scholarly journals A Systematic Approach to Identifying and Developing Implementation Strategies to Support the Uptake of a Risk Tool to Aid in Clinical Management of Patients with Syncope: A Qualitative Study

2021 ◽  
Author(s):  
Geneviève Rouleau ◽  
Venkatesh Thiruganasambandamoorthy ◽  
Kelly Wu ◽  
Bahareh Ghaedi ◽  
Phuong Anh NGuyen ◽  
...  
Keyword(s):  
Improve Patient Safety ◽  
Implementation Strategies ◽  
Behaviour Change Techniques ◽  
User Centered Design ◽  
Study Objective ◽  
Effect Change ◽  
Journal Clubs ◽  
Physician Engagement ◽  
Risk Stratification Tool ◽  
Evidence Summaries

Abstract Background: The Canadian Syncope Risk Score (CSRS) is a validated risk stratification tool developed to optimize the accuracy of emergency department decisions and inform evidence-based clinical actions. While preliminary work has been undertaken to understand the barriers to CSRS use, no work to date has explored how to implement the CSRS to overcome these barriers in practice. This study aimed to identify which implementation strategies are most appropriate to address these barriers and how they should be implemented to mitigate the possibility of poor uptake. Methods: We conducted a series of three iterative online user-centered design workshops with emergency medicine physicians from three hospital sites in Ontario, Canada. The objective of the workshops was to engage participants in identifying acceptable strategies to promote CSRS uptake and how they should be operationalized. To support this, we systematically mapped previously identified barriers to corresponding behaviour change techniques to identify the most likely strategies to effect change. The sessions were audio-recorded and dialogue relating directly to the study objective were transcribed. We performed a qualitative content data analysis according to pre-defined objectives for each workshop. Results: Fourteen physicians participated across the three workshops. The main implementation strategies identified to overcome identified barriers were: education in the format of meetings, videos, journal clubs, and posters (uncertainty around when and how to apply the CSRS); an online calculator and integration of the CSRS into electronic medical record (uncertainty in how to apply the CSRS), local champion (lack of team buy-in); and dissemination of evidence summaries and feedback through email communications (lack of evidence about impact). Conclusions: The ability of the CSRS to effectively improve patient safety and syncope management relies on broad buy-in and uptake across physicians. To ensure the CSRS is well-positioned for impact, a comprehensive suite of implementation strategies was identified to address known barriers. This next phase of work will provide insight into whether these strategies facilitated better alignment with barriers, higher physician engagement with the implementation strategies, and broader uptake of the CSRS, with the objective of improving the likelihood that the CSRS will positively influence patient outcomes.

scholarly journals Effectiveness and meaningful use of paediatric surgical safety checklists and their implementation strategies: a systematic review with narrative synthesis

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016298 ◽  
Author(s):  
Janaka Lagoo ◽  
Steven R Lopushinsky ◽  
Alex B Haynes ◽  
Paul Bain ◽  
Helene Flageole ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Implementation Strategy ◽  
Citation Index ◽  
Improve Patient Safety ◽  
Implementation Strategies ◽  
Meaningful Use ◽  
Narrative Synthesis ◽  
Surgical Safety ◽  
Full Text Review

ObjectiveTo examine the effectiveness and meaningful use of paediatric surgical safety checklists (SSCs) and their implementation strategies through a systematic review with narrative synthesis.Summary background dataSince the launch of the WHO SSC, checklists have been integrated into surgical systems worldwide. Information is sparse on how SSCs have been integrated into the paediatric surgical environment.MethodsA broad search strategy was created using Pubmed, Embase, CINAHL, Cochrane Central, Web of Science, Science Citation Index and Conference Proceedings Citation Index. Abstracts and full texts were screened independently, in duplicate for inclusion. Extracted study characteristic and outcomes generated themes explored through subgroup analyses and idea webbing.Results1826 of 1921 studies were excluded after title and abstract review (kappa 0.77) and 47 after full-text review (kappa 0.86). 20 studies were of sufficient quality for narrative synthesis. Clinical outcomes were not affected by SSC introduction in studies without implementation strategies. A comprehensive SSC implementation strategy in developing countries demonstrated improved outcomes in high-risk surgeries. Narrative synthesis suggests that meaningful compliance is inconsistently measured and rarely achieved. Strategies involving feedback improved compliance. Stakeholder-developed implementation strategies, including team-based education, achieved greater acceptance. Three studies suggest that parental involvement in the SSC is valued by parents, nurses and physicians and may improve patient safety.ConclusionsA SSC implementation strategy focused on paediatric patients and their families can achieve high acceptability and good compliance. SSCs’ role in improving measures of paediatric surgical outcome is not well established, but they may be effective when used within a comprehensive implementation strategy especially for high-risk patients in low-resource settings.

