scholarly journals From novice to expert: methods for transferring implementation facilitation skills to improve healthcare delivery

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Mona J. Ritchie ◽  
Louise E. Parker ◽  
JoAnn E. Kirchner
Keyword(s):  
Transfer Process ◽  
Qualitative Interviews ◽  
Healthcare Delivery ◽  
Organizational Capacity ◽  
Information Modeling ◽  
Local Context ◽  
Evidence Based ◽  
Novice To Expert ◽  
Negative Effect ◽  
Facilitation Skills

Abstract Background There is substantial evidence that facilitation can address the challenges of implementing evidence-based innovations. However, facilitators need a wide variety of complex skills; lack of these can have a negative effect on implementation outcomes. Literature suggests that novice and less experienced facilitators need ongoing support from experts to develop these skills. Yet, no studies have investigated the transfer process. During a test of a facilitation strategy applied at 8 VA primary care clinics, we explored the techniques and processes an expert external facilitator utilized to transfer her skills to two initially novice internal facilitators who became experts. Methods In this qualitative descriptive study, we conducted monthly debriefings with three facilitators over a 30-month period and documented these in detailed notes. Debriefings with the expert facilitator focused on how she trained and mentored facilitation trainees. We also conducted, recorded, and transcribed two semi-structured qualitative interviews with each facilitator and queried them about training content and process. We used a mix of inductive and deductive approaches to analyze data; our analysis was informed by a review of mentoring, coaching, and cognitive apprenticeship literature. We also used a case comparison approach to explore how the expert tailored her efforts. Results The expert utilized 21 techniques to transfer implementation facilitation skills. Techniques included both active (providing information, modeling, and coaching) and participatory ones. She also used techniques to support learning, i.e., cognitive supports (making thinking visible, using heuristics, sharing experiences), psychosocial supports, strategies to promote self-learning, and structural supports. Additionally, she transferred responsibility for facilitation through a dynamic process of interaction with trainees and site stakeholders. Finally, the expert varied the level of focus on particular skills to tailor her efforts to trainee and local context. Conclusions This study viewed the journey from novice to expert facilitator through the lens of the expert who transferred facilitation skills to support implementation of an evidence-based program. It identified techniques and processes that may foster transfer of these skills and build organizational capacity for future implementation efforts. As the first study to document the implementation facilitation skills transfer process, findings have research and practical implications.

scholarly journals Development of a behaviour change workplace-based intervention to improve nurses’ eating and physical activity

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Brian T. Power ◽  
Kirsty Kiezebrink ◽  
Julia L. Allan ◽  
Marion K. Campbell
Keyword(s):  
Physical Activity ◽  
Behaviour Change ◽  
Qualitative Interviews ◽  
Healthcare Delivery ◽  
Physical Activity Behaviour ◽  
Evidence Base ◽  
Workplace Intervention ◽  
Behaviour Change Techniques ◽  
Evidence Based ◽  
Activity Behaviour

Abstract Background There is a critical need for an intervention to improve nurses’ eating and physical activity behaviours. As nurses spend a substantial proportion of their waking hours at work, concerted efforts to deliver such interventions in the workplace is growing. This study formed part of a multiphase programme of research that aimed to systematically develop an evidence-based and theory-informed workplace intervention to promote changes in eating and physical activity among nurses. Methods The intervention was developed iteratively, in line with Medical Research Council complex intervention guidelines. It involved four activities: (1) identifying the evidence base, (2) understanding the determinants of nurses’ eating and physical activity behaviour change through theory-based qualitative interviews and survey, (3) identifying intervention options using the Behaviour Change Wheel, and (4) specifying intervention content and implementation options using a taxonomy of behaviour change techniques. Results Data from 13 randomised controlled trials indicated that workplace-based behaviour change interventions targeted to this population are effective in changing behaviour. The evidence base was, however, limited in quantity and quality. Nurses’ beliefs about important factors determining their eating and physical activity behaviour were identified across 16 qualitative interviews and 245 survey responses, and key determinants included environmental context and resources, behavioural regulation, emotion, beliefs about consequences, knowledge and optimism. Based on these findings, 22 behaviour change techniques suitable for targeting the identified determinants were identified and combined into a potential workplace intervention. Conclusions An evidence-based and theory-informed intervention tailored to the target population and setting has been explicitly conceptualised using a systematic approach. The proposed intervention addresses previous evidence gaps for the user population of nurses. Further to this, such an intervention, if implemented, has the potential to impact nurses’ eating and physical activity behaviours and in turn, the health of nurses and the quality of healthcare delivery.

