scholarly journals Improving care in surgery – a qualitative study of managers’ experiences of implementing evidence-based practice in the operating room

2015 ◽  
Vol 4 (4) ◽  
pp. 73 ◽  
Author(s):  
Annette Erichsen Andersson ◽  
Wendy Gifford ◽  
Kerstin Nilsson
Keyword(s):  
Operating Room ◽  
Evidence Based Practice ◽  
Implementation Process ◽  
Organizational Structures ◽  
Evidence Based ◽  
Safety Measures ◽  
Professional Groups ◽  
Leadership Support ◽  
Qualitative Descriptive ◽  
And Control

Background: More knowledge is needed on the preconditions and circumstances for leading implementation of evidence based practice in the operating room (OR). Effective leadership support is critical to enhance the provision of safer care. The aim of this study was to explore managers’ and clinical leaders’ experiences of implementing evidence-based practice to increase patient safety in the operating room.Methods: The study had a qualitative descriptive design. In all, 25 managers were interviewed, with different surgical specialities (orthopedics, general and pediatric surgery) and operating room suites, from eight hospitals and 15 departments.Results: The organizational structures were defined as key obstacles to implementation. Specifically, lack of a common platform for cooperation between managers from different departments, organizational levels and professional groups impeded the alignment of shared goals and directions. In cases where implementation was successful, well-functioning and supportive relationships between the managers from different professions and levels were crucial along with a strong sense of ownership and control over the implementation process. Whilst managers expressed the conviction that safety was an important issue that was supported by top management, the goal was usually to “get through” as many operations as possible. This created conflicts between either prioritizing implementation of safety measures or production goals, which sometimes led to decisions that were counter to evidence-based practice (EBP). While evidence was considered crucial in all implementation efforts, it might be neglected and mistrusted if hierarchical boundaries between professional subgroups were challenged, or if it concerned preventive innovations as opposed to technical innovations.Conclusions: The preconditions for implementing EBP in the OR are suboptimal; thus addressing leadership, organizational and interprofessional barriers are of vital importance.

Implementation of the Comprehensive Operating Room Ergonomics Program for Surgeons Through an OT Approach: A Feasibility Study

2021 ◽  
Vol 75 (Supplement_2) ◽  
pp. 7512515314p1-7512515314p1
Author(s):  
Pamela Hess ◽  
Penelope Moyers Cleveland
Keyword(s):  
Operating Room ◽  
Feasibility Study ◽  
Mixed Methods Research ◽  
Implementation Process ◽  
Evidence Based ◽  
Health And Wellness ◽  
Design And Implementation ◽  
The Core ◽  
Core Program ◽  
Primary Author

Abstract Date Presented 04/22/21 The Comprehensive Operating Room Ergonomics (CORE) program was developed to address the physical and environmental demands among surgeons. This feasibility study examined the design and implementation process of an evidence-based OT ergonomics intervention using a mixed-methods research design. The CORE program supports the American Occupational Therapy Association’s Vision 2025 of promoting population health and wellness, especially among surgeons who are essential to our health care system. Primary Author and Speaker: Pamela Hess Additional Authors and Speakers: Elena Donoso Brown

scholarly journals Educating change agents: a qualitative descriptive study of graduates of a Master’s program in evidence-based practice

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Grete Oline Hole ◽  
Sissel Johansson Brenna ◽  
Birgitte Graverholt ◽  
Donna Ciliska ◽  
Monica Wammen Nortvedt
Keyword(s):  
Evidence Based Practice ◽  
Change Agents ◽  
Descriptive Study ◽  
Evidence Based ◽  
Master's Program ◽  
Qualitative Descriptive

Furthering Dissemination and Implementation Research

2017 ◽  
Author(s):  
Lawrence W. Green ◽  
Mona Nasser
Keyword(s):  
Systematic Reviews ◽  
Implementation Research ◽  
External Validity ◽  
Evidence Based Practice ◽  
Internal Validity ◽  
Implementation Process ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Dissemination And Implementation Research

