Transforming the online learning space through advanced development retreats

Learning technologies have the potential to transform Higher Education, although multifaceted demands on staff time, confidence and training in using new technologies, and a lack of support can make this transformation difficult. The University of Huddersfield recently transitioned to a new virtual learning environment (VLE), which provided the opportunity to change the way staff view and use the new VLE for teaching and learning. As part of this project, three off-site retreats were run to help staff to reflect on and develop their teaching practice to better support student learning in the digital space and develop advanced online resources that support the democratisation of learning, close differential attainment gaps and give every student the best chance of success. Although much is written about different models of practice, there is a lack of theory and conceptualisation around changing practice. Examining the motivations and experiences of staff who participated provides insight into the challenges of implementing change on an institutional level, whilst examining their setup and design highlights ways to support staff during this process. Using participant feedback and experiences to underpin this research, we explore the immediate and ongoing outcomes of these off-site retreats to help transform the University’s approach to technology-enhanced learning.

A Strategy Matching Tool for Boosting Implementation of Geriatric Telehealth Services in Rural CBOCs

Fifteen Veterans Administration Medical Centers (VAMCs) offer geriatric specialty care telehealth services through a hub and spoke model to patients at affiliated community-based outpatient clinics (CBOCs). These services are not used to the extent they could be. Through interviews with 50 staff and providers at rural CBOCs we identified several implementation facilitators and barriers. CBOC-level barriers included space constraints, low staffing, internet connection issues, and limited knowledge of services available and referral processes. Patient-level barriers included discomfort with technology, cognitive decline, and inability to travel to the CBOC. We found that champions within the CBOC and iterative, targeted outreach from the hub helped facilitate uptake of services. We entered the identified barriers into the CFIR-ERIC (Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool to help generate targeted strategies that will be used to refine each hub’s implementation approach.

Using Implementation Science Strategy Mapping on the Age-Friendly Health System's 4Ms Journey

Background Implementation science is the study of methods to promote the adoption and integration of evidence-based practices into routine health care to improve the quality of care. The purpose of this study was to use Implementation Mapping to guide the implementation of The John A. Hartford evidence-based Age-Friendly Health Systems (AFHS) 4Ms Framework: What Matters, Medications, Mentation, and Mobility. Methods Implementation Mapping, a systematic process for planning implementation strategies, guided the 9-month integration of the 4Ms Framework in the 1,100 MinuteClinics across the US. Implementation Mapping includes five tasks: (1) conduct an implementation needs assessment and identify program adopters and implementers; (2) state adoption and implementation outcomes and performance objectives, identify determinants, and create matrices of change objectives; (3) choose theoretical methods (mechanisms of change) and select or design implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes. Results The implementation plan, developed by the implementation mapping method, was carried out over 9-months. Seven implementation strategies were identified from the Expert Recommendations for Implementing Change (ERIC) project including the provision of education, electronic health record integration, internal champion facilitation, cues to action, and a dashboard to monitor progress. To date, the implementation mapping has resulted in the adoption of the 4Ms by 1145 providers (37%). Monitoring of the adoption of the 4Ms Framework and consideration of future implementation strategies is ongoing. Conclusions Implementation Mapping provided a systematic process to develop strategies to improve the adoption, implementation, sustainment, and scale-up of the evidence-based 4Ms Framework.

Tracking Adaptation and Fidelity When Embedding COPE, Evidence-Based Dementia Care, in PACE Sites

One essential question in moving dementia care interventions to practice is, “What is the optimal balance between fidelity to, and adaptation of, a proven program in “real world” settings?" We present a protocol for measuring the adaptation/fidelity and implementation of an evidence-based dementia care program (Care of Persons in their Environment, COPE) in PACE settings. During pre-implementation, science-based elements of COPE were documented including the theory of change, logic model and core components. Possible adaptations to COPE in its delivery were identified and included program structure (sequence of sessions), content (assessments), and delivery methods (online). During implementation, documentation of implementation strategies is captured using an evidence-informed checklist derived from the Expert Recommendations for Implementing Change (ERIC) workgroup. Ongoing documentation of fidelity/adaptation aspects of program implementation is conducted using the FRAME framework. Understanding methods and measures deployed in adaptation and implementation of evidence-based dementia programs can help guide future translation efforts.

