Lessons learned from a pilot implementation of physical activity recommendations in axial spondyloarthritis exercise group therapy

Background The Ankylosing Spondylitis Association of Switzerland (SVMB) aimed to implement physical activity recommendations (PAR) within their exercise groups (EGs). The PAR promote exercise in all fitness dimensions at the correct dose. To implement the PAR within EGs, they were translated into a new EG concept with five key activities: (a) training for supervising physiotherapists (PTs), (b) correctly dosed exercises in all fitness dimensions, (c) exercise counselling, (d) bi-annual fitness assessments, and (e) individual exercise training, in addition to EG. All these activities were realized in close coordination with SVMB management. Objectives To analyse the implementation success by evaluating adherence/fidelity, feasibility, and satisfaction at the patient, PTs, and organisational level. Methods The five key activities of the new EG concept were developed, executed, and assessed after 6 months. The primary outcomes for implementation success were adherence of patients to the recommended exercise behaviour, self-reported by electronic diary; fidelity of PTs to the new concept, self-reported by diary; SVMB organisational changes. Secondary outcomes were feasibility and satisfaction with the new EG concept at all three levels. The tertiary outcome, to evaluate the effectiveness of PAR, was patient fitness, assessed through fitness assessments. Results 30 patients with axSpA (ten women, mean age 58 ± 9 years) and four PTs (three women, mean age 46 ± 9 years) participated. The patients' self-reporting of adherence to the PAR was insufficient (43%), possibly due to technical problems with the electronic dairy. The PTs' fidelity to the new EG concept was satisfactory. On all levels, the new concept was generally perceived as feasible and useful for supporting personalised exercise.The frequency of exercise counselling and the fitness assessments was found by patients and PTs to be too high and rigid. Patients' cardiorespiratory fitness [ES 1.21 (95%CI 0.59, 1.89)] and core strength [ES 0.61 (95%CI 0.18, 1.06)] improved over the 6 months. Conclusions The pilot implementation of PAR showed acceptance and satisfaction to be sufficient, thus confirming the need for evidence-based EGs, provided by a patient organisation in order to support active PA behaviour. However, adaptations are necessary to increase its feasibility for nationwide implementation. Trial Registration: SNCTP, SNCTP000002880. Registered 31 May 2018, https://www.kofam.ch/en/snctp-portal/search/0/study/42491.

A Critical Review of Open Innovation in SMEs: Implementation, Success Factors and Challenges

<p><strong><em>Abstract</em></strong></p><p><em>This literature review explores the Open Innovation of SME companies, their application, success factors, impact, and challenges. The theoretical framework is built starting from the definition, a critical pillar, and Open Innovation in SME companies. The main factor in the Open Innovation process stage is finding innovative ideas and establishing network access with the external environment. Balanced, systematic, and thorough collaboration is the key to this process. Although European scholars have done it quite a lot, the study of literature on Open Innovation in SMEs still could continue to be developed. Several research results were found in studies conducted in developing countries such as China, Taiwan, and Korea, distinguishing them from similar studies in Europe.</em></p><p><strong><em>Keywords:</em></strong><em> <em>innovation; SMEs; technology; entrepreneurship; open innovation</em></em></p>

Practitioners’ views on shared decision-making implementation: A qualitative study

Introduction Shared decision-making (SDM) refers to the collaboration between patients and their healthcare providers to make clinical decisions based on evidence and patient preferences, often supported by patient decision aids (PDAs). This study explored practitioner experiences of SDM in a context where SDM has been successfully implemented. Specifically, we focused on practitioners’ perceptions of SDM as a paradigm, factors influencing implementation success, and outcomes. Methods We used a qualitative approach to examine the experiences and perceptions of 10 Danish practitioners at a cancer hospital experienced in SDM implementation. A semi-structured interview format was used and interviews were audio-recorded and transcribed. Data was analyzed through thematic analysis. Results Prior to SDM implementation, participants had a range of attitudes from skeptical to receptive. Those with more direct long-term contact with patients (such as nurses) were more positive about the need for SDM. We identified four main factors that influenced SDM implementation success: raising awareness of SDM behaviors among clinicians through concrete measurements, supporting the formation of new habits through reinforcement mechanisms, increasing the flexibility of PDA delivery, and strong leadership. According to our participants, these factors were instrumental in overcoming initial skepticism and solidifying new SDM behaviors. Improvements to the clinical process were reported. Sustaining and transferring the knowledge gained to other contexts will require adapting measurement tools. Conclusions Applying SDM in clinical practice represents a major shift in mindset for clinicians. Designing SDM initiatives with an understanding of the underlying behavioral mechanisms may increase the probability of successful and sustained implementation.

