scholarly journals An Implementation Science Laboratory as One Approach to Whole System Improvement: A Canadian Healthcare Perspective

2021 ◽  
Vol 18 (23) ◽  
pp. 12681
Author(s):  
Rachel Flynn ◽  
Stephanie P. Brooks ◽  
Denise Thomson ◽  
Gabrielle L. Zimmermann ◽  
David Johnson ◽  
...  
Keyword(s):  
Implementation Science ◽  
Health Systems ◽  
System Approach ◽  
Health Service Delivery ◽  
Routine Practice ◽  
Evidence Based ◽  
Science Laboratory ◽  
Learning Health System ◽  
System Improvement ◽  
Canadian Healthcare

Implementation science (IS) has emerged as an integral component for evidence-based whole system improvement. IS studies the best methods to promote the systematic uptake of evidence-based interventions into routine practice to improve the quality and effectiveness of health service delivery and patient care. IS laboratories (IS labs) are one mechanism to integrate implementation science as an evidence-based approach to whole system improvement and to support a learning health system. This paper aims to examine if IS labs are a suitable approach to whole system improvement. We retrospectively analyzed an existing IS lab (Alberta, Canada’s Implementation Science Collaborative) to assess the potential of IS labs to perform as a whole system approach to improvement and to identify key activities and considerations for designing IS labs specifically to support learning health systems. Results from our evaluation show the extent to which IS labs support learning health systems through enabling infrastructures for system-wide improvement and research.

scholarly journals Building capacity from within: qualitative evaluation of a training program aimed at upskilling healthcare workers in delivering an evidence-based implementation approach

2021 ◽  
Author(s):  
April Morrow ◽  
Priscilla Chan ◽  
Gabriella Tiernan ◽  
Julia Steinberg ◽  
Deborah Debono ◽  
...  
Keyword(s):  
Training Program ◽  
Implementation Science ◽  
Health Systems ◽  
Healthcare Workers ◽  
Controlled Trial ◽  
System Capacity ◽  
Evidence Based ◽  
Science Methods ◽  
Implementation Barriers ◽  
Implementation Approach

Abstract Translating evidence into complex health systems is an ongoing challenge. Building the capacity of healthcare workers in behavioral and implementation science methods may facilitate the use of evidence-based implementation approaches, leading to sustainable and effective translation. The aim was to describe the development, contents and evaluation of a training workshop aimed at upskilling hospital-embedded staff to deliver an evidence-based implementation approach. The Hide and Seek Project (HaSP) is a cluster randomized controlled trial testing two implementation approaches for improving hereditary cancer referral at eight Australian hospitals. Healthcare workers were recruited as “Implementation Leads” and trained via a one-day workshop—TRAining in evideNce-baSed ImpLementATion for hEalth (TRANSLATE). The purpose of TRANSLATE was to upskill Implementation Leads in the delivery of HaSP, as well as implementation science methods more broadly. Implementation Leads participated in semi-structured evaluation interviews, which were analyzed using inductive thematic analysis. Nine Implementation Leads from various professional backgrounds completed the training. Four key themes were identified: (i) training day reactions, (ii) learning, (iii) implementation barriers and facilitators, and (iv) building health system capacity for implementation. Participants reported high levels of satisfaction, and anticipated that the knowledge and skills may be useful in the future. We describe a novel training program focused on the delivery of evidence-based implementation within health systems. Guided by insights from this study, methods to deliver the training on a larger scale and across different contexts are being explored. The prolonged impact of TRANSLATE will be further evaluated at trial completion. Trial registration: ANZCTR, ACTRN12618001072202. Registered on June 27, 2018

scholarly journals Evidence-based mental health care and implementation science in low- and middle-income countries

2012 ◽  
Vol 21 (3) ◽  
pp. 241-244 ◽  
Author(s):  
G. Thornicroft
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Implementation Science ◽  
Low Income ◽  
Routine Practice ◽  
Evidence Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Although the evidence base for what to do about the mental health gap in low- and middle-income countries (LAMICs) has improved significantly over the last decade, mental health care in LAMICs still provide services to only a small minority of people with mental disorders. The problem is how to translate the relevant body of scientific knowledge into routine practice. It is clear from over two decades of research that the creation of evidence-based guidelines is necessary but not sufficient for evidence-based practice, whether in high- or low-income settings. In this Editorial, I discuss whether the recent development of ‘implementation science’ may offer an opportunity towards effective guideline implementation in low- and medium-income settings, so that clinical practice is more often based on evidence that does lead to patient benefit.

