The unpredictable journeys of spreading, sustaining and scaling healthcare innovations: a scoping review

Abstract Innovation has the potential to improve the quality of care and health service delivery, but maximising the reach and impact of innovation to achieve large-scale health system transformation remains understudied. Interest is growing in three processes of the innovation journey within health systems, namely the spread, sustainability and scale-up (3S) of innovation. Recent reviews examine what we know about these processes. However, there is little research on how to support and operationalise the 3S. This study aims to improve our understanding of the 3S of healthcare innovations. We focus specifically on the definitions of the 3S, the mechanisms that underpin them, and the conditions that either enable or limit their potential. We conducted a scoping review, systematically investigating six bibliographic databases to search, screen and select relevant literature on the 3S of healthcare innovations. We screened 641 papers, then completed a full-text review of 112 identified as relevant based on title and abstract. A total of 24 papers were retained for analysis. Data were extracted and synthesised through descriptive and inductive thematic analysis. From this, we develop a framework of actionable guidance for health system actors aiming to leverage the 3S of innovation across five key areas of focus, as follows: (1) focus on the why, (2) focus on perceived-value and feasibility, (3) focus on what people do, rather than what they should be doing, (4) focus on creating a dialogue between policy and delivery, and (5) focus on inclusivity and capacity building. While there is no standardised approach to foster the 3S of healthcare innovations, a variety of practical frameworks and tools exist to support stakeholders along this journey.

Download Full-text

Using systems thinking to support clinical system transformation

Journal of Health Organization and Management ◽

10.1108/jhom-12-2014-0206 ◽

2016 ◽

Vol 30 (3) ◽

pp. 302-323 ◽

Cited By ~ 13

Author(s):

Allan Best ◽

Alex Berland ◽

Carol Herbert ◽

Jennifer Bitz ◽

Marlies W van Dijk ◽

...

Keyword(s):

Health System ◽

Complex Adaptive Systems ◽

Clinical Guidelines ◽

Large Scale ◽

Guideline Implementation ◽

Clear Understanding ◽

Care Providers ◽

System Transformation ◽

Content Type

Purpose – The British Columbia Ministry of Health’s Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC’s health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings. Design/methodology/approach – Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers and board members were validated through an online survey. Findings – The functional themes for managing large-scale clinical change included: creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system. Research limitations/implications – The action research methodology was designed to guide continuing improvement of implementation. A sample of initiatives was selected; it was not intended to compare and contrast facilitators and barriers across all initiatives and regions. Similarly, evaluating the results or process of guideline implementation was outside the scope; the methods were designed to enable conversations at multiple levels – policy, management and practice – about how to improve implementation. The study is best seen as a case study of LSC, offering a possible model for replication by others and a tool to shape further dialogue. Practical implications – Recommended action-oriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing change fatigue; ensuring adequate resources; providing consistent communication especially for front-line care providers; and supporting local teams to demonstrate the clinical value of the guidelines to their colleagues. Originality/value – Bringing a complex systems perspective to clinical guideline implementation resulted in a clear understanding of the challenges involved in LSC.

Download Full-text

Current state of the evidence on community treatments for people with complex emotional needs: a scoping review

10.1101/2021.12.07.21267399 ◽

2021 ◽

Author(s):

Sarah Ledden ◽

Luke Sheridan Rains ◽

Merle Schlief ◽

Phoebe Barnett ◽

Brian Chi Fung Ching ◽

...