scholarly journals Development of a behaviour change workplace-based intervention to improve nurses’ eating and physical activity

2020 ◽  
Author(s):  
Brian Power ◽  
Kirsty Kiezebrink ◽  
Julia L Allan ◽  
Marion K Campbell
Keyword(s):  
Physical Activity ◽  
Behaviour Change ◽  
Qualitative Interviews ◽  
Healthcare Delivery ◽  
Physical Activity Behaviour ◽  
Evidence Base ◽  
Workplace Intervention ◽  
Behaviour Change Techniques ◽  
Evidence Based ◽  
Activity Behaviour

Abstract Background: There is a critical need for an intervention to improve nurse’s eating and physical activity behaviours. As nurses spend a substantial proportion of their waking hours at work, concerted efforts to deliver such interventions in the workplace is growing. This study formed part of a multiphase programme of research that aimed to systematically develop an evidence-based and theory-informed workplace intervention to promote changes in eating and physical activity among nurses. Methods: The intervention was developed iteratively, in line with Medical Research Council complex intervention guidelines. It involved four activities; (1) identifying the evidence base; (2) understanding the determinants of nurses’ eating and physical activity behaviour change through theory-based qualitative interviews and survey; (3) identifying intervention options using the Behaviour Change Wheel; and (4) specifying intervention content and implementation options using a taxonomy of behaviour change techniques.Results: Data from 13 randomised controlled trials indicated that workplace-based behaviour change interventions targeted to this population are effective in changing behaviour. The evidence base was, however, limited in quantity and quality. Nurses’ beliefs about important factors determining their eating and physical activity behaviour were identified across 16 qualitative interviews and 245 survey responses and key determinants included: environmental context and resources; behavioural regulation; emotion; beliefs about consequences; knowledge and optimism. Based on these findings, 22 behaviour change techniques suitable for targeting the identified determinants were identified and combined into a potential workplace intervention.Conclusions: An evidence-based and theory-informed intervention tailored to the target population and setting has been explicitly conceptualised using a systematic approach. The proposed intervention addresses previous evidence gaps for the user population of nurses. Further to this, such an intervention, if implemented, has the potential to impact nurses’ eating and physical activity behaviours and in turn, the health of nurses and the quality of healthcare delivery.

scholarly journals Development of a behaviour change workplace-based intervention to improve nurses’ eating and physical activity

2020 ◽  
Author(s):  
BRIAN POWER ◽  
Kirsty Kiezebrink ◽  
Julia L Allan ◽  
Marion K Campbell
Keyword(s):  
Physical Activity ◽  
Behaviour Change ◽  
Qualitative Interviews ◽  
Healthcare Delivery ◽  
Physical Activity Behaviour ◽  
Evidence Base ◽  
Workplace Intervention ◽  
Behaviour Change Techniques ◽  
Evidence Based ◽  
Activity Behaviour

Abstract Background There is a critical need for an intervention to improve nurse’s eating and physical activity behaviours. As nurses spend a substantial proportion of their waking hours at work, concerted efforts to deliver such interventions in the workplace is growing. This study formed part of a multiphase programme of research that aimed to systematically develop an evidence-based and theory-informed workplace intervention to promote changes in eating and physical activity among nurses. Methods The intervention was developed iteratively, in line with Medical Research Council complex intervention guidelines. It involved four activities; (1) identifying the evidence base; (2) understanding the determinants of nurses’ eating and physical activity behaviour change through theory-based qualitative interviews and survey; (3) identifying intervention options using the Behaviour Change Wheel; and (4) specifying intervention content and implementation options using a taxonomy of behaviour change techniques. Results Data from 13 randomised controlled trials indicated that workplace-based behaviour change interventions targeted to this population are effective in changing behaviour. The evidence base was, however, limited in quantity and quality. Nurses’ beliefs about important factors determining their eating and physical activity behaviour were identified across 16 qualitative interviews and 245 survey responses and key determinants included: environmental context and resources; behavioural regulation; emotion; beliefs about consequences; knowledge and optimism. Based on these findings, 22 behaviour change techniques suitable for targeting the identified determinants were identified and combined into a potential workplace intervention. Conclusions An evidence-based and theory-informed intervention tailored to the target population and setting has been explicitly conceptualised using a systematic approach. The proposed intervention addresses previous evidence gaps for the user population of nurses. Further to this, such an intervention, if implemented, has the potential to impact nurses’ eating and physical activity behaviours and in turn, the health of nurses and the quality of healthcare delivery.

