Sample records for facilitating submetering implementation

  1. 77 FR 46987 - Utility Allowances Submetering

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-07

    ... Utility Allowances Submetering AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of... amend the utility allowance regulations concerning the low-income housing tax credit. The proposed regulations update the utility allowance regulations to clarify that utility costs paid by a tenant based on...

  2. Hierarchical Object-based Image Analysis approach for classification of sub-meter multispectral imagery in Tanzania

    NASA Astrophysics Data System (ADS)

    Chung, C.; Nagol, J. R.; Tao, X.; Anand, A.; Dempewolf, J.

    2015-12-01

    Increasing agricultural production while at the same time preserving the environment has become a challenging task. There is a need for new approaches for use of multi-scale and multi-source remote sensing data as well as ground based measurements for mapping and monitoring crop and ecosystem state to support decision making by governmental and non-governmental organizations for sustainable agricultural development. High resolution sub-meter imagery plays an important role in such an integrative framework of landscape monitoring. It helps link the ground based data to more easily available coarser resolution data, facilitating calibration and validation of derived remote sensing products. Here we present a hierarchical Object Based Image Analysis (OBIA) approach to classify sub-meter imagery. The primary reason for choosing OBIA is to accommodate pixel sizes smaller than the object or class of interest. Especially in non-homogeneous savannah regions of Tanzania, this is an important concern and the traditional pixel based spectral signature approach often fails. Ortho-rectified, calibrated, pan sharpened 0.5 meter resolution data acquired from DigitalGlobe's WorldView-2 satellite sensor was used for this purpose. Multi-scale hierarchical segmentation was performed using multi-resolution segmentation approach to facilitate the use of texture, neighborhood context, and the relationship between super and sub objects for training and classification. eCognition, a commonly used OBIA software program, was used for this purpose. Both decision tree and random forest approaches for classification were tested. The Kappa index agreement for both algorithms surpassed the 85%. The results demonstrate that using hierarchical OBIA can effectively and accurately discriminate classes at even LCCS-3 legend.

  3. Electricity Submetering on the Cheap: Stick-on Electricity Meters

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Lanzisera, Steven; Lorek, Michael; Pister, Kristofer

    2014-08-17

    We demonstrate a low-cost, 21 x 12 mm prototype Stick-on Electricity Meter (SEM) to replace traditional in-circuit-breaker-panel current and voltage sensors for building submetering. A SEM sensor is installed on the external face of a circuit breaker to generate voltage and current signals. This allows for the computation of real and apparent power as well as capturing harmonics created by non-linear loads. The prototype sensor is built using commercially available components, resulting in a production cost of under $10 per SEM. With no highvoltage install work requiring an electrician, home owners or other individuals can install the system in amore » few minutes with no safety implications. This leads to an installed system cost that is much lower than traditional submetering technology.. Measurement results from lab characterization as well as a real-world residential dwelling installation are presented, verifying the operation of our proposed SEM sensor. The SEM sensor can resolve breaker power levels below 10W, and it can be used to provide data for non-intrusive load monitoring systems at full sample rate.« less

  4. Nissan North America: How Sub-Metering Changed the Way a Plant Does Business

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    None

    2011-06-30

    Case study - For Nissan, sub-metering data now drives decision-making and has empowered plant staff, helped senior leadership understand the bottom-line impact of proposed projects, and produced meaningful energy savings.

  5. Weighing the costs: Implementing the SLMTA programme in Zimbabwe using internal versus external facilitators.

    PubMed

    Shumba, Edwin; Nzombe, Phoebe; Mbinda, Absolom; Simbi, Raiva; Mangwanya, Douglas; Kilmarx, Peter H; Luman, Elizabeth T; Zimuto, Sibongile N

    2014-01-01

    In 2010, the Zimbabwe Ministry of Health and Child Welfare (MoHCW) adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme as a tool for laboratory quality systems strengthening. To evaluate the financial costs of SLMTA implementation using two models (external facilitators; and internal local or MoHCW facilitators) from the perspective of the implementing partner and to estimate resources needed to scale up the programme nationally in all 10 provinces. The average expenditure per laboratory was calculated based on accounting records; calculations included implementing partner expenses but excluded in-kind contributions and salaries of local facilitators and trainees. We also estimated theoretical financial costs, keeping all contextual variables constant across the two models. Resource needs for future national expansion were estimated based on a two-phase implementation plan, in which 12 laboratories in each of five provinces would implement SLMTA per phase; for the internal facilitator model, 20 facilitators would be trained at the beginning of each phase. The average expenditure to implement SLMTA in 11 laboratories using external facilitators was approximately US$5800 per laboratory; expenditure in 19 laboratories using internal facilitators was approximately $6000 per laboratory. The theoretical financial cost of implementing a 12-laboratory SLMTA cohort keeping all contextual variables constant would be approximately $58 000 using external facilitators; or $15 000 using internal facilitators, plus $86 000 to train 20 facilitators. The financial cost for subsequent SLMTA cohorts using the previously-trained internal facilitators would be approximately $15 000, yielding a break-even point of 2 cohorts, at $116 000 for either model. Estimated resources required for national implementation in 120 laboratories would therefore be $580 000 using external facilitators ($58 000 per province) and $322 000 using internal facilitators ($86

  6. Facilitators and Hindrances of Implementing Colorectal Cancer Screening Intervention Among Vietnamese Americans.

    PubMed

    Sin, Mo-Kyung; Yip, Mei-Po; Kimura, Amanda; Tu, Shin-Ping

    Little is published about the factors that facilitate and hinder the intervention implementation process. The aim of this study was to examine factors that facilitated and hindered the implementation of a culturally appropriate colorectal cancer screening intervention targeting Vietnamese Americans in a Federally Qualified Health Center located in the Puget Sound area of Washington. Three focus group discussions (2 during the implementation phase and 1 during the maintenance phase) with the medical assistants (N = 13) who were the intervention implementation agents were conducted at the Federally Qualified Health Center. Three research team members independently analyzed the data using content analysis and then compared for agreement. We reread and recoded the transcripts until consensus was reached. The themes were clustered by similar codes and categorized into 4 groups, each including facilitators and hindrances of implementation: identification of implementation agents, implementation environment, intervention recipients, and the colorectal cancer screening intervention. Facilitators included medical assistants' high motivation with a positive attitude toward the intervention, team approach, and simplicity of the intervention, whereas hindrances included lack of time, forgetfulness, staff turnover, and language barriers. The findings emphasized the importance of supporting implementation agents to ensure effective intervention program implementation. Oncology nurses need to particularly take into consideration the evidence-based findings when planning any intervention programs.

  7. Implementation of integrated dual disorders treatment: a qualitative analysis of facilitators and barriers.

    PubMed

    Brunette, Mary F; Asher, Dianne; Whitley, Rob; Lutz, Wilma J; Wieder, Barbara L; Jones, Amanda M; McHugo, Gregory J

    2008-09-01

    Approximately half of the people who have serious mental illnesses experience a co-occurring substance use disorder at some point in their lifetime. Integrated dual disorders treatment, a program to treat persons with co-occurring disorders, improves outcomes but is not widely available in public mental health settings. This report describes the extent to which this intervention was implemented by 11 community mental health centers participating in a large study of practice implementation. Facilitators and barriers to implementation are described. Trained implementation monitors conducted regular site visits over two years. During visits, monitors interviewed key informants, conducted ethnographic observations of implementation efforts, and assessed fidelity to the practice model. These data were coded and used as a basis for detailed site reports summarizing implementation processes. The authors reviewed the reports and distilled the three top facilitators and barriers for each site. The most prominent cross-site facilitators and barriers were identified. Two sites reached high fidelity, six sites reached moderate fidelity, and three sites remained at low fidelity over the two years. Prominent facilitators and barriers to implementation with moderate to high fidelity were administrative leadership, consultation and training, supervisor mastery and supervision, chronic staff turnover, and finances. Common facilitators and barriers to implementation of integrated dual disorders treatment emerged across sites. The results confirmed the importance of the use of the consultant-trainer in the model of implementation, as well as the need for intensive activities at multiple levels to facilitate implementation. Further research on service implementation is needed, including but not limited to clarifying strategies to overcome barriers.

  8. Facilitating the implementation of clinical technology in healthcare: what role does a national agency play?

    PubMed

    Harvey, Gill; Llewellyn, Sue; Maniatopoulos, Greg; Boyd, Alan; Procter, Rob

    2018-05-10

    Accelerating the implementation of new technology in healthcare is typically complex and multi-faceted. One strategy is to charge a national agency with the responsibility for facilitating implementation. This study examines the role of such an agency in the English National Health Service. In particular, it compares two different facilitation strategies employed by the agency to support the implementation of insulin pump therapy. The research involved an empirical case study of four healthcare organisations receiving different levels of facilitation from the national agency: two received active hands-on facilitation; one was the intended recipient of a more passive, web-based facilitation strategy; the other implemented the technology without any external facilitation. The primary method of data collection was semi-structured qualitative interviews with key individuals involved in implementation. The integrated-PARIHS framework was applied as a conceptual lens to analyse the data. The two sites that received active facilitation from an Implementation Manager in the national agency made positive progress in implementing the technology. In both sites there was a high level of initial receptiveness to implementation. This was similar to a site that had successfully introduced insulin pump therapy without facilitation support from the national agency. By contrast, a site that did not have direct contact with the national agency made little progress with implementation, despite the availability of a web-based implementation resource. Clinicians expressed differences of opinion around the value and effectiveness of the technology and contextual barriers related to funding for implementation persisted. The national agency's intended roll out strategy using passive web-based facilitation appeared to have little impact. When favourable conditions exist, in terms of agreement around the value of the technology, clinician receptiveness and motivation to change, active

  9. [Facilitators and barriers to implementation of intercultural health policy in Chile].

    PubMed

    Pérez, Camila; Nazar, Gabriela; Cova, Félix

    2016-02-01

    Objective To identify elements that either facilitate or hinder implementation of Chile's intercultural health policy. Methods A descriptive study was conducted with the participation of health services users from the Mapuche ethnic group, biomedical health professionals, intercultural facilitators, and key informants in two health facilities serving towns with a high density of Mapuche population. The information was obtained through semi-structured interviews that were analyzed thematically. Results Factors identified as facilitating the implementation of this policy include laws and regulations pertaining to the rights of indigenous peoples, the empowerment of users around their rights, the formation of implementation teams, the presence of professionals of Mapuche origin in health facilities, and the existence of processes for systematization of the work carried out. The asymmetric relationship between the Mapuche people and the state, and between the Mapuche health system and the biomedical model, constitutes a fundamental barrier. Other obstacles include the lack of theoretical and practical clarity around the concept of intercultural health and a lack of resources. Conclusions Despite the facilitators identified and the achievements to date, meaningful progress in implementation of an intercultural health policy is limited by barriers that are hard to change. These include the usual forms of government planning and the hegemony of the biomedical model.

  10. Implementing a novel dance intervention in rehabilitation: perceived barriers and facilitators.

    PubMed

    Demers, Marika; Thomas, Aliki; Wittich, Walter; McKinley, Patricia

    2015-01-01

    To identify clinicians' perceptions regarding the facilitators and barriers to the use of dance in rehabilitation. This study used a qualitative descriptive design. Three focus groups were conducted with clinicians across three purposively selected rehabilitation centers. Data were analyzed using thematic content analysis. Fourteen allied health-care professionals (six occupational therapists, six physical therapists, and two social workers) with previous dance experience participated in this study. Four main themes emerged from the analysis representing the personal and organizational factors influencing on the implementation of dance interventions: (1) Clinician's dance experience and training, (2) Interest and personal beliefs towards using dance as a potential intervention, (3) Support from the organization of the institution, and (4) Available resources. Although each site was different, the main factors acting as barriers and facilitators were similar for all three sites. The identification of the barriers and facilitators to implementing dance in rehabilitation is the first step to support the translation of knowledge about dance. A tailored approach designed for clinicians and managers should address the main barriers to knowledge use about dance, as a potential rehabilitation modality for individuals with disabilities. Personal and organizational factors can act simultaneously as barriers and facilitators to the implementation of a dance intervention. Lack of time for professional development and lack of support from the organization are the main barriers to the uptake of knowledge about dance in rehabilitation. A knowledge translation strategy addressing the barriers to knowledge use is helpful for clinicians and managers facilitating the implementation of dance in rehabilitation settings.

  11. Barriers and facilitators to implementing electronic prescription: a systematic review of user groups' perceptions.

    PubMed

    Gagnon, Marie-Pierre; Nsangou, Édith-Romy; Payne-Gagnon, Julie; Grenier, Sonya; Sicotte, Claude

    2014-01-01

    We conducted a systematic review identifying users groups' perceptions of barriers and facilitators to implementing electronic prescription (e-prescribing) in primary care. We included studies following these criteria: presence of an empirical design, focus on the users' experience of e-prescribing implementation, conducted in primary care, and providing data on barriers and facilitators to e-prescribing implementation. We used the Donabedian logical model of healthcare quality (adapted by Barber et al) to analyze our findings. We found 34 publications (related to 28 individual studies) eligible to be included in this review. These studies identified a total of 594 elements as barriers or facilitators to e-prescribing implementation. Most user groups perceived that e-prescribing was facilitated by design and technical concerns, interoperability, content appropriate for the users, attitude towards e-prescribing, productivity, and available resources. This review highlights the importance of technical and organizational support for the successful implementation of e-prescribing systems. It also shows that the same factor can be seen as a barrier or a facilitator depending on the project's own circumstances. Moreover, a factor can change in nature, from a barrier to a facilitator and vice versa, in the process of e-prescribing implementation. This review summarizes current knowledge on factors related to e-prescribing implementation in primary care that could support decision makers in their design of effective implementation strategies. Finally, future studies should emphasize on the perceptions of other user groups, such as pharmacists, managers, vendors, and patients, who remain neglected in the literature.

