The Impact of Policy Changes, Dedicated Funding and Implementation Support on Early Intervention Programs for Psychosis

Introduction Early intervention services for psychosis (EIS) are associated with improved clinical and economic outcomes. In Quebec, clinicians led the development of EIS from the late 1980s until 2017 when the provincial government announced EIS-specific funding, implementation support and provincial standards. This provides an interesting context to understand the impacts of policy commitments on EIS. Our primary objective was to describe the implementation of EIS three years after this increased political involvement. Methods This cross-sectional descriptive study was conducted in 2020 through a 161-question online survey, modeled after our team's earlier surveys, on the following themes: program characteristics, accessibility, program operations, clinical services, training/supervision, and quality assurance. Descriptive statistics were performed. When relevant, we compared data on programs founded before and after 2017. Results Twenty-eight of 33 existing EIS completed the survey. Between 2016 and 2020, the proportion of Quebec's population having access to EIS rose from 46% to 88%; >1,300 yearly admissions were reported by surveyed EIS, surpassing governments’ epidemiological estimates. Most programs set accessibility targets; adopted inclusive intake criteria and an open referral policy; engaged in education of referral sources. A wide range of biopsychosocial interventions and assertive outreach were offered by interdisciplinary teams. Administrative/organisational components were less widely implemented, such as clinical/administrative data collection, respecting recommended patient-to-case manager ratios and quality assurance. Conclusion Increased governmental implementation support including dedicated funding led to widespread implementation of good-quality, accessible EIS. Though some differences were found between programs founded before and after 2017, there was no overall discernible impact of year of implementation. Persisting challenges to collecting data may impede monitoring, data-informed decision-making, and quality improvement. Maintaining fidelity and meeting provincial standards may prove challenging as programs mature and adapt to their catchment area's specificities and as caseloads increase. Governmental incidence estimates may need recalculation considering recent epidemiological data.

How Can Human Resource Management Help the Theory of Constraints

Now, more companies consider human resource management (HRM) as part of strategic business management. A critical analysis of The Goal: A Process of Ongoing Improvement by Goldratt as it relates to HRM allows for discussion and evaluation of HRM implications. However, does HRM implementation support achieving a companies' strategic objectives? If so, how is it related to The Goal? This report seeks answering these questions by evaluating HRM in the book's context. This article discusses the role of HRM in companies, HRM principals that impact operations, roles of stakeholders and their value in the Theory of Constraints (TOC), HRM and its impact on the TOC, roles of HRM management and leadership, and the relationship between technology and human resources. Discussing these topics, this article provides an overview of HRM's impact on organizations. The main findings indicate that HRM implementation is a strategic management resource to be implemented by any businesses.

The Mechanisms of Implementation Support - Findings from a Systematic Integrative Review

Purpose: Mechanisms of Change (MoC) explain how strategies used to enhance the uptake of evidence in social and human services enable change in the behaviors of individual practitioners, organizational leaders or entire organizations, and systems. One such strategy is the use of implementation support practitioner (ISPs). This study examines the mechanisms through which ISPs facilitate behavior supportive of the implementation of research-supported interventions. Methods: A systematic, integrative review was conducted. The conceptualization of MoCs built on a model by Dalkin and colleagues. Results: Based on a unique combination of knowledge, skills, and attitudes, ISPs install trust in and among their stakeholders and utilize this trust to promote meaningful and relevant learning; provide ongoing opportunities for learning, reflection, and support; help to span boundaries; and positively motivate stakeholders. Discussion: ISPs do not represent a short cut to better implementation. They represent an additional implementation challenge that requires dedicated attention and resources.

Patients’ health outcomes after an implementation intervention targeting the physiotherapists’ clinical behaviour

