scholarly journals Development of an Implementation Process Model: A Delphi Study

2020 ◽  
Author(s):  
Gillian Parker ◽  
Monika Kastner ◽  
Karen Born ◽  
Whitney Berta
Keyword(s):  
Knowledge Translation ◽  
Clinical Outcomes ◽  
Delphi Study ◽  
Process Model ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Implementation Support ◽  
Support Tool ◽  
Modified Delphi ◽  
The Impact

Abstract Background: There is general scarcity of research on key elements of implementation processes and the factors which impact implementation success. Implementation of healthcare interventions is a complex process. Tools to support implementation can facilitate this process and improve effectiveness of the interventions and clinical outcomes. Understanding the impact of implementation support tools is a critical aspect of this process. The objective of this study was to solicit knowledge and consensus from relevant implementation science and knowledge translation healthcare experts in order to refine and validate a process model of key elements in the implementation process.Methods: A two round consensus-based modified Delphi study involving international experts in knowledge translation and implementation (researchers, scientists, professors, decision-makers) was conducted. Participants rated and commented on all aspects of the process model, including the organization, content, scope, and structure. Delphi questions rated at 75% agreement or lower were reviewed and revised. Qualitative comments supported the restructuring and refinement. A second-round survey followed the same process as Round 1. Results: Fifty-four experts participated in Round 1, and 32 experts participated in Round 2. Twelve percent (n=6) of the Round 1 questions did not reach consensus. Key themes for revision and refinement were: stakeholder engagement throughout the process, iterative nature of the implementation process; importance of context; and importance of using guiding theories or frameworks. The process model was revised and refined based on the quantitative and qualitative data and reassessed by the experts in Round 2. Consensus was achieved on all items in Round 2 and the Delphi concluded. Additional feedback was obtained regarding terminology, target users and definition of the implementation process.Conclusions: High levels of agreement were attained for all sub-domains, elements, and sub-elements of the Implementation Process Model. This validated model will be used to develop an Implementation Support Tool to be used by healthcare providers to facilitate effective implementation and improved clinical outcomes.

scholarly journals Development of An Implementation Process Model: A Delphi Study

2021 ◽  
Author(s):  
Gillian Parker ◽  
Monika Kastner ◽  
Karen Born ◽  
Whitney Berta
Keyword(s):  
Knowledge Translation ◽  
Clinical Outcomes ◽  
Delphi Study ◽  
Process Model ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Implementation Support ◽  
Support Tool ◽  
Modified Delphi ◽  
The Impact

Abstract Background: There is general scarcity of research on key elements of implementation processes and the factors which impact implementation success. Implementation of healthcare interventions is a complex process. Tools to support implementation can facilitate this process and improve effectiveness of the interventions and clinical outcomes. Understanding the impact of implementation support tools is a critical aspect of this process. The objective of this study was to solicit knowledge and consensus from relevant implementation science and knowledge translation healthcare experts in order to refine and validate a process model of key elements in the implementation process.Methods: A two round consensus-based modified Delphi study involving international experts in knowledge translation and implementation (researchers, scientists, professors, decision-makers) was conducted. Participants rated and commented on all aspects of the process model, including the organization, content, scope, and structure. Delphi questions rated at 75% agreement or lower were reviewed and revised. Qualitative comments supported the restructuring and refinement. A second-round survey followed the same process as Round 1. Results: Fifty-four experts participated in Round 1, and 32 experts participated in Round 2. Twelve percent (n=6) of the Round 1 questions did not reach consensus. Key themes for revision and refinement were: stakeholder engagement throughout the process, iterative nature of the implementation process; importance of context; and importance of using guiding theories or frameworks. The process model was revised and refined based on the quantitative and qualitative data and reassessed by the experts in Round 2. Consensus was achieved on all items in Round 2 and the Delphi concluded. Additional feedback was obtained regarding terminology, target users and definition of the implementation process.Conclusions: High levels of agreement were attained for all sub-domains, elements, and sub-elements of the Implementation Process Model. This validated model will be used to develop an Implementation Support Tool to be used by healthcare providers to facilitate effective implementation and improved clinical outcomes.

scholarly journals Development of an Implementation Process Model: a Delphi study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gillian Parker ◽  
Monika Kastner ◽  
Karen Born ◽  
Whitney Berta
Keyword(s):  
Knowledge Translation ◽  
Clinical Outcomes ◽  
Delphi Study ◽  
Process Model ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Implementation Support ◽  
Support Tool ◽  
Modified Delphi ◽  
The Impact