Dementia Care Coaching: A Pilot to Evaluate Acceptability and Feasibility in Care Communities

The Alzheimer’s Association (AA) Dementia Care Practice Recommendations (DCPR) outline ten recommendations to achieve quality care with a person-centered focus. The AA has developed tools to assist care communities (CC) to evaluate their status within the recommendations by working with a trained coach to maximize adoption and implementation of these recommendations. The purpose of this pilot was to evaluate the acceptability and feasibility of pairing trained DCPR coaches with CC teams to implement the DCPR tools. Seven CCs were recruited and four received the DCPR overview and self-assessment. Of the four CC, one withdrew and did not receive the intervention. The remaining three were located in a suburban area, nonprofit, and with memory care units. Data was collected from November 2019 through March 2020. Nine CC staff participated with a mean age 35.8 years and had worked for 11.8 years. Baseline mean scores on the Organizational Readiness to Implementing Change (ORIC) scale were 4.6 for the commitment domain and 4.4 for the efficacy domain. Mean scores on the Nursing Home Employee Satisfaction Survey were high. Sixty-nine percent of CC participants were satisfied with their jobs (greater than 4). Findings from mid-project interviews with the coaches revealed difficulty with scheduling appointments, significant efforts needed to get the “right” people at the table and need for the DCPR tools to be more user-friendly. No post-intervention results were collected due to closing of the CCs to visitors due to COVID. The DCPR tools shows promise and are being evaluated in additional CCs.

Translating Science Into Practice and Making It Stick: System-Level Approaches

The delay between establishing evidence-based practice and implementing this evidence base is well documented. This presentation will focus on the application of implementation science principles to real-world clinical programs. A VA priority is to implement evidence-based practice for management of DBD in CLCs. Key implementation science concepts will be introduced, along with a description of how these conceptual models facilitate application of roll-out and sustainment of complex evidence-based interventions. Conceptual frameworks that contributed to intervention selection and facilitation of STAR-VA implementation, including the Consolidated Framework for Implementation Research (CFIR) and Knowledge Reservoirs (KR) framework, and their application in health care practice, will be discussed. The CFIR Expert Recommendation for Implementing Change (ERIC) Mapping Tool will be introduced as useful to identify strategies that address barriers to sustaining implementation. Attendees will be provided with resources to support implementation and sustainment efforts.

Enabling Sustainable Organizational Change: A Case of Cognitive Diversity in the Automotive Industry

In diverse societies such as South Africa, organizations continue to face inclusion challenges when implementing change. This study proposes a different method and new dimension of diversity management within the cognitive diversity construct, namely human niche theory, to tackle the diversity dilemma of exclusivity. The research question asked whether human niche theory, as a defined concept within cognitive diversity, could be utilized by managers to enable inclusion and promote sustainable organizational change implementation. Conceptually, this paper relates human niche theory to seven themes in the change process, namely, communication, training, motivation, resources, control, monitoring, and feedback. An exploratory single case study in a multicultural South African automotive organization that implemented a company-wide technology change project was used as a unit of analysis. The single case study revealed a new understanding of change implementation processes using the human niche theoretical framework related to radical technological change implementation. Data collection included in-depth interviews, focus group sessions, solicited company data, field notes, and observations. Content and comparative data analysis were used to present findings. This research showed that managers’ awareness of human niche theory in terms of cognitive diversity could assist in managing diversity, enabling inclusion, and change effectiveness in the organization, while minimizing emotional exclusion.

Comparing Output from Two Methods of Participatory Design for Developing Implementation Strategies: Traditional Contextual Inquiry vs. Rapid Crowd Sourcing