Background A behavioural medicine approach in physiotherapy has shown positive effects on increased and sustained activities and participation, including reduced sick leave for patients with persistent musculoskeletal pain. The aim of this study was to explore the health outcomes of patients with persistent musculoskeletal pain treated by physiotherapists who had received active compared with passive support when implementing a behavioural medicine approach. Methods An explorative and comparative pre−/post-test trial was conducted. A total of 155 patients with musculoskeletal pain ≥4 weeks were consecutively recruited by physiotherapists in primary healthcare who had received active or passive support when implementing a behavioural medicine approach. Data concerning health outcomes for patients were collected using questionnaires before and after the physiotherapy treatment and at half-, one- and two-year follow-ups. Descriptive, non-parametric and parametric bi- and multivariate statistics were used. Results There were no differences over time between the patients treated by physiotherapists who had received active compared to passive implementation support regarding pain-related disability, pain intensity, self-rated health, self-efficacy in performing daily activities, catastrophic thinking related to pain, and fear of movement. Significant improvements over time were identified in both groups regarding all variables and the effect sizes were large. The percentage of patients on sick leave significantly decreased in the patient group treated by physiotherapists who had received active implementation support. Conclusion It is very important to include patient outcomes when evaluating the implementation of multicomponent interventions. It seems that the implementation method did not play a major role for the patients’ outcomes in this study. Most of the patients’ health outcomes improved regardless of whether they were treated by physiotherapists who had received active or passive support when implementing a behavioural medicine approach. This was likely because the active implementation support was not extensive enough to enable the physiotherapists to sustain the behavioural medicine approach. Trial registration The study protocol was retrospectively registered in ClinicalTrials.gov. ID NCT03118453, March 20, 2017.

EVALUASI PELAKSANAAN SISTEM SURVEILANS HEALTHCARE ACQUIRED INFECTIONS (HAIS) DI RSU HAJI SURABAYA TAHUN 2020

Healthcare Acquired Infections (HAIs) or nosocomial infections are infections that occur in patients during hospitalization. HAIs are classified into 4 namely Catheter-Associated Urinary Tract Infection, Surgical Site Infection, Ventilator-Associated Pneumonia, and Blood Stream Infection. The purpose of this study is to evaluate the implementation of the HAIs surveillance sistem. The research method used is a descriptive evaluation study with an observational research design. The data sources used are the Reports and dissemination of HAIs Surveillance at RSU Haji Surabaya in 2019-2020. The results showed that HAIs cases at RSU Haji Surabaya in 2020 were 0.03%. The problems in the implementation of HAIs surveillance are the accuracy and completeness of data reports, implementation support facilities, and employee participation in training has not been running optimally, application bundle items are under repair, and job rotation for employees. Conclusion : the implementation of HAIs surveillance activities is in accordance the Regulation of the Peraturan Menteri Kesehatan Republik Indonesia Number 27 of 2017 Tentang Pedoman Pencegahan Dan Pengendalian Infeksi di Fasilitas Pelayanan Kesehatan, but the implementation still running unoptimally, researchers recommend the implementation of reward and punishment activities for surveillance officers as a solution to improve the sistem surveillance.

PROMPT Wales project: national scaling of an evidence-based intervention to improve safety and training in maternity

BackgroundIn healthcare, there is increasing recognition of the importance of developing and testing strategies to scale effective interventions. The NHS long-term plan (2019) acknowledges that often a gold standard approach to a problem already exists somewhere within the NHS, however, it has not been replicated widely across the system.MethodsWe describe the approach and process measures for national scaling of PROMPT (Practical Obstetric Multi-Professional Training) across 12 obstetric-led maternity units in Wales. PROMPT is an evidence-based training package for local maternity staff, previously associated with improvements in maternal and neonatal outcomes, reduction in litigation related to preventable harm and improved safety culture. PROMPT has previously been disseminated internationally using a train-the-trainer model. However, this has been associated with variations in uptake, fidelity and impact. In Wales, the project was supported by Welsh Government, and a structured scaling plan was developed, encompassing ongoing implementation support from a multi-professional team.ResultsPROMPT was successfully implemented in all obstetric led units in Wales, with 326 local PROMPT facilitators trained, and 82.5%–100% of maternity staff attended a local PROMPT course in the first 15 months of the project (January 2019–March 2020). All training courses included evidence-based authentic elements, and 93% of courses in the first year (100/107) were supported by a national implementation team, providing coaching, implementation support and quality assurance.ConclusionsAuthentically scaling up complex interventions is a significant challenge. To replicate the improved outcomes demonstrated by PROMPT, intervention reach and fidelity must first be demonstrated.In this national scaling project, our scaling methodology led to the successful implementation of PROMPT across all health boards in Wales. Additionally, we demonstrated reduced variation in adoption, reach, timescale and intervention fidelity between maternity units with varying readiness for change, which had been difficult in two previous large-scale PROMPT implementation projects.