scholarly journals Barriers and Facilitators for Implementation of a Patient Prioritization Tool in Rehabilitation Settings

2020 ◽  
Author(s):  
Julien Déry ◽  
Angel Ruiz ◽  
François Routhier ◽  
Valérie Bélanger ◽  
André Côté ◽  
...  
Keyword(s):  
Service Providers ◽  
Implementation Process ◽  
Barriers And Facilitators ◽  
Relative Advantage ◽  
Successful Implementation ◽  
Clinical Practices ◽  
Implementation Framework ◽  
Rehabilitation Programs ◽  
Patient Prioritization ◽  
Facilitators And Barriers

Abstract Introduction. Prioritization tools aim to manage access to care by ranking patients equitably in waiting list based on determined criteria. Patient prioritization has been studied in a wide variety of clinical health services, including rehabilitation contexts. We created a web-based patient prioritization tool with the participation of stakeholders in two rehabilitation programs, which we aim to implement into clinical practice. Successful implementation of such innovation can be influenced by a variety of determinants. The goal of this study was to explore facilitators and barriers to the implementation of a patient prioritization tool in rehabilitation programs.Methods. We used two questionnaires and conducted two focus groups among service providers from two rehabilitation programs. We used descriptive statistics to report results of the questionnaires and qualitative content analysis based on Consolidated Framework for Implementation Research.Results. Key facilitators are the flexibility and relative advantage of the tool to improve clinical practices and produce beneficial outcomes on patients. Main barriers are the lack of training, financial support and human resources to sustain the implementation process.Conclusion. This is the first study that highlights organizational, individual and innovation levels facilitators and barriers for the implementation of a prioritization tool from service providers’ perspective.Contributions to the literatureMethods used in this study could be operationalized in future studies to investigate barriers and facilitators of the implementation of an innovative intervention in rehabilitation settings.We used a well-known implementation framework (CFIR) to classified the determinants of the implementation, which could help to compare the results with other similar studies in implementation science.The barriers and facilitators identified in this study are an important first step in the implementation process of a patient prioritization tool in rehabilitation programs.

Patient and Provider Perspectives Regarding Criteria for Patient Prioritization in Rehabilitation Programs (Preprint)

2019 ◽  
Author(s):  
Julien Déry ◽  
Angel Ruiz ◽  
François Routhier ◽  
Marie-Pierre Gagnon ◽  
André Côté ◽  
...  
Keyword(s):  
Service Providers ◽  
Quebec City ◽  
Web Based ◽  
Rehabilitation Programs ◽  
Provider Perspectives ◽  
Patient Prioritization ◽  
Services Sociaux ◽  
Multiple Case ◽  
Patient And Provider Perspectives

BACKGROUND Queueing patients on waiting lists is a common practice to manage access to rehabilitation services. To increase fairness and equity in access, a strategy emerging from the literature is patient prioritization. The goal is for patients with the greatest needs to be treated first and for patient wait times to be determined objectively on the basis of explicit criteria. Selecting criteria, however, is a complex task because it is important to simultaneously consider the objectives of all stakeholders. OBJECTIVE The aim of this study was to compare service users’ and service providers’ perspectives regarding patient prioritization criteria in two rehabilitation programs. METHODS We conducted a multiple case study in two rehabilitation programs at the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale in Quebec City (Canada), i.e. a driving evaluation program (DEP) and a compression garment manufacturing program (CGMP). We sent a web-based survey asking two groups (patients and providers) of informed stakeholders to individually produce a set of criteria. We then conducted an inductive thematic analysis where each group’s individual answers were coded and combined in a single set of criteria. RESULTS Stakeholders from the DEP identified a total of 22 criteria to prioritize patients while those from the CGMP listed 27 criteria. Providers shared 76% of the criteria mentioned by patients. Some criteria, such as age, occupation, functional level, pain, absence of caregiver, and time since referral, were considered important by both stakeholders in both programs. CONCLUSIONS Patients and providers tended to have similar opinions about a majority of the criteria to prioritize patients in waitlists. Nonetheless, our study confirms that patients and providers base their choices on different types of knowledge and values, which explains some of the differences observed. Taking into consideration the opinions of all stakeholders concerning prioritization criteria is an important part of the decision-making process, based on a multiple constituency approach.

scholarly journals Risk and Opportunity—The Leadership Challenge in a World of Uncertainty—Learnings from Research into the Implementation of the Australian National Disability Insurance Scheme

