (LVC). Hospitals and healthcare providers are examining existing practices and putting interventions in place to reduce practices that offer little to no benefit to patients or may cause them harm. De-implementation, the reduction or removal of a healthcare practice is an emerging field of research. Little is known about the factors which (i) sustain LVC; and (ii) the magnitude of the problem of LVC. In addition, little is known about the processes of de-implementation, and if and how these processes differ from implementation endeavours. The objective of this study was to explicate the myriad factors which impact the processes and outcomes of de-implementation initiatives that are designed to address national Choosing Wisely campaign recommendations.Methods:Semi-structured interviews were conducted with individuals implementing Choosing Wisely Canada recommendations in healthcare settings in four provinces. The interview guide was developed using concepts from the literature and the Implementation Process Model (IPM) as a framework. All interviews were conducted virtually, recorded, and transcribed verbatim. Data were analysed using thematic analysis.Findings:Seventeen Choosing Wisely team members were interviewed. Participants identified numerous provider factors, most notably habit, which sustain LVC. Contrary to reporting in recent studies, the majority of LVC in the sample was not ‘patient facing’; therefore, patients were not a significant driver for the LVC, nor a barrier to reducing it. Participants detailed aspects of the magnitude of the problems of LVC, specifically the impact of harm and resources. Unique factors influencing the processes of de-implementation reported were: influence of Choosing Wisely campaigns, availability of data, lack of targets and hard-coded interventions. Conclusions: This study explicates factors ranging from those which impact the maintenance of LVC to factors that impact the success of de-implementation interventions intended to reduce them. The findings draw attention to the significance of unintentional factors, highlight the importance of understanding the impact of harm and resources to reduce LVC and illuminate the overstated impact of patients in de-implementation literature. These findings illustrate the complexities of de-implementation.

Refractory suffering: The impact of team dynamics on the interdisciplinary palliative care team

2011 ◽  
Vol 9 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Kate Swetenham ◽  
Meg Hegarty ◽  
Katrina Breaden ◽  
Carol Grbich
Keyword(s):  
Palliative Care ◽  
Interdisciplinary Team ◽  
Team Cohesion ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Skill Sets ◽  
Team Members ◽  
Care Experience ◽  
The Individual ◽  
The Impact

AbstractObjective:This qualitative study aimed to describe the skill sets that experienced palliative care clinicians possess when managing refractory suffering.Method:Thirteen tape recorded semi-structured interviews and four online questionnaires were completed by participants with at least two years clinical palliative care experience. The research team undertook cross sectional thematic analysis of the transcribed interviews.Results:In the face of refractory suffering, team cohesion was identified as a key requirement to support the interdisciplinary team. However, team cohesion was found to be undermined by philosophical differences between team members, a paradigm shift concerning cure versus care and individual opinions regarding the chosen approach and levels of respect between the individual disciplines involved in the care of a person with a life limiting illness.Significance of results:The findings of this study highlight the precarious nature of the interdisciplinary team when significant challenges are faced. As a result of witnessing refractory suffering the division and fracturing of teams can easily occur; often team members are completely unaware of its cause. The findings of this study contribute to the limited literature on the nature of refractory suffering from the perspective of the interdisciplinary team.

Team cohesion: the impact of team design and technical factors

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Keyword(s):  
Social Cohesion ◽  
Structural Equation ◽  
Team Cohesion ◽  
Content Type ◽  
Team Members ◽  
Task Cohesion ◽  
Negative Effect ◽  
Team Design ◽  
The Impact ◽  
And Task

Purpose The purpose of this study is to investigate the effects of team boundedness, and formal coordination on task and social cohesion and the moderating effect of organization tenure diversity. Design/methodology/approach Data was gathered from the responses of 398 team members and leaders working in 111 software development teams to a questionnaire survey. The hypotheses were all tested using structural equation modelling. Findings The results show team boundedness and formal coordination have positive and significant associations with task and social cohesion. Formal coordination is a stronger positive predictor for task than social cohesion. Organization tenure has a greater negative effect on social cohesion than task cohesion and moderates the relationship between formal coordination and task cohesion. Practical implications Therefore, for organizations to optimize team cohesion the impact of antecedent variables on social and task cohesion should be taken into considering in planning strategies for improvement. Originality/value This paper has an original approach by adding to the literature through an examination of the antecedent variables of task and social cohesion which are two key components of team cohesion.

THE IMPACT OF LEADERSHIP PRACTICES TO TEAM MEMBERS’ SATISFACTION

2009 ◽  
Vol 8 (1) ◽  
Author(s):  
Chalimah .
Keyword(s):  
Conflict Resolution ◽  
Leadership Practices ◽  
Hotel Industry ◽  
Leader Behavior ◽  
Team Leader ◽  
Shop Floor ◽  
Team Members ◽  
Top Executives ◽  
Wide Range ◽  
The Impact

eamwork is becoming increasingly important to wide range of operations. It applies to all levels of the company. It is just as important for top executives as it is to middle management, supervisors and shop floor workers. Poor teamwork at any level or between levels can seriously damage organizational effectiveness. The focus of this paper was therefore to examine whether leadership practices consist of team leader behavior, conflict resolution style and openness in communication significantly influenced the team member’s satisfaction in hotel industry. Result indicates that team leader behavior and the conflict resolution style significantly influenced team member satisfaction. It was surprising that openness in communication did not affect significantly to the team members’ satisfaction.

scholarly journals Exploring the Relationship between Communication and Success of Construction Projects: The Mediating Role of Conflict