Tailored interventions to support the implementation of the German national guideline on screening, diagnosis and treatment of alcohol-related disorders: a project protocol

2019 ◽  
Vol 65 (6) ◽  
pp. 373-381 ◽  
Author(s):  
Bernd Schulte ◽  
Christina Lindemann ◽  
Angela Buchholz ◽  
Anke Rosahl ◽  
Martin Härter ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Guideline Implementation ◽  
Implementation Strategies ◽  
Organizational Factors ◽  
Diagnosis And Treatment ◽  
Primary Data ◽  
Routine Practice ◽  
Evidence Based ◽  
Advisory Boards ◽  
Prevention And Treatment

Abstract. Background: The German Guideline on Screening, Diagnosis and Treatment of Alcohol Use Disorders aims to increase the uptake of evidence-based interventions for the early identification, diagnosis, prevention and treatment of alcohol-related disorders in relevant healthcare settings. To date, dissemination has not been accompanied by a guideline implementation strategy. The aim of this study is to develop tailored guideline implementation strategies and to field-test these in relevant medical and psycho-social settings in the city of Bremen, Germany. Methods: The study will conduct an impact and needs assessment of healthcare provision for alcohol use orders in Bremen, drawing on a range of secondary and primary data to: evaluate existing healthcare services; model the potential impact of improved care on public health outcomes; and identify potential barriers and facilitators to implementing evidence-based guidelines. Community advisory boards will be established for the selection of single-component or multi-faceted guideline implementation strategies. The tailoring approach considers guideline, provider and organizational factors shaping implementation. In field tests quality outcome indicators of the delivery of evidence-based interventions will be evaluated accompanied by a process evaluation to examine patient, provider and organizational factors. Outlook: This project will support the translation of guideline recommendations for the identification, prevention and treatment of AUD in routine practice and therefore contributes to the reduction of alcohol-related burden in Germany. The project is running since October 2017 and will provide its main outcomes by end of 2020. Project results will be published in scientific journals and presented at national and international conferences.

Best Practices for Data Visualization: Creating and Evaluating a Report for an Evidence-Based Fall Prevention Program (Preprint)

2018 ◽  
Author(s):  
Srijesa Khasnabish ◽  
Zoe Burns ◽  
Madeline Couch ◽  
Mary Mullin ◽  
Randall Newmark ◽  
...  
Keyword(s):  
Literature Review ◽  
Best Practices ◽  
Implementation Science ◽  
Data Visualization ◽  
Systematic Literature Review ◽  
Fall Prevention ◽  
Prevention Program ◽  
Evidence Based ◽  
Data Display ◽  
Fall Prevention Program

BACKGROUND Data visualization experts have identified core principles to follow when creating visual displays of data that facilitate comprehension. Such principles can be applied to creating effective reports for clinicians that display compliance with quality improvement protocols. A basic tenet of implementation science is continuous monitoring and feedback. Applying best practices for data visualization to reports for clinicians can catalyze implementation and sustainment of new protocols. OBJECTIVE To apply best practices for data visualization to create reports that clinicians find clear and useful. METHODS First, we conducted a systematic literature review to identify best practices for data visualization. We applied these findings and feedback collected via a questionnaire to improve the Fall TIPS Monthly Report (FTMR), which shows compliance with an evidence-based fall prevention program, Fall TIPS (Tailoring Interventions for Patient Safety). This questionnaire was based on the requirements for effective data display suggested by expert Stephen Few. We then evaluated usability of the FTMR using a 15-item Health Information Technology Usability Evaluation Scale (Health-ITUES). Items were rated on a 5-point Likert scale from strongly disagree (1) to strongly agree (5). RESULTS The results of the systematic literature review emphasized that the ideal data display maximizes the information communicated while minimizing the cognitive efforts involved with data interpretation. Factors to consider include selecting the correct type of display (e.g. line vs bar graph) and creating simplistic reports. The qualitative and quantitative evaluations of the original and final FTMR revealed improved perceptions of the visual display of the reports and their usability. Themes that emerged from the staff interviews emphasized the value of simplified reports, meaningful data, and usefulness to clinicians. The mean (SD) rating on the Health-ITUES scale when evaluating the original FTMR was 3.86 (0.19) and increased to 4.29 (0.11) when evaluating the revised FTMR (Mann Whitney U Test, z=-12.25, P<0.001). CONCLUSIONS Best practices identified through a systematic review can be applied to create effective reports for clinician use. The lessons learned from evaluating FTMR perceptions and measuring usability can be applied to creating effective reports for clinician use in the context of other implementation science projects.