scholarly journals Development of a Behaviour Change Workplace-Based Intervention to Improve Nurses’ Eating and Physical Activity

2020 ◽  
Author(s):  
Brian T Power ◽  
Kirsty Kiezebrink ◽  
Julia L Allan ◽  
Marion K Campbell
Keyword(s):  
Physical Activity ◽  
Behaviour Change ◽  
Qualitative Interviews ◽  
Healthcare Delivery ◽  
Physical Activity Behaviour ◽  
Evidence Base ◽  
Workplace Intervention ◽  
Behaviour Change Techniques ◽  
Evidence Based ◽  
Activity Behaviour

Abstract Background There is a critical need for an intervention to improve nurse’s eating and physical activity behaviours. As nurses spend a substantial proportion of their waking hours at work, concerted efforts to deliver such interventions in the workplace is growing. This study formed part of a multiphase programme of research that aimed to systematically develop an evidence-based and theory-informed workplace intervention to promote changes in eating and physical activity among nurses.Methods The intervention was developed iteratively, in line with Medical Research Council complex intervention guidelines. It involved four activities; (1) identifying the evidence base; (2) understanding the determinants of nurses’ eating and physical activity behaviour change through theory-based qualitative interviews and survey; (3) identifying intervention options using the Behaviour Change Wheel; and (4) specifying intervention content and implementation options using a taxonomy of behaviour change techniques.Results Data from 13 randomised controlled trials indicated that workplace-based behaviour change interventions targeted to this population are effective in changing behaviour. The evidence base was, however, limited in quantity and quality. Nurses’ beliefs about important factors determining their eating and physical activity behaviour were identified across 16 qualitative interviews and 245 survey responses and key determinants included: environmental context and resources; behavioural regulation; emotion; beliefs about consequences; knowledge and optimism. Based on these findings, 22 behaviour change techniques suitable for targeting the identified determinants were identified and combined into a potential workplace intervention. Conclusions An evidence-based and theory-informed intervention tailored to the target population and setting has been explicitly conceptualised using a systematic approach. The proposed intervention addresses previous evidence gaps for the user population of nurses. Further to this, such an intervention, if implemented, has the potential to impact nurses’ eating and physical activity behaviours and in turn, the health of nurses and the quality of healthcare delivery.

scholarly journals Evidence-Based Design in Architectural Education: Designing the First Maggie’s Centre in Israel

2021 ◽  
pp. 193758672110079
Author(s):  
Nirit Putievsky Pilosof ◽  
Yasha Jacob Grobman
Keyword(s):  
Literature Review ◽  
Architectural Design ◽  
Early Stage ◽  
Scientific Research ◽  
Well Being ◽  
Architectural Education ◽  
Local Context ◽  
Evidence Based ◽  
Architecture Education ◽  
The Impact

Objective The study examines the integration of the Evidence-based Design (EBD) approach in healthcare architecture education in the context of an academic design studio. Background Previous research addressed the gap between scientific research and architectural practice and the lack of research on the use of the EBD approach in architectural education. Methods The research examines an undergraduate architectural studio to design a Maggie’s Centre for cancer care in Israel and evaluates the impact of the EBD approach on the design process and design outcomes. The research investigates the impact of the integration of three predesign tasks: (1) literature review of healing architecture research, (2) analysis and comparison of existing Maggie’s Centres, and (3) analysis of the context of the design project. Results The literature review of scientific research supported the conceptual design and development of the projects. The analysis of existing Maggie’s centers, which demonstrated the interpretation of the evidence by different architects, developed the students’ ability to evaluate EBD in practice critically, and the study of the projects’ local context led the students to define the relevance of the evidence to support their vision for the project. Conclusions The research demonstrates the advantages of practicing EBD at an early stage in healthcare architectural education to enhance awareness of the impact of architectural design on the users’ health and well-being and the potential to support creativity and innovative design. More studies in design studios are needed to assess the full impact of integrating EBD in architectural education.