  12. Facilitators and barriers of implementing and delivering social prescribing services: a systematic review.

    PubMed

    Pescheny, Julia Vera; Pappas, Yannis; Randhawa, Gurch

    2018-02-07

    Social Prescribing is a service in primary care that involves the referral of patients with non-clinical needs to local services and activities provided by the third sector (community, voluntary, and social enterprise sector). Social Prescribing aims to promote partnership working between the health and the social sector to address the wider determinants of health. To date, there is a weak evidence base for Social Prescribing services. The objective of the review was to identify factors that facilitate and hinder the implementation and delivery of SP services based in general practice involving a navigator. We searched eleven databases, the grey literature, and the reference lists of relevant studies to identify the barriers and facilitators to the implementation and delivery of Social Prescribing services in June and July 2016. Searches were limited to literature written in English. No date restrictions were applied. Findings were synthesised narratively, employing thematic analysis. The Mixed Methods Appraisal Tool Version 2011 was used to evaluate the methodological quality of included studies. Eight studies were included in the review. The synthesis identified a range of factors that facilitate and hinder the implementation and delivery of SP services. Facilitators and barriers were related to: the implementation approach, legal agreements, leadership, management and organisation, staff turnover, staff engagement, relationships and communication between partners and stakeholders, characteristics of general practices, and the local infrastructure. The quality of most included studies was poor and the review identified a lack of published literature on factors that facilitate and hinder the implementation and delivery of Social Prescribing services. The review identified a range of factors that facilitate and hinder the implementation and delivery of Social Prescribing services. Findings of this review provide an insight for commissioners, managers, and providers

  13. Facilitating Elementary Science Teachers' Implementation of Inquiry-Based Science Teaching

    ERIC Educational Resources Information Center

    Qablan, Ahmad M.; DeBaz, Theodora

    2015-01-01

    Preservice science teachers generally feel that the implementation of inquiry-based science teaching is very difficult to manage. This research project aimed at facilitating the implementation of inquiry-based science teaching through the use of several classroom strategies. The evaluation of 15 classroom strategies from 80 preservice elementary…

  14. Determination of GPS orbits to submeter accuracy

    NASA Technical Reports Server (NTRS)

    Bertiger, W. I.; Lichten, S. M.; Katsigris, E. C.

    1988-01-01

    Orbits for satellites of the Global Positioning System (GPS) were determined with submeter accuracy. Tests used to assess orbital accuracy include orbit comparisons from independent data sets, orbit prediction, ground baseline determination, and formal errors. One satellite tracked 8 hours each day shows rms error below 1 m even when predicted more than 3 days outside of a 1-week data arc. Differential tracking of the GPS satellites in high Earth orbit provides a powerful relative positioning capability, even when a relatively small continental U.S. fiducial tracking network is used with less than one-third of the full GPS constellation. To demonstrate this capability, baselines of up to 2000 km in North America were also determined with the GPS orbits. The 2000 km baselines show rms daily repeatability of 0.3 to 2 parts in 10 to the 8th power and agree with very long base interferometry (VLBI) solutions at the level of 1.5 parts in 10 to the 8th power. This GPS demonstration provides an opportunity to test different techniques for high-accuracy orbit determination for high Earth orbiters. The best GPS orbit strategies included data arcs of at least 1 week, process noise models for tropospheric fluctuations, estimation of GPS solar pressure coefficients, and combine processing of GPS carrier phase and pseudorange data. For data arc of 2 weeks, constrained process noise models for GPS dynamic parameters significantly improved the situation.

  15. Conditions That Facilitate the Implementation of Educational Technology Innovations.

    ERIC Educational Resources Information Center

    Ely, Donald P.

    1990-01-01

    Describes eight conditions that facilitate the adoption, implementation, and institutionalization of educational technology innovations and suggests applications to the transfer of portable software. Applications of these conditions involving educational technology in Indonesia, Chile, and Peru are evaluated, and guidelines for successful…

  16. Barriers and Facilitators Affecting Patient Portal Implementation from an Organizational Perspective: Qualitative Study.

    PubMed

    Kooij, Laura; Groen, Wim G; van Harten, Wim H

    2018-05-11

    The number of patient portals is rising, and although portals can have positive effects, their implementation has major impacts on the providing health care institutions. However, little is known about the organizational factors affecting successful implementation. Knowledge of the specific barriers to and facilitators of various stakeholders is likely to be useful for future implementations. The objective of this study was to identify the barriers to and facilitators of patient portal implementation facing various stakeholders within hospital organizations in the Netherlands. Purposive sampling was used to select hospitals of various types. A total of 2 university medical centers, 3 teaching hospitals, and 2 general hospitals were included. For each, 3 stakeholders were interviewed: (1) medical professionals, (2) managers, and (3) information technology employees. In total, 21 semistructured interviews were conducted using the Grol and Wensing model, which describes barriers to and facilitators of change in health care practice at 6 levels: (1) innovation; (2) individual professional; (3) patient; (4) social context; (5) organizational context; and (6) economic and political context. Two researchers independently selected and coded quotes by applying this model using a (deductive) directed content approach. Additional factors related to technical and portal characteristics were added using the model of McGinn et al, developed for implementation of electronic health records. In total, we identified 376 quotes, 26 barriers, and 28 facilitators. Thirteen barriers and 12 facilitators were common for all stakeholder groups. The facilitators' perceived usefulness (especially less paperwork) was mentioned by all the stakeholders, followed by subjects' positive attitude. The main barriers were lack of resources (namely, lack of staff and materials), financial difficulties (especially complying with high costs, lack of reimbursements), and guaranteeing privacy and security

  17. Facilitating large-scale implementation of evidence based health care: insider accounts from a co-operative inquiry.

    PubMed

    Waterman, Heather; Boaden, Ruth; Burey, Lorraine; Howells, Brook; Harvey, Gill; Humphreys, John; Rothwell, Katy; Spence, Michael

    2015-02-13

    Facilitators are known to be influential in the implementation of evidence-based health care (EBHC). However, little evidence exists on what it is that they do to support the implementation process. This research reports on how knowledge transfer associates (KTAs) working as part of the UK National Institute for Health Research 'Collaboration for Leadership in Applied Health Research and Care' for Greater Manchester (GM CLAHRC) facilitated the implementation of EBHC across several commissioning and provider health care agencies. A prospective co-operative inquiry with eight KTAs was carried out comprising of 11 regular group meetings where they reflected critically on their experiences. Twenty interviews were also conducted with other members of the GM CLAHRC Implementation Team to gain their perspectives of the KTAs facilitation role and process. There were four phases to the facilitation of EBHC on a large scale: (1) Assisting with the decision on what EBHC to implement, in this phase, KTAs pulled together people and disparate strands of information to facilitate a decision on which EBHC should be implemented; (2) Planning of the implementation of EBHC, in which KTAs spent time gathering additional information and going between key people to plan the implementation; (3) Coordinating and implementing EBHC when KTAs recruited general practices and people for the implementation of EBHC; and (4) Evaluating the EBHC which required the KTAs to set up (new) systems to gather data for analysis. Over time, the KTAs demonstrated growing confidence and skills in aspects of facilitation: research, interpersonal communication, project management and change management skills. The findings provide prospective empirical data on the large scale implementation of EBHC in primary care and community based organisations focusing on resources and processes involved. Detailed evidence shows facilitation is context dependent and that 'one size does not fits all'. Co-operative inquiry

  18. Barriers and Facilitators Affecting Patient Portal Implementation from an Organizational Perspective: Qualitative Study.

    PubMed Central

    Kooij, Laura; Groen, Wim G

    2018-01-01

    Background The number of patient portals is rising, and although portals can have positive effects, their implementation has major impacts on the providing health care institutions. However, little is known about the organizational factors affecting successful implementation. Knowledge of the specific barriers to and facilitators of various stakeholders is likely to be useful for future implementations. Objective The objective of this study was to identify the barriers to and facilitators of patient portal implementation facing various stakeholders within hospital organizations in the Netherlands. Methods Purposive sampling was used to select hospitals of various types. A total of 2 university medical centers, 3 teaching hospitals, and 2 general hospitals were included. For each, 3 stakeholders were interviewed: (1) medical professionals, (2) managers, and (3) information technology employees. In total, 21 semistructured interviews were conducted using the Grol and Wensing model, which describes barriers to and facilitators of change in health care practice at 6 levels: (1) innovation; (2) individual professional; (3) patient; (4) social context; (5) organizational context; and (6) economic and political context. Two researchers independently selected and coded quotes by applying this model using a (deductive) directed content approach. Additional factors related to technical and portal characteristics were added using the model of McGinn et al, developed for implementation of electronic health records. Results In total, we identified 376 quotes, 26 barriers, and 28 facilitators. Thirteen barriers and 12 facilitators were common for all stakeholder groups. The facilitators’ perceived usefulness (especially less paperwork) was mentioned by all the stakeholders, followed by subjects’ positive attitude. The main barriers were lack of resources (namely, lack of staff and materials), financial difficulties (especially complying with high costs, lack of

  19. Facilitating Ambulatory Electronic Health Record System Implementation: Evidence from a Qualitative Study

    PubMed Central

    Hefner, Jennifer; Robbins, Julie; Huerta, Timothy R.

    2013-01-01

    Background. Ambulatory care practices have increasing interest in leveraging the capabilities of electronic health record (EHR) systems, but little information is available documenting how organizations have successfully implemented these systems. Objective. To characterize elements of successful electronic health record (EHR) system implementation and to synthesize the key informants' perspectives about successful implementation practices. Methods. Key informant interviews and focus groups were conducted with a purposive sample of individuals from US healthcare organizations identified for their success with ambulatory EHR implementation. Rigorous qualitative data analyses used both deductive and inductive methods. Results. Participants identified personal and system-related barriers, at both the individual and organization levels, including poor computer skills, productivity losses, resistance to change, and EHR system failure. Implementation success was reportedly facilitated by careful planning and consistent communication throughout distinct stages of the implementation process. A significant element of successful implementation was an emphasis on optimization, both during “go-live” and, subsequently, when users had more experience with the system. Conclusion. Successful EHR implementation requires both detailed planning and clear mechanisms to deal with unforeseen or unintended consequences. Focusing on user buy-in early and including plans for optimization can facilitate greater success. PMID:24228257

  20. Winter mass balance of Drangajökull ice cap (NW Iceland) derived from satellite sub-meter stereo images

    NASA Astrophysics Data System (ADS)

    Belart, Joaquín M. C.; Berthier, Etienne; Magnússon, Eyjólfur; Anderson, Leif S.; Pálsson, Finnur; Thorsteinsson, Thorsteinn; Howat, Ian M.; Aðalgeirsdóttir, Guðfinna; Jóhannesson, Tómas; Jarosch, Alexander H.

    2017-06-01

    Sub-meter resolution, stereoscopic satellite images allow for the generation of accurate and high-resolution digital elevation models (DEMs) over glaciers and ice caps. Here, repeated stereo images of Drangajökull ice cap (NW Iceland) from Pléiades and WorldView2 (WV2) are combined with in situ estimates of snow density and densification of firn and fresh snow to provide the first estimates of the glacier-wide geodetic winter mass balance obtained from satellite imagery. Statistics in snow- and ice-free areas reveal similar vertical relative accuracy (< 0.5 m) with and without ground control points (GCPs), demonstrating the capability for measuring seasonal snow accumulation. The calculated winter (14 October 2014 to 22 May 2015) mass balance of Drangajökull was 3.33 ± 0.23 m w.e. (meter water equivalent), with ∼ 60 % of the accumulation occurring by February, which is in good agreement with nearby ground observations. On average, the repeated DEMs yield 22 % less elevation change than the length of eight winter snow cores due to (1) the time difference between in situ and satellite observations, (2) firn densification and (3) elevation changes due to ice dynamics. The contributions of these three factors were of similar magnitude. This study demonstrates that seasonal geodetic mass balance can, in many areas, be estimated from sub-meter resolution satellite stereo images.