A review of the applicability of the Motivations and Abilities (MOTA) framework for assessing the implementation success of water resources management plans and policies

Implementation failure is widely acknowledged as a major impediment to the success of water resource plans and policies, yet there are very few proactive approaches available for analysing potential implementation issues during the planning stage. The Motivations and Abilities (MOTA) framework was established to address this planning stage gap, by offering a multi-stakeholder, multi-level approach to evaluate the implementation feasibility of plans and policies. MOTA is a stepwise process focusing on the relationship between trigger, motivation, and ability. Here we outline the base model of the MOTA framework and review existing MOTA applications in assorted water resource management contexts. From our review we identify the strengths and limitations of the MOTA framework in various institutional implementation and social adoptability contexts. Our findings indicate that the existing MOTA base model framework has been successful in identifying the motivations and abilities of the stakeholders involved in a range of bottom-up water resource planning contexts, and in subsequently providing insight into the types of capacity- or consent-building strategies needed for effective implementation. We propose several complementary add-in applications to complement the base model, which specific applications may benefit from. Specifically, the incorporation of formal context and stakeholder analyses during the problem definition stage (Step 1), could provide a more considered basis for designing the latter steps within the MOTA analyses. In addition, the resolution of the MOTA analyses could be enhanced by developing more nuanced scoring approaches, or by adopting empirically proven ones from well-established published models. Through setting the base model application, additional add-in applications can easily be added to enhance different aspects of the analysis while still maintaining comparability with other MOTA applications. With a robust base model and a suite of add-in applications, there is great potential for the MOTA framework to become a staple tool for optimising implementation success in any water planning and policy-making context.

Lean six sigma through an Australasian lens: project definition, structure and practices

Purpose The purpose of this paper is to investigate how successful lean six sigma (LSS) manifests in the Australasian (Australian and New Zealand) context relative to the context in the USA in terms of LSS project definition, structure and practices. Design/methodology/approach In-depth investigation through case studies – 12 Australian/New Zealand cases and 4 US cases – on the implementation mechanisms of successful LSS initiatives. Findings A significant difference was found between Australasian and US definitions of an LSS project. However, firms in both regions followed similar project selection, initiating and execution practices. LSS reporting structures were found to be well-established in US organizations, but none of the Australasian organizations were found to be equipped with such a structure, although the effectiveness of LSS implementation success remained unaffected. Research limitations/implications Sufficient uniformity of LSS was found across two regions implying its usefulness/generalizability, but the findings are based only on 12 cases. Originality/value The paper provides the groundwork to develop a unique LSS model for Australasian organizations to improve processes in an effective and efficient manner.

The Case of Organizational Innovation Capability and Health Information Technology Implementation Success

Organizational innovation capability is defined as the ability to continuously transform knowledge and ideas into new products, processes and systems for the benefit of an organization and its stakeholders. This study examines the relationship between the innovation capability of healthcare organizations and their ability to successfully implement electronic medical records (EMR), a health information technology (HIT) innovation. Data was collected using a cross-sectional survey and structural equation modeling (SEM) method was used to analyze the data. Results demonstrate that organizational product innovation capability positively affects EMR implementation success. A positive relationship also exists between organizational process innovation capability and EMR implementation success. This study is one of the first to empirically validate the relationship between healthcare organization’s innovation capability and HIT innovation implementation success, in the context of EMRs. Implications of the study for the academic and industry practitioner are discussed.

Process evaluation of an implementation study in dementia care (EIT-4-BPSD): stakeholder perspectives

Background Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care in nursing homes. The Evidence Integration Triangle (EIT)-4-BPSD in nursing homes was a pragmatic Hybrid III trial of an implementation strategy to help staff use evidence-based non-pharmacological interventions to prevent and manage BPSD. This study aimed to describe and explore the stakeholders’ perceptions of the process to implement the EIT-4-BPSD strategy including its utility, and the barriers and facilitators to implementation in real-world settings. Methods EIT-4-BPSD was a multi-layer implementation strategy that engaged nursing home stakeholder groups to define community specific goals towards reducing BPSD over a 12-month period. Stakeholder groups from nursing homes that completed all 12-months of the implementation strategy were invited to participate in this process evaluation study. Qualitative data from focus group transcripts were analyzed using a conventional content analysis. Emerging codes were sorted into categories, then organized in meaningful clusters based on the domains of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Results The EIT-4-BPSD implementation strategy was completed in 21 nursing homes; 93 stakeholders participated in focus groups. Over half of participating nursing homes reported meeting their BPSD goals as expected or more. Challenges, facilitators, and contextual factors reported by stakeholder members explains variability in the implementation of EIT-4-BPSD strategy in 11 key categories: family; staff; organizational; staff, environmental, and resident outcomes; utility of EIT resources; adoption barriers and facilitators; care process adaptations; and future planning. Conclusion Stakeholders offered guidance on salient factors influencing the feasibility and utility of EIT-4-BPSD adoption and implementation to consider in future implementation research that aims to improve behavioral well-being in NH residents living with dementia. Engagement of family and staff at all levels of the organization (Management, leadership, and direct care); and measurement of staff, environmental, and resident outcomes were perceived as critical for future implementation success. While regulations, finances, and competing demands on staff time were perceived as reducing implementation success. Trial Registration The Testing the Implementation of EIT-4-BPSD study was registered in the ClinicalTrials.gov (NCT03014570) January 9, 2017.