2021 ◽  
Vol 14 (8) ◽  
pp. 383
Author(s):  
David Rosenbaum ◽  
Elizabeth More
Keyword(s):  
Large Scale ◽  
Service Providers ◽  
Implementation Process ◽  
Disability Insurance ◽  
Framework Analysis ◽  
Insurance Scheme ◽  
Implementation Framework ◽  
Non Profit ◽  
Leadership Challenges ◽  
Implementation Challenges

This paper considers the risks and opportunities inherent in a major national change process through a descriptive approach to the implementation challenges for Australian non-profit disability service providers as they grapple with the implementation of the transformational National Disability Insurance Scheme (NDIS). It highlights the leadership challenges associated with the newly developed NDIS Implementation Framework and, in doing so, recognises the risk and opportunity issues contained with that implementation process. The research used grounded theory coupled with framework analysis in a qualitative study that, in part, sought to identify leadership characteristics deemed necessary to minimize risks, capitalize on opportunities, and support positive change outcomes leading to successful NDIS implementations amongst several participating organisations, each with differing demographics and at different stages in the implementation process. The findings, which have been grouped into phases, suggest a range of leadership attributes at key phases of the NDIS implementation that are necessary to minimise implementation risks and maximise opportunities associated with the NDIS. These phases have been identified as: (i) An input phase where the emphasis must be on internal change preparedness and external environmental impacts and drivers; (ii) A process phase where the emphasis is on direct implementation issues; and (iii) An outcomes phase where active consideration needs to be on organisational mission sustainability, as well as the risk and opportunity challenge. The study is crucial in revealing leadership challenges and lessons for large scale change and risk management in the non-profit sector, within and beyond the specific case of Australia’s NDIS implementation, useful for both scholars and practitioners.

Staff Training Aimed at Reducing Rearrest: Probation officer attitudes and experiences

2020 ◽  
Vol 12 (3) ◽  
pp. 238-264
Author(s):  
Jill Viglione ◽  
Lucas M Alward ◽  
DeCarlos L Sheppard
Keyword(s):  
Staff Training ◽  
Implementation Process ◽  
Probation Officer ◽  
Community Supervision ◽  
Successful Implementation ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Facilitators And Barriers ◽  
Training Programmes ◽  
Officer Attitudes

Community correction organisations have recognised the importance of implementing evidence-based practices to improve probation practice and reduce recidivism rates. Research finds when probation agencies implement evidence-based practices in line with the Risk, Need, Responsivity model with fidelity, reductions in recidivism are possible. However, challenges of implementation persist. To assist in the translation of evidence-based practices to real-world practice, researchers and practitioners developed community supervision officer training programmes. Using qualitative interview data of trained federal probation officers, this study examined the implementation of the Staff Training Aimed at Reducing Rearrest. This study explored (1) probation officer attitudes and perceptions of Staff Training Aimed at Reducing Rearrest, training and implementation process; (2) how users and coaches implement key components of Staff Training Aimed at Reducing Rearrest; and (3) the organisational facilitators and barriers associated with Staff Training Aimed at Reducing Rearrest implementation. Findings suggest positive attitudes towards Staff Training Aimed at Reducing Rearrest for improving supervision process and highlight key facilitators and barriers that can be addressed to support successful implementation efforts.

scholarly journals A framework for the implementation of certification procedures at nurse level: a case study in a French hospital

2020 ◽  
Author(s):  
Israa SALMA ◽  
Mathias WAELLI
Keyword(s):  
Empirical Studies ◽  
Implementation Process ◽  
Local Context ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Implementation Framework ◽  
Healthcare Facilities ◽  
Definition Of ◽  
Implementation Tool

Abstract Background The implementation of certification procedures across healthcare systems is an essential component of the management process. In the past, several promising approaches have been developed towards the successful implementation of such policies, however, precise adaptation and implementation at the local context is essential. Thus, local activities must be considered to generate more pragmatic recommendations for managers. In this pilot study, we built an implementation framework for the inception of certification in healthcare facilities, particularly at nurse level activities. Our hypothesis comprised two objectives: the identification of key implementation process components, and the precise definition of these elements within local social activities. Methods This study used a two-step abductive approach. The first was inductive, and consisted of a qualitative case study, where we analysed the implementation of certification procedures in a French teaching hospital. The study was conducted between April and December 2019. Data were collected using semi-structured interviews, and observations by shadowing. In the second step, the emerging data were analysed using two approaches: The Quality Implementation Tool (QIT) and Translational Mobilisation Theory (TMT). Results Sixteen interviews were conducted with managers and nurses. We also accumulated 83 observational hours from two different wards. Our results showed that, first, all the retrieved elements over the implementation of certification procedures were captured by the QIT components and only one component was no applicable for the studied case. Second, we identified the elements in the local context of activity, with the different interrelationships between actors, actions and contexts, through the TMT. Third, our analyses were integrated and translated into a framework that described the implementation of certification procedures in healthcare facilities and with interest to the implementation at nurse/mid-managers level. In adopting QIT, the framework components took a transversal aspect then adapted to the local context of work through the TMT. Conclusions In this study, we generated an implementation framework that underpinned a certification procedures implementation. Our approach revealed broad interactions between proximity managers, teams and contexts during change mobilisation, not captured by transversal framework only as QIT. Going forward, this framework must be tested in future empirical studies.