  1. The facilitators and barriers associated with implementation of a patient-centered medical home in VHA.

    PubMed

    Helfrich, Christian D; Sylling, Philip W; Gale, Randall C; Mohr, David C; Stockdale, Susan E; Joos, Sandra; Brown, Elizabeth J; Grembowski, David; Asch, Steven M; Fihn, Stephan D; Nelson, Karin M; Meredith, Lisa S

    2016-02-24

    The patient-centered medical home (PCMH) is a team-based, comprehensive model of primary care. When effectively implemented, PCMH is associated with higher patient satisfaction, lower staff burnout, and lower hospitalization for ambulatory care-sensitive conditions. However, less is known about what factors contribute to (or hinder) PCMH implementation. We explored the associations of specific facilitators and barriers reported by primary care employees with a previously validated, clinic-level measure of PCMH implementation, the Patient Aligned Care Team Implementation Progress Index (Pi(2)). We used a 2012 survey of primary care employees in the Veterans Health Administration to perform cross-sectional, respondent-level multinomial regressions. The dependent variable was the Pi(2) categorized as high implementation (top decile, 54 clinics, 235 respondents), medium implementation (middle eight deciles, 547 clinics, 4537 respondents), and low implementation (lowest decile, 42 clinics, 297 respondents) among primary care clinics. The independent variables were ordinal survey items rating 19 barriers to patient-centered care and 10 facilitators of PCMH implementation. For facilitators, we explored clinic Pi(2) score decile both as a function of respondent-reported availability of facilitators and of rating of facilitator helpfulness. The availability of five facilitators was associated with higher odds of a respondent's clinic's Pi(2) scores being in the highest versus lowest decile: teamlet huddles (OR = 3.91), measurement tools (OR = 3.47), regular team meetings (OR = 2.88), information systems (OR = 2.42), and disease registries (OR = 2.01). The helpfulness of four facilitators was associated with higher odds of a respondent's clinic's Pi(2) scores being in the highest versus lowest decile. Six barriers were associated with significantly higher odds of a respondent's clinic's Pi(2) scores being in the lowest versus highest decile, with the

  2. Facilitators and Barriers of Implementing a Measurement Feedback System in Public Youth Mental Health.

    PubMed

    Kotte, Amelia; Hill, Kaitlin A; Mah, Albert C; Korathu-Larson, Priya A; Au, Janelle R; Izmirian, Sonia; Keir, Scott S; Nakamura, Brad J; Higa-McMillan, Charmaine K

    2016-11-01

    This study examines implementation facilitators and barriers of a statewide roll-out of a measurement feedback system (MFS) in a youth public mental health system. 76 % of all state care coordinators (N = 47) completed interviews, which were coded via content analysis until saturation. Facilitators (e.g., recognition of the MFS's clinical utility) and barriers (e.g., MFS's reliability and validity) emerged paralleling the Exploration, Adoption/Preparation, Implementation, and Sustainment framework outlined by Aarons et al. (Adm Policy Mental Health Mental Health Serv Res, 38:4-23, 2011). Sustainment efforts may leverage innovation fit, individual adopter, and system related facilitators.

  3. Pharmacists' barriers and facilitators on implementing a post-discharge home visit.

    PubMed

    Ensing, Hendrik T; Koster, Ellen S; Sontoredjo, Timothy A A; van Dooren, Ad A; Bouvy, Marcel L

    Introducing a post-discharge community pharmacist home visit can secure continuity of care and prevent drug-related problems. Currently, this type of pharmaceutical care is not standard practice and implementation is challenging. Mapping the factors influencing the implementation of this new form of care is crucial to ensure successful embedding. To explore which barriers and facilitators influence community pharmacists' adoption of a post-discharge home visit. A mixed methods study was conducted with community pharmacists who had recently participated in a study that evaluated the effectiveness of a post-discharge home visit in identifying drug-related problems. Four focus groups were held guided by a topic guide based on the framework of Greenhalgh et al. After the focus groups, major barriers and facilitators were formulated into statements and presented to all participants in a scoring list to rank for relevance and feasibility in daily practice. Twenty-two of the eligible 26 pharmacists participated in the focus groups. Twenty pharmacists (91%) returned the scoring list containing 21 statements. Most of these statements were perceived as both relevant and feasible by the responding pharmacists. A small number scored high on relevance but low on feasibility, making these potential important barriers to overcome for broad implementation. These were the necessity of dedicated time for performing pharmaceutical care, implementing the home visit in pharmacists' daily routine and an adequate reimbursement fee for the home visit. The key to successful implementation of a post-discharge home visit may lay in two facilitators which are partly interrelated: changing daily routine and reimbursement. Reimbursement will be a strong incentive, but additional efforts will be needed to reprioritize daily routines. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Provider-identified barriers and facilitators to implementing a supported employment program in spinal cord injury.

    PubMed

    Cotner, Bridget A; Ottomanelli, Lisa; O'Connor, Danielle R; Trainor, John K

    2018-06-01

    In a 5-year study, individual placement and support (IPS) significantly increased employment rate of United States Veterans with spinal cord injury (SCI), a historically underemployed population. In a follow-up study, data on barriers and facilitators to IPS implementation were identified. Over 24 months of implementation, 82 key medical and vocational staff underwent semi-structured interviews (n = 130). Interviews were digitally recorded and qualitatively analyzed (ATLAS.ti v0.7) using a constant comparative method to generate themes. Some barriers to implementation occurred throughout the study, such as Veterans' lack of motivation and providers' difficulty integrating vocational and medical rehabilitation. Other barriers emerged at specific stages, for example, early barriers included a large geographic service area and a large patient caseload, and late barriers included need for staff education. Facilitators were mostly constant throughout implementation and included leadership support and successful integration of vocational staff into the medical care team. Implementation strategies need to be adjusted as implementation progresses and matures. The strategies that succeeded in this setting, which were situated in a real-world context of providing IPS as a part of SCI medical care, may inform implementation of IPS for other populations with physical disabilities. Implications for Rehabilitation Key facilitators to IPS in SCI implementation are integrating vocational staff with expertise in IPS and SCI on clinical rehabilitation teams and providing leadership support. Ongoing barriers to IPS in SCI include patient specific and program administration factors such as caseload size and staffing patterns. Varying implementation strategies are needed to address barriers as they arise and facilitate successful implementation.

  5. What Barriers and Facilitators Do School Nurses Experience When Implementing an Obesity Intervention?

    PubMed

    Schroeder, Krista; Smaldone, Arlene

    2017-12-01

    A recent evaluation of a school nurse-led obesity intervention demonstrated a 5% implementation rate. The purpose of this study was to explore school nurses' perceived barriers to and facilitators of the intervention in order to understand reasons for the low implementation rate. Methods included semi-structured individual interviews with school nurses. Data were analyzed using content analysis and heat mapping. Nineteen nurses participated and eight themes were identified. Parental and administrative gatekeeping, heavy nurse workload, obesogenic environments, and concerns about obesity stigma were barriers to implementation. Teamwork with parents and school staff was a key facilitator of implementation. Nurses also noted the importance of cultural considerations and highlighted the need to tailor the intervention to the unique needs of their school environment and student population. These findings suggest that for school nurses to play a key role in school-based obesity interventions, barriers must be identified and addressed prior to program implementation.

  6. Awareness, Facilitators, and Barriers to Policy Implementation Related to Obesity Prevention for Primary School Children in Malaysia.

    PubMed

    Chan, Camelina; Moy, Foong Ming; Lim, Jennifer N W; Dahlui, Maznah

    2018-03-01

    To assess the awareness, facilitators, and barriers to policy implementation related to obesity prevention for primary school children. A cross-sectional study administered using an online questionnaire. Conducted in 447 primary schools in a state in Malaysia. One school administrator from each school served as a participant. The questionnaires consisted of 32 items on awareness, policy implementation, and facilitators and barriers to policy implementation. Descriptive analysis was used to describe the awareness, facilitators, and barriers of policies implementation. Association between schools' characteristics and policy implementation was assessed using logistic regression. The majority (90%) of school administrators were aware of the policies. However, only 50% to 70% of schools had implemented the policies fully. Reported barriers were lack of equipment, insufficient training, and limited time to complete implementation. Facilitators of policy implementation were commitment from the schools, staff members, students, and canteen operators. Policy implementation was comparable in all school types and locality; except the policy on "Food and Drinks sold at the school canteens" was implemented by more rural schools compared to urban schools (odds ratio: 1.74, 95% confidence interval: 1.13-2.69). Majority of the school administrators were aware of the existing policies; however, the implementation was only satisfactory. The identified barriers to policy implementation were modifiable and thus, the stakeholders should consider restrategizing plans in overcoming them.

  7. Implementing healthier foodservice guidelines in hospital and federal worksite cafeterias: barriers, facilitators and keys to success.

    PubMed

    Jilcott Pitts, S B; Graham, J; Mojica, A; Stewart, L; Walter, M; Schille, C; McGinty, J; Pearsall, M; Whitt, O; Mihas, P; Bradley, A; Simon, C

    2016-12-01

    Healthy foodservice guidelines are being implemented in worksites and healthcare facilities to increase access to healthy foods by employees and public populations. However, little is known about the barriers to and facilitators of implementation. The present study aimed to examine barriers to and facilitators of implementation of healthy foodservice guidelines in federal worksite and hospital cafeterias. Using a mixed-methods approach, including a quantitative survey followed by a qualitative, in-depth interview, we examined: (i) barriers to and facilitators of implementation; (ii) behavioural design strategies used to promote healthier foods and beverages; and (iii) how implementation of healthy foodservice guidelines influenced costs and profitability. We used a purposive sample of five hospital and four federal worksite foodservice operators who recently implemented one of two foodservice guidelines: the United States Department of Health and Human Services/General Services Administration Health and Sustainability Guidelines ('Guidelines') in federal worksites or the Partnership for a Healthier America Hospital Healthier Food Initiative ('Initiative') in hospitals. Descriptive statistics were used to analyse quantitative survey data. Qualitative data were analysed using a deductive approach. Implementation facilitators included leadership support, adequate vendor selections and having dietitians assist with implementation. Implementation barriers included inadequate selections from vendors, customer complaints and additional expertise required for menu labelling. Behavioural design strategies used most frequently included icons denoting healthier options, marketing using social media and placement of healthier options in prime locations. Lessons learned can guide subsequent steps for future healthy foodservice guideline implementation in similar settings. © 2016 The British Dietetic Association Ltd.

  8. Barriers, facilitators, and recommendations related to implementing the Baby-Friendly Initiative (BFI): an integrative review.

    PubMed

    Semenic, Sonia; Childerhose, Janet E; Lauzière, Julie; Groleau, Danielle

    2012-08-01

    Despite growing evidence for the positive impact of the Baby-Friendly Initiative (BFI) on breastfeeding outcomes, few studies have investigated the barriers and facilitators to the implementation of Baby-Friendly practices that can be used to improve uptake of the BFI at the local or country levels. This integrative review aimed to identify and synthesize information on the barriers, facilitators, and recommendations related to the BFI from the international, peer-reviewed literature. Thirteen databases were searched using the keywords Baby Friendly, Baby-Friendly Hospital Initiative, BFI, BFHI, Ten Steps, implementation, adoption, barriers, facilitators, and their combinations. A total of 45 English-language articles from 16 different countries met the inclusion criteria for the review. Data analysis was guided by Cooper's five stages of integrative research review. Using a multiple intervention program framework, findings were categorized into sociopolitical, organizational-level, and individual-level barriers and facilitators to implementing the BFI, as well as intra-, inter-, and extraorganizational recommendations for strengthening BFI implementation. A wide variety of obstacles and potential solutions to BFI implementation were identified. Findings suggest some priority issues to address when pursuing Baby-Friendly designation, including the endorsements of both local administrators and governmental policy makers, effective leadership of the practice change process, health care worker training, the marketing influence of formula companies, and integrating hospital and community health services. Framing the BFI as a complex, multilevel, evidence-based change process and using context-focused research implementation models to guide BFI implementation efforts may help identify effective strategies for promoting wider adoption of the BFI in health services.