scholarly journals Uncovering Burdens, Examining Needs, and Shedding Assumptions of Evidence-Based Social Support Programs for Mothers: A Descriptive Qualitative Study in a Remote Community

2021 ◽  
Vol 8 ◽  
pp. 233339362110357
Author(s):  
Johanna R. Jahnke ◽  
Julee Waldrop ◽  
Alasia Ledford ◽  
Beatriz Martinez
Keyword(s):  
Social Support ◽  
Young Children ◽  
Healthcare Workers ◽  
Qualitative Interviews ◽  
Well Being ◽  
Evidence Based ◽  
Community Stakeholders ◽  
Significant Burden ◽  
Many Sources ◽  
Evidence Based Programs

Many studies have demonstrated a significant burden of maternal stress and depression for women living on the Galápagos Islands. Here, we aim to uncover burdens and needs of women with young children on San Cristóbal Island and then explore options for implementing evidence-based programs of social support to meet these needs. We conducted 17 semi-structured qualitative interviews with mothers of young children, healthcare workers, and community stakeholders. We then used Summary Oral Reflective Analysis (SORA), an interactive methodology, for qualitative analysis. Despite initial reports of a low-stress environment, women described many sources of stress and concerns for their own and their children’s health and well-being. We uncovered three broad areas of need for mothers of young children: (1) the need for information and services, (2) the need for trust, and (3) the need for space. In response to these concerns, mothers, healthcare workers, and community leaders overwhelmingly agreed that a social support program would be beneficial for the health of mothers and young children. Still, they expressed concern over the feasibility of such a program. To address these feasibility concerns, we propose that a web-based education and social support intervention led by nurses would best meet mothers’ needs. Women could learn about child health and development, develop strong, trusting friendships with other mothers, and have their own space to speak freely among experts and peers.

scholarly journals Psychological Consequences of the Delay in the Silent Mentor Programme During the COVID-19 Pandemic: Perspectives From Family Members of Silent Mentors

2021 ◽  
pp. 003022282110009
Author(s):  
Li Ping Wong ◽  
Sik Loo Tan ◽  
Haridah Alias ◽  
Thiam Eng Sia ◽  
Aik Saw
Keyword(s):  
Mental Health ◽  
Qualitative Interviews ◽  
Psychological Impact ◽  
Family Members ◽  
Well Being ◽  
The Body ◽  
Functional Health ◽  
Psychological Consequences ◽  
Negative Effect ◽  
Health And Well Being

The COVID-19 pandemic has put a hold on the Silent Mentor Programme (SMP); this pause has not only caused unprecedented challenges for the delivery of medical education but has forced changes in the programme ceremony sessions. We aimed to describe the psychological impact and experiences of family members of silent mentors during the COVID-19 pandemic using qualitative interviews. Many expressed feelings of remorse and unrest about the unprecedented delay of the SMP. The delay increased negative emotions particularly among some elderly family members; however, there was no prominent negative effect on their functional health and well-being. Several participants relayed the belief that the soul cannot rest until the body receives a proper burial while some worried about the deterioration of the physical condition of the mentors. In conclusion, findings provide insights into the importance of not overlooking the mental health implications of delaying the SMP in future outbreaks or crises.

scholarly journals “What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anh Ly ◽  
Roger Zemek ◽  
Bruce Wright ◽  
Jennifer Zwicker ◽  
Kathryn Schneider ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Clinical Pathways ◽  
Theoretical Domains Framework ◽  
Local Context ◽  
Emergency Department Physician ◽  
Evidence Based ◽  
Care Providers ◽  
Structured Interviews ◽  
Pediatric Concussion