Abstract Background There is general scarcity of research on key elements of implementation processes and the factors which impact implementation success. Implementation of healthcare interventions is a complex process. Tools to support implementation can facilitate this process and improve effectiveness of the interventions and clinical outcomes. Understanding the impact of implementation support tools is a critical aspect of this process. The objective of this study was to solicit knowledge and agreement from relevant implementation science and knowledge translation healthcare experts in order to develop a process model of key elements in the implementation process. Methods A two round, modified Delphi study involving international experts in knowledge translation and implementation (researchers, scientists, professors, decision-makers) was conducted. Participants rated and commented on all aspects of the process model, including the organization, content, scope, and structure. Delphi questions rated at 75% agreement or lower were reviewed and revised. Qualitative comments supported the restructuring and refinement. A second-round survey followed the same process as Round 1. Results Fifty-four experts participated in Round 1, and 32 experts participated in Round 2. Twelve percent (n = 6) of the Round 1 questions did not reach agreement. Key themes for revision and refinement were: stakeholder engagement throughout the process, iterative nature of the implementation process; importance of context; and importance of using guiding theories or frameworks. The process model was revised and refined based on the quantitative and qualitative data and reassessed by the experts in Round 2. Agreement was achieved on all items in Round 2 and the Delphi concluded. Additional feedback was obtained regarding terminology, target users and definition of the implementation process. Conclusions High levels of agreement were attained for all sub-domains, elements, and sub-elements of the Implementation Process Model. This model will be used to develop an Implementation Support Tool to be used by healthcare providers to facilitate effective implementation and improved clinical outcomes.

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 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.

VP163 Patient Involvement In The Development Of Multi-Criteria Decision Tool

2017 ◽  
Vol 33 (S1) ◽  
pp. 223-223
Author(s):  
Marie-Pierre Gagnon ◽  
Sylvain L'Espérance ◽  
Carmen Lindsay ◽  
Marc Rhainds ◽  
Martin Coulombe ◽  
...  
Keyword(s):  
Decision Support ◽  
Delphi Study ◽  
Value Added ◽  
Decision Support Tool ◽  
Strategic Choices ◽  
Healthcare Organizations ◽  
Support Tool ◽  
Health Technologies ◽  
Modified Delphi ◽  
Patient Representatives

INTRODUCTION:Healthcare organizations should assess the relevance of both existing and new practices. Involving patients in decisions regarding which health technologies and interventions should be prioritized could favor a better fit between strategic choices and patients needs.METHODS:Following a systematic review of existing multi-criteria decision support tools and a consultation with hospital clinicians and managers, a set of potentially relevant criteria was identified. A three-round modified Delphi study was then conducted among four groups (hospital managers, heads of department, clinicians, and patient representatives) in order to reach consensus on criteria that should be considered in the tool.RESULTS:In total, seventy-four participants completed the third round of the Delphi study. Consensus was obtained on twelve criteria. There were some significant differences between groups in priority scores given to criteria. Patient representatives differed significantly from other groups on two criteria. Their ranking of the accessibility criteria was higher, and their ranking of the organizational aspect criteria was lower than for the other groups.CONCLUSIONS:Patient representatives can be involved in the development of a multi-criteria decision support tool to identify, evaluate and prioritize high value-added health technologies and interventions in order to enhancing clinical appropriateness The fact that accessibility aspects were more important for patient representatives calls for specific attention to these criteria when prioritizing health technologies or interventions. Furthermore, we need to ensure that the decisions made regarding the relevance of these technologies and interventions also reflect patients’ preferences.

scholarly journals Clinical indicators to identify neuropathic pain in low back-related leg pain: protocol for a modified Delphi study

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e033547 ◽  
Author(s):  
Jai Mistry ◽  
Deborah Falla ◽  
Tim Noblet ◽  
Nicola R Heneghan ◽  
Alison B Rushton
Keyword(s):  
Neuropathic Pain ◽  
Delphi Study ◽  
A Priori ◽  
Healthcare Providers ◽  
Leg Pain ◽  
Eligibility Criterion ◽  
Low Back ◽  
Clinical Indicators ◽  
Modified Delphi ◽  
Ethical Approval

