Implementation Factors Related to Improving the Food Environment Within Health Care Institutions: A Multiple Case Study

2021 ◽  
Author(s):  
Elizaveta Walker ◽  
Robin L Baker ◽  
Kerth O'Brien ◽  
Lynne C Messer ◽  
Cara L Eckhardt ◽  
...  
Keyword(s):  
Health Care ◽  
Food Environment ◽  
Implementation Process ◽  
System Level ◽  
Implementation Barriers ◽  
Executive Leaders ◽  
Sugar Sweetened Beverage ◽  
Implementation Challenges ◽  
Health Care Institutions ◽  
Facilitators And Barriers

Abstract Background Healthy food environment policies (HFEPs), such as sugar-sweetened beverage bans or nutritional standards for vending machines, can improve the healthfulness of retail food venues, particularly within health care institutions that have a health-focused mission. The degree to which operational managers’ and executive leaders’ perceptions of implementation challenges align or diverge, and the extent to which these perceptions affect HFEP implementation, is unknown.Methods We conducted ten semi-structured key informant interviews with managers and executive leaders who participated in HFEP development within five health care organizations. Interviews explored facilitators and barriers for HFEP adoption and maintenance. We transcribed, coded, and analyzed interviews and derived contextual facilitators and barriers.Results We identified 27 facilitators and 30 barriers, which were refined into six and five categories, respectively, and ultimately paired to create three overarching recommendations. Operational managers’ and executive leaders’ perceptions overlapped 44-75% when identifying facilitators but only 33-58% when identifying implementation barriers. Interpersonal issues such as over-delegation and mistrust were prominent among those organizations whose respondents’ perceptions diverged substantially.Conclusion As the obesity epidemic continues to increase, understanding key facilitators and barriers to HFEPs, as well as the influence on leaderships’ perceptions on the implementation process, will be key to addressing obesogenic food environments. Though leaders were generally aligned in perspectives regarding facilitators, there was greater divergence when barriers were discussed. Executive leaders are encouraged to familiarize themselves with operational barriers and refrain from over-delegating these challenges to their operational counterparts, who lack the institutional authority to override organizational or system-level decisions.

scholarly journals Barriers to Implementing an Artificial Intelligence Model for Unplanned Readmissions

ACI Open ◽  
2020 ◽  
Vol 04 (02) ◽  
pp. e108-e113
Author(s):  
Sally L. Baxter ◽  
Jeremy S. Bass ◽  
Amy M. Sitapati
Keyword(s):  
Artificial Intelligence ◽  
Health Care ◽  
Implementation Process ◽  
Unintended Consequences ◽  
Risk Scores ◽  
Implementation Barriers ◽  
New Model ◽  
Home Health Services ◽  
Key Stakeholders ◽  
Discharged Patients

Abstract Background Electronic health record (EHR) vendors now offer “off-the-shelf” artificial intelligence (AI) models to client organizations. Our health system faced difficulties in promoting end-user utilization of a new AI model for predicting readmissions embedded in the EHR. Objectives The aim is to conduct a case study centered on identifying barriers to uptake/utilization. Methods A qualitative study was conducted using interviews with stakeholders. The interviews were used to identify relevant stakeholders, understand current workflows, identify implementation barriers, and formulate future strategies. Results We discovered substantial variation in existing workflows around readmissions. Some stakeholders did not perform any formal readmissions risk assessment. Others accustomed to using existing risk scores such as LACE+ had concerns about transitioning to a new model. Some stakeholders had existing workflows in place that could accommodate the new model, but they were not previously aware that the new model was in production. Concerns expressed by end-users included: whether the model's predictors were relevant to their work, need for adoption of additional workflow processes, need for training and change management, and potential for unintended consequences (e.g., increased health care resource utilization due to potentially over-referring discharged patients to home health services). Conclusion AI models for risk stratification, even if “off-the-shelf” by design, are unlikely to be “plug-and-play” in health care settings. Seeking out key stakeholders and defining clear use cases early in the implementation process can better facilitate utilization of these models.

