Longitudinal Use of The Consolidated Framework For Implementation Research To Evaluate The Creation of A Rural Center of Excellence in Transgender Health 

2020 ◽  
Author(s):  
Pamela Jane Tinc ◽  
Christopher Wolf-Gould ◽  
Carolyn Wolf-Gould ◽  
Anne Gadomski
Keyword(s):  
Organizational Culture ◽  
Implementation Research ◽  
Robert Wood Johnson Foundation ◽  
Transgender People ◽  
Implementation Team ◽  
The Core ◽  
Center Of Excellence ◽  
Rural Settings ◽  
Wellness Center

Abstract Background: Transgender people face numerous barriers to accessing care, particularly in rural settings. Transportation, travel time, a lack of providers offering transgender care, and discrimination all contribute to these barriers. The Gender Wellness Center was established to fill a gap in rural transgender care, and was subsequently awarded a Robert Wood Johnson Foundation grant to establish a Center of Excellence. This study examines the implementation of the Center of Excellence, a complex intervention, over the course of 18 months. Methods: The Consolidated Framework for Implementation Research was used to develop baseline and follow-up surveys. These were distributed to members of the core implementation team at the Gender Wellness Center at the midpoint and conclusion of the Robert Wood Johnson Foundation grant. Responses were largely open-ended and analyzed qualitatively. Results: Results are presented in terms of Consolidated Framework domains and constructs, as well as the relative outlook (positive or negative) of implementation. Overall, there were improvements over time, with more encouraging feedback and examples of success at follow-up. Though true, organizational culture and individual beliefs about the provision of transgender care challenged implementation of the Center of Excellence throughout the project. Conclusions: This study highlights the importance of organizational culture on implementation efforts, as well as the need for complex, multi-faceted interventions to overcome such challenges in order to improve care for marginalized populations. Trial registration: Not applicable

scholarly journals Longitudinal Use of the Consolidated Framework for Implementation Research to Evaluate the Creation of a Rural Center of Excellence in Transgender Health

2020 ◽  
Author(s):  
Pamela Jane Tinc ◽  
Christopher Wolf-Gould ◽  
Carolyn Wolf-Gould ◽  
Anne Gadomski
Keyword(s):  
Organizational Culture ◽  
Implementation Research ◽  
Robert Wood Johnson Foundation ◽  
Implementation Team ◽  
The Core ◽  
Center Of Excellence ◽  
Rural Settings ◽  
Wellness Center ◽  
Over Time

Abstract BackgroundTransgender people face numerous barriers to accessing care, particularly in rural settings. Transportation, travel time, a lack of providers offering transgender care, and discrimination all contribute to these barriers. The Gender Wellness Center was established to fill a gap in rural transgender care, and was subsequently awarded a Robert Wood Johnson Foundation grant to establish a Center of Excellence. This study examines the implementation of the Center of Excellence, a complex intervention, over the course of 18 months.MethodsThe Consolidated Framework for Implementation Research was used to develop baseline and follow-up surveys. These were distributed to members of the core implementation team at the Gender Wellness Center at the midpoint and conclusion of the Robert Wood Johnson Foundation grant. Responses were largely open-ended and analyzed qualitatively.ResultsResults are presented in terms of Consolidated Framework domains and constructs, as well as the relative outlook (positive or negative) of implementation. Overall, there were improvements over time, with more encouraging feedback and examples of success at follow-up. Though true, organizational culture and individual beliefs about the provision of transgender care challenged implementation of the Center of Excellence throughout the project.ConclusionsThis study highlights the importance of organizational culture on implementation efforts, as well as the need for complex, multi-faceted interventions to overcome such challenges in order to improve care for marginalized populations.Trial registrationNot applicable

scholarly journals Longitudinal Use of the Consolidated Framework for Implementation Research to Evaluate the Creation of a Rural Center of Excellence in Transgender Health