Implementation Strategies

2017 ◽  
Author(s):  
JoAnn E. Kirchner ◽  
Thomas J. Waltz ◽  
Byron J. Powell ◽  
Jeffrey L. Smith ◽  
Enola K. Proctor
Keyword(s):  
Implementation Science ◽  
Comparative Effectiveness ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Efficient Manner

As the field of implementation science moves beyond studying barriers to and facilitators of implementation to the comparative effectiveness of different strategies, it is essential that we create a common taxonomy to define the strategies that we study. Similarly, we must clearly document the implementation strategies that are applied, the factors that influence their selection, and any adaptation of the strategy during the course of implementation and sustainment of the innovation being implemented. By incorporating this type of rigor into our work we will be able to not only advance the science of implementation but also our ability to place evidence-based innovations into the hands of practitioners in a timely and efficient manner.

scholarly journals Key factors to facilitate locally driven family planning programming: a qualitative analysis of urban stakeholder perspectives in Africa and Asia

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Lisa Mwaikambo ◽  
Sarah Brittingham ◽  
Saori Ohkubo ◽  
Ruwaida Salem ◽  
Denis Joel Sama ◽  
...  
Keyword(s):  
Family Planning ◽  
Health Systems ◽  
Thematic Analysis ◽  
Urban Areas ◽  
Local Governments ◽  
Scale Up ◽  
Analytical Framework ◽  
Essential Elements ◽  
Evidence Based ◽  
Country Ownership

Abstract Background There has been greater recognition of the importance of country ownership in global health and development. However, operationalising country ownership to ensure the scale up and sustainability of proven interventions remains elusive at best. To address this challenge, we undertook a thematic analysis of interviews collected from representatives of local governments, public health systems, and communities in poor urban areas of East Africa, Francophone West Africa, India, and Nigeria, supported by The Challenge Initiative (TCI), aiming to rapidly and sustainably scale up evidence-based reproductive health and family planning solutions. Methods The main objective of this study was to explore critical elements needed for implementing and scaling evidence-based family planning interventions. The research team conducted thematic analysis of 96 stories collected using the Most Significant Change (MSC) technique between July 2018 and September 2019. After generating 55 unique codes, the codes were grouped into related themes, using TCI’s model as a general analytical framework. Results Five key themes emerged: (1) strengthening local capacity and improving broader health systems, (2) shifting mindsets of government and community toward local ownership, (3) institutionalising the interventions within existing government structures, (4) improving data demand and use for better planning of health services, and (5) enhancing coordination of partners. Conclusion While some themes feature more prominently in a particular region than others, taken together they represent what stakeholders perceive to be essential elements for scaling up locally-driven health programmes in urban areas in Africa and Asia.

Implementation Science: Application of Evidence‐Based Practice Models to Improve Healthcare Quality

2021 ◽  
Vol 18 (2) ◽  
pp. 76-84
Author(s):  
Sharon Tucker ◽  
Molly McNett ◽  
Bernadette Mazurek Melnyk ◽  
Kirsten Hanrahan ◽  
Sarah C. Hunter ◽  
...  
Keyword(s):  
Implementation Science ◽  
Evidence Based Practice ◽  
Healthcare Quality ◽  
Evidence Based ◽  
Practice Models ◽  
Science Application

scholarly journals Evidence-Based Practice Implementation: Case Report of the Evolution of a Quality Improvement Program in a Multicenter Physical Therapy Organization

2015 ◽  
Vol 95 (4) ◽  
pp. 588-599 ◽  
Author(s):  
Joel M. Stevans ◽  
Christopher G. Bise ◽  
John C. McGee ◽  
Debora L. Miller ◽  
Paul Rockar ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Case Report ◽  
Physical Therapy ◽  
Care Quality ◽  
Routine Practice ◽  
Evidence Based ◽  
Implementation Barriers ◽  
Improvement Program ◽  
Improvement Project ◽  
Systems Perspective