BackgroundParticipatory design methods are a key component of designing tailored implementation strategies. These methods vary in the resources required to execute and analyze their outputs. No work to date has examined the extent to which the output obtained from different approaches to participatory design varies.MethodsWe concurrently used two separate participatory design methods: 1) field observations and qualitative interviews and 2) rapid crowd sourcing (an innovation tournament). Our goal was to generate information to tailor implementation strategies to increase the use of evidence-based data collection practices among one-to-one aides working with children with autism. Each method was executed and analyzed by study team members blinded to the output of the other method. We estimated the personnel time and monetary costs associated with each method to further facilitate comparison.ResultsObservations and interviews generated nearly double the number of implementation strategies (n = 26) than did the innovation tournament (n = 14). When strategies were classified into clusters from the Expert Recommendations for Implementing Change (ERIC) taxonomy, there was considerable overlap in the content of identified strategies. Strategies derived from observations and interviews were more specific than those from the innovation tournament. Nine strategies (23%) reflected content unique to observations and interviews and 4 (10%) strategies were unique to the innovation tournament. Only observations and interviews identified implementation strategies related to adapting and tailoring to context; only the innovation tournament identified implementation strategies that used incentives. Observations and interviews required more than three times the personnel hours than the innovation tournament, but the innovation tournament was more costly overall due to the technological platform used.ConclusionsThere was substantial overlap in content derived from observations and interviews and the innovation tournament. However, each yielded unique information. To select the best participatory design approach to inform implementation strategy design for a particular context, researchers should carefully consider what each method may elicit and weigh the resources available to invest in the process.Trial RegistrationN/A

Considering Health Literacy in Cardiovascular Disease Management: A Qualitative Study on Healthcare Professionals’ and Patients' Perspectives

Background: Implementing practices adapted to patient health literacy (HL) is a promising avenue for improving their outcomes in the context of cardiovascular diseases (CVD). The health communication skills of healthcare professionals (HCPs) and the quality of information provided are essential for low-HL patients. We aimed to explore HCPs knowledge about HL, patients and HCPs views on current practices regarding low-HL patients, and facilitators and barriers to adapting communication to patients’ HL level, in order to prepare the implementation of a complex intervention dedicated to improve CVD management for low-HL patients.Methods: We conducted face-to-face semi-structured interviews with HCPs practicing in cardiology units and patients hospitalized for CVD. Study design and analysis were based on the Theory of Planned Behavior for HCPs and the framework of Health Literacy and Health Action for patients. Deductive and inductive thematic analysis were used. Barriers and facilitators were structured into an Ishikawa fishbone diagram and implementation strategies were selected to address resulting themes from the Expert Recommendations for Implementing Change (ERIC).Results: Fifteen patients and 14 HCPs were interviewed. HCPs had partial knowledge of HL dimensions. Perceptions of HCPs and patients were not congruent regarding HCP-patient interactions and information provided by hospital and community HCPs. HCPs perceived they lacked validated tools and skills, and declared they adapted spontaneously their communication when interacting with low-HL patients. Patients expressed unmet needs regarding communication during hospital discharge and at return to home. Conclusion: To implement HL-tailored practices in this setting, our results suggest that several implementation strategies will be valuable at individual (engaging patients and their family), interactional (educating and training of HCPs about HL) and organizational levels (creating a multidisciplinary HCPs interest group dedicated to HL). Trial registration: The study was registered on Clinical Trials: NCT03949309.

The Development of a Systemic Approach to the Positive Management of Behaviour in One Secondary School

<p>This thesis demonstrates one way in which the tenets of positive behaviour support could be used to meet the challenges of enhancing the academic and social learning of students in secondary school. Positive behaviour support (PBS) is a relatively new concept (and certainly new to New Zealand secondary education) which provides innovative ways in which students at secondary school can be supported and their progress through school sustained at the best possible level. A school-wide approach to developing positive behaviour support involves the integration of ecological assessment, measurable outcomes, data-based decision making, evidence-based practices and development of systems supports for these implementing change. This study centres on the development of a Positive Behaviour Support system in one secondary school. The researcher began this study as a collaborative intervention with class teachers to assist individual students at risk of failure or exclusion from school. What emerged was a wider study to meet the developing needs of the school and the staff and students. The emergent study was conducted in three distinct phases. The (original) individual student investigation was followed by a classroom investigation phase using a case study research approach. The third phase, school development, evolved into the beginning of a community of practice model. This mixed method approach to research uses a combination of qualitative and quantitative data sources to record the experience of this secondary school embarking on a journey of school reform as it moves to a school-wide positive behaviour support approach. This thesis describes the development of three tiers of support in a systemic model. It identifies the constituent elements of each tier and makes suggestions about how other schools could initiate a similar model of support in their own context. The study concludes that it is possible to develop a systemic approach within existing school systems. The result of such a development is improved academic outcomes for students, increased efficacy for teachers and effective processes for student support.</p>