2020 ◽  
Vol 17 (23) ◽  
pp. 9047
Author(s):  
Pamela J. Tinc ◽  
Christopher Wolf-Gould ◽  
Carolyn Wolf-Gould ◽  
Anne Gadomski
Keyword(s):  
New York ◽  
Organizational Culture ◽  
Implementation Research ◽  
New York State ◽  
Robert Wood Johnson Foundation ◽  
Transgender People ◽  
Implementation Team ◽  
Center Of Excellence ◽  
Wellness Center

Background: Transgender people face numerous barriers to accessing care, particularly in rural settings. Transportation, travel time, a lack of providers offering transgender care, and discrimination all contribute to these barriers. The Gender Wellness Center was established in New York State, USA, to fill a gap in rural transgender care and was subsequently awarded a Robert Wood Johnson Foundation grant to establish a Center of Excellence. This study examined the implementation of the Center of Excellence, a complex intervention, to assess barriers and facilitators to implementation over 18 months. Methods: The Consolidated Framework for Implementation Research (CFIR) was used to develop baseline and follow-up surveys. These were distributed to members of the core implementation team at the Gender Wellness Center at the midpoint and conclusion of the Robert Wood Johnson Foundation grant. Responses were largely open-ended and analyzed qualitatively. Results: Results are presented in terms of CFIR domains and constructs, as well as the relative outlook (positive or negative) of implementation. Overall, there were improvements over time, with more encouraging feedback and examples of success at follow-up. Though true, organizational culture and individual beliefs about the provision of transgender care challenged implementation of the Center of Excellence throughout the project. Conclusions: This study highlights the importance of organizational culture on implementation efforts, as well as the need for complex, multifaceted interventions to overcome such challenges in order to improve care for marginalized populations.

How Do Public Service Professionals Behave in Risky Situations? The Importance of Organizational Culture

2021 ◽  
pp. 027507402110103
Author(s):  
Emily Rose Tangsgaard
Keyword(s):  
Organizational Culture ◽  
Risk Perception ◽  
Public Service ◽  
Health Professionals ◽  
Organizational Cultures ◽  
Negative Consequences ◽  
Seeking Behavior ◽  
Subsequent Behavior ◽  
Hospital Wards

Many situations in public service delivery are characterized by uncertainty about the potential negative consequences following decisions. These risky situations make the behavior of frontline professionals particularly important. But what shapes the risk perception and subsequent behavior of frontline professionals in risky situations? This article explores the idea that organizational culture provides part of the answer. To examine this, a comprehensive qualitative study with participant observations and interviews at five public hospital wards was conducted. The findings demonstrate the importance of organizational culture on risk perception and behavior in risky situations. Basic cultural assumptions related to professional discussion, administering medicine, grading of adverse events, and prioritizing follow-up activities matter to behavior in risky situations. In organizational cultures with high levels of trust and dialogue about decision-making, the health professionals rely on each other and ask for second opinions, when making decisions in risky situations. Conversely, in organizational cultures with little trust and professional discussion, the health professionals are less likely to ask for second opinions and follow up on risky situations, which increases the possibility of unintended, negative consequences. In this way, organizational culture can be a driver of risk-reducing and risk-seeking behavior among frontline professionals.

scholarly journals A framework for the evaluation of patients with congenital facial weakness

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Bryn D. Webb ◽  
Irini Manoli ◽  
Elizabeth C. Engle ◽  
Ethylin W. Jabs
Keyword(s):  
Genetic Counseling ◽  
Genetic Testing ◽  
Patient Population ◽  
Clinical Care ◽  
Diagnostic Algorithm ◽  
Accurate Diagnosis ◽  
Facial Weakness ◽  
The Core ◽  
Follow Up Studies