scholarly journals Harmonizing evidence-based practice, implementation context, and implementation strategies with user-centered design: a case example in young adult cancer care

2020 ◽  
Author(s):  
Emily R Haines ◽  
Alex Dopp ◽  
Aaron R. Lyon ◽  
Holly O. Witteman ◽  
Miriam Bender ◽  
...  
Keyword(s):  
Young Adult ◽  
Outcome Measure ◽  
Implementation Strategies ◽  
Patient Reported Outcome ◽  
Evidence Based ◽  
User Centered Design ◽  
Evidence Based Practices ◽  
Patient Reported Outcome Measure ◽  
Patient Reported ◽  
User Centered

Abstract Background. Attempting to implement evidence-based practices in contexts for which they are not well-suited may compromise their fidelity and effectiveness or burden users (e.g., patients, providers, healthcare organizations) with elaborate strategies intended to force implementation. To improve the fit between evidence-based practices and contexts, implementation science experts have called for methods for adapting evidence-based practices and contexts, and tailoring implementation strategies; yet, methods for considering the dynamic interplay among evidence-based practices, contexts, and implementation strategies remain lacking. We argue that harmonizing the three can be accomplished with User-Centered Design, an iterative and highly stakeholder-engaged set of principles and methods. Methods. This paper presents a case example in which we used User-Centered Design methods and a three-phase User-Centered Design process to design a care coordination intervention for young adults with cancer. Specifically, we used usability testing to redesign an existing evidence-based practice (i.e., patient-reported outcome measure that served as the basis for intervention) to optimize usability and usefulness, an ethnographic user and contextual inquiry to prepare the context (i.e., comprehensive cancer center) to promote receptivity to implementation, and iterative prototyping workshops with a multidisciplinary design team to design the care coordination intervention and anticipate implementation strategies needed to enhance contextual fit. Results. Our User-Centered Design process resulted in the Young Adult Needs Assessment and Service Bridge (NA-SB), including a patient-reported outcome measure redesigned to promote usability and usefulness and a protocol for its implementation. By ensuring NA-SB directly responded to features of users and context, we designed NA-SB for implementation , potentially minimizing the strategies needed to address misalignment that may have otherwise existed. Furthermore, we designed NA-SB for scale-up ; by engaging users from other cancer programs across the country to identify points of contextual variation which would require flexibility in delivery, we created a tool not overly tailored to one unique context. Conclusions. User-Centered Design can help maximize usability and usefulness when designing evidence-based practices, preparing contexts, and informing implementation strategies- in effect, harmonizing evidence-based practices, contexts, and implementation strategies to promote implementation and effectiveness.

scholarly journals Empowering junior doctors: a qualitative study of a QI programme in South West England

2018 ◽  
Vol 94 (1116) ◽  
pp. 571-577 ◽  
Author(s):  
Natasha J Doran ◽  
Rob Bethune ◽  
Joanne Watson ◽  
Katherine Finucane ◽  
Andrew Carson-Stevens
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Qualitative Interviews ◽  
Working Environment ◽  
Junior Doctors ◽  
Effect Change ◽  
Medical Careers ◽  
South West ◽  
Before And After ◽  
New Generation

AimTo explore how the South-West Foundation Doctor Quality Improvement programme affected foundation year 1 (F1) doctors’ attitudes and ability to implement change in healthcare.MethodsTwenty-two qualitative interviews were carried out with two cohorts of doctors. The first F1 group before and after their participation in the QI programme; the second group comprised those who had completed the programme between 1 and 5 years earlier. Qualitative data were analysed using thematic analysis techniques.Results Prior to taking part in the QI programme, junior doctors’ attitudes towards QI were mixed. Although there was agreement on the importance of QI in terms of patient safety, not all shared enthusiasm for engaging in QI, while some were sceptical that they could bring about any change. Following participation in the programme, attitudes towards QI and the ability to effect change were significantly transformed. Whether their projects were considered a success or not, all juniors reported that they valued the skills learnt and the overall experience they gained through carrying out QI projects. Participants reported feeling more empowered in their role as junior doctors, with several describing how they felt ‘listened to’ and able to ‘have a voice’, that they were beginning to see things ‘at systems level’ and learning to ‘engage more critically’ in their working environment.Conclusions Junior doctors are ideally placed to engage in QI. Training in QI at the start of their medical careers may enable a new generation of doctors to acquire the skills necessary to improve patient safety and quality of care.