2021 ◽  
Vol 13 (8) ◽  
pp. 4513
Author(s):  
Summaira Malik ◽  
Muhammad Taqi ◽  
José Moleiro Martins ◽  
Mário Nuno Mata ◽  
João Manuel Pereira ◽  
...  
Keyword(s):  
Project Success ◽  
Negative Impact ◽  
Positive Impact ◽  
Construction Project ◽  
Project Team ◽  
Relationship Conflict ◽  
Team Members ◽  
Mediating Role ◽  
The Impact

The success of a construction project is a widely discussed topic, even today, and there exists a difference of opinion. The impact of communication and conflict on project success is an important, but least addressed, issue in literature, especially in the case of underdeveloped countries. Miscommunication and conflict not only hinder the success of a project but also may lead to conflicts. The focus of this paper was to examine the impact of communication on project success with the mediating role of conflict. By using SPSS, demographics, descriptive statistics and correlation were determined. Smart PLS version 3.0 was used for confirmatory factor analysis (CFA), internal accuracy and validity estimates, hypothesis checking and mediation testing. The results showed that formal communication has a negative impact on the success of a construction project, resulting in conflicts among project team members, whereas informal communication and communication willingness have a positive impact on project success because people tend to know each other, and trust is developed. Task, process and relationship conflicts were used as mediating variables. It was found that task conflict effects the relations positively because project team members suggest different ways to do a certain task, and, hence, project success is achieved. On the contrary, process conflict and relationship conflict have a negative impact on communication and project success. Both of these conflicts lead to miscommunication, and project success is compromised. Hence, it is the responsibility of the project manager to enhance communication among project team members and to reduce the detrimental effects of process and relationship conflict on project success.

scholarly journals An evaluation of the implementation of quality improvement (QI) in primary care dentistry: a multi-method approach

2021 ◽  
Vol 10 (2) ◽  
pp. e000839
Author(s):  
Heather Cassie ◽  
Vinay Mistry ◽  
Laura Beaton ◽  
Irene Black ◽  
Janet E Clarkson ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Case Studies ◽  
Quality Care ◽  
Theoretical Domains Framework ◽  
Team Members ◽  
Knowledge And Skills ◽  
Scottish Government ◽  
The Impact

ObjectivesEnsuring that healthcare is patient-centred, safe and harm free is the cornerstone of the NHS. The Scottish Patient Safety Programme (SPSP) is a national initiative to support the provision of safe, high-quality care. SPSP promotes a coordinated approach to quality improvement (QI) in primary care by providing evidence-based methods, such as the Institute for Healthcare Improvement’s Breakthrough Series Collaborative methodology. These methods are relatively untested within dentistry. The aim of this study was to evaluate the impact to inform the development and implementation of improvement collaboratives as a means for QI in primary care dentistry.DesignA multimethod study underpinned by the Theoretical Domains Framework and the Kirkpatrick model. Quantitative data were collected using baseline and follow-up questionnaires, designed to explore beliefs and behaviours towards improving quality in practice. Qualitative data were gathered using interviews with dental team members and practice-based case studies.ResultsOne hundred and eleven dental team members completed the baseline questionnaire. Follow-up questionnaires were returned by 79 team members. Twelve practices, including two case studies, participated in evaluation interviews. Findings identified positive beliefs and increased knowledge and skills towards QI, as well as increased confidence about using QI methodologies in practice. Barriers included time, poor patient and team engagement, communication and leadership. Facilitators included team working, clear roles, strong leadership, training, peer support and visible benefits. Participants’ knowledge and skills were identified as an area for improvement.ConclusionsFindings demonstrate increased knowledge, skills and confidence in relation to QI methodology and highlight areas for improvement. This is an example of partnership working between the Scottish Government and NHSScotland towards a shared ambition to provide safe care to every patient. More work is required to evaluate the sustainability and transferability of improvement collaboratives as a means for QI in dentistry and wider primary care.

scholarly journals MCR: Open-Source Software to Automate Compilation of Health Study Report-Back

2021 ◽  
Vol 18 (11) ◽  
pp. 6104
Author(s):  
Erin Polka ◽  
Ellen Childs ◽  
Alexa Friedman ◽  
Kathryn S. Tomsho ◽  
Birgit Claus Henn ◽  
...  
Keyword(s):  
Quality Control ◽  
Open Source ◽  
Open Source Software ◽  
Research Team ◽  
Self Determination ◽  
Health Study ◽  
Equitable Access ◽  
Team Members ◽  
Study Participants ◽  
The Impact

Sharing individualized results with health study participants, a practice we and others refer to as “report-back,” ensures participant access to exposure and health information and may promote health equity. However, the practice of report-back and the content shared is often limited by the time-intensive process of personalizing reports. Software tools that automate creation of individualized reports have been built for specific studies, but are largely not open-source or broadly modifiable. We created an open-source and generalizable tool, called the Macro for the Compilation of Report-backs (MCR), to automate compilation of health study reports. We piloted MCR in two environmental exposure studies in Massachusetts, USA, and interviewed research team members (n = 7) about the impact of MCR on the report-back process. Researchers using MCR created more detailed reports than during manual report-back, including more individualized numerical, text, and graphical results. Using MCR, researchers saved time producing draft and final reports. Researchers also reported feeling more creative in the design process and more confident in report-back quality control. While MCR does not expedite the entire report-back process, we hope that this open-source tool reduces the barriers to personalizing health study reports, promotes more equitable access to individualized data, and advances self-determination among participants.

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