This chapter raises questions about the reliability of much “evidence-based practice” disseminated from the original studies and systematic reviews of those studies, insofar as they were often conducted and reviewed with inadequate attention to external validity. Important issues are raised for dissemination and implementation researchers. Indeed, the pressure on investigators to provide for increasingly rigorous controls on threats to internal validity, and to exclude studies that fall below standards for internal validity, has made many such sources of evidence more suspect in their external validity and less credible to the practitioners or policymakers who would adopt them. Greater attention is needed to ways to incorporate considerations of external validity into studies and in systematic reviews of studies to produce more generalizable evidence, and greater attention to practice-based evidence that can complement the more formal evidence-based practices in the process of implementing and evaluating the dissemination and implementation process

Changing Clinicians’ Behavior: a Randomized Controlled Trial of Fees and Education

2008 ◽  
Vol 87 (7) ◽  
pp. 640-644 ◽  
Author(s):  
J.E. Clarkson ◽  
S. Turner ◽  
J.M. Grimshaw ◽  
C.R. Ramsay ◽  
M. Johnston ◽  
...  
Keyword(s):  
Evidence Based Practice ◽  
Controlled Trial ◽  
Implementation Strategies ◽  
Cost Effective ◽  
Evidence Based ◽  
Permanent Molars ◽  
Primary Hypothesis ◽  
And Control ◽  
Treatment Education ◽  
Fissure Sealing

The fissure-sealing of newly erupted molars is an effective caries prevention treatment, but remains underutilized. Two plausible reasons are the financial disincentive produced by the dental remuneration system, and dentists’ lack of awareness of evidence-based practice. The primary hypothesis was that implementation strategies based on remuneration or training in evidence-based healthcare would produce a higher proportion of children receiving sealed second permanent molars than standard care. The four study arms were: fee per sealant treatment, education in evidence-based practice, fee plus education, and control. A cost-effectiveness analysis was conducted. Analysis was based on 133 dentists and 2833 children. After adjustment for baseline differences, the primary outcome was 9.8% higher when a fee was offered. The education intervention had no statistically significant effect. ‘Fee only’ was the most cost-effective intervention. The study contributes to the incentives in health care provision debate, and led to the introduction of a direct fee for this treatment.

Considerations for developing an evidenced-based practice in orthotics and prosthetics

2008 ◽  
Vol 32 (1) ◽  
pp. 93-102 ◽  
Author(s):  
N. Ramstrand ◽  
T.-H. Brodtkorb
Keyword(s):  
Cultural Change ◽  
Evidence Based Practice ◽  
Daily Practice ◽  
Evidence Based ◽  
Professional Groups ◽  
Body Of Knowledge ◽  
Professional Body ◽  
Research Findings ◽  
Evidenced Based ◽  
Evidenced Based Practice

Evidence-based practice has become somewhat of a catchphrase over the past ten years. In this paper evidence-based practice is defined and its importance for the development of the prosthetics and orthotics profession is highlighted. The authors suggest that evidence-based practice needs to be prioritized within the profession and that a cultural change needs to be initiated which supports clinicians in incorporating research findings into their daily practice. In addition, the authors highlight the need for prosthetists/orthotists to become more active in generating research rather than relying on other professional groups to contribute to their professional body of knowledge.

scholarly journals Implementation Evaluation of an Online Peer-Mentor Training Program for Individuals With Spinal Cord Injury

2019 ◽  
Vol 25 (4) ◽  
pp. 303-315 ◽  
Author(s):  
Marie-Eve Lamontagne ◽  
Krista L. Best ◽  
Teren Clarke ◽  
Frederic S. Dumont ◽  
Luc Noreau
Keyword(s):  
Evidence Based Practice ◽  
Readiness To Change ◽  
Implementation Process ◽  
Evidence Based ◽  
Peer Mentors ◽  
Mentor Training ◽  
Community Based ◽  
Peer Mentor ◽  
Cord Injury ◽  
Organizational Readiness To Change