  9. Barriers and facilitators to the implementation of physical activity policies in schools: A systematic review.

    PubMed

    Nathan, Nicole; Elton, Ben; Babic, Mark; McCarthy, Nicole; Sutherland, Rachel; Presseau, Justin; Seward, Kirsty; Hodder, Rebecca; Booth, Debbie; Yoong, Sze Lin; Wolfenden, Luke

    2018-02-01

    Research consistently indicates that schools fail to implement mandatory physical activity policies. This review aimed to describe factors (barriers and facilitators) that may influence the implementation of school physical activity policies which specify the time or intensity that physical activity should be implemented and to map these factors to a theoretical framework. A systematic search was undertaken in six databases for quantitative or qualitative studies published between 1995-March 2016 that examined teachers', principals' or school administrators' reported barriers and/or facilitators to implementing mandated school physical activity policies. Two independent reviewers screened texts, extracted and coded data from identified articles using the Theoretical Domains Framework (TDF). Of the 10,346 articles identified, 17 studies met the inclusion criteria (8 quantitative, 9 qualitative). Barriers and facilitators identified in qualitative studies covered 9 and 10 TDF domains respectively. Barriers and facilitators reported in quantitative studies covered 8 TDF domains each. The most common domains identified were: 'environmental context and resources' (e.g., availability of equipment, time or staff), 'goals' (e.g., the perceived priority of the policy in the school), 'social influences' (e.g., support from school boards), and 'skills' (e.g., teachers' ability to implement the policy). Implementation support strategies that target these factors may represent promising means to improve implementation of physical activity policies and increase physical activity among school-aged children. Future studies assessing factors that influence school implementation of physical activity policies would benefit from using a comprehensive framework to help identify if any domains have been overlooked in the current literature. This review was prospectively registered with PROSPERO (CRD42016051649) on the 8th December 2016. Copyright © 2017 Elsevier Inc. All rights

  10. Results of a feasibility study: barriers and facilitators in implementing the Sherbrooke model in France.

    PubMed

    Fassier, Jean-Baptiste; Durand, Marie-José; Caillard, Jean-François; Roquelaure, Yves; Loisel, Patrick

    2015-05-01

    Return-to-work interventions associated with the workplace environment are often more effective than conventional care. The Sherbrooke model is an integrated intervention that has proved successful in preventing work disability due to low-back pain. Implementation, however, runs up against many obstacles, and failure has been reported in many countries. The present study sought to identify barriers to and facilitators of the implementation of the Sherbrooke model within the French health system. A multiple case study with nested levels of analysis was performed in two regions of France. A conceptual framework was designed and refined to identify barriers and facilitators at the individual, organizational and contextual levels. Qualitative data were collected via semi-structured interview (N=22), focus groups (N=7), and observation and from the gray literature. Participants (N=61) belonged to three fields: healthcare, social insurance, and the workplace. Numerous barriers and facilitators were identified in each field and at each level, some specific and others common to workers in all fields. Individual and organizational barriers comprised lack of time and resources, discordant professional values, and perceived risk. Legal barriers comprised medical confidentiality, legal complexity, and priority given to primary prevention. Individual-level facilitators comprised needs and perceived benefits. Some organizations had concordant values and practices. Legal facilitators comprised possibilities of collaboration and gradual return to work. The present feasibility analysis of implementing the Sherbrooke model revealed numerous barriers and facilitators suggesting a new implementation strategy be drawn up if failure is to be avoided.

  11. Growing the terrestrial planets from the gradual accumulation of submeter-sized objects.

    PubMed

    Levison, Harold F; Kretke, Katherine A; Walsh, Kevin J; Bottke, William F

    2015-11-17

    Building the terrestrial planets has been a challenge for planet formation models. In particular, classical theories have been unable to reproduce the small mass of Mars and instead predict that a planet near 1.5 astronomical units (AU) should roughly be the same mass as Earth. Recently, a new model called Viscously Stirred Pebble Accretion (VSPA) has been developed that can explain the formation of the gas giants. This model envisions that the cores of the giant planets formed from 100- to 1,000-km bodies that directly accreted a population of pebbles-submeter-sized objects that slowly grew in the protoplanetary disk. Here we apply this model to the terrestrial planet region and find that it can reproduce the basic structure of the inner solar system, including a small Mars and a low-mass asteroid belt. Our models show that for an initial population of planetesimals with sizes similar to those of the main belt asteroids, VSPA becomes inefficient beyond ∼ 1.5 AU. As a result, Mars's growth is stunted, and nothing large in the asteroid belt can accumulate.

  12. User's perspectives of barriers and facilitators to implementing quality colonoscopy services in Canada: a study protocol.

    PubMed

    Jobin, Gilles; Gagnon, Marie Pierre; Candas, Bernard; Dubé, Catherine; Ben Abdeljelil, Anis; Grenier, Sonya

    2010-11-02

    Colorectal cancer (CRC) represents a serious and growing health problem in Canada. Colonoscopy is used for screening and diagnosis of symptomatic or high CRC risk individuals. Although a number of countries are now implementing quality colonoscopy services, knowledge synthesis of barriers and facilitators perceived by healthcare professionals and patients during implementation has not been carried out. In addition, the perspectives of various stakeholders towards the implementation of quality colonoscopy services and the need of an efficient organisation of such services have been reported in the literature but have not been synthesised yet. The present study aims to produce a comprehensive synthesis of actual knowledge on the barriers and facilitators perceived by all stakeholders to the implementation of quality colonoscopy services in Canada. First, we will conduct a comprehensive review of the scientific literature and other published documentation on the barriers and facilitators to implementing quality colonoscopy services. Standardised literature searches and data extraction methods will be used. The quality of the studies and their relevance to informing decisions on colonoscopy services implementation will be assessed. For each group of users identified, barriers and facilitators will be categorised and compiled using narrative synthesis and meta-analytical techniques. The principle factors identified for each group of users will then be validated for its applicability to various Canadian contexts using the Delphi study method. Following this study, a set of strategies will be identified to inform decision makers involved in the implementation of quality colonoscopy services across Canadian jurisdictions. This study will be the first to systematically summarise the barriers and facilitators to implementation of quality colonoscopy services perceived by different groups and to consider the local contexts in order to ensure the applicability of this

  13. What Barriers and Facilitators Do School Nurses Experience When Implementing an Obesity Intervention?

    ERIC Educational Resources Information Center

    Schroeder, Krista; Smaldone, Arlene

    2017-01-01

    A recent evaluation of a school nurse-led obesity intervention demonstrated a 5% implementation rate. The purpose of this study was to explore school nurses' perceived barriers to and facilitators of the intervention in order to understand reasons for the low implementation rate. Methods included semi-structured individual interviews with school…

  14. Barriers and facilitators to implementing continuous quality improvement programs in colonoscopy services: a mixed methods systematic review.

    PubMed

    Candas, Bernard; Jobin, Gilles; Dubé, Catherine; Tousignant, Mario; Abdeljelil, Anis Ben; Grenier, Sonya; Gagnon, Marie-Pierre

    2016-02-01

    Continuous quality improvement (CQI) programs may result in quality of care and outcome improvement. However, the implementation of such programs has proven to be very challenging. This mixed methods systematic review identifies barriers and facilitators pertaining to the implementation of CQI programs in colonoscopy services and how they relate to endoscopists, nurses, managers, and patients. We developed a search strategy adapted to 15 databases. Studies had to report on the implementation of a CQI intervention and identified barriers or facilitators relating to any of the four groups of actors directly concerned by the provision of colonoscopies. The quality of the selected studies was assessed and findings were extracted, categorized, and synthesized using a generic extraction grid customized through an iterative process. We extracted 99 findings from the 15 selected publications. Although involving all actors is the most cited factor, the literature mainly focuses on the facilitators and barriers associated with the endoscopists' perspective. The most reported facilitators to CQI implementation are perception of feasibility, adoption of a formative approach, training and education, confidentiality, and assessing a limited number of quality indicators. Receptive attitudes, a sense of ownership and perceptions of positive impacts also facilitate the implementation. Finally, an organizational environment conducive to quality improvement has to be inclusive of all user groups, explicitly supportive, and provide appropriate resources. Our findings corroborate the current models of adoption of innovations. However, a significant knowledge gap remains with respect to barriers and facilitators pertaining to nurses, patients, and managers.

  15. Vegetation cover in relation to socioeconomic factors in a tropical city assessed from sub-meter resolution imagery.

    PubMed

    Martinuzzi, Sebastián; Ramos-González, Olga M; Muñoz-Erickson, Tischa A; Locke, Dexter H; Lugo, Ariel E; Radeloff, Volker C

    2018-04-01

    Fine-scale information about urban vegetation and social-ecological relationships is crucial to inform both urban planning and ecological research, and high spatial resolution imagery is a valuable tool for assessing urban areas. However, urban ecology and remote sensing have largely focused on cities in temperate zones. Our goal was to characterize urban vegetation cover with sub-meter (<1 m) resolution aerial imagery, and identify social-ecological relationships of urban vegetation patterns in a tropical city, the San Juan Metropolitan Area, Puerto Rico. Our specific objectives were to (1) map vegetation cover using sub-meter spatial resolution (0.3-m) imagery, (2) quantify the amount of residential and non-residential vegetation, and (3) investigate the relationship between patterns of urban vegetation vs. socioeconomic and environmental factors. We found that 61% of the San Juan Metropolitan Area was green and that our combination of high spatial resolution imagery and object-based classification was highly successful for extracting vegetation cover in a moist tropical city (97% accuracy). In addition, simple spatial pattern analysis allowed us to separate residential from non-residential vegetation with 76% accuracy, and patterns of residential and non-residential vegetation varied greatly across the city. Both socioeconomic (e.g., population density, building age, detached homes) and environmental variables (e.g., topography) were important in explaining variations in vegetation cover in our spatial regression models. However, important socioeconomic drivers found in cities in temperate zones, such as income and home value, were not important in San Juan. Climatic and cultural differences between tropical and temperate cities may result in different social-ecological relationships. Our study provides novel information for local land use planners, highlights the value of high spatial resolution remote sensing data to advance ecological research and urban

  16. What are the barriers and facilitators to implementing Collaborative Care for depression? A systematic review.

    PubMed

    Wood, Emily; Ohlsen, Sally; Ricketts, Thomas

    2017-05-01

    Collaborative Care is an evidence-based approach to the management of depression within primary care services recommended within NICE Guidance. However, uptake within the UK has been limited. This review aims to investigate the barriers and facilitators to implementing Collaborative Care. A systematic review of the literature was undertaken to uncover what barriers and facilitators have been reported by previous research into Collaborative Care for depression in primary care. The review identified barriers and facilitators to successful implementation of Collaborative Care for depression in 18 studies across a range of settings. A framework analysis was applied using the Collaborative Care definition. The most commonly reported barriers related to the multi-professional approach, such as staff and organisational attitudes to integration, and poor inter-professional communication. Facilitators to successful implementation particularly focussed on improving inter-professional communication through standardised care pathways and case managers with clear role boundaries and key underpinning personal qualities. Not all papers were independent title and abstract screened by multiple reviewers thus limiting the reliability of the selected studies. There are many different frameworks for assessing the quality of qualitative research and little consensus as to which is most appropriate in what circumstances. The use of a quality threshold led to the exclusion of six papers that could have included further information on barriers and facilitators. Although the evidence base for Collaborative Care is strong, and the population within primary care with depression is large, the preferred way to implement the approach has not been identified. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  17. Barriers and facilitators to implementing continuous quality improvement programs in colonoscopy services: a mixed methods systematic review

    PubMed Central

    Candas, Bernard; Jobin, Gilles; Dubé, Catherine; Tousignant, Mario; Abdeljelil, Anis Ben; Grenier, Sonya; Gagnon, Marie-Pierre

    2016-01-01

    Background and aim: Continuous quality improvement (CQI) programs may result in quality of care and outcome improvement. However, the implementation of such programs has proven to be very challenging. This mixed methods systematic review identifies barriers and facilitators pertaining to the implementation of CQI programs in colonoscopy services and how they relate to endoscopists, nurses, managers, and patients. Methods: We developed a search strategy adapted to 15 databases. Studies had to report on the implementation of a CQI intervention and identified barriers or facilitators relating to any of the four groups of actors directly concerned by the provision of colonoscopies. The quality of the selected studies was assessed and findings were extracted, categorized, and synthesized using a generic extraction grid customized through an iterative process. Results: We extracted 99 findings from the 15 selected publications. Although involving all actors is the most cited factor, the literature mainly focuses on the facilitators and barriers associated with the endoscopists’ perspective. The most reported facilitators to CQI implementation are perception of feasibility, adoption of a formative approach, training and education, confidentiality, and assessing a limited number of quality indicators. Receptive attitudes, a sense of ownership and perceptions of positive impacts also facilitate the implementation. Finally, an organizational environment conducive to quality improvement has to be inclusive of all user groups, explicitly supportive, and provide appropriate resources. Conclusion: Our findings corroborate the current models of adoption of innovations. However, a significant knowledge gap remains with respect to barriers and facilitators pertaining to nurses, patients, and managers. PMID:26878037

  18. Identifying the challenges and facilitators of implementing a COPD care bundle.

    PubMed

    Lennox, Laura; Green, Stuart; Howe, Cathy; Musgrave, Hannah; Bell, Derek; Elkin, Sarah

    2014-01-01

    Care bundles have been shown to improve outcomes, reduce hospital readmissions and reduce length of hospital stay; therefore increasing the speed of uptake and delivery of care bundles should be a priority in order to deliver more timely improvements and consistent high-quality care. Previous studies have detailed the difficulties of obtaining full compliance to bundle elements but few have described the underlying reasons for this. In order to improve future implementation this paper investigates the challenges encountered by clinical teams implementing a chronic obstructive pulmonary disease (COPD) care bundle and describes actions taken to overcome these challenges. An initial retrospective documentary analysis of data from seven clinical implementation teams was undertaken to review the challenges faced by the clinical teams. Three focus groups with healthcare professionals and managers explored solutions to these challenges developed during the project. Documentary analysis identified 28 challenges which directly impacted implementation of the COPD care bundle within five themes; staffing, infrastructure, process, use of improvement methodology and patient and public involvement. Focus groups revealed that the five most significant challenges for all groups were: staff too busy, staff shortages, lack of staff engagement, added workload of the bundle and patient coding issues. The participants shared facilitating factors used to overcome issues including: shifting perceptions to improve engagement, further education sessions to increase staff participation and gaining buy-in from managers through payment frameworks. Maximising the impact of a care bundle relies on its successful and timely implementation. Teams implementing the COPD care bundle encountered challenges that were common to all teams and sites. Understanding and learning from the challenges faced by previous endeavours and identifying the facilitators to overcoming these barriers provides an