Ethnography and user-centered design to inform context-driven implementation

2021 ◽  
Author(s):  
Emily R Haines ◽  
M Alexis Kirk ◽  
Lauren Lux ◽  
Andrew B Smitherman ◽  
Byron J Powell ◽  
...  
Keyword(s):  
Contextual Information ◽  
Scale Up ◽  
Implementation Strategies ◽  
Clinical Intervention ◽  
Patient Reported Outcome ◽  
Design Approach ◽  
User Centered Design ◽  
Patient Reported ◽  
Implementation Context ◽  
User Centered

Abstract Despite pervasive findings pointing to its inextricable role in intervention implementation, context remains poorly understood in implementation science. Existing approaches for describing context (e.g., surveys, interviews) may be narrow in scope or superficial in their elicitation of contextual data. Thus, in-depth and multilevel approaches are needed to meaningfully describe the contexts into which interventions will be implemented. Moreover, many studies assess context without subsequently using contextual information to enhance implementation. To be useful for improving implementation, though, methods are needed to apply contextual information during implementation. In the case example presented in this paper, we embedded an ethnographic assessment of context within a user-centered design approach to describe implementation context and apply that information to promote implementation. We developed a patient-reported outcome measure-based clinical intervention to assess and address the pervasive unmet needs of young adults with cancer: the Needs Assessment & Service Bridge (NA-SB). In this paper, we describe the user-centered design process that we used to anticipate context modifications needed to deliver NA-SB and implementation strategies needed to facilitate its implementation. Our ethnographic contextual inquiry yielded a rich understanding of local implementation context and contextual variation across potential scale-up contexts. Other methods from user-centered design (i.e., translation tables and a design team prototyping workshop) allowed us to translate that information into specifications for NA-SB delivery and a plan for implementation. Embedding ethnographic methods within a user-centered design approach can help us to tailor interventions and implementation strategies to their contexts of use to promote implementation.

A Toolkit for Implementation of Clinical Genomic Testing: Using a Combined Stakeholder and Evidence-Driven Approach

2021 ◽  
Author(s):  
Natalie Taylor ◽  
Janet C Long ◽  
Clara Gaff ◽  
Kathryn North ◽  
Jeffrey Braithwaite ◽  
...  
Keyword(s):  
Scale Up ◽  
Health Benefit ◽  
Intervention Development ◽  
Theoretical Domains Framework ◽  
Implementation Strategies ◽  
Practice Change ◽  
Genomic Testing ◽  
Behaviour Change Techniques ◽  
Target Behaviour ◽  
Specific Implementation

Abstract BACKGROUNDThe complexity of clinical genomics – testing your entire genetic information for health benefit – is a rapidly evolving field demanding swift clinical practice change at multiple levels as widespread testing in healthcare becomes a reality. We aimed to a) describe a combined stakeholder- and evidence-driven approach to developing a toolkit for implementing genomics into the Australian health system, and b) hypothesise key steps in the change to Theoretical Domains Framework (TDF) domains via coded implementation strategies and associated mechanistic links. METHODSThe TDF was used to analyse interview data from 16 nongenetic medical specialists using genomics in practice. Barriers and enablers were identified for three key target behaviour areas across the genomic testing process: 1) identifying patients, 2) test ordering/reporting, and 3) providing results. Barriers were grouped by distinct TDF domains, and, where barriers overlapped, ‘overarching’ domains were identified. Intuitive enabling strategies generated by clinicians were aligned with identified barriers, and retrospectively coded against evidence-based behaviour change techniques (BCTs). Additional theory-driven strategies were developed to address remaining identified barriers. Using structured expert consensus processes, members of the research team participated in a series of workshops to discuss and agree theory-informed links and propose mechanisms through which specific implementation strategies would address TDF-based barriers.RESULTSA total of 32 barriers were coded against TDF domains and constructs, and eight overarching TDF domains were identified on 13 occasions. Across all target behaviour areas, 21 BCTs were represented within the 30 intuitive enabling strategies generated by clinicians, found to be used on 49 occasions. Of these, nine (18%) aligned with a corresponding distinct TDF domain coded barrier that has previously demonstrated statistically significant mechanistic links. 20 new implementation strategies were developed to address nine remaining barriers using a theory-driven approach.CONCLUSIONThis study provides rich detail of crucial stages in intervention development, aiming to ensure implementation strategies are both evidence-informed and contextually appropriate. All barriers were mapped to the TDF, implementation strategies coded against BCTs, and standardised hypothesised behavioural pathways have been proposed, making potential underlying theory explicit. Next steps will be to test toolkit effectiveness for facilitating scale-up of genomics across Australia.