scholarly journals What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review

2020 ◽  
Author(s):  
Melanie Karrer ◽  
Julian Hirt ◽  
Adelheid Zeller ◽  
Susi Saxer
Keyword(s):  
Scoping Review ◽  
Implementation Process ◽  
Dementia Care ◽  
Barriers And Facilitators ◽  
Successful Implementation ◽  
Evidence Based ◽  
Management Support ◽  
Implementation Processes ◽  
Culture Of Care ◽  
People With Dementia

Abstract Background The implementation of evidence-based interventions for people with dementia is complex and challenging. However, successful implementation might be a key element to ensure evidence-based practice and high quality of care. There is a need to improve implementation processes in dementia care by better understanding the arising challenges. Thus, the aim of this study was to identify recent knowledge concerning barriers and facilitators to implementing nurse-led interventions in dementia care. Methods We performed a scoping review using the methodological framework of Arksey and O’Malley. Studies explicitly reporting on the implementation process and factors influencing the implementation of a nurse-led intervention in dementia care in all settings were included. We searched eight databases from January 2015 until January 2019. Two authors independently selected the studies. For data analysis, we used an inductive approach to build domains and categories. Results We included 26 studies in the review and identified barriers as well as facilitators in five domains: policy (e.g. financing issues, health insurance), organisation (e.g. organisational culture and vision, resources, management support), intervention/implementation (e.g. complexity of the intervention, perceived value of the intervention), staff (e.g. knowledge, experience and skills, attitude towards the intervention), and person with dementia/family (e.g. nature and stage of dementia, response of persons with dementia and their families). Conclusions Besides general influencing factors for implementing nursing interventions, we identified dementia-specific factors reaching beyond already known barriers and facilitators. A pre-existing person-centred culture of care as well as consistent team cultures and attitudes have a facilitating effect on implementation processes. Furthermore, there is a need for interventions that are highly flexible and sensitive to patients’ condition, needs and behaviour.

scholarly journals Barriers and facilitators to the implementation of osteoarthritis management programmes in primary or community care settings: a systematic review and qualitative framework synthesis protocol

2021 ◽  
Vol 4 ◽  
pp. 102
Author(s):  
Joice Cunningham ◽  
Andrew M. Briggs ◽  
Elizabeth Cottrell ◽  
Frank Doyle ◽  
Krysia Dziedzic ◽  
...  
Keyword(s):  
Community Care ◽  
Service Providers ◽  
Data Extraction ◽  
Theoretical Domains Framework ◽  
Barriers And Facilitators ◽  
System Level ◽  
Evidence Based ◽  
Implementation Framework ◽  
Evidence Based Treatments ◽  
Data Extraction Form

Despite consistent international guidelines for osteoarthritis (OA) management, evidence-based treatments are underutilised. OA management programmes (OAMPs) are being implemented internationally to address this evidence-practice gap. An OAMP is defined as a ‘model of evidence-based, non-surgical OA care that has been implemented in a real-world setting’. Our objective is to identify, synthesise and appraise qualitative research identifying anticipated or experienced micro (individual/behavioural), meso (organisational) or macro (context/system) level barriers or facilitators to the implementation of primary or community care-based OAMPs. Five electronic databases will be searched for papers published between 2010 and 2021. Qualitative or mixed-methods studies that include qualitative data on the anticipated or experienced barriers or facilitators to the implementation of primary or community care-based OAMPs, from the perspective of service users or service providers, will be included. The review will be reported using the PRISMA and ENTREQ guidelines. A data extraction form will be used to provide details of the included studies. Data will be analysed and identified barriers and facilitators will be mapped onto an appropriate implementation framework, such as the Theoretical Domains Framework. The appropriate JBI critical appraisal tools will be used to assess methodological quality, while the GRADE‐CERQual approach will be used to assess confidence in the findings. Translation of evidence-based guidelines into practice is challenging and reliant on the quality of implementation. By comparing and contrasting anticipated and experienced barriers, this review will determine the extent of congruence between the two, and provide valuable insights into the views and experiences of key stakeholders involved in the implementation of OAMPs. The mapping of identified barriers and facilitators to behaviour change theory will enhance the applicability and construct validity of our findings and will offer significant utility for future development and implementation of OAMPs. Registration: This protocol was registered with PROSPERO (CRD42021255698) on 15/07/21.