  19. Identifying the challenges and facilitators of implementing a COPD care bundle

    PubMed Central

    Lennox, Laura; Green, Stuart; Howe, Cathy; Musgrave, Hannah; Bell, Derek; Elkin, Sarah

    2014-01-01

    Background Care bundles have been shown to improve outcomes, reduce hospital readmissions and reduce length of hospital stay; therefore increasing the speed of uptake and delivery of care bundles should be a priority in order to deliver more timely improvements and consistent high-quality care. Previous studies have detailed the difficulties of obtaining full compliance to bundle elements but few have described the underlying reasons for this. In order to improve future implementation this paper investigates the challenges encountered by clinical teams implementing a chronic obstructive pulmonary disease (COPD) care bundle and describes actions taken to overcome these challenges. Methods An initial retrospective documentary analysis of data from seven clinical implementation teams was undertaken to review the challenges faced by the clinical teams. Three focus groups with healthcare professionals and managers explored solutions to these challenges developed during the project. Results Documentary analysis identified 28 challenges which directly impacted implementation of the COPD care bundle within five themes; staffing, infrastructure, process, use of improvement methodology and patient and public involvement. Focus groups revealed that the five most significant challenges for all groups were: staff too busy, staff shortages, lack of staff engagement, added workload of the bundle and patient coding issues. The participants shared facilitating factors used to overcome issues including: shifting perceptions to improve engagement, further education sessions to increase staff participation and gaining buy-in from managers through payment frameworks. Conclusions Maximising the impact of a care bundle relies on its successful and timely implementation. Teams implementing the COPD care bundle encountered challenges that were common to all teams and sites. Understanding and learning from the challenges faced by previous endeavours and identifying the facilitators to

  20. Facilitators and Barriers to Implementing Clinical Governance: A Qualitative Study among Senior Managers in Iran.

    PubMed

    Ravaghi, Hamid; Rafiei, Sima; Heidarpour, Peigham; Mohseni, Maryam

    2014-09-01

    Health care systems should assign quality improvement as their main mission. Clinical governance (CG) is a key strategy to improve quality of health care services. The Iranian Ministry of Health and Medical Education (MOHME) has promoted CG as a framework for safeguarding quality and safety in all hospitals since 2009. The purpose of this study was to explore perceived facilitators and barriers to implementing CG by deputies for curative affairs of Iranian medical universities. A qualitative study was conducted using face to face interviews with a purposeful sample of 43 deputies for curative affairs of Iranian Medical Universities and documents review. Thematic analysis was used to analyze the data. Five themes were explored including: knowledge and attitude toward CG, culture, organizational factors, managerial factors and barriers. The main perceived facilitating factors were adequate knowledge and positive attitude toward CG, supporting culture, managers' commitment, effective communication and well designed incentives. Pe rceived barriers were the reverse of facilitators noted above in addition to insufficient resources, legal challenges, workload and parallel quality programs. Successful implementation of CG in Iran will require identifying barriers and challenges existing in the way of CG implementation and try to mitigate them by using appropriate facilitators.

  1. Barriers and facilitators in the implementation of recommendations for hand eczema prevention among healthcare workers.

    PubMed

    van der Meer, Esther W C; van der Gulden, Joost W J; van Dongen, Diana; Boot, Cécile R L; Anema, Johannes R

    2015-05-01

    Evidence-based recommendations are available for the prevention of hand eczema among healthcare workers. However, the implementation of these recommendations is not always successful. To identify barriers and facilitators in the implementation of recommendations for the prevention of hand eczema among healthcare workers alongside a randomized controlled trial. A qualitative study was performed in which 19 healthcare workers were interviewed. The interview transcripts were open coded and also coded by means of a template by two researchers to identify relevant barriers and facilitators. Most barriers and facilitators reported for the recommendations were found at the level of the innovation (e.g. the recommendations), whereas for the guideline as a whole, multiple levels (socio-political, organization, user, and facilities) were identified. To enhance the implementation of recommendations for the prevention of hand eczema in a healthcare setting, having knowledge about these recommendations seems to be an important first step. In addition, maintaining the attention of the subject, testing the products beforehand and close collaboration with the infection control department might enhance implementation. Furthermore, it is important that the recommendations fit in with the work of the healthcare workers. When the implementation of the recommendations is prepared, these points should be taken into account. © 2015 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.

  2. How to implement quality indicators successfully in palliative care services: perceptions of team members about facilitators of and barriers to implementation.

    PubMed

    Leemans, Kathleen; Van den Block, Lieve; Vander Stichele, Robert; Francke, Anneke L; Deliens, Luc; Cohen, Joachim

    2015-12-01

    There is an increasing demand for the use of quality indicators in palliative care. With previous research about implementation in this field lacking, we aimed to evaluate the barriers to and facilitators of implementation. Three focus group interviews were organized with 21 caregivers from 18 different specialized palliative care services in Belgium. Four had already worked with the indicators during a pilot study. The focus group discussions were transcribed verbatim and analyzed using the thematic framework approach. The caregivers anticipated that a positive attitude by the team towards quality improvement, the presence of a good leader, and the possible link between quality indicators and reimbursement might facilitate the implementation of quality indicators in specialized palliative care services. Other facilitators concerned the presence of a need to demonstrate quality of care, to perform improvement actions, and to learn from other caregivers and services in the field. A negative attitude by caregivers towards quality measurement and a lack of skills, time, and staff were mentioned as barriers to successful implementation. Palliative caregivers anticipate a number of opportunities and problems when implementing quality indicators. These relate to the attitudes of the team regarding quality measurement; the attitudes, knowledge, and skills of the individual caregivers within the team; and the organizational context and the economic and political context. Training in the advantages of quality indicators and how to use them is indispensable, as are structural changes in the policy concerning palliative care, in order to progress towards systematic quality monitoring.

  3. Implementing a WIC-Based Intervention to Promote Exclusive Breastfeeding: Challenges, Facilitators, and Adaptive Strategies.

    PubMed

    Eldridge, Johanna D; Hartnett, Josette O; Lee, Furrina F; Sekhobo, Jackson P; Edmunds, Lynn S

    Understand factors that contributed to the implementation of a successful multicomponent intervention to promote exclusive breastfeeding (EBF) within Special Supplemental Nutrition Program for Woman, Infants, and Children (WIC) clinics. Qualitative study of staff implementers' experiences using implementation status reports, facilitated group discussion immediately after implementation, and WIC administrative data. WIC staff from 12 clinics participated in an EBF Learning Community composed of 8 intervention trainings and ongoing support from trainers and peers. A total of 47 WIC staff including 11 directors, 20 other administrators, 8 nutritionists, and 6 peer counselors. A WIC-integrated EBF promotion initiative, supported through a Learning Community, composed of prenatal screening, tailored trimester-specific counseling, and timely postpartum follow-up. Challenges and facilitators to implementation within clinics. Iterative qualitative analysis using directed, emergent, and thematic coding. Implementation experiences were characterized by (1) perceived benefits of implementation, including improved EBF knowledge and counseling confidence among staff; and (2) managing implementation, including responding to challenges posed by clinic settings (resources, routine practices, values, and perceptions of mothers) through strategies such as adapting clinic practices and intervention components. Implementation was shaped by clinic setting and adaptive strategies. Future WIC interventions may benefit from formal consideration of intervention fit with local clinic setting and allowable adaptations. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  4. Growing the terrestrial planets from the gradual accumulation of submeter-sized objects

    PubMed Central

    Levison, Harold F.; Kretke, Katherine A.; Walsh, Kevin J.; Bottke, William F.

    2015-01-01

    Building the terrestrial planets has been a challenge for planet formation models. In particular, classical theories have been unable to reproduce the small mass of Mars and instead predict that a planet near 1.5 astronomical units (AU) should roughly be the same mass as Earth. Recently, a new model called Viscously Stirred Pebble Accretion (VSPA) has been developed that can explain the formation of the gas giants. This model envisions that the cores of the giant planets formed from 100- to 1,000-km bodies that directly accreted a population of pebbles—submeter-sized objects that slowly grew in the protoplanetary disk. Here we apply this model to the terrestrial planet region and find that it can reproduce the basic structure of the inner solar system, including a small Mars and a low-mass asteroid belt. Our models show that for an initial population of planetesimals with sizes similar to those of the main belt asteroids, VSPA becomes inefficient beyond ∼ 1.5 AU. As a result, Mars’s growth is stunted, and nothing large in the asteroid belt can accumulate. PMID:26512109

  5. Facilitators and barriers experienced by federal cross-sector partners during the implementation of a healthy eating campaign.

    PubMed

    Fernandez, Melissa Anne; Desroches, Sophie; Marquis, Marie; Turcotte, Mylène; Provencher, Véronique

    2017-09-01

    To identify facilitators and barriers that Health Canada's (HC) cross-sector partners experienced while implementing the Eat Well Campaign: Food Skills (EWC; 2013-2014) and describe how these experiences might differ according to distinct partner types. A qualitative study using hour-long semi-structured telephone interviews conducted with HC partners that were transcribed verbatim. Facilitators and barriers were identified inductively and analysed according partner types. Implementation of a national mass-media health education campaign. Twenty-one of HC's cross-sector partners (food retailers, media and health organizations) engaged in the EWC. Facilitators and barriers were grouped into seven major themes: operational elements, intervention factors, resources, collaborator traits, developer traits, partnership factors and target population factors. Four of these themes had dual roles as both facilitators and barriers (intervention factors, resources, collaborator traits and developer traits). Sub-themes identified as both facilitators and barriers illustrate the extent to which a facilitator can easily become a barrier. Partnership factors were unique facilitators, while operational and target population factors were unique barriers. Time was a barrier that was common to almost all partners regardless of partnership type. There appeared to be a greater degree of uniformity among facilitators, whereas barriers were more diverse and unique to the realities of specific types of partner. Collaborative planning will help public health organizations anticipate barriers unique to the realities of specific types of organizations. It will also prevent facilitators from becoming barriers. Advanced planning will help organizations manage time constraints and integrate activities, facilitating implementation.

  6. Relative Ranking of Conditions that Facilitate Innovation Implementation in the USA

    ERIC Educational Resources Information Center

    Ensminger, David C.; Surry, Daniel W,

    2008-01-01

    This study compared how people working in three different types of organisations in the United States (K-12 schools, higher education, and business) rank the importance of eight conditions that have been shown to facilitate the implementation of innovations. The study also sought to determine if the nature of the innovation (i.e., technology or…

  7. Physically active academic lessons: acceptance, barriers and facilitators for implementation.

    PubMed

    Dyrstad, Sindre M; Kvalø, Silje E; Alstveit, Marianne; Skage, Ingrid

    2018-03-06

    To improve health and academic learning in schoolchildren, the Active School programme in Stavanger, Norway has introduced physically active academic lessons. This is a teaching method combining physical activity with academic content. The purpose of this paper was to evaluate the response to the physically active lessons and identify facilitators and barriers for implementation of such an intervention. Five school leaders (principals or vice-principals), 13 teachers and 30 children from the five intervention schools were interviewed about their experiences with the 10-month intervention, which consisted of weekly minimum 2 × 45 minutes of physically active academic lessons, and the factors affecting its implementation. All interviews were transcribed and analysed using the qualitative data analysis program NVivo 10 (QSR international, London, UK). In addition, weekly teacher's intervention delivery logs were collected and analysed. On average, the physically active academic lessons in 18 of the 34 weeks (53%) were reported in the teacher logs. The number of delivered physically active academic lessons covered 73% of the schools' planned activity. Physically active lessons were well received among school leaders, teachers and children. The main facilitators for implementation of the physically active lessons were active leadership and teacher support, high self-efficacy regarding mastering the intervention, ease of organizing physically active lessons, inclusion of physically active lessons into the lesson curricula, and children's positive reception of the intervention. The main barriers were unclear expectations, lack of knowledge and time to plan the physiclly active lessons, and the length of the physically active lessons (15-20 min lessons were preferred over the 45 min lessons). Physically active academic lessons were considered an appropriate pedagogical method for creating positive variation, and were highly appreciated among both teachers and

  8. Facilitators and Barriers to Implementing Clinical Governance: A Qualitative Study among Senior Managers in Iran

    PubMed Central

    RAVAGHI, Hamid; RAFIEI, Sima; HEIDARPOUR, Peigham; MOHSENI, Maryam

    2014-01-01

    Abstract Background Health care systems should assign quality improvement as their main mission. Clinical governance (CG) is a key strategy to improve quality of health care services. The Iranian Ministry of Health and Medical Education (MOHME) has promoted CG as a framework for safeguarding quality and safety in all hospitals since 2009. The purpose of this study was to explore perceived facilitators and barriers to implementing CG by deputies for curative affairs of Iranian medical universities. Methods A qualitative study was conducted using face to face interviews with a purposeful sample of 43 deputies for curative affairs of Iranian Medical Universities and documents review. Thematic analysis was used to analyze the data Results Five themes were explored including: knowledge and attitude toward CG, culture, organizational factors, managerial factors and barriers. The main perceived facilitating factors were adequate knowledge and positive attitude toward CG, supporting culture, managers’ commitment, effective communication and well designed incentives. Pe rceived barriers were the reverse of facilitators noted above in addition to insufficient resources, legal challenges, workload and parallel quality programs. Conclusions Successful implementation of CG in Iran will require identifying barriers and challenges existing in the way of CG implementation and try to mitigate them by using appropriate facilitators. PMID:26175981