scholarly journals Harmonizing evidence-based practice, implementation context, and implementation strategies with user-centered design: a case example in young adult cancer care

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Emily R. Haines ◽  
Alex Dopp ◽  
Aaron R. Lyon ◽  
Holly O. Witteman ◽  
Miriam Bender ◽  
...  
Keyword(s):  
Young Adults ◽  
Outcome Measure ◽  
Implementation Strategies ◽  
Patient Reported Outcome ◽  
Evidence Based ◽  
User Centered Design ◽  
Evidence Based Practices ◽  
Patient Reported Outcome Measure ◽  
Patient Reported ◽  
User Centered

Abstract Background Attempting to implement evidence-based practices in contexts for which they are not well suited may compromise their fidelity and effectiveness or burden users (e.g., patients, providers, healthcare organizations) with elaborate strategies intended to force implementation. To improve the fit between evidence-based practices and contexts, implementation science experts have called for methods for adapting evidence-based practices and contexts and tailoring implementation strategies; yet, methods for considering the dynamic interplay among evidence-based practices, contexts, and implementation strategies remain lacking. We argue that harmonizing the three can be facilitated by user-centered design, an iterative and highly stakeholder-engaged set of principles and methods. Methods This paper presents a case example in which we used a three-phase user-centered design process to design and plan to implement a care coordination intervention for young adults with cancer. Specifically, we used usability testing to redesign and augment an existing patient-reported outcome measure that served as the basis for our intervention to optimize its usability and usefulness, ethnographic contextual inquiry to prepare the context (i.e., a comprehensive cancer center) to promote receptivity to implementation, and iterative prototyping workshops with a multidisciplinary design team to design the care coordination intervention and anticipate implementation strategies needed to enhance contextual fit. Results Our user-centered design process resulted in the Young Adult Needs Assessment and Service Bridge (NA-SB), including a patient-reported outcome measure and a collection of referral pathways that are triggered by the needs young adults report, as well as implementation guidance. By ensuring NA-SB directly responded to features of users and context, we designed NA-SB for implementation, potentially minimizing the strategies needed to address misalignment that may have otherwise existed. Furthermore, we designed NA-SB for scale-up; by engaging users from other cancer programs across the country to identify points of contextual variation which would require flexibility in delivery, we created a tool intended to accommodate diverse contexts. Conclusions User-centered design can help maximize usability and usefulness when designing evidence-based practices, preparing contexts, and informing implementation strategies—in effect, harmonizing evidence-based practices, contexts, and implementation strategies to promote implementation and effectiveness.

scholarly journals Strategies To Implement SARS-CoV-2 Point-of-Care Testing Into Primary Care Settings: A Qualitative Secondary Analysis Guided By The Behaviour Change Wheel

2021 ◽  
Author(s):  
Patrick Kierkegaard ◽  
Timothy Hicks ◽  
A. Joy Allen ◽  
Yaling Yang ◽  
Gail Hayward ◽  
...  
Keyword(s):  
Primary Care ◽  
Behaviour Change ◽  
Point Of Care ◽  
Implementation Strategies ◽  
Intervention Strategies ◽  
Routine Practice ◽  
Behaviour Change Techniques ◽  
Successful Implementation ◽  
Primary Care Settings ◽  
Behaviour Change Wheel

Abstract Background: There is little empirical evidence to inform implementation strategies for introducing SARS-CoV-2 point of care (POC) testing into primary care settings. The purpose of this study is to develop a theory-driven understanding of the behavioural determinants underpinning the implementation of SARS-CoV-2 POC testing in primary care. This will allow identification of potential intervention strategies that could encourage successful implementation of testing into routine practice and facilitate face-to-face consultations.Methods: We used a secondary qualitative analysis approach to re-analyse data from a qualitative study that involved interviewing 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify barriers/enablers to the implementation of SARS-CoV-2 POC testing and identified behaviour change techniques to inform intervention strategies that targeted the barriers/enablers.Results: We identified 10 barriers and enablers to POC implementation under eight Theoretical Domains Framework (TDF): (1) knowledge; (2) behavioural regulation; (3) reinforcement; (4) skills; (5) environmental context and resources; (6) social influence; (7) professional role and identity; and (8) belief about consequences. Linkages with the Behaviour Change Techniques (BCT) taxonomy enabled the identification of intervention strategies to address the social and contextual factors influencing primary care physician’s willingness and capacity to adopt POC testing.Conclusions: A theory-informed approach identified barriers to the adoption of POC tests in primary care as well as guiding implementation strategies to address these challenges.