scholarly journals Implementation of the First US Sugar-Sweetened Beverage Tax in Berkeley, CA, 2015–2019

2020 ◽  
Vol 110 (9) ◽  
pp. 1429-1437 ◽  
Author(s):  
Jennifer Falbe ◽  
Anna H. Grummon ◽  
Nadia Rojas ◽  
Suzanne Ryan-Ibarra ◽  
Lynn D. Silver ◽  
...  
Keyword(s):  
Public Health ◽  
Public Support ◽  
Implementation Process ◽  
Food Prices ◽  
Lessons Learned ◽  
Sugar Sweetened Beverage ◽  
Excise Tax ◽  
Sweetened Beverage ◽  
Advisory Commissions ◽  
Facilitators And Barriers

Objectives. To identify lessons learned from implementation of the nation’s first sugar-sweetened beverage (SSB) excise tax in 2015 in Berkeley, California. Methods. We interviewed city stakeholders and SSB distributors and retailers (n = 48) from June 2015 to April 2017 and analyzed records through January 2019. Results. Lessons included the importance of thorough and timely communications with distributors and retailers, adequate lead time for implementation, advisory commissions for revenue allocations, and funding of staff, communications, and evaluation before tax collection begins. Early and robust outreach about the tax and programs funded can promote and sustain public support, reduce friction, and facilitate beverage price increases on SSBs only. No retailer reported raising food prices, indicating that Berkeley’s SSB tax did not function as a “grocery tax,” as industry claimed. Revenue allocations totaled more than $9 million for public health, nutrition, and health equity through 2021. Conclusions. The policy package, context, and implementation process facilitated translating policy into public health outcomes. Further research is needed to understand long-term facilitators and barriers to sustaining public health benefits of Berkeley’s tax and how those differ from facilitators and barriers in jurisdictions facing significant industry-funded repeal efforts.

An Exploratory Study of How Trust in Health Care Institutions Varies across African American, Hispanic and white Populations

2011 ◽  
Vol 8 (1) ◽  
Author(s):  
Elizabeth Jacobs ◽  
Emily Mendenhall ◽  
Ann Scheck-McAlearney ◽  
Italia Rolle ◽  
Eric Whitaker ◽  
...  
Keyword(s):  
Health Care ◽  
African American ◽  
Exploratory Study ◽  
Health Care Institutions

scholarly journals Analysis of Facilitators and Barriers to the Delivery of Routine Care during the COVID-19 Global Pandemic: A Systematic Review

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 528
Author(s):  
Cristian Lieneck ◽  
Brooke Herzog ◽  
Raven Krips
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Routine Care ◽  
Future Research ◽  
Healthcare Organizations ◽  
Care Services ◽  
Global Pandemic ◽  
Facilitators And Barriers

The delivery of routine health care during the COVID-19 global pandemic continues to be challenged as public health guidelines and other local/regional/state and other policies are enforced to help prevent the spread of the virus. The objective of this systematic review is to identify the facilitators and barriers affecting the delivery of routine health care services during the pandemic to provide a framework for future research. In total, 32 articles were identified for common themes surrounding facilitators of routine care during COVID-19. Identified constructed in the literature include enhanced education initiatives for parents/patients regarding routine vaccinations, an importance of routine vaccinations as compared to the risk of COVID-19 infection, an enhanced use of telehealth resources (including diagnostic imagery) and identified patient throughput/PPE initiatives. Reviewers identified the following barriers to the delivery of routine care: conservation of medical providers and PPE for non-routine (acute) care delivery needs, specific routine care services incongruent the telehealth care delivery methods, and job-loss/food insecurity. Review results can assist healthcare organizations with process-related challenges related to current and/or future delivery of routine care and support future research initiatives as the global pandemic continues.