  9. Facilitators and barriers of implementing the chronic care model in primary care: a systematic review.

    PubMed

    Kadu, Mudathira K; Stolee, Paul

    2015-02-06

    The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. The purpose of this review is to synthesize findings of studies that implemented the CCM in primary care, in order to identify facilitators and barriers encountered during implementation. This study identified English-language, peer-reviewed research articles, describing the CCM in primary care settings. Searches were performed in three data bases: Web of Knowledge, Pubmed and Scopus. Article abstracts and titles were read based on whether they met the following inclusion criteria: 1) studies published after 2003 that described or evaluated the implementation of the CCM; 2) the care setting was primary care; 3) the target population of the study was adults over the age of 18 with chronic conditions. Studies were categorized by reference, study design and methods, participants and setting, study objective, CCM components used, and description of the intervention. The next stage of data abstraction involved qualitative analysis of cited barriers and facilitators using the Consolidating Framework for Research Implementation. This review identified barriers and facilitators of implementation across various primary care settings in 22 studies. The major emerging themes were those related to the inner setting of the organization, the process of implementation and characteristics of the individual healthcare providers. These included: organizational culture, its structural characteristics, networks and communication, implementation climate and readiness, presence of supportive leadership, and provider attitudes and beliefs. These findings highlight the importance of assessing organizational capacity and needs prior

  10. Investigating the complementary value of discrete choice experiments for the evaluation of barriers and facilitators in implementation research: a questionnaire survey

    PubMed Central

    van Helvoort-Postulart, Debby; van der Weijden, Trudy; Dellaert, Benedict GC; de Kok, Mascha; von Meyenfeldt, Maarten F; Dirksen, Carmen D

    2009-01-01

    Background The potential barriers and facilitators to change should guide the choice of implementation strategy. Implementation researchers believe that existing methods for the evaluation of potential barriers and facilitators are not satisfactory. Discrete choice experiments (DCE) are relatively new in the health care sector to investigate preferences, and may be of value in the field of implementation research. The objective of our study was to investigate the complementary value of DCE for the evaluation of barriers and facilitators in implementation research. Methods Clinical subject was the implementation of the guideline for breast cancer surgery in day care. We identified 17 potential barriers and facilitators to the implementation of this guideline. We used a traditional questionnaire that was made up of statements about the potential barriers and facilitators. Respondents answered 17 statements on a five-point scale ranging from one (fully disagree) to five (fully agree). The potential barriers and facilitators were included in the DCE as decision attributes. Data were gathered among anaesthesiologists, surgical oncologists, and breast care nurses by means of a paper-and-pencil questionnaire. Results The overall response was 10%. The most striking finding was that the responses to the traditional questionnaire hardly differentiated between barriers. Forty-seven percent of the respondents thought that DCE is an inappropriate method. These respondents considered DCE too difficult and too time-consuming. Unlike the traditional questionnaire, the results of a DCE provide implementation researchers and clinicians with a relative attribute importance ranking that can be used to prioritize potential barriers and facilitators to change, and hence to better fine-tune the implementation strategies to the specific problems and challenges of a particular implementation process. Conclusion The results of our DCE and traditional questionnaire would probably lead to

  11. Processes, barriers and facilitators to implementation of a participatory ergonomics program among eldercare workers.

    PubMed

    Rasmussen, Charlotte Diana Nørregaard; Lindberg, Naja Klærke; Ravn, Marie Højbjerg; Jørgensen, Marie Birk; Søgaard, Karen; Holtermann, Andreas

    2017-01-01

    This study aimed to investigate the processes of a participatory ergonomics program among 594 eldercare workers with emphasis on identified risk factors for low back pain and solutions, and reveal barriers and facilitators for implementation. Sixty-nine per cent of the identified risk factors were physical ergonomic, 24% were organisational and 7% were psychosocial risk factors. Most solutions were organisational (55%), followed by physical (43%) and psychosocial solutions (2%). Internal factors (e.g. team or management) constituted 47% of the barriers and 75% of the facilitators. External factors (e.g. time, financial resources, collaboration with resident or relatives) constituted 53% of the barriers and 25% of the facilitators. This study revealed the processes and implementation of a participatory ergonomics program among eldercare workers. The findings can be transferred to workers, workplaces, health and safety professionals, and researchers to improve future participatory ergonomics programs. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. Identification and visualisation of possible ancient ocean shoreline on Mars using submeter-resolution Digital Terrain Models

    NASA Astrophysics Data System (ADS)

    Świąder, Andrzej

    2014-12-01

    Digital Terrain Models (DTMs) produced from stereoscopic, submeter-resolution High Resolution Imaging Science Experiment (HiRISE) imagery provide a solid basis for all morphometric analyses of the surface of Mars. In view of the fact that a more effective use of DTMs is hindered by complicated and time-consuming manual handling, the automated process provided by specialists of the Ames Intelligent Robotics Group (NASA), Ames Stereo Pipeline, constitutes a good alternative. Four DTMs, covering the global dichotomy boundary between the southern highlands and northern lowlands along the line of the presumable Arabia shoreline, were produced and analysed. One of them included forms that are likely to be indicative of an oceanic basin that extended across the lowland northern hemisphere of Mars in the geological past. The high resolution DTMs obtained were used in the process of landscape visualisation.

  13. Perspectives of health care professionals on the facilitators and barriers to the implementation of a stroke rehabilitation guidelines cluster randomized controlled trial.

    PubMed

    Munce, Sarah E P; Graham, Ian D; Salbach, Nancy M; Jaglal, Susan B; Richards, Carol L; Eng, Janice J; Desrosiers, Johanne; MacKay-Lyons, Marilyn; Wood-Dauphinee, Sharon; Korner-Bitensky, Nicol; Mayo, Nancy E; Teasell, Robert W; Zwarenstein, Merrick; Mokry, Jennifer; Black, Sandra; Bayley, Mark T

    2017-06-26

    The Stroke Canada Optimization of Rehabilitation by Evidence Implementation Trial (SCORE-IT) was a cluster randomized controlled trial that evaluated two knowledge translation (KT) interventions for the promotion of the uptake of best practice recommendations for interventions targeting upper and lower extremity function, postural control, and mobility. Twenty rehabilitation centers across Canada were randomly assigned to either the facilitated or passive KT intervention. The objective of the current study was to understand the factors influencing the implementation of the recommended treatments and KT interventions from the perspective of nurses, occupational therapists and physical therapists, and clinical managers following completion of the trial. A qualitative descriptive approach involving focus groups was used. Thematic analysis was used to understand the factors influencing the implementation of the recommended treatments and KT interventions. The Clinical Practice Guidelines Framework for Improvement guided the analysis. Thirty-three participants were interviewed from 11 of the 20 study sites (6 sites from the facilitated KT arm and 5 sites from the passive KT arm). The following factors influencing the implementation of the recommended treatments and KT interventions emerged: facilitation, agreement with the intervention - practical, familiarity with the recommended treatments, and environmental factors, including time and resources. Each of these themes includes the sub-themes of facilitator and/or barrier. Improved team communication and interdisciplinary collaboration emerged as an unintended outcome of the trial across both arms in addition to a facilitator to the implementation of the treatment recommendations. Facilitation was identified as a facilitator to implementation of the KT interventions in the passive KT intervention arm despite the lack of formally instituted facilitators in this arm of the trial. This is one of the first studies to

  14. Exploring the barriers to and facilitators of implementing research into practice.

    PubMed

    Johnston, Bridget; Coole, Carol; Narayanasamy, Melanie; Feakes, Ruth; Whitworth, Gillian; Tyrell, Tracy; Hardy, Beth

    2016-08-02

    District and community nursing roles have changed rapidly in recent years. Community nurses are increasingly being tasked with carrying out multiple roles, which require them to put research into practice and use evidence-based tools and interventions. The implementation of interventions and tools needs to be developed from empirical research, requiring evidence, to be translated into practice. However, this process may be compromised or enhanced by a number of factors. This exploratory, descriptive qualitative study sought to identify barriers and facilitators to community nurses implementing research into practice. Four focus groups were conducted with registered community nurses and district nurses (n=22). Analysis identified four main themes: keeping up to date with evidence; using a clinical tool; education/training and implementation. Findings suggest that there are barriers at a personal, professional and organisational level. Strategies are suggested to overcome these obstacles.

  15. Perceived barriers to and facilitators of the implementation of priority clinical preventive services guidelines.

    PubMed

    Ayres, Cynthia G; Griffith, Hurdis M

    2007-03-01

    To obtain feedback from contracted health plan (HP) clinicians responsible for implementing preventive services regarding an established set of priority guidelines identified by a coalition of medical directors and to identify barriers to and facilitators of the implementation of these priority guidelines in clinician practice. Qualitative design using a focus group approach. Three focus group meetings among contracted HP clinicians were conducted in New Jersey in 3 geographic regions (northern, central, and southern New Jersey). Clinicians directly involved in delivering preventive services to pediatric, adult, and geriatric patients participated. Barriers to guideline implementation were identified by the clinicians regarding payment and cost, time, legal issues, inconsistency among HP tools, tracking, a lack of internalization, and the patient-clinician relationship. In addition, facilitators of guideline implementation, including HP support, patient materials, clinician awareness, and tool consistency, were identified. Clinicians' perceived barriers to guideline implementation are in themselves a barrier to the delivery of preventive care services. If clinicians perceive barriers to implementing priority recommendations, they may be unlikely to make the conscious effort to deliver preventive care. There needs to be better dialogue between HPs and contracted clinicians to minimize the perceptions of barriers and to increase clinician awareness of and sensitivity to preventive care for priority implementation. To improve the delivery of preventive services in clinician practice, competing HPs must communicate in a single voice with contracted clinicians in the area of preventive care.

  16. Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program.

    PubMed

    Tappen, Ruth M; Wolf, David G; Rahemi, Zahra; Engstrom, Gabriella; Rojido, Carolina; Shutes, Jill M; Ouslander, Joseph G

    Implementation of major organizational change initiatives presents a challenge for long-term care leadership. Implementation of the INTERACT® (Interventions to Reduce Acute Care Transfers) quality improvement program, designed to improve the management of acute changes in condition and reduce unnecessary emergency department visits and hospitalizations of nursing home residents, serves as an example to illustrate the facilitators and barriers to major change in long-term care. As part of a larger study of the impact of INTERACT® on rates of emergency department visits and hospitalizations, staff of 71 nursing homes were called monthly to follow-up on their progress and discuss successful facilitating strategies and any challenges and barriers they encountered during the yearlong implementation period. Themes related to barriers and facilitators were identified. Six major barriers to implementation were identified: the magnitude and complexity of the change (35%), instability of facility leadership (27%), competing demands (40%), stakeholder resistance (49%), scarce resources (86%), and technical problems (31%). Six facilitating strategies were also reported: organization-wide involvement (68%), leadership support (41%), use of administrative authority (14%), adequate training (66%), persistence and oversight on the part of the champion (73%), and unfolding positive results (14%). Successful introduction of a complex change such as the INTERACT® quality improvement program in a long-term care facility requires attention to the facilitators and barriers identified in this report from those at the frontline.

  17. Barriers and Facilitators to Implementing the HEADS-ED: A Rapid Screening Tool for Pediatric Patients in Emergency Departments.

    PubMed

    MacWilliams, Kate; Curran, Janet; Racek, Jakub; Cloutier, Paula; Cappelli, Mario

    2017-12-01

    This study sought to identify barriers and facilitators to the implementation of the HEADS-ED, a screening tool appropriate for use in the emergency department (ED) that facilitates standardized assessments, discharge planning, charting, and linking pediatric mental health patients to appropriate community resources. A qualitative theory-based design was used to identify barriers and facilitators to implementing the HEADS-ED tool. Focus groups were conducted with participants recruited from 6 different ED settings across 2 provinces (Ontario and Nova Scotia). The Theoretical Domains Framework was used as a conceptual framework to guide data collection and to identify themes from focus group discussions. The following themes spanning 12 domains were identified as reflective of participants' beliefs about the barriers and facilitators to implementing the HEADS-ED tool: knowledge, skills, beliefs about capabilities, social professional role and identity, optimism, beliefs about consequences, reinforcement, environmental context and resources, social influences, emotion, behavioral regulation and memory, and attention and decision process. The HEADS-ED has the potential to address the need for better discharge planning, complete charting, and standardized assessments for the increasing population of pediatric mental health patients who present to EDs. This study has identified potential barriers and facilitators, which should be considered when developing an implementation plan for adopting the HEADS-ED tool into practice within EDs.

  18. Family Engagement in Schoolwide Positive Behavioral Interventions and Supports: Barriers and Facilitators to Implementation.