AbstractThere is a broad differential for patients presenting with congenital facial weakness, and initial misdiagnosis unfortunately is common for this phenotypic presentation. Here we present a framework to guide evaluation of patients with congenital facial weakness disorders to enable accurate diagnosis. The core categories of causes of congenital facial weakness include: neurogenic, neuromuscular junction, myopathic, and other. This diagnostic algorithm is presented, and physical exam considerations, additional follow-up studies and/or consultations, and appropriate genetic testing are discussed in detail. This framework should enable clinical geneticists, neurologists, and other rare disease specialists to feel prepared when encountering this patient population and guide diagnosis, genetic counseling, and clinical care.

scholarly journals Measures of organizational culture, organizational climate, and implementation climate in behavioral health: A systematic review

2021 ◽  
Vol 2 ◽  
pp. 263348952110188
Author(s):  
Byron J Powell ◽  
Kayne D Mettert ◽  
Caitlin N Dorsey ◽  
Bryan J Weiner ◽  
Cameo F Stanick ◽  
...  
Keyword(s):  
Organizational Culture ◽  
Organizational Climate ◽  
Psychometric Properties ◽  
Behavioral Health ◽  
Implementation Research ◽  
Learning Climate ◽  
Evidence Based ◽  
Implementation Climate ◽  
Relative Priority ◽  
Evidence Based Practices

Background: Organizational culture, organizational climate, and implementation climate are key organizational constructs that influence the implementation of evidence-based practices. However, there has been little systematic investigation of the availability of psychometrically strong measures that can be used to assess these constructs in behavioral health. This systematic review identified and assessed the psychometric properties of measures of organizational culture, organizational climate, implementation climate, and related subconstructs as defined by the Consolidated Framework for Implementation Research (CFIR) and Ehrhart and colleagues. Methods: Data collection involved search string generation, title and abstract screening, full-text review, construct assignment, and citation searches for all known empirical uses. Data relevant to nine psychometric criteria from the Psychometric and Pragmatic Evidence Rating Scale (PAPERS) were extracted: internal consistency, convergent validity, discriminant validity, known-groups validity, predictive validity, concurrent validity, structural validity, responsiveness, and norms. Extracted data for each criterion were rated on a scale from −1 (“poor”) to 4 (“excellent”), and each measure was assigned a total score (highest possible score = 36) that formed the basis for head-to-head comparisons of measures for each focal construct. Results: We identified full measures or relevant subscales of broader measures for organizational culture ( n = 21), organizational climate ( n = 36), implementation climate ( n = 2), tension for change ( n = 2), compatibility ( n = 6), relative priority ( n = 2), organizational incentives and rewards ( n = 3), goals and feedback ( n = 3), and learning climate ( n = 2). Psychometric evidence was most frequently available for internal consistency and norms. Information about other psychometric properties was less available. Median ratings for psychometric properties across categories of measures ranged from “poor” to “good.” There was limited evidence of responsiveness or predictive validity. Conclusion: While several promising measures were identified, the overall state of measurement related to these constructs is poor. To enhance understanding of how these constructs influence implementation research and practice, measures that are sensitive to change and predictive of key implementation and clinical outcomes are required. There is a need for further testing of the most promising measures, and ample opportunity to develop additional psychometrically strong measures of these important constructs. Plain Language Summary Organizational culture, organizational climate, and implementation climate can play a critical role in facilitating or impeding the successful implementation and sustainment of evidence-based practices. Advancing our understanding of how these contextual factors independently or collectively influence implementation and clinical outcomes requires measures that are reliable and valid. Previous systematic reviews identified measures of organizational factors that influence implementation, but none focused explicitly on behavioral health; focused solely on organizational culture, organizational climate, and implementation climate; or assessed the evidence base of all known uses of a measure within a given area, such as behavioral health–focused implementation efforts. The purpose of this study was to identify and assess the psychometric properties of measures of organizational culture, organizational climate, implementation climate, and related subconstructs that have been used in behavioral health-focused implementation research. We identified 21 measures of organizational culture, 36 measures of organizational climate, 2 measures of implementation climate, 2 measures of tension for change, 6 measures of compatibility, 2 measures of relative priority, 3 measures of organizational incentives and rewards, 3 measures of goals and feedback, and 2 measures of learning climate. Some promising measures were identified; however, the overall state of measurement across these constructs is poor. This review highlights specific areas for improvement and suggests the need to rigorously evaluate existing measures and develop new measures.

