scholarly journals Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

2020 ◽  
Author(s):  
Liana Zucco ◽  
Nadav Levy ◽  
Yunping Li ◽  
Toni Golen ◽  
Scott A Shainker ◽  
...  
Keyword(s):  
Personal Attributes ◽  
Retrospective Evaluation ◽  
Implementation Success ◽  
Process Implementation ◽  
Implementation Planning ◽  
External Pressures ◽  
Group Deliberation ◽  
Innovation Characteristics ◽  
Inner Setting ◽  
Implementation Experience

Abstract Background Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe the rapid cycle implementation of a comprehensive perioperative checklist for care of the COVID-19 parturient and a retrospective analysis of the factors which influenced implementation success. Methods A newly designed workflow for COVID-19 parturients requiring perioperative care was produced as a checklist, intended for use as a cognitive aid. Implementation and refinement of the workflow was accomplished through rapid-cycling, debriefing and on-site walkthroughs. Retrospective evaluation of the implementation experience was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results Post-implementation, consistent use of the workflow was reported for all obstetric COVID-19 perioperative cases (100% compliance). Evaluation of our implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting and characteristic of individuals (external pressures, baseline culture, and personal attributes) were felt to act as barriers. Constructs such as communication, shifted in influence over time. Conclusion We describe the implementation of a comprehensive obstetric workflow checklist for care of the COVID-19 perioperative patient. A retrospective evaluation of our implementation experience was possible using CFIR, which enabled identification of barriers and facilitators for change within our unit. Furthermore, we observed that implementation success was possible, despite facilitation being perceived within only two domains at baseline. Emerging themes from this study highlight the importance of thoughtful innovation design, careful implementation planning and the establishment of a long-standing culture of improvement, in order to facilitate implementation of change during a time of crisis.

scholarly journals Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

2020 ◽  
Author(s):  
Liana Zucco ◽  
Nadav Levy ◽  
Yunping Li ◽  
Toni Golen ◽  
Scott A Shainker ◽  
...  
Keyword(s):  
Personal Attributes ◽  
Retrospective Evaluation ◽  
Implementation Success ◽  
Process Implementation ◽  
Implementation Planning ◽  
External Pressures ◽  
Group Deliberation ◽  
Innovation Characteristics ◽  
Inner Setting ◽  
Implementation Experience

Abstract Background: Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe the rapid cycle implementation of a comprehensive perioperative checklist for care of the COVID-19 parturient and a retrospective analysis of the factors which influenced implementation success.Methods: A newly designed workflow for COVID-19 parturients requiring perioperative care was produced as a checklist, intended for use as a cognitive aid. Implementation and refinement of the workflow was accomplished through rapid-cycling, debriefing and on-site walkthroughs. Retrospective evaluation of the implementation experience was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results: Post-implementation, consistent use of the workflow was reported for all obstetric COVID-19 perioperative cases (100% compliance). Evaluation of our implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting and characteristic of individuals (external pressures, baseline culture, and personal attributes) were felt to act as barriers. Constructs such as communication, shifted in influence over time.Conclusion: We describe the implementation of a comprehensive obstetric workflow checklist for care of the COVID-19 perioperative patient. A retrospective evaluation of our implementation experience was possible using CFIR, which enabled identification of barriers and facilitators for change within our unit. Furthermore, we observed that implementation success was possible, despite facilitation being perceived within only two domains at baseline. Emerging themes from this study highlight the importance of thoughtful innovation design, careful implementation planning and the establishment of a long-standing culture of improvement, in order to facilitate implementation of change during a time of crisis.

scholarly journals Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

2021 ◽  
Author(s):  
Liana Zucco ◽  
Nadav Levy ◽  
Yunping Li ◽  
Toni Golen ◽  
Scott A Shainker ◽  
...  
Keyword(s):  
Rapid Change ◽  
Influential Factors ◽  
Personal Attributes ◽  
Learning Climate ◽  
Factors Influencing ◽  
Process Implementation ◽  
Implementation Planning ◽  
Group Deliberation ◽  
Inner Setting ◽  
Communication Culture