    PubMed

    Garbacz, S Andrew; Hirano, Kara; McIntosh, Kent; Eagle, John W; Minch, Devon; Vatland, Christopher

    2017-11-20

    The purpose of this study was to identify barriers and facilitators to family engagement in schools implementing schoolwide positive behavioral interventions and supports (PBIS). Participants consisted of 1 representative member each from 204 school PBIS teams across 3 states. Qualitative analysis guided examination of responses to 1 question regarding barriers and 2 questions about facilitators to family engagement. Survey respondents identified key barriers to family engagement as a lack of resources, inconsistent communication, and reluctance of families and school staff to partner. Specified facilitators included communication, PBIS, shared decision-making, and strategies to build relationships with families. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  19. Implementing a Measurement Feedback System in Community Mental Health Clinics: A Case Study of Multilevel Barriers and Facilitators

    PubMed Central

    Gleacher, Alissa A.; Olin, Serene S.; Nadeem, Erum; Pollock, Michele; Ringle, Vanesa; Bickman, Leonard; Douglas, Susan; Hoagwood, Kimberly

    2015-01-01

    Measurement feedback systems (MFSs) have been proposed as a means of improving practice. The present study examined the implementation of a MFS, the Contextualized Feedback System (CFS), in two community-based clinic sites. Significant implementation differences across sites provided a basis for examining factors that influenced clinician uptake of CFS. Following the theoretical implementation framework of Aarons, Hurlburt & Horwitz (2011), we coded qualitative data collected from eighteen clinicians (13 from Clinic U and 5 from Clinic R) who participated in semi-structured interviews about their experience with CFS implementation. Results suggest that clinicians at both clinics perceived more barriers than facilitators to CFS implementation. Interestingly, clinicians at the higher implementing clinic reported a higher proportion of barriers to facilitators (3:1 vs. 2:1); however, these clinicians also reported a significantly higher level of organizational and leadership supports for CFS implementation. Implications of these findings are discussed. PMID:25735619

  20. Turning Knowledge Into Action at the Point-of-Care: The Collective Experience of Nurses Facilitating the Implementation of Evidence-Based Practice

    PubMed Central

    Dogherty, Elizabeth J; Harrison, Margaret B; Graham, Ian D; Vandyk, Amanda Digel; Keeping-Burke, Lisa

    2013-01-01

    Background: Facilitation is considered a way of enabling clinicians to implement evidence into practice by problem solving and providing support. Practice development is a well-established movement in the United Kingdom that incorporates the use of facilitators, but in Canada, the role is more obtuse. Few investigations have observed the process of facilitation as described by individuals experienced in guideline implementation in North America. AimTo describe the tacit knowledge regarding facilitation embedded in the experiences of nurses implementing evidence into practice. Methods: Twenty nurses from across Canada were purposively selected to attend an interactive knowledge translation symposium to examine what has worked and what has not in implementing evidence in practice. This study is an additional in-depth analysis of data collected at the symposium that focuses on facilitation as an intervention to enhance evidence uptake. Critical incident technique was used to elicit examples to examine the nurses’ facilitation experiences. Participants shared their experiences with one another and completed initial data analysis and coding collaboratively. The data were further thematically analyzed using the qualitative inductive approach of constant comparison. Results: A number of factors emerged at various levels associated with the successes and failures of participants’ efforts to facilitate evidence-based practice. Successful implementation related to: (a) focus on a priority issue, (b) relevant evidence, (c) development of strategic partnerships, (d) the use of multiple strategies to effect change, and (e) facilitator characteristics and approach. Negative factors influencing the process were: (a) poor engagement or ownership, (b) resource deficits, (c) conflict, (d) contextual issues, and (e) lack of evaluation and sustainability. Conclusions: Factors at the individual, environmental, organizational, and cultural level influence facilitation of evidence

  1. Implementing a Measurement Feedback System in Community Mental Health Clinics: A Case Study of Multilevel Barriers and Facilitators.

    PubMed

    Gleacher, Alissa A; Olin, Serene S; Nadeem, Erum; Pollock, Michele; Ringle, Vanesa; Bickman, Leonard; Douglas, Susan; Hoagwood, Kimberly

    2016-05-01

    Measurement feedback systems (MFSs) have been proposed as a means of improving practice. The present study examined the implementation of a MFS, the Contextualized Feedback System (CFS), in two community-based clinic sites. Significant implementation differences across sites provided a basis for examining factors that influenced clinician uptake of CFS. Following the theoretical implementation framework of Aarons et al. (Adm Policy Mental Health Mental Health Serv Res 38(1):4-23, 2011), we coded qualitative data collected from eighteen clinicians (13 from Clinic U and 5 from Clinic R) who participated in semi-structured interviews about their experience with CFS implementation. Results suggest that clinicians at both clinics perceived more barriers than facilitators to CFS implementation. Interestingly, clinicians at the higher implementing clinic reported a higher proportion of barriers to facilitators (3:1 vs. 2:1); however, these clinicians also reported a significantly higher level of organizational and leadership supports for CFS implementation. Implications of these findings are discussed.

  2. Barriers and Facilitators to Implementing Primary Stroke Center Policy in the United States: Results From 4 Case Study States

    PubMed Central

    Slade, Catherine P.; Brewer, Gene A.; Gase, Lauren N.

    2011-01-01

    Objectives. We identified barriers and facilitators to the state-level implementation of primary stroke center (PSC) policies, which encourage the certification or designation of specialized stroke treatment facilities and may address concerns such as transportation bypass, telemedicine, and treatment protocols. Methods. We studied the experiences of 4 states (Florida, Massachusetts, New Mexico, and New York) selected from the 18 states that had enacted PSC policies or were actively considering doing so. We conducted semistructured interviews during fieldwork in each case study state. Results. Our results showed that system fragmentation, gaps in human and financial resources, and complexity at the interorganizational and operational levels are common barriers and that policy champions, stakeholder support and communication, and operational adaptation are essential facilitators in the adoption and implementation of PSC policies. Conclusions. The identification of barriers and facilitators reveals the contextual elements that can help or hinder policy implementation and may be useful in informing policy formulation and implementation in other jurisdictions. Proactively identifying jurisdictional challenges and opportunities may help facilitate the policy process for PSC designation and allow jurisdictions to develop more effective stroke systems of care. PMID:21233430

  3. [Facilitators in the implantation of telemedicine services. Perspective of professionals involved in its design and implementation].

    PubMed

    Loscertales, F Roig; Rubió, F Saigí

    2011-01-01

    Given the difficulties encountered by Telemedicine for final incorporation into clinical practice and given the lack of scientific evidence regarding the most appropriate implementation strategies, it is necessary to collect and disseminate lessons gained from experience in its introduction and diffusion in our health system. The aim of this study is to identify the facilitators perceived by professionals who actively participate in the design and implementation of telemedicine projects in the health care system. Qualitative study of data from semi-structured interviews with 17 key informants belonging to different Catalan health organizations. The identified facilitators are grouped in four broad areas: a TM service that meets a need clearly perceived by practitioners; a core leadership with a clinical profile, managing an open, participatory and flexible model that takes into account the needs of professionals; the ability to establish partnerships with different stakeholders beyond the customer-supplier relationship; and the inclusion in the initial design of a strategy for sustainability and normalization. Understanding the facilitators and barriers that appear in the process of implementing TM experiences in health care organizations becomes an item of high value for its final introduction. An approach combining the evidence on clinical effectiveness and cost-benefit with lessons learned about the dynamics of implementation and normalization will allow for a holistic understanding of the adoption of the TM and provide guidance for improving its organizational management.

  4. Barriers to and facilitators of implementing complex workplace dietary interventions: process evaluation results of a cluster controlled trial.

    PubMed

    Fitzgerald, Sarah; Geaney, Fiona; Kelly, Clare; McHugh, Sheena; Perry, Ivan J

    2016-04-21

    Ambiguity exists regarding the effectiveness of workplace dietary interventions. Rigorous process evaluation is vital to understand this uncertainty. This study was conducted as part of the Food Choice at Work trial which assessed the comparative effectiveness of a workplace environmental dietary modification intervention and an educational intervention both alone and in combination versus a control workplace. Effectiveness was assessed in terms of employees' dietary intakes, nutrition knowledge and health status in four large manufacturing workplaces. The study aimed to examine barriers to and facilitators of implementing complex workplace interventions, from the perspectives of key workplace stakeholders and researchers involved in implementation. A detailed process evaluation monitored and evaluated intervention implementation. Interviews were conducted at baseline (27 interviews) and at 7-9 month follow-up (27 interviews) with a purposive sample of workplace stakeholders (managers and participating employees). Topic guides explored factors which facilitated or impeded implementation. Researchers involved in recruitment and data collection participated in focus groups at baseline and at 7-9 month follow-up to explore their perceptions of intervention implementation. Data were imported into NVivo software and analysed using a thematic framework approach. Four major themes emerged; perceived benefits of participation, negotiation and flexibility of the implementation team, viability and intensity of interventions and workplace structures and cultures. The latter three themes either positively or negatively affected implementation, depending on context. The implementation team included managers involved in coordinating and delivering the interventions and the researchers who collected data and delivered intervention elements. Stakeholders' perceptions of the benefits of participating, which facilitated implementation, included managers' desire to improve company

  5. Barriers and facilitators to implementing the Baby-Friendly hospital initiative in neonatal intensive care units.

    PubMed

    Benoit, Britney; Semenic, Sonia

    2014-01-01

    To explore manager, educator, and clinical leader perceptions of barriers and facilitators to implementing Baby-Friendly practice in the neonatal intensive care unit (NICU). Qualitative, descriptive design. Two university-affiliated level-III NICUs in Canada. A purposive sample of 10 medical and nursing managers, nurse educators, lactation consultants, and neonatal nurse practitioners. In-depth, semistructured interviews transcribed and analyzed using qualitative content analysis. Participants valued breastfeeding and family-centered care yet identified numerous contextual barriers to Baby-Friendly care including infant health status, parent/infant separation, staff workloads and work patterns, gaps in staff knowledge and skills, and lack of continuity of breastfeeding support. Facilitators included breastfeeding education, breastfeeding champions, and interprofessional collaboration. Despite identifying numerous barriers, participants recognized the potential value of expanding the Baby-Friendly Hospital Initiative (BFHI) to the NICU setting. Recommendations include promoting BFHI as a facilitator of family-centered care, interdisciplinary staff education, increasing access to lactation consultants, and establishing a group of NICU champions dedicated to BFHI implementation. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  6. Barriers and facilitators to implementing addiction medicine fellowships: a qualitative study with fellows, medical students, residents and preceptors.

    PubMed

    Klimas, J; Small, W; Ahamad, K; Cullen, W; Mead, A; Rieb, L; Wood, E; McNeil, R

    2017-09-20

    Although progress in science has driven advances in addiction medicine, this subject has not been adequately taught to medical trainees and physicians. As a result, there has been poor integration of evidence-based practices in addiction medicine into physician training which has impeded addiction treatment and care. Recently, a number of training initiatives have emerged internationally, including the addiction medicine fellowships in Vancouver, Canada. This study was undertaken to examine barriers and facilitators of implementing addiction medicine fellowships. We interviewed trainees and faculty from clinical and research training programmes in addiction medicine at St Paul's Hospital in Vancouver, Canada (N = 26) about barriers and facilitators to implementation of physician training in addiction medicine. We included medical students, residents, fellows and supervising physicians from a variety of specialities. We analysed interview transcripts thematically by using NVivo software. We identified six domains relating to training implementation: (1) organisational, (2) structural, (3) teacher, (4) learner, (5) patient and (6) community related variables either hindered or fostered addiction medicine education, depending on context. Human resources, variety of rotations, peer support and mentoring fostered implementation of addiction training. Money, time and space limitations hindered implementation. Participant accounts underscored how faculty and staff facilitated the implementation of both the clinical and the research training. Implementation of addiction medicine fellowships appears feasible, although a number of barriers exist. Research into factors within the local/practice environment that shape delivery of education to ensure consistent and quality education scale-up is a priority.

  7. A Bridge Over Turbulent Waters: Illustrating the Interaction Between Managerial Leaders and Facilitators When Implementing Research Evidence.

    PubMed

    van der Zijpp, Teatske Johanna; Niessen, Theo; Eldh, Ann Catrine; Hawkes, Claire; McMullan, Christel; Mockford, Carole; Wallin, Lars; McCormack, Brendan; Rycroft-Malone, Jo; Seers, Kate

    2016-02-01

    Emerging evidence focuses on the importance of the role of leadership in successfully transferring research evidence into practice. However, little is known about the interaction between managerial leaders and clinical leaders acting as facilitators (internal facilitators [IFs]) in this implementation process. To describe the interaction between managerial leaders and IFs and how this enabled or hindered the facilitation process of implementing urinary incontinence guideline recommendations in a local context in settings that provide long-term care to older people. Semistructured interviews with 105 managers and 22 IFs, collected for a realist process evaluation across four European countries informed this study. An interpretive data analysis unpacks interactions between managerial leaders and IFs. This study identified three themes that were important in the interactions between managerial leaders and IFs that could hinder or support the implementation process: "realising commitment"; "negotiating conditions"; and "encouragement to keep momentum going." The findings revealed that the continuous reciprocal relationships between IFs and managerial leaders influenced the progress of implementation, and could slow the process down or disrupt it. A metaphor of crossing a turbulent river by the "building of a bridge" emerged as one way of understanding the findings. Our findings illuminate a neglected area, the effects of relationships between key staff on implementing evidence into practice. Relational aspects of managerial and clinical leadership roles need greater consideration when planning guideline implementation and practice change. In order to support implementation, staff assigned as IFs as well as stakeholders like managers at all levels of an organisation should be engaged in realising commitment, negotiating conditions, and keeping momentum going. Thus, communication is crucial between all involved. © 2016 Sigma Theta Tau International.