Background and Purpose Our nation's suboptimal health care quality and unsustainable costs can be linked to the failure to implement evidence-based interventions. Implementation is the bridge between the decision to adopt a strategy and its sustained use in practice. The purpose of this case report is threefold: (1) to outline the historical implementation of an evidence-based quality improvement project, (2) to describe the program's future direction using a systems perspective to identify implementation barriers, and (3) to provide implications for the profession as it works toward closing the evidence-to-practice gap. Case Description The University of Pittsburgh Medical Center (UPMC) Centers for Rehab Services is a large, multicenter physical therapy organization. In 2005, they implemented a Low Back Initiative utilizing evidence-based protocols to guide clinical decision making. Outcomes The initial implementation strategy used a multifaceted approach. Formative evaluations were used repeatedly to identify barriers to implementation. Barriers may exist outside the organization, they can be created internally, they may result from personnel, or they may be a direct function of the research evidence. Since the program launch, 3 distinct improvement cycles have been utilized to address identified implementation barriers. Discussion Implementation is an iterative process requiring evaluation, measurement, and refinement. During this period, behavior change is actualized as clinicians become increasingly proficient and committed to their use of new evidence. Successfully incorporating evidence into routine practice requires a systems perspective to account for the complexity of the clinical setting. The value the profession provides can be enhanced by improving the implementation of evidence-based strategies. Achieving this outcome will require a concerted effort in all areas of the profession. New skills will be needed by leaders, researchers, managers, and clinicians.

scholarly journals Implementation Science: How to Jump-Start Infection Prevention

2010 ◽  
Vol 31 (S1) ◽  
pp. S14-S17 ◽  
Author(s):  
Sanjay Saint ◽  
Joel D. Howell ◽  
Sarah L. Krein
Keyword(s):  
Patient Safety ◽  
Implementation Science ◽  
Infection Prevention ◽  
Theory And Practice ◽  
Evidence Based ◽  
Clinical Model ◽  
Healthcare Epidemiology

Implementing evidence-based infection prevention practices is challenging. Implementation science, which is the study of methods promoting the uptake of evidence into practice, addresses the gap between theory and practice. Just as healthcare epidemiology has emerged as a paradigm for patient safety, infection prevention may serve as a clinical model for implementation researchers.

Feasibility barriers and effectiveness of specific treatments for early psychosis in routine mental health care

2011 ◽  
Vol 26 (S2) ◽  
pp. 2042-2042
Author(s):  
M. Ruggeri
Keyword(s):  
Psychosocial Interventions ◽  
Early Psychosis ◽  
Control Group ◽  
Routine Practice ◽  
Evidence Based ◽  
Roles And Responsibilities ◽  
Or Practice ◽  
Representative Samples ◽  
Poor Management

IntroductionIssues of organisational structure and commitment, resource development, and clarity of roles and responsibilities must be addressed before proceeding with any attempt to implement evidence based interventions in a specific service.Evidence suggests that the management of most mental disorders and especially of psychoses is frequently suboptimal. This trend might reflect instances of inadequate resource allocation, but might also reflect the effects of stigma, discrimination, and social exclusion that people with psychosis often experience. It might also indicate poor management of available resources or deficiencies in knowledge or practice.AimsMulti-element psychosocial interventions in the first 5 years from psychosis onset have proved to facilitating recovery and reducing long-term disability. However, most studies often do not test efficacy against a control group and have been conducted in non-epidemiologically representative samples. The presentation will be focussed on process of assessment of acceptability and discrepancies between evidence and clinical practice in the treatment of schizophrenia in community care.Methods and ResultsTrials - such as the GET UP Trial (National Coordinator: Mirella Ruggeri) that is part of the Strategic Research Programs of the Italian Government - that are being conducted in the routine practice and that aim to test the feasibility and cost-effectiveness of evidence-based psychosocial interventions will be presented and discussed.ConclusionsVerify the barriers to application and situations when evidence-based interventions practice might be ineffective or inappropriate, understanding their advantages and limitations is a crucial challenge in the area of early psychosis treatment.

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