Abstract Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.

scholarly journals Assessment of Urban Agriculture for Evidence-Based Food Planning: A Case Study in Chengdu, China

2021 ◽  
Vol 13 (6) ◽  
pp. 3234
Author(s):  
Nan Wang ◽  
Li Zhu ◽  
Yuanhao Bing ◽  
Liwei Chen ◽  
Shulang Fei
Keyword(s):  
Urban Agriculture ◽  
Food System ◽  
Point Of View ◽  
Assessment Tools ◽  
Local Context ◽  
Evidence Based ◽  
Sustainable Food ◽  
Local Food System ◽  
Food Planning ◽  
Indicator Framework

Along the rapid pace of urbanization, urban agriculture is increasingly recognized as an important tool of sustainable food and nutrition supply, while contributing to the resilience and sustainability of cities from various dimensions. From a governance point of view, it is fundamental to systemically assess the urban agriculture based on local context for evidence-based food planning. In China, values of urban agriculture are being noticed in recent years, with attempts emerging to involve urban agriculture in urban planning and agriculture strategies. However, clear definition to identify the scope and holistic approaches to assess and monitor local urban agriculture are still lacking. The paper took Chengdu as the study area, to conduct a thorough assessment of the foundation, capacity, practices, functions, opportunities, and challenges of the urban agriculture locally. Building on these results, the study further developed an indicator framework tailored to Chengdu’s conditions and city objectives, for in-depth evaluation and monitoring of local urban agriculture by themes, following which a pilot in-depth assessment was conducted in Chengdu using the indicator framework. The outcome of this research for the first time provided an overall characterization of the urban agriculture in Chengdu and assessment tools tailored to urban agriculture in Chinese cities, establishing a good basis for strategic local food system planning and contributing to the formation of the Chinese paradigm in urban agriculture research.

scholarly journals Implementing large-system, value-based healthcare initiatives: a realist study protocol for seven natural experiments

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e044049
Author(s):  
Mitchell N Sarkies ◽  
Emilie Francis-Auton ◽  
Janet C Long ◽  
Andrew Partington ◽  
Chiara Pomare ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Quantitative Data ◽  
Care Delivery ◽  
Qualitative Interviews ◽  
Healthcare Delivery ◽  
Implementation Strategies ◽  
Large System ◽  
Natural Experiments ◽  
System Transformation ◽  
Delivery Models

IntroductionValue-based healthcare delivery models have emerged to address the unprecedented pressure on long-term health system performance and sustainability and to respond to the changing needs and expectations of patients. Implementing and scaling the benefits from these care delivery models to achieve large-system transformation are challenging and require consideration of complexity and context. Realist studies enable researchers to explore factors beyond ‘what works’ towards more nuanced understanding of ‘what tends to work for whom under which circumstances’. This research proposes a realist study of the implementation approach for seven large-system, value-based healthcare initiatives in New South Wales, Australia, to elucidate how different implementation strategies and processes stimulate the uptake, adoption, fidelity and adherence of initiatives to achieve sustainable impacts across a variety of contexts.Methods and analysisThis exploratory, sequential, mixed methods realist study followed RAMESES II (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) reporting standards for realist studies. Stage 1 will formulate initial programme theories from review of existing literature, analysis of programme documents and qualitative interviews with programme designers, implementation support staff and evaluators. Stage 2 envisages testing and refining these hypothesised programme theories through qualitative interviews with local hospital network staff running initiatives, and analyses of quantitative data from the programme evaluation, hospital administrative systems and an implementation outcome survey. Stage 3 proposes to produce generalisable middle-range theories by synthesising data from context–mechanism–outcome configurations across initiatives. Qualitative data will be analysed retroductively and quantitative data will be analysed to identify relationships between the implementation strategies and processes, and implementation and programme outcomes. Mixed methods triangulation will be performed.Ethics and disseminationEthical approval has been granted by Macquarie University (Project ID 23816) and Hunter New England (Project ID 2020/ETH02186) Human Research Ethics Committees. The findings will be published in peer-reviewed journals. Results will be fed back to partner organisations and roundtable discussions with other health jurisdictions will be held, to share learnings.

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