  8. Improving safety culture in hospitals: Facilitators and barriers to implementation of Systemic Falls Investigative Method (SFIM).

    PubMed

    Zecevic, Aleksandra A; Li, Alvin Ho-Ting; Ngo, Charity; Halligan, Michelle; Kothari, Anita

    2017-06-01

    The purpose of this study was to assess the facilitators and barriers to implementation of the Systemic Falls Investigative Method (SFIM) on selected hospital units. A cross-sectional explanatory mixed methods design was used to converge results from a standardized safety culture survey with themes that emerged from interviews and focus groups. Findings were organized by six elements of the Ottawa Model of Research Use framework. A geriatric rehabilitation unit of an acute care hospital and a neurological unit of a rehabilitation hospital were selected purposefully due to the high frequency of falls. Hospital staff who took part in: surveys (n = 39), interviews (n = 10) and focus groups (n = 12), and 38 people who were interviewed during falls investigations: fallers, family, unit staff and hospital management. Implementation of the SFIM to investigate fall occurrences. Percent of positive responses on the Modified Stanford Patient Safety Culture Survey Instrument converged with qualitative themes on facilitators and barriers for intervention implementation. Both hospital units had an overall poor safety culture which hindered intervention implementation. Facilitators were hospital accreditation, strong emphasis on patient safety, infrastructure and dedicated champions. Barriers included heavy workloads, lack of time, lack of resources and poor communication. Successful implementation of SFIM requires regulatory and organizational support, committed frontline staff and allocation of resources to identify active causes and latent contributing factors to falls. System-wide adjustments show promise for promotion of safety culture in hospitals where falls happen regularly. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  9. Providing long-acting reversible contraception services in Seattle school-based health centers: key themes for facilitating implementation.

    PubMed

    Gilmore, Kelly; Hoopes, Andrea J; Cady, Janet; Amies Oelschlager, Anne-Marie; Prager, Sarah; Vander Stoep, Ann

    2015-06-01

    The purpose of this study was to describe the implementation of a program that provides long-acting reversible contraception (LARC) services within school-based health centers (SBHCs) and to identify barriers and facilitators to implementation as reported by SBHC clinicians and administrators, public health officials, and community partners. We conducted 14 semistructured interviews with key informants involved in the implementation of LARC services. Key informants included SBHC clinicians and administrators, public health officials, and community partners. We used a content analysis approach to analyze interview transcripts for themes. We explored barriers to and facilitators of LARC service delivery across and within key informant groups. The most cited barriers across key informant groups were as follows: perceived lack of provider procedural skills and bias and negative attitudes about LARC methods. The most common facilitators identified across groups were as follows: clear communication strategies, contraceptive counseling practice changes, provider trainings, and stakeholder engagement. Two additional barriers emerged in specific key informant groups. Technical and logistical barriers to LARC service delivery were cited heavily by SBHC administrative staff, community partners, and public health officials. Expense and billing was a major barrier to SBHC administrative staff. LARC counseling and procedural services can be implemented in an SBHC setting to promote access to effective contraceptive options for adolescent women. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  10. Facilitators and barriers for the adoption, implementation and monitoring of child safety interventions: a multinational qualitative analysis.

    PubMed

    Scholtes, Beatrice; Schröder-Bäck, Peter; MacKay, J Morag; Vincenten, Joanne; Förster, Katharina; Brand, Helmut

    2017-06-01

    The efficiency and effectiveness of child safety interventions are determined by the quality of the implementation process. This multinational European study aimed to identify facilitators and barriers for the three phases of implementation: adoption, implementation and monitoring (AIM process). Twenty-seven participants from across the WHO European Region were invited to provide case studies of child safety interventions from their country. Cases were selected by the authors to ensure broad coverage of injury issues, age groups and governance level of implementation (eg, national, regional or local). Each participant presented their case and provided a written account according to a standardised template. Presentations and question and answer sessions were recorded. The presentation slides, written accounts and the notes taken during the workshops were analysed using thematic content analysis to elicit facilitators and barriers. Twenty-six cases (from 26 different countries) were presented and analysed. Facilitators and barriers were identified within eight general themes, applicable across the AIM process: management and collaboration; resources; leadership; nature of the intervention; political, social and cultural environment; visibility; nature of the injury problem and analysis and interpretation. The importance of the quality of the implementation process for intervention effectiveness, coupled with limited resources for child safety makes it more difficult to achieve successful actions. The findings of this study, divided by phase of the AIM process, provide practitioners with practical suggestions, where proactive planning might help increase the likelihood of effective implementation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. Implementation of a Substance Use Recovery Support Mobile Phone App in Community Settings: Qualitative Study of Clinician and Staff Perspectives of Facilitators and Barriers.

    PubMed

    Lord, Sarah; Moore, Sarah K; Ramsey, Alex; Dinauer, Susan; Johnson, Kimberly

    2016-06-28

    Research supports the effectiveness of technology-based treatment approaches for substance use disorders. These approaches have the potential to broaden the reach of evidence-based care. Yet, there is limited understanding of factors associated with implementation of technology-based care approaches in different service settings. In this study, we explored provider and staff perceptions of facilitators and barriers to implementation of a mobile phone substance use recovery support app with clients in 4 service settings. Interviews were conducted with leadership and provider stakeholders (N=12) from 4 agencies in the first year of an implementation trial of the mobile phone app. We used the Consolidated Framework for Implementation Research as the conceptual foundation for identifying facilitators and barriers to implementation. Implementation process facilitators included careful planning of all aspects of implementation before launch, engaging a dedicated team to implement and foster motivation, working collaboratively with the app development team to address technical barriers and adapt the app to meet client and agency needs, and consistently reviewing app usage data to inform progress. Implementation support strategies included training all staff to promote organization awareness about the recovery support app and emphasize its priority as a clinical care tool, encouraging clients to try the technology before committing to use, scaling rollout to clients, setting clear expectations with clients about use of the app, and using peer coaches and consistent client-centered messaging to promote engagement. Perceived compatibility of the mobile phone app with agency and client needs and readiness to implement emerged as salient agency-level implementation facilitators. Facilitating characteristics of the recovery support app itself included evidence of its impact for recovery support, perceived relative advantage of the app over usual care, the ability to adapt the

  12. Implementation of a web-based national child health-care programme in a local context: A complex facilitator role.

    PubMed

    Tell, Johanna; Olander, Ewy; Anderberg, Peter; Berglund, Johan Sanmartin

    2018-02-01

    The aim of this study was to investigate child health-care coordinators' experiences of being a facilitator for the implementation of a new national child health-care programme in the form of a web-based national guide. The study was based on eight remote, online focus groups, using Skype for Business. A qualitative content analysis was performed. The analysis generated three categories: adapt to a local context, transition challenges and led by strong incentives. There were eight subcategories. In the latent analysis, the theme 'Being a facilitator: a complex role' was formed to express the child health-care coordinators' experiences. Facilitating a national guideline or decision support in a local context is a complex task that requires an advocating and mediating role. For successful implementation, guidelines and decision support, such as a web-based guide and the new child health-care programme, must match professional consensus and needs and be seen as relevant by all. Participation in the development and a strong bottom-up approach was important, making the web-based guide and the programme relevant to whom it is intended to serve, and for successful implementation. The study contributes valuable knowledge when planning to implement a national web-based decision support and policy programme in a local health-care context.

  13. Using normalisation process theory to understand barriers and facilitators to implementing mindfulness-based stress reduction for people with multiple sclerosis.

    PubMed

    Simpson, Robert; Simpson, Sharon; Wood, Karen; Mercer, Stewart W; Mair, Frances S

    2018-01-01

    Objectives To study barriers and facilitators to implementation of mindfulness-based stress reduction for people with multiple sclerosis. Methods Qualitative interviews were used to explore barriers and facilitators to implementation of mindfulness-based stress reduction, including 33 people with multiple sclerosis, 6 multiple sclerosis clinicians and 2 course instructors. Normalisation process theory provided the underpinning conceptual framework. Data were analysed deductively using normalisation process theory constructs (coherence, cognitive participation, collective action and reflexive monitoring). Results Key barriers included mismatched stakeholder expectations, lack of knowledge about mindfulness-based stress reduction, high levels of comorbidity and disability and skepticism about embedding mindfulness-based stress reduction in routine multiple sclerosis care. Facilitators to implementation included introducing a pre-course orientation session; adaptations to mindfulness-based stress reduction to accommodate comorbidity and disability and participants suggested smaller, shorter classes, shortened practices, exclusion of mindful-walking and more time with peers. Post-mindfulness-based stress reduction booster sessions may be required, and objective and subjective reports of benefit would increase clinician confidence in mindfulness-based stress reduction. Discussion Multiple sclerosis patients and clinicians know little about mindfulness-based stress reduction. Mismatched expectations are a barrier to participation, as is rigid application of mindfulness-based stress reduction in the context of disability. Course adaptations in response to patient needs would facilitate uptake and utilisation. Rendering access to mindfulness-based stress reduction rapid and flexible could facilitate implementation. Embedded outcome assessment is desirable.

  14. Qualitative evaluation of the implementation of the Interdisciplinary Management Tool: a reflective tool to enhance interdisciplinary teamwork using Structured, Facilitated Action Research for Implementation.

    PubMed

    Nancarrow, Susan A; Smith, Tony; Ariss, Steven; Enderby, Pamela M

    2015-07-01

    Reflective practice is used increasingly to enhance team functioning and service effectiveness; however, there is little evidence of its use in interdisciplinary teams. This paper presents the qualitative evaluation of the Interdisciplinary Management Tool (IMT), an evidence-based change tool designed to enhance interdisciplinary teamwork through structured team reflection. The IMT incorporates three components: an evidence-based resource guide; a reflective implementation framework based on Structured, Facilitated Action Research for Implementation methodology; and formative and summative evaluation components. The IMT was implemented with intermediate care teams supported by independent facilitators in England. Each intervention lasted 6 months and was evaluated over a 12-month period. Data sources include interviews, a focus group with facilitators, questionnaires completed by team members and documentary feedback from structured team reports. Data were analysed qualitatively using the Framework approach. The IMT was implemented with 10 teams, including 253 staff from more than 10 different disciplines. Team challenges included lack of clear vision; communication issues; limited career progression opportunities; inefficient resource use; need for role clarity and service development. The IMT successfully engaged staff in the change process, and resulted in teams developing creative strategies to address the issues identified. Participants valued dedicated time to focus on the processes of team functioning; however, some were uncomfortable with a focus on teamwork at the expense of delivering direct patient care. The IMT is a relatively low-cost, structured, reflective way to enhance team function. It empowers individuals to understand and value their own, and others' roles and responsibilities within the team; identify barriers to effective teamwork, and develop and implement appropriate solutions to these. To be successful, teams need protected time to take

  15. Barriers, facilitators, and benefits of implementation of dialectical behavior therapy in routine care: results from a national program evaluation survey in the Veterans Health Administration.

    PubMed

    Landes, Sara J; Rodriguez, Allison L; Smith, Brandy N; Matthieu, Monica M; Trent, Lindsay R; Kemp, Janet; Thompson, Caitlin

    2017-12-01

    National implementation of evidence-based psychotherapies (EBPs) in the Veterans Health Administration (VHA) provides important lessons on the barriers and facilitators to implementation in a large healthcare system. Little is known about barriers and facilitators to the implementation of a complex EBP for emotional and behavioral dysregulation-dialectical behavioral therapy (DBT). The purpose of this study was to understand VHA clinicians' experiences with barriers, facilitators, and benefits from implementing DBT into routine care. This national program evaluation survey measured site characteristics of VHA sites (N = 59) that had implemented DBT. DBT was most often implemented in general mental health outpatient clinics. While 42% of sites offered all four modes of DBT, skills group was the most frequently implemented mode. Fifty-nine percent of sites offered phone coaching in any form, yet only 11% of those offered it all the time. Providers were often provided little to no time to support implementation of DBT. Barriers that were difficult to overcome were related to phone coaching outside of business hours. Facilitators to implementation included staff interest and expertise. Perceived benefits included increased hope and functioning for clients, greater self-efficacy and compassion for providers, and ability to treat unique symptoms for clinics. There was considerable variability in the capacity to address implementation barriers among sites implementing DBT in VHA routine care. Mental health policy makers should note the barriers and facilitators reported here, with specific attention to phone coaching barriers.

  16. Practice Facilitators' and Leaders' Perspectives on a Facilitated Quality Improvement Program.

    PubMed

    