IntroductionNeuropathic low back-related leg pain (LBLP) can be a challenge to healthcare providers to diagnose and treat. Accurate diagnosis of neuropathic pain is fundamental to ensure appropriate intervention is given. However, to date there is no gold standard to diagnose neuropathic LBLP. A Delphi study will therefore be conducted to obtain an expert-derived consensus list of clinical indicators to identify a neuropathic component to LBLP.Methods/analysisIncluded participants will be considered experts within the field as measured against a predefined eligibility criterion. Through an iterative multistage process, participants will rate their agreement with a list of clinical indicators and suggest any missing clinical indicators during each round. Agreement will be measured using a 5-point Likert scale. Descriptive statistics will be used to measure agreement; median, IQR and percentage of agreement. A priori consensus criteria will be defined for each round. Data analysis at the end of round three will enable a list of clinical indicators to be derived.Ethics and disseminationEthical approval was gained from the University of Birmingham (ERN_19-1142). On completion of the study, findings will be disseminated in a peer-reviewed journal and presented at relevant conferences.

scholarly journals Improvements in Pain Outcomes in a Canadian Pediatric Teaching Hospital Following Implementation of a Multifaceted, Knowledge Translation Initiative

2012 ◽  
Vol 17 (3) ◽  
pp. 173-179 ◽  
Author(s):  
Lisa M Zhu ◽  
Jennifer Stinson ◽  
Lori Palozzi ◽  
Kevin Weingarten ◽  
Mary-Ellen Hogan ◽  
...  
Keyword(s):  
Pain Management ◽  
Knowledge Translation ◽  
Clinical Outcomes ◽  
Pain Assessment ◽  
Management Practices ◽  
Audit And Feedback ◽  
Opioid Administration ◽  
Pain Outcomes ◽  
Pain Prevalence ◽  
The Impact

BACKGROUND: A previous audit performed at a tertiary/quaternary pediatric hospital in Toronto, Ontario, demonstrated suboptimal assessment and treatment of children’s pain. Knowledge translation (KT) initiatives (education, reminders, audit and feedback) were implemented to address identified care gaps; however, the impact is unknown.OBJECTIVES: To determine the impact of KT initiatives on pain outcomes including process outcomes (eg, pain assessment and management practices) and clinical outcomes (eg, pain prevalence and intensity); and to benchmark additional pain practices, particularly opioid administration and painful procedures.METHODS: Medical records at The Hospital for Sick Children (Toronto, Ontario) were reviewed on a single day in September 2007. Pain assessment and management practices, and pain prevalence and intensity in the preceding 24 h were recorded on a standardized data collection form. Where possible, pain outcomes were compared with previous audit results.RESULTS: Records of 265 inpatients were audited. Sixty-three per cent of children underwent a documented pain assessment compared with 27% in an audit conducted previously (P<0.01). Eighty-three per cent of children with documented pain received at least one pain management intervention. Overall, 51% of children received pharmacological therapy, and 15% received either a psychological or physical pain-relieving intervention. Of those assessed, 44% experienced pain in the previous 24 h versus 66% in the previous audit (P<0.01). Fewer children experienced severe pain compared with the first audit (8.7% versus 26.1%; P<0.01). One-third of children received opioids; 19% of these had no recorded pain assessment. Among 131 children who underwent a painful procedure, 21% had a concurrent pain assessment. Painful procedures were accompanied by a pain-relieving intervention in 12.5% of cases.CONCLUSIONS: Following KT initiatives, significant improvements in pain processes (pain assessment documentation and pain management interventions) and clinical outcomes (pain prevalence, pain intensity) were observed. Further improvements are recommended, specifically with respect to procedural pain practices and opioid utilization patterns.

scholarly journals A Delphi study to establish a consensus definition and clinical reporting guidelines for Mesenchymal Stromal Cells.

2021 ◽  
Author(s):  
Laurent Renesme ◽  
Kelly D Cobey ◽  
Maxime Le ◽  
Manoj M Lalu ◽  
Bernard Thebaud
Keyword(s):  
Knowledge Translation ◽  
Scoping Review ◽  
Delphi Study ◽  
Clinical Studies ◽  
Reporting Guidelines ◽  
Research Network ◽  
Dissemination And Implementation ◽  
Consensus Definition ◽  
Core Group ◽  
Modified Delphi

Introduction. Despite being more than two decades of research, Mesenchymal Stromal Cell (MSC) treatments are still struggling to cross the translational gap. Two key issues that likely contribute to these failures are i) the lack of clear definition for MSC and ii) poor quality of reporting in MSC clinical studies. To address these issues, we propose a modified Delphi study to establish a consensus definition for MSC and clinical reporting guidelines for MSC. Methods and analysis. We will conduct a three-round international modified Delphi Survey. Findings from a recent scoping review examining how MSC are defined and reported in preclinical and clinical studies were used to draft the initial survey for round one of our Delphi. Participants will include a "core group" of individuals as well as researchers whose work was captured in our scoping review. The core group will include stakeholders from different research fields including developmental biology, translational science, research methods, regulatory practices, scholarly journal editing, and industry. The first two survey rounds will be online, and the final round will take place in person. Each participant will be asked to rate their agreement on potential MSC definition characteristics and reporting items using a Likert scale. After each round, we will analyse data to determine which items have reached consensus for inclusion/exclusion, and then develop a revised questionnaire for any new items, or items that did not reach consensus. Ethics and dissemination. This study received ethical approval from the Ottawa Health Research Network Research Ethics Board. To support the dissemination of our findings, we will use an evidence-based "integrated knowledge translation" approach to engage knowledge users from the inception of the research. This will allow us to develop a tailored end-of-project knowledge translation plan to support and ensure dissemination and implementation of the Delphi results.