scholarly journals Advancing mechanisms of implementation to accelerate sustainable evidence-based practice integration: protocol for generating a research agenda

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e053474
Author(s):  
Cara C Lewis ◽  
Byron J Powell ◽  
Stephanie K Brewer ◽  
Ann M Nguyen ◽  
Simone H Schriger ◽  
...  
Keyword(s):  
Concept Mapping ◽  
Implementation Research ◽  
Research Agenda ◽  
Research Policy ◽  
Research Training ◽  
Implementation Strategies ◽  
Nominal Group ◽  
Deep Dive ◽  
Effect Change ◽  
Causal Pathway

IntroductionMechanisms explain how implementation strategies work. Implementation research requires careful operationalisation and empirical study of the causal pathway(s) by which strategies effect change, and factors that may amplify or weaken their effects. Understanding mechanisms is critically important to replicate findings, learn from negative studies or adapt an implementation strategy developed in one setting to another. Without understanding implementation mechanisms, it is difficult to design strategies to produce expected effects across contexts, which may have disproportionate effects on settings in which priority populations receive care. This manuscript outlines the protocol for an Agency for Healthcare Research and Quality-funded initiative to: (1) establish priorities for an agenda to guide research on implementation mechanisms in health and public health, and (2) disseminate the agenda to research, policy and practice audiences.Methods and analysisA network of scientific experts will convene in ‘Deep Dive’ meetings across 3 years. A research agenda will be generated through analysis and synthesis of information from six sources: (1) systematic reviews, (2) network members’ approaches to studying mechanisms, (3) new proposals presented in implementation proposal feedback sessions, (4) working group sessions conducted in a leading implementation research training institute, (5) breakout sessions at the Society for Implementation Research Collaboration’s (SIRC) 2019 conference and (6) SIRC conference abstracts. Two members will extract mechanism-relevant text segments from each data source and a third member will generate statements as an input for concept mapping. Concept mapping will generate unique clusters of challenges, and the network will engage in a nominal group process to identify priorities for the research agenda.Ethics and disseminationThis initiative will yield an actionable research agenda to guide research to identify and test mechanisms of change for implementation strategies. The agenda will be disseminated via multiple channels to solicit feedback and promote rigorous research on implementation mechanisms.

scholarly journals Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: A qualitative secondary analysis guided by the Behaviour Change Wheel

2021 ◽  
Author(s):  
Patrick Kierkegaard ◽  
Timothy Hicks ◽  
A. Joy Allen ◽  
Yaling Yang ◽  
Gail Hayward ◽  
...  
Keyword(s):  
Primary Care ◽  
Behaviour Change ◽  
Point Of Care ◽  
Implementation Strategies ◽  
Intervention Strategies ◽  
Routine Practice ◽  
Behaviour Change Techniques ◽  
Successful Implementation ◽  
Primary Care Settings ◽  
Behaviour Change Wheel

Abstract Background There is little empirical evidence to inform implementation strategies for introducing SARS-CoV-2 point of care (POC) testing into primary care settings. The purpose of this study is to develop a theory-driven understanding of the behavioural determinants underpinning the implementation of SARS-CoV-2 POC testing in primary care. This will allow identification of potential intervention strategies that could encourage successful implementation of testing into routine practice and facilitate face-to-face consultations. Methods We used a secondary qualitative analysis approach to re-analyse data from a qualitative study that involved interviewing 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify barriers/enablers to the implementation of SARS-CoV-2 POC testing and identified behaviour change techniques to inform intervention strategies that targeted the barriers/enablers. Results We identified 10 barriers and enablers to POC implementation under eight Theoretical Domains Framework (TDF): (1) knowledge; (2) behavioural regulation; (3) reinforcement; (4) skills; (5) environmental context and resources; (6) social influence; (7) professional role and identity; and (8) belief about consequences. Linkages with the Behaviour Change Techniques (BCT) taxonomy enabled the identification of intervention strategies to address the social and contextual factors influencing primary care physician’s willingness and capacity to adopt POC testing. Conclusions A theory-informed approach identified barriers to the adoption of POC tests in primary care as well as guiding implementation strategies to address these challenges.

Sign in / Sign up

Export Citation Format

Share Document