Reframing implementation as an organisational behaviour problem

2015 ◽  
Vol 29 (6) ◽  
pp. 670-683 ◽  
Author(s):  
Robyn Clay-Williams ◽  
Jeffrey Braithwaite
Keyword(s):  
Resource Constraints ◽  
Controlled Trial ◽  
Implementation Process ◽  
Team Training ◽  
Barriers And Facilitators ◽  
Successful Implementation ◽  
Behaviour Problem ◽  
Content Type ◽  
Randomised Controlled ◽  
Training Programmes

Purpose – The purpose of this paper is to report on a process evaluation of a randomised controlled trial (RCT) intervention study that tested the effectiveness of classroom- and simulation-based crew resource management courses, alone and in combination, and identifies organisational barriers and facilitators to implementation of team training programmes in healthcare. Design/methodology/approach – The RCT design consisted of a before and after study with a team training intervention. Quantitative data were gathered on utility and affective reactions to training, and on teamwork knowledge, attitudes, and behaviours of the learners. A sample of participants was interviewed at the conclusion of the study. Interview responses were analysed, alongside qualitative elements of the classroom course critique, to search for evidence, context, and facilitation clues to the implementation process. Findings – The RCT method provided scientifically robust data that supported the benefits of classroom training. Qualitative data identified a number of facilitators to implementation of team training, and shed light on some of the ways that learning was diffused throughout the organisation. Barriers to successful implementation were also identified, including hospital time and resource constraints and poor organisational communication. Originality/value – Quantitative randomised methods have intermittently been used to evaluate team training interventions in healthcare. Despite two decades of team training trials, however, the authors do not know as well as the authors would like what goes on inside the “black box” of such RCTs. While results are usually centred on outcomes, this study also provides insight into the context and mechanisms associated with those outcomes and identifies barriers and facilitators to successful intervention implementation.

scholarly journals Protocol for Implementation of an Evidence Based Parentally Administered Intervention for Preterm Infants

2020 ◽  
Author(s):  
Rosemary C White-Traut ◽  
Debra Brandon ◽  
Karen Kavanaugh ◽  
Karen Gralton ◽  
Wei Pan ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Behavioral Interventions ◽  
Neonatal Intensive Care ◽  
Developmental Trajectories ◽  
Implementation Process ◽  
Routine Care ◽  
Individual Characteristics ◽  
Successful Implementation ◽  
Evidence Based ◽  
Facilitators And Barriers

Abstract BackgroundMulti-sensory behavioral interventions for preterm infants have the potential to accelerate feeding, growth, and optimize developmental trajectories and increase parents’ interactive engagement with their infants. However, few neonatal intensive care units (NICUs) provide evidence-based standardized early behavioral interventions as routine care. Lack of implementation is a major gap between research and clinical practice. H-HOPE, is a standardized behavioral intervention with an infant- directed component (Massage+) and a parent-directed component (four participatory guidance sessions that focus on preterm infants’ behaviors and appropriate responses). H-HOPE has well documented efficacy. The purpose of this implementation study is to establish H-HOPE as the standard of care in 5 NICUs. MethodsThe study employs a Type 3 Hybrid design to simultaneously examine the implementation process and effectiveness in five NICUs. To stagger implementation across the clinical sites, we use an incomplete stepped wedge design. The five participating NICUs were purposively selected to represent different acuity levels, number of beds, locations and populations served. Our implementation strategy integrates our experience conducting H-HOPE and a well-established implementation model, the Consolidated Framework for Implementation Research (CFIR). The CFIR identifies influences (facilitators and barriers) that affect successful implementation within five domains: intervention characteristics, outer setting (the hospital and external events and stakeholders), inner setting (NICU), implementers’ individual characteristics, and the implementation process. NICUs will use the CFIR process, which includes three phases: Planning and Engaging, Executing, and Reflecting and Evaluating. Because sustaining is a critical goal of implementation, we modify the CFIR implementation process by adding a final phase of Sustaining.DiscussionThis study builds on the CFIR, adding Sustaining H-HOPE to observe what happens when sites begin to maintain implementation without outside support, and extends its use to the NICU acute care setting. Our mixed methods analysis systematically identifies key facilitators and barriers of implementation success and effectiveness across the five domains of the CFIR. Long term benefits have not yet been studied but may include substantial health and developmental outcome for infants, more optimal parent-child relationships, reduced stress and costs for families, and substantial indirect societal benefits including reduced health care and special education costs.Trial registrationClinicalTrials.gov registration number NCT04555590, Registered on 8/19/2020