Abstract Background: Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe factors which influenced rapid cycle implementation a novel comprehensive perioperative checklist for care of the COVID-19 parturient.Methods: Implementation of a novel workflow for the COVID-19 parturient requiring perioperative care was accomplished through rapid cycling, debriefing and on-site walkthroughs. Post-implementation, consistent use of the workflow was reported for all obstetric COVID-19 perioperative cases (100% workflow checklist utilization). Retrospective analysis of the factors influencing implementation was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results: Analysis of factors influencing implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting, and characteristic of individuals (external pressures, baseline culture, and personal attributes) were perceived to act as early barriers. Constructs such as communication culture and learning climate, shifted in influence over time.Conclusion: We describe the influential factors of implementing a novel comprehensive obstetric workflow for care of the COVID-19 perioperative parturient during the first surge of the pandemic using the CFIR framework. Early workflow adoption was facilitated primarily by two domains, namely thoughtful innovation design and careful implementation planning in the setting of a long-standing culture of improvement. Factors initially assessed as barriers such as communication, culture and learning climate, transitioned into facilitators once a perceived benefit was experienced by healthcare teams. These results provide important information for the implementation of rapid change during a time of crisis.

scholarly journals Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Liana Zucco ◽  
Nadav Levy ◽  
Yunping Li ◽  
Toni Golen ◽  
Scott A. Shainker ◽  
...  
Keyword(s):  
Perioperative Care ◽  
Rapid Change ◽  
Influential Factors ◽  
Learning Climate ◽  
Factors Influencing ◽  
Process Implementation ◽  
Implementation Planning ◽  
Group Deliberation ◽  
Inner Setting ◽  
Communication Culture

Abstract Background Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe factors which influenced rapid cycle implementation of a novel comprehensive checklist for the perioperative care of the COVID-19 parturient. Methods Within our labour and delivery unit, implementation of a novel checklist for the COVID-19 parturient requiring perioperative care was accomplished through rapid cycling, debriefing and on-site walkthroughs. Post-implementation, consistent use of the checklist was reported for all obstetric COVID-19 perioperative cases (100% workflow checklist utilization). Retrospective analysis of the factors influencing implementation was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results Analysis of factors influencing implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting, and characteristic of individuals (external pressures, baseline culture, and personal attributes) were perceived to act as early barriers. Constructs such as communication culture and learning climate, shifted in influence over time. Conclusion We describe the influential factors of implementing a novel comprehensive obstetric workflow for care of the COVID-19 perioperative parturient during the first surge of the pandemic using the CFIR framework. Early workflow adoption was facilitated primarily by two domains, namely thoughtful innovation design and careful implementation planning in the setting of a long-standing culture of improvement. Factors initially assessed as barriers such as communication, culture and learning climate, transitioned into facilitators once a perceived benefit was experienced by healthcare teams. These results provide important information for the implementation of rapid change during a time of crisis.

scholarly journals Health-related stakeholders’ perceptions of clinical pharmacy services in Qatar

2020 ◽  
Author(s):  
Tesnime Jebara ◽  
Scott Cunningham ◽  
Katie MacLure ◽  
Ahmed Awaisu ◽  
Abdulrouf Pallivalapila ◽  
...  
Keyword(s):  
Clinical Pharmacy ◽  
Public Awareness ◽  
Healthcare Delivery ◽  
Pharmacy Practice ◽  
Service Development ◽  
Pharmacy Services ◽  
Clinical Pharmacy Services ◽  
Health Related ◽  
Innovation Characteristics ◽  
Inner Setting