scholarly journals Using the knowledge translation framework to change practical care of central catheters in a Brazilian neonatal unit

2017 ◽  
Vol 11 (06) ◽  
pp. 445-452
Author(s):  
Gabriela Ramos Ferreira Curan ◽  
Edilaine Giovanini Rossetto ◽  
Thaíla Corrêa Castral
Keyword(s):  
Knowledge Translation ◽  
Conceptual Framework ◽  
Implementation Process ◽  
Central Line ◽  
Neonatal Unit ◽  
Line Bundles ◽  
Before And After ◽  
Quasi Experimental ◽  
The Impact ◽  
Central Catheters

Introduction: The use of central catheters in intensive care is essential, but exposes the patient to the risk of a bloodstream infection. Although there is evidence to improve the care for these patients, there is a gap between knowledge and healthcare practices. This study was designed to describe the bundle implementation for central catheters in light of the knowledge translation (KT) conceptual framework in a neonatal unit and assess its impact on care practices with catheters. Methodology: A time-series quasi-experimental study design was conducted in a Brazilian neonatal unit, through 289 non-participant observations of professional practices before and after the implementation of the bundles. Results: The deployment of two bundles was guided through the steps of a careful selection of adopting KT evidence and context-related and investment factors in the facilitation process. The implementation of the bundles was planned by a group manager, mediated by a facilitator, and guided by targets established by professionals. The biggest impact was on the maintenance of catheters; seven of eleven practices improved significantly (p < 0.01). The insertion of catheters showed lesser impact of change, with high adequacy ratios before implementation, but also presented satisfactory adherence to recommendations. Conclusions: This is the first Brazilian study using the KT conceptual framework to develop, implement, and evaluate the impact of central line bundles in a neonatal care environment, detailing the implementation process. It highlights the importance of accountability and staff involvement in all stages of the study.

scholarly journals Action, actor, context, target, time (AACTT): a framework for specifying behaviour

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Justin Presseau ◽  
Nicola McCleary ◽  
Fabiana Lorencatto ◽  
Andrea M. Patey ◽  
Jeremy M. Grimshaw ◽  
...  
Keyword(s):  
Process Model ◽  
Outcome Measurement ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Target Time ◽  
Barriers And Enablers ◽  
Healthcare Settings ◽  
Action Context ◽  
Potential Applications ◽  
Key Steps

Abstract Background Designing implementation interventions to change the behaviour of healthcare providers and other professionals in the health system requires detailed specification of the behaviour(s) targeted for change to ensure alignment between intervention components and measured outcomes. Detailed behaviour specification can help to clarify evidence-practice gaps, clarify who needs to do what differently, identify modifiable barriers and enablers, design interventions to address these and ultimately provides an indicator of what to measure to evaluate an intervention’s effect on behaviour change. An existing behaviour specification framework proposes four domains (Target, Action, Context, Time; TACT), but insufficiently clarifies who is performing the behaviour (i.e. the Actor). Specifying the Actor is especially important in healthcare settings characterised by multiple behaviours performed by multiple different people. We propose and describe an extension and re-ordering of TACT to enhance its utility to implementation intervention designers, practitioners and trialists: the Action, Actor, Context, Target, Time (AACTT) framework. We aim to demonstrate its application across key steps of implementation research and to provide tools for its use in practice to clarify the behaviours of stakeholders across multiple levels of the healthcare system. Methods and results We used French et al.’s four-step implementation process model to describe the potential applications of the AACTT framework for (a) clarifying who needs to do what differently, (b) identifying barriers and enablers, (c) selecting fit-for-purpose intervention strategies and components and (d) evaluating implementation interventions. Conclusions Describing and detailing behaviour using the AACTT framework may help to enhance measurement of theoretical constructs, inform development of topic guides and questionnaires, enhance the design of implementation interventions and clarify outcome measurement for evaluating implementation interventions.

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