Background: Community-based spinal cord injury (SCI) associations play a critical role in successful community integration of individuals having experienced an SCI, with knowledge translation being increasingly important for the process. The implementation of a new online peer-mentor training program was perceived as being useful in improving and standardizing training practices for peer mentors across Canada. It was also seen as an opportunity to explore the context, process, and influence of a formal implementation process in SCI community-based associations that are corporate members of SCI Canada with a view to informing future implementation efforts. Objectives: The objectives of this study were to (a) explore the context in which the implementation process will be conducted, (b) identify barriers and facilitators that influence the implementation process, and (c) measure the influence of the implementation process on service delivery. Methods: A sequential cross-sectional design was used with SCI Canada provincial member associations. SCI Canada's purpose is to support collaboration among provincial corporate members. SCI Canada enlisted the participation of several employees from the provincial associations to assess the implementation context using the Evidence-Based Practice Attitude Scale and the Organizational Readiness to Change Assessmen t and to identify barriers to and facilitators of the implementation of an evidence-based practice through an open-ended questionnaire based on the Consolidated Framework for Implementation Research. A pre-post design was used to evaluate the influence of the implementation process on peer-mentors using the Determinants of Implementation Behavior Questionnaire. Results: Participants reported an overall positive attitude toward evidence-based practice and a positive perception of the organizational readiness to change. The relevance of the practice chosen was a facilitator because peer support is central to the mission of SCI Canada and this type of practice is in line with the organization' culture and values. Equally important, but as an obstacle, is the scarcity of existing resources within the association in general and specifically resources devoted to the implementation of the program. Finally, the implementation process seems to influence half of the implementation determinant types on potential peer mentors. Conclusion: Community-based organizations, such as the provincial association members of SCI Canada, show positive context for the implementation of evidence-based practices. However, successful implementation of online peer-mentor training will require specific consideration of financial and human resources.

scholarly journals Implementing evidence-based practice: the challenge of delivering what works for people with learning disabilities at risk of behaviours that challenge

2020 ◽  
Vol 25 (3) ◽  
pp. 133-143
Author(s):  
Louise D. Denne ◽  
Nick J. Gore ◽  
J. Carl Hughes ◽  
Sandy Toogood ◽  
Edwin Jones ◽  
...  
Keyword(s):  
At Risk ◽  
Learning Disabilities ◽  
Service Delivery ◽  
Best Practice ◽  
Evidence Based Practice ◽  
Implementation Process ◽  
Building Blocks ◽  
Evidence Based ◽  
Content Type ◽  
Successive Generations

Purpose There is an apparent disconnect between the understanding of best practice and service delivery in the support of people with learning disabilities at risk of behaviours that challenge. We suggest, is a problem of implementation. The purpose of this paper is to explore reasons why this might be the case: a failure to recognise the collective works of successive generations of research and practice; and a failure to address the macro-systems involved and systems changes needed to support implementation. Design/methodology/approach This paper reviews the consensus that exists in respect of best practice. Drawing upon ideas from implementation science the paper highlights the complexities involved in the implementation of all evidence-based practices and uses this as a framework to propose ways in which an infrastructure that facilitates the delivery of services in the learning disabilities field might be built. Findings This paper highlights core recommended practices that have been consistent over time and across sources and identifies the systems involved in the implementation process. This paper demonstrates that many of the necessary building blocks of implementation already exist and suggests areas that are yet to be addressed. Critically, the paper highlights the importance of, and the part that all systems need to play in the process. Originality/value In the absence of any generalised implementation frameworks of evidence-based practice in the learning disabilities field, the paper suggests that the findings may provide the basis for understanding how the gap that exists between best practice and service delivery in the support of people with a learning disability at risk of behaviours that challenge might be closed.

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