Keyword(s):

Scoping Review ◽

Quantitative Methods ◽

Mental Health Problems ◽

Relevant Literature ◽

Bibliographic Databases ◽

Emotional Needs ◽

Post Traumatic Stress ◽

Community Based ◽

Current State ◽

Testing Stage

AbstractBackgroundImproving the quality of care in community settings for people with ‘Complex Emotional Needs’ (CEN - our preferred working term for services for people with a “personality disorder” diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care should be rooted as far as possible in evidence. We aimed to take stock of the current state of such evidence, and identify significant gaps through a scoping review of published investigations of outcomes of community-based psychosocial interventions designed for CEN.MethodsWe conducted a scoping review with systematic searches. We searched six bibliographic databases, including forward and backward citation searching, and reference searching of relevant systematic reviews. We included studies using quantitative methods to test for effects on any clinical, social, and functioning outcomes from community-based interventions for people with CEN.ResultsWe included 226 papers in all (209 studies). Little relevant literature was published before 2000. Since then, publications per year and sample sizes have gradually increased, but most studies are relatively small, including many pilot or uncontrolled studies. Most studies focus on symptom and self-harm outcomes of various forms of specialist psychotherapy: most result in outcomes better than from inactive controls and similar to other specialist psychotherapies. We found large evidence gaps.Adaptation and testing of therapies for significant groups (e.g. people with comorbid psychosis, bipolar disorder, post-traumatic stress disorder or substance misuse; older and younger groups; parents) have for the most part only reached a feasibility testing stage. We found little evidence regarding interventions to improve social aspects of people’s lives, peer support or ways of designing effective services.ConclusionsCompared with other longer term mental health problems that significantly impair functioning, the evidence base on how to provide high quality care for people with CEN is very limited. There is good evidence that people with CEN can be effectively helped when specialist therapies are available and they are able to engage with them. However, a much more methodologically robust and substantial literature addressing a much wider range of research questions is urgently needed to optimise treatment and support across this group.

Download Full-text

The Lumos Pilot Project: Feasibility of Linking General Practice Data to Other Health-Related Data

International Journal for Population Data Science ◽

10.23889/ijpds.v5i5.1584 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Patricia Correll ◽

Adrian Power ◽

Samantha Moubarak ◽

Katie Irvine ◽

Anne-Marie Feyer

Keyword(s):

Health System ◽

Integrated Care ◽

Large Scale ◽

Data Extraction ◽

Scale Up ◽

Pilot Project ◽

Patient Privacy ◽

Patient Journey ◽

Related Data ◽

Health Related

IntroductionDelivering integrated care is an aspiration of health systems around the world. General Practices (GPs) operate between other types of health care and are therefore key to effective integrated care. However, information to understand the patient journey across the health system, such as between primary and acute care, is currently impeded in Australia by lack of interoperable clinical software, privacy concerns, and cross-jurisdictional barriers. This presents a challenge to the formation of an evidence base for the design and implementation of integrated health services. Objectives and ApproachThe Lumos Pilot Project aims to address these challenges. Following ethics approval in February 2016, the pilot was rolled out over five stages to develop a proof of concept for extracting and linking GP data to other health-related data. The objectives were to:I. Build cross-jurisdictional collaborations between primary care and the state health system in New South Wales (NSW), Australia.II. Develop methodologies to address confidentiality requirements.III. Develop technological solutions that will allow for a large scale program. ResultsData were extracted from 102 GPs, covering nearly 1 million patients, and linked to emergency department, hospital and mortality records. GPs were recruited to participate through collaborations with all NSW Primary Health regions. Privacy preserving record linkage was successfully implemented in the fifth stage of the project. This process encoded patient identifiers prior to extraction from the GP and negated the need for identified information during data linkage. Software was developed and tested across all stages of the project so that once enrolled, GP data extraction and transfer were fully automated. Conclusion / ImplicationsThe resultant dataset has provided a new picture of patients’ healthcare journeys while preserving patient privacy. The technological solutions allow for a large scale up of GP recruitment in future.

Download Full-text

Prevention and Treatment of Problem Gambling Among Older Adults: A Scoping Review

Journal of Gambling Issues ◽

10.4309/jgi.2018.39.2 ◽

2018 ◽

Cited By ~ 1

Author(s):

Flora I Matheson ◽

Travis Sztainert ◽

Yana Lakman ◽

Sarah Jane Steele ◽

Carolyn P Ziegler ◽

...