scholarly journals Barriers and Facilitators to Implementing Web-Based Dementia Caregiver Education From the Clinician’s Perspective: Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Anthony J Levinson ◽  
Stephanie Ayers ◽  
Lianna Butler ◽  
Alexandra Papaioannou ◽  
Sharon Marr ◽  
...  
Keyword(s):  
Implementation Process ◽  
Educational Interventions ◽  
Dementia Care ◽  
Barriers And Facilitators ◽  
Relative Advantage ◽  
Theory Approach ◽  
Web Based ◽  
Caregiver Education ◽  
Dementia Caregiver ◽  
Clinical Resource

BACKGROUND Internet-based dementia caregiver interventions have been shown to be effective for a range of caregiver outcomes; however, little is known about how to best implement them. We developed iGeriCare, an evidence-based, multimedia, web-based educational resource for family caregivers of people living with dementia. OBJECTIVE This study aims to obtain feedback and opinions from experts and clinicians involved in dementia care and caregiver education about 1 iGeriCare and 2 barriers and facilitators to implementing a web-based caregiver program. METHODS We carried out semistructured interviews with individuals who had a role in dementia care and/or caregiver education in several key stakeholder settings in Southern Ontario, Canada. We queried participants’ perceptions of iGeriCare, caregiver education, the implementation process, and their experience with facilitators and barriers. Transcripts were coded and analyzed using a grounded theory approach. The themes that emerged were organized using the Consolidated Framework for Implementation Research. RESULTS A total of 12 participants from a range of disciplines described their perceptions of iGeriCare and identified barriers and facilitators to the implementation of the intervention. The intervention was generally perceived as a high-quality resource for caregiver education and support, with many stakeholders highlighting the relative advantage of a web-based format. The intervention was seen to meet dementia caregiver needs, partially because of its flexibility, accessibility, and compatibility within existing clinical workflows. In addition, the intervention helps to overcome time constraints for both caregivers and clinicians. CONCLUSIONS Study findings indicate a generally positive response to the use of internet-based interventions for dementia caregiver education. Results suggest that iGeriCare may be a useful clinical resource to complement traditional face-to-face and print material–based caregiver education. More comprehensive studies are required to identify the effectiveness and longevity of web-based caregiver education interventions and to better understand barriers and facilitators with regard to the implementation of technology-enhanced caregiver educational interventions in various health care settings.

scholarly journals A Framework for the Implementation of Certification Procedures at Nurse Level: A Case Study in a French Hospital.

2020 ◽  
Author(s):  
Israa SALMA ◽  
Mathias WAELLI
Keyword(s):  
Empirical Studies ◽  
Implementation Process ◽  
Local Context ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Implementation Framework ◽  
Healthcare Facilities ◽  
Definition Of ◽  
Implementation Tool

Abstract Background: The implementation of certification procedures across healthcare systems is an essential component of the management process. In the past, several promising approaches have been developed towards the successful implementation of such policies, however, precise adaptation and implementation at the local context is essential. Thus, local activities must be considered to generate more pragmatic recommendations for managers. In this pilot study, we built an implementation framework for the inception of certification in healthcare facilities, particularly at nurse level activities. Our hypothesis comprised two objectives: the identification of key implementation process components, and the precise definition of these elements within local social activities.Methods: This study used a two-step abductive approach. The first was inductive, and consisted of a qualitative case study, where we analysed the implementation of certification procedures in a French teaching hospital. The study was conducted between April and December 2019. Data were collected using semi-structured interviews, and observations by shadowing. In the second step, the emerging data were analysed using two approaches: The Quality Implementation Tool (QIT) and Translational Mobilisation Theory (TMT). Results: Sixteen interviews were conducted with managers and nurses. We also accumulated 83 observational hours from two different wards. Our results showed that, first, all the retrieved elements over the implementation of certification procedures were captured by the QIT components and only one component was no applicable for the studied case. Second, we identified the elements in the local context of activity, with the different interrelationships between actors, actions and contexts, through the TMT. Third, our analyses were integrated and translated into a framework that described the implementation of certification procedures in healthcare facilities and with interest to the implementation at nurse/mid-managers level. In adopting QIT, the framework components took a transversal aspect then adapted to the local context of work through the TMT.Conclusions: In this study, we generated an implementation framework that underpinned a certification procedures implementation. Our approach revealed broad interactions between proximity managers, teams and contexts during change mobilisation, not captured by transversal framework only as QIT. Going forward, this framework must be tested in future empirical studies.

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