A Proposal For A Nonreinstatement Rule In Unfair Labor Practice Cases Involving Patient Abuse

1985 ◽  
Vol 11 (3) ◽  
pp. 319-341
Author(s):  
Clare T. Tully
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Labor Relations ◽  
Quality Care ◽  
Disciplinary Action ◽  
Non Profit ◽  
Health Care Institutions ◽  
Care Workers ◽  
Union Activists ◽  
Patient Abuse

AbstractNursing home discharges of employees based on patient abuse raise a difficult issue when the motivating factor for the disciplinary action is union activism. A tension is created between the rights of employees to engage in protected concerted activity and the rights of patients to quality care. In 1974, Congress passed the Health Care Institutions Amendments, which granted to non-profit health care workers collective organizing and bargaining rights substantially similar to those which workers in other industries had enjoyed for decades under the National Labor Relations Act. Congress intended to give health care workers only that degree of parity, however, which is compatible with the provision of high quality patient care. The agency charged with enforcing the Act, the National Labor Relations Board (NLRB), has failed to distinguish employee misconduct in industrial settings from patient abuse in health care institutions when fashioning remedies for discriminatorily discharged union activists. The NLRB typically has ordered the reinstatement, with back pay, of the patient abuser as the patient’s primary care-giver. This Article suggests that a front pay remedy is more appropriate to these cases because it protects the patient’s right to be free from abuse without sacrificing employee unionization rights.

ESBL-producing Escherichia coli and Klebsiella pneumoniae from health-care institutions in Mexico

2020 ◽  
pp. 1-5
Author(s):  
Viridiana Gallegos-Miranda ◽  
Ulises Garza-Ramos ◽  
Enrique Bolado-Martínez ◽  
Moisés Navarro-Navarro ◽  
Katya Rocío Félix-Murray ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Health Care ◽  
Klebsiella Pneumoniae ◽  
Health Care Institutions

scholarly journals Navigating change – managers’ experience of implementation processes in disability health care: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anette Granberg ◽  
Marie Matérne ◽  
Lars-Olov Lundqvist ◽  
Anna Duberg
Keyword(s):  
Health Care ◽  
Health Care Organizations ◽  
Contextual Factors ◽  
Implementation Process ◽  
Public And Private ◽  
Implementation Processes ◽  
Telephone Interviews ◽  
External Conditions ◽  
The Many ◽  
Dance Intervention

Abstract Background Effective implementation processes play a central role in health care organizations and affect the care of patients. Managers are pivotal in facilitating the use of new practices, but their experience and how it affects the implementation outcome are still largely unknown. In the field of disability health care in particular, managers experiences have scarcely been investigated. Therefore, the aim of this study is to explore managers’ experiences of the implementation process when transferring new practices into disability health care settings. Methods Semi-structured individual telephone interviews were conducted with managers at disability health care organizations in four administrative regions in central Sweden. A total of 23 managers with formal managerial responsibility from both public and private health care were strategically selected to be interviewed. The interviews were analysed using reflexive thematic analysis with an inductive approach. Results The analysis resulted in two themes about factors influencing the implementation process: firstly, Contextual factors set the agenda for what can be achieved, which highlighted aspects that hinder or enable the implementation process, such as internal and external conditions, the workplace culture, the employees and managers’ attitudes and openness to change: secondly, Leadership in the winds of change, which described the challenges of balancing managerial tasks with leading the change, and the importance of a leadership that involves the participation of the employees. Conclusions This study explored how and to what extent managers address and manage the implementation process and the many associated challenges. The findings highlight the importance of leadership support and organizational structure in order to transfer new practices into the work setting, and to encourage an organizational culture for leading change that promotes positive outcomes. We suggest that identifying strategies by focusing on contextual factors and on aspects of leadership will facilitate implementation processes. Trial registration The SWAN (Structured Water Dance Intervention) study was retrospectively registered on April 9, 2019 and is available online at ClinicalTrials.gov (ID: NCT03908801).

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