Keyword(s):

Older Adults ◽

Problem Gambling ◽

Nous Avons ◽

Scoping Review ◽

Mental Health Problems ◽

Relevant Literature ◽

Personnes Âgées ◽

Bibliographic Databases ◽

Quantitative And Qualitative Research ◽

Prevention And Treatment

Gambling is a socially acceptable form of recreation for older adults, but excessive gambling can lead to negative financial consequences and mental health problems. The lack of attention given to gambling problems among older adults has been highlighted in the literature for over a decade. The objectives of this review were to examine relevant literature on interventions for prevention and treatment of problem gambling (PG) among older adults and to identify research gaps. To this end, we conducted a scoping review of both quantitative and qualitative research, focusing on adult studies. Because of the lack of PG research specific to older adults, we focused our review on prevention and treatment among adult studies that covered a wide age range. Our literature search, conducted in a range of bibliographic databases, located 7,632 titles. After duplicates were eliminated, 4,268 records remained; 2,321 were excluded based on title and 1,247 remained after abstract review. Three independent assessors reviewed the full text of 700 articles and found 247 that met our inclusion/exclusion criteria. We identified a paucity of research on prevention and treatment of problem gambling specific to older adults, with the gaps in evidence even greater for prevention. We found only six studies specific to adults aged 55 years and older. Studies on older women are severely lacking. We conclude with some suggestions for future research.RésuméLe jeu est une forme de loisir socialement acceptable pour les personnes en âge avancé, mais le jeu excessif peut entraîner des conséquences financières graves et des problèmes de santé mentale. Depuis plus d’une décennie, le manque d’attention accordée aux problèmes de jeu chez les personnes âgées a été souligné dans la littérature. Cette étude avait pour but d’examiner les ouvrages portant sur les interventions de prévention et le traitement du jeu problématique chez les personnes âgées et de cerner les lacunes dans la recherche. À cette fin, on a entrepris un examen de l’étendue de la recherche quantitative et qualitative axée sur les études sur les adultes. En raison de l’absence de recherche sur le jeu compulsif propre aux adultes âgés, nous avons axé notre examen sur la prévention et le traitement dans les études pour adultes couvrant plusieurs tranches d’âge. Notre revue de la littérature, menée dans diverses bases de données bibliographiques, a permis de répertorier 7 632 titres. Après l’élimination des doublons, il est resté 4268 titres; 2321 ont été exclus sur la base du titre et nous en avons conservé 1247 après la lecture des résumés. Trois évaluateurs indépendants ont examiné le texte intégral de 700 articles et ont repéré 247 articles qui répondaient à nos critères d’inclusion/d’exclusion. Nous avons constaté un manque de recherche sur la prévention et le traitement du jeu problématique propre aux personnes âgées, et des lacunes encore plus évidentes au chapitre de la prévention. Nous avons trouvé seulement six études portant spécifiquement sur les adultes âgés de 55 ans et plus. Les études sur les femmes d’âge mûr font cruellement défaut. Nous avons conclu en donnant quelques suggestions pour de futures recherches.

Download Full-text

Choosing Physical, Physicochemical and Chemical Methods of Pre-Treating Lignocellulosic Wastes to Repurpose into Solid Fuels

Sustainability ◽

10.3390/su11133604 ◽

2019 ◽

Vol 11 (13) ◽

pp. 3604 ◽

Cited By ~ 10

Author(s):

Martin Taylor ◽

Hassan Alabdrabalameer ◽

Vasiliki Skoulou

Keyword(s):