Early Clinical Outcomes of the Active Seal Technology of the AFX Endovascular Aortic Aneurysm System With the VELA Cuff for Patients With a Conical Proximal Neck

2022 ◽  
pp. 152660282110709
Author(s):  
Naoki Fujimura ◽  
Hideaki Obara ◽  
Takaaki Nagano ◽  
Yukihisa Ogawa ◽  
Taira Kobayashi ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Proximal Neck ◽  
Landing Zone ◽  
The Core ◽  
The Mean ◽  
Instructions For Use ◽  
Lost To Follow Up

Purpose: To evaluate the efficacy of the Active Seal technology employed in the AFX endovascular aortic aneurysm system (AFX), during endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysms (AAAs) having a conical proximal neck. Materials and Methods: A retrospective analysis of the EVAR for AAA with a conical proximal neck using the AFX was performed at 17 Japanese hospitals between January 2016 and August 2020. The conical proximal neck was defined as a cone-shaped proximal neck, with more than 10% diameter increase within a 15 mm length at the proximal landing zone. All anatomical analyses were performed in the core laboratory, and cases with parallel walls within the proximal neck adequate for the landing zone were excluded from the study. Results: This study included 53 patients, but only 39 patients (mean age, 76.6 ± 6.7 years; 87.0% males; mean aneurysm diameter, 52.0 ± 8.0 mm) were analyzed after being characterized as having a pure conical neck by the core laboratory. The mean proximal neck diameters at the lower renal artery and proximal edge of the aneurysm were 20.0 ± 2.9 mm and 27.5 ± 4.9 mm, respectively. The mean proximal neck length was 21.5 ± 6.0 mm. Instructions for use violations other than the conical neck were observed in 15 patients (38.5%). The VELA cuff was used in all cases; however, additional proximal cuff was required in 9 more cases (23.1%). The Active Seal technology was able to significantly extend the proximal sealing zone from 21.5 ± 6.0 to 26.0 ± 12.2 mm ( p = .047). Thirty-six patients completed the 12-month follow-up (one patient was lost to follow-up, and 2 patients died from causes unrelated to the aneurysm), and there were no type-1a and 3 endoleaks with only one reintervention (2.6%) related to type 1b endoleak in the 12-month period. Furthermore, there was no significant enlargement of the proximal neck diameter at 12 months (at 1 month: 20.6 ± 3.4 mm and at 12 months: 21.3 ± 3.8 mm; p = .420). Conclusion: The Active Seal technology of the AFX significantly extended the proximal seal zone and no type-1a endoleak and proximal neck dilation was observed in patients with conical proximal neck at 12 months.

Experiencing Misgendered Pronouns: A Classroom Activity to Encourage Empathy

2017 ◽  
Vol 45 (3) ◽  
pp. 269-278 ◽  
Author(s):  
Jessica MacNamara ◽  
Sarah Glann ◽  
Paul Durlak
Keyword(s):  
Research University ◽  
Discussion Board ◽  
Social Boundaries ◽  
Class Discussion ◽  
Transgender People ◽  
Gender Nonconforming ◽  
The Social ◽  
And Gender ◽  
Large Research

How can teachers help students understand the importance of gender pronouns for transgender and gender-nonconforming people? This article presents a gender pronoun reversal activity that simulates the experience of being verbally misgendered. Students followed up on the activity by posting reflections on an online class discussion board. The activity promoted empathy among cisgender students for transgender people and reflexivity regarding the social boundaries of gender identity. Empathy and reflexivity were common responses among students enrolled in Sociology of Diversity and Sociology of Gender at a large research university in the northeast. We present the activity, including preparation and follow-up along with an analysis of student responses.