Abstract Background In Qatar, the National Vision 2030 and the National Health Strategy 2018–2022 articulate the need to improve healthcare delivery by better utilisation of the skilled workforce. In this regard, pharmacy practice is rapidly advancing and several extended pharmacy services are now available in institutionalised settings. Objective This study aimed to determine health-related stakeholders’ perceptions of current clinical pharmacy services in Qatar, and the potential development and implementation of further patient-centred roles. Setting All major organisations and institutions relating to the practice, education, regulation, and governance of pharmacy in Qatar. Method Qualitative, face-to-face semi-structured interviews were conducted with individuals in key strategic positions of policy development and influence (i.e. health-related academic leaders, healthcare policy developers, directors of medicine/pharmacy/nursing, and patient safety leaders). Participants were recruited via a combination of purposeful and snowball sampling, until the point of data saturation was reached. The interview guide was grounded in the Consolidated Framework for Implementation Research domains of innovation characteristics, outer and inner setting, characteristics of individuals, and implementation process. The interviews were digitally recorded, transcribed and independently analysed by two researchers using the Framework approach. Main outcome measure Perceptions of stakeholders regarding current and potential for future clinical pharmacy services in Qatar. Results Thirty-seven interviews were conducted with stakeholders of policy influence in healthcare. The interviewees reported a variety of clinical pharmacy services available in Qatar, which they perceived as positively impacting patient care outcomes, pharmacists’ professional autonomy, and the healthcare system in general (innovation characteristics). However, they perceived that these services were mainly performed in hospitals and less in community pharmacy setting (inner setting) and were undervalued by patients and the public (outer setting). Expansion of pharmacists’ clinical activities was supported, with recognition of facilitators such as the skillset and training of pharmacists, potential time release due to automation and well-considered implementation processes (characteristics of individuals, inner setting, process). Conclusion Health-related stakeholders in Qatar have positive perceptions of current clinical pharmacy services and support the expansion of pharmacist’s roles. However, service development needs to consider the issues of patient and public awareness and initially target institutionalised healthcare settings.

scholarly journals An evaluation of the coverage of theoretically based implementation factors in disseminated classroom physical activity programs

2018 ◽  
Vol 10 (4) ◽  
pp. 959-969 ◽  
Author(s):  
Hannah G Calvert ◽  
Hannah G Lane ◽  
Carolina M Bejarano ◽  
Kelli Snow ◽  
Kate Hoppe ◽  
...  
Keyword(s):  
Physical Activity ◽  
Organizational Climate ◽  
Research Evidence ◽  
Effective Strategies ◽  
Process Implementation ◽  
School Programs ◽  
Internet Searches ◽  
Inner Setting ◽  
Implementation Factors ◽  
Children’S Physical Activity

Abstract Classroom-based physical activity (CBPA) is increasingly recommended as a method to support children’s physical activity, health, and academic performance. Many adoption-ready programs exist to aid in the implementation of CBPA in schools; yet, implementation rates remain low. The purpose of this study was to evaluate the extent to which resources provided by adoption-ready CBPA programs addressed theory-based implementation contextual factors to support implementation. Existing CBPA programs (N = 37) were identified through Internet searches and all materials (e.g., implementation guides) provided by each program were coded for their inclusion of 51 implementation factors based on the Consolidated Framework for Implementation Research (CFIR). Analyses were conducted to compare inclusion of implementation factors across CFIR Domains and by three program groupings: free (yes/no), research evidence (yes/no), and targeted to teacher only (vs. school). Programs covered a mean of 25.9 per cent (SD = 18.7 per cent) of the 14 Inner Setting implementation factors, 34.2 per cent (SD = 18.0 per cent) of the 6 Characteristics of Individuals implementation factors, and 34.8 per cent (SD = 24.3 per cent) of the 8 Process implementation factors. Programs with research evidence covered more implementation factors than programs without research evidence (43.7 vs. 25.9 per cent; p < .05). Although numerous adoption-ready CBPA programs are available and have many strengths, their inclusion of theory-based factors that support or inhibit implementation is generally low. Consideration of such factors, including organizational climate and teacher-level behavior change, is likely critical to supporting ongoing school-wide implementation of CBPA. Research is needed to develop and test effective strategies for addressing these factors to support more widespread CBPA implementation.