Lignocellulosic Biomass ◽

Large Scale ◽

Relevant Literature ◽

Scale Up ◽

Value Added ◽

Solid Fuels ◽

Biomass Waste ◽

True Value ◽

Pre Treatment ◽

Downstream Processes

Various methods of physical, chemical and combined physicochemical pre-treatments for lignocellulosic biomass waste valorisation to value-added feedstock/solid fuels for downstream processes in chemical industries have been reviewed. The relevant literature was scrutinized for lignocellulosic waste applicability in advanced thermochemical treatments for either energy or liquid fuels. By altering the overall naturally occurring bio-polymeric matrix of lignocellulosic biomass waste, individual components such as cellulose, hemicellulose and lignin can be accessed for numerous downstream processes such as pyrolysis, gasification and catalytic upgrading to value-added products such as low carbon energy. Assessing the appropriate lignocellulosic pre-treatment technology is critical to suit the downstream process of both small- and large-scale operations. The cost to operate the process (temperature, pressure or energy constraints), the physical and chemical structure of the feedstock after pre-treatment (decomposition/degradation, removal of inorganic components or organic solubilization) or the ability to scale up the pre-treating process must be considered so that the true value in the use of bio-renewable waste can be revealed.

Download Full-text

Integrated health service delivery during COVID-19: a scoping review of published evidence from low-income and lower-middle-income countries

BMJ Global Health ◽

10.1136/bmjgh-2021-005667 ◽

2021 ◽

Vol 6 (6) ◽

pp. e005667

Author(s):

Md Zabir Hasan ◽

Rachel Neill ◽

Priyanka Das ◽

Vasuki Venugopal ◽

Dinesh Arora ◽

...

Keyword(s):

Health Service ◽

Service Delivery ◽

Health System ◽

Scoping Review ◽

Low Income ◽

Building Blocks ◽

Health Service Delivery ◽

Middle Income ◽

Published Evidence ◽

Integrated Health

BackgroundIntegrated health service delivery (IHSD) is a promising approach to improve health system resilience. However, there is a lack of evidence specific to the low/lower-middle-income country (L-LMIC) health systems on how IHSD is used during disease outbreaks. This scoping review aimed to synthesise the emerging evidence on IHSD approaches adopted in L-LMIC during the COVID-19 pandemic and systematically collate their operational features.MethodsA systematic scoping review of peer-reviewed literature, published in English between 1 December 2019 and 12 June 2020, from seven electronic databases was conducted to explore the evidence of IHSD implemented in L-LMICs during the COVID-19 pandemic. Data were systematically charted, and key features of IHSD systems were presented according to the postulated research questions of the review.ResultsThe literature search retrieved 1487 published articles from which 18 articles met the inclusion criteria and included in this review. Service delivery, health workforce, medicine and technologies were the three most frequently integrated health system building blocks during the COVID-19 pandemic. While responding to COVID-19, the L-LMICs principally implemented the IHSD system via systematic horizontal integration, led by specific policy measures. The government’s stewardship, along with the decentralised decision-making capacity of local institutions and multisectoral collaboration, was the critical facilitator for IHSD. Simultaneously, fragmented service delivery structures, fragile supply chain, inadequate diagnostic capacity and insufficient workforce were key barriers towards integration.ConclusionA wide array of context-specific IHSD approaches were operationalised in L-LMICs during the early phase of the COVID-19 pandemic. Emerging recommendations emphasise the importance of coordination and integration across building blocks and levels of the health system, supported by a responsive governance structure and stakeholder engagement strategies. Future reviews can revisit this emerging evidence base at subsequent phases of COVID-19 response and recovery in L-LMICs to understand how the approaches highlighted here evolve.

Download Full-text

Rehabilitation, the Great Absentee of Virtual Coaching in Medical Care: Scoping Review

Journal of Medical Internet Research ◽

10.2196/12805 ◽

2019 ◽

Vol 21 (10) ◽

pp. e12805 ◽

Cited By ~ 10

Author(s):

Peppino Tropea ◽

Hannes Schlieter ◽

Irma Sterpi ◽

Elda Judica ◽

Kai Gand ◽

...