Structuring the Wider Environment and the DBT Team

2018 ◽  
pp. 216-234
Author(s):  
Michaela A. Swales ◽  
Christine Dunkley
Keyword(s):  
Clinical Experience ◽  
Implementation Research ◽  
Dialectical Tensions ◽  
Behaviour Therapy ◽  
Dialectical Behaviour Therapy ◽  
The Core ◽  
Clinical Literature ◽  
Consultation Team ◽  
The Individual

The role of the dialectical behaviour therapy (DBT) team lead is rarely discussed in the DBT academic or clinical literature. However, much implementation research and clinical experience in training and supporting teams new to DBT indicates the importance of the team lead to the correct and efficient functioning of the team itself. This chapter outlines the role of the team lead in relation to two of the functions of DBT; structuring the environment, and enhancing therapists’ capabilities and motivation. It outlines and discusses the core tasks of each of these functions for the team lead. Additionally, it describes the skills and strategies team leads need to learn and deploy to their team in the individual therapeutic and consultation team settings. Lastly, it outlines common dialectical tensions that can arise for team leads, and offers strategies for their management.

scholarly journals The Role Of Youth-Based Mosque Organization In Counter Radicalism Movement

2018 ◽  
Vol 4 (2) ◽  
pp. 261
Author(s):  
Zuri Pamuji
Keyword(s):  
The Core

Counter-radicalism is all prevention efforts to build awareness or understanding that radicalism in the form of terror is violence and not related to religious teachings and must be fought together. This research aims to explore conceptually the role of youth-based mosque organization on counter radicalism movement. As for some findings from this research are: first, the core in counter radicalism rests on the function and purpose of the organization. Second, the movement of the organization in counter-radicalisme is divided into three main parts: the guidance and direction, the implementation of various activities of the organization, the control and follow-up of the organization's programs. Third, the role of this organization is more appropriately done in the micro and messo spectrum related the causes of radicalism. The implementation of all efforts requires the active support of stakeholders in society.

The role of organizational culture in the adoption of customer profitability analysis: a field study

2017 ◽  
Vol 14 (1) ◽  
pp. 38-59 ◽  
Author(s):  
Matthew Fish ◽  
William Miller ◽  
D’Arcy Becker ◽  
Aimee Pernsteiner
Keyword(s):  
Organizational Culture ◽  
Financial Reporting ◽  
Performance Measurement System ◽  
Growth Spurt ◽  
Stage Model ◽  
Customer Profitability ◽  
Content Type ◽  
Implementation Team ◽  
Profitability Analysis

Purpose The purpose of this paper is to examine the role of organizational culture as a company migrates through a four-stage model for designing a performance measurement system (PMS) focused on customer profitability. Design/methodology/approach This is a single-site phenomenological case study, at Growth Spurt Marine Accessories (Growth Spurt), a manufacturing organization headquartered in the USA. Data were collected over a two-year period through interviews with accounting staff, internal company documents and recording observational notes. Findings The paper identifies three major factors that prevented Growth Spurt from transitioning its customer profitability analysis (CPA) reporting package through Kaplan and Cooper’s four-stage model of PMS design: executives exerting their power and spending political capital to prevent implementation without providing rationale, executives believing that the allocation methods were too subjective and executives relying on their own intuition in analyzing customer profitability rather than relying on data. These factors suggest that organizational culture plays an important role in migrating a customer-focused profitability PMS through Kaplan and Cooper’s four-stage model of PMS system design. Research limitations/implications The findings suggest that a PMS focused on customer profitability that does not advance beyond Stage II (financial reporting-driven) may still suit the needs of an organization. Additionally, managers should advocate for a multidisciplinary PMS design and implementation team to minimize potentially adverse effects of organizational culture. Originality/value This paper is unique because it applies Kaplan and Cooper’s four-stage model for PMS design to CPA and it uses a phenomenological case approach to explore impediments to a comprehensive CPA implementation.

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