Successful is Innovation: The Contingent Contributions of Innovation Characteristics and Implementation Process

1999 ◽  
Vol 14 (1) ◽  
pp. 53-68 ◽  
Author(s):  
Philip Yetton ◽  
Rajeev Sharma ◽  
Gray Southon
Keyword(s):  
Implementation Process ◽  
Group Level ◽  
State Health ◽  
Implementation Success ◽  
Individual Level ◽  
Is Implementation ◽  
Process Theories ◽  
Implementation Context ◽  
Innovation Characteristics ◽  
Using Data

This paper unifies two apparently competing theories of information systems (IS) implementation by developing a model in which the contributions of innovation characteristics and implementation process theories are contingent upon the implementation context. To do this, we identify the different assumptions regarding the implementation context implicit in the two theories and, based on these differences, develop a contingent model within which to integrate the two theories. A partial test of the model within one particular context is reported using data collected from the end-users of an IS innovation introduced in a State health system in Australia. As hypothesized, we find that, within the context, characterized by high individual level impact and low group level impact, the contribution of innovation characteristics to implementation success is higher than that of implementation process.

scholarly journals Barriers and facilitators to development and implementation of a rural primary health care intervention for dementia: a process evaluation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Debra Morgan ◽  
Julie Kosteniuk ◽  
Megan E. O’Connell ◽  
Andrew Kirk ◽  
Norma J. Stewart ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Process Evaluation ◽  
Barriers And Facilitators ◽  
Relative Advantage ◽  
Small Scale ◽  
Team Members ◽  
Primary Health ◽  
Innovation Characteristics ◽  
Inner Setting

Abstract Background With rural population aging there are growing numbers of people with dementia in rural and remote settings. The role of primary health care (PHC) is critical in rural locations, yet there is a lack of rural-specific PHC models for dementia, and little is known about factors influencing the development, implementation, and sustainability of rural PHC interventions. Using a community-based participatory research approach, researchers collaborated with a rural PHC team to co-design and implement an evidence-based interdisciplinary rural PHC memory clinic in the Canadian province of Saskatchewan. This paper reports barriers and facilitators to developing, implementing, and sustaining the intervention. Methods A qualitative longitudinal process evaluation was conducted over two and half years, from pre- to post-implementation. Data collection and analyses were guided by the Consolidated Framework for Implementation Research (CFIR) which consists of 38 constructs within five domains: innovation characteristics, outer setting, inner setting, individual characteristics, and process. Data were collected via focus groups with the PHC team and stakeholders, smaller team workgroup meetings, and team member interviews. Analysis was conducted using a deductive approach to apply CFIR codes to the data and an inductive analysis to identify barriers and facilitators. Results Across all domains, 14 constructs influenced development and implementation. Three domains (innovation characteristics, inner setting, process) were most important. Facilitators were the relative advantage of the intervention, ability to trial on a small scale, tension for change, leadership engagement, availability of resources, education and support from researchers, increased self-efficacy, and engagement of champions. Barriers included the complexity of multiple intervention components, required practice changes, lack of formal incentive programs, time intensiveness of modifying the EMR during iterative development, lack of EMR access by all team members, lack of co-location of team members, workload and busy clinical schedules, inability to justify a designated dementia care manager role, and turnover of PHC team members. Conclusions The study identified key factors that supported and hindered the development and implementation of a rural-specific strategy for dementia assessment and management in PHC. Despite challenges related to the rural context, the researcher-academic partnership was successful in developing and implementing the intervention.

Passing on: Personal attributes associated with midlife expressions of intended legacies.

2016 ◽  
Vol 52 (2) ◽  
pp. 341-353 ◽  
Author(s):  
Nicky J. Newton ◽  
Brady K. Jones
Keyword(s):  
Personal Attributes
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