Keyword(s):

Physical Activity ◽

Scoping Review ◽

Relevant Literature ◽

Smart Device ◽

Future Research ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Virtual Coaching ◽

Full Text Review ◽

Coaching Activities

Background In the last few years, several studies have focused on describing and understanding how virtual coaches (ie, coaching program or smart device aiming to provide coaching support through a variety of application contexts) could be key drivers for health promotion in home care settings. As there has been enormous technological progress in the field of artificial intelligence and data processing in the past decade, the use of virtual coaches gains an augmented attention in the considerations of medical innovations. Objective This scoping review aimed at providing an overview of the applications of a virtual coach in the clinical field. In particular, the review focused on the papers that provide tangible information for coaching activities with an active implication for engaging and guiding patients who have an ongoing plan of care. Methods We aimed to investigate the use of the term virtual coach in the clinical field performing a methodical review of the relevant literature indexed on PubMed, Scopus, and Embase databases to find virtual coach papers focused on specific activities dealing with clinical or medical contexts, excluding those aimed at surgical settings or electronic learning purposes. Results After a careful revision of the inclusion and exclusion criteria, 46 records were selected for the full-text review. Most of the identified articles directly or indirectly addressed the topic of physical activity. Some papers were focused on the use of virtual coaching (VC) to manage overweight or nutritional issues. Other papers dealt with technological interfaces to facilitate interactions with patients suffering from different chronic clinical conditions such as heart failure, chronic obstructive pulmonary disease, depression, and chronic pain. Conclusions Although physical activity is a healthy practice that is most encouraged by a virtual coach system, in the current scenario, rehabilitation is the great absentee. This paper gives an overview of the tangible applications of this tool in the medical field and may inspire new ideas for future research on VC.

Download Full-text

Rehabilitation, the Great Absentee of Virtual Coaching in Medical Care: Scoping Review (Preprint)

10.2196/preprints.12805 ◽

2018 ◽

Author(s):

Peppino Tropea ◽

Hannes Schlieter ◽

Irma Sterpi ◽

Elda Judica ◽

Kai Gand ◽

...

Keyword(s):

Physical Activity ◽

Scoping Review ◽

Relevant Literature ◽

Smart Device ◽

Future Research ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Virtual Coaching ◽

Full Text Review ◽

Coaching Activities

BACKGROUND In the last few years, several studies have focused on describing and understanding how virtual coaches (ie, coaching program or smart device aiming to provide coaching support through a variety of application contexts) could be key drivers for health promotion in home care settings. As there has been enormous technological progress in the field of artificial intelligence and data processing in the past decade, the use of virtual coaches gains an augmented attention in the considerations of medical innovations. OBJECTIVE This scoping review aimed at providing an overview of the applications of a virtual coach in the clinical field. In particular, the review focused on the papers that provide tangible information for coaching activities with an active implication for engaging and guiding patients who have an ongoing plan of care. METHODS We aimed to investigate the use of the term <italic>virtual coach</italic> in the clinical field performing a methodical review of the relevant literature indexed on PubMed, Scopus, and Embase databases to find <italic>virtual coach</italic> papers focused on specific activities dealing with clinical or medical contexts, excluding those aimed at surgical settings or electronic learning purposes. RESULTS After a careful revision of the inclusion and exclusion criteria, 46 records were selected for the full-text review. Most of the identified articles directly or indirectly addressed the topic of physical activity. Some papers were focused on the use of virtual coaching (VC) to manage overweight or nutritional issues. Other papers dealt with technological interfaces to facilitate interactions with patients suffering from different chronic clinical conditions such as heart failure, chronic obstructive pulmonary disease, depression, and chronic pain. CONCLUSIONS Although physical activity is a healthy practice that is most encouraged by a virtual coach system, in the current scenario, rehabilitation is the great absentee. This paper gives an overview of the tangible applications of this tool in the medical field and may inspire new ideas for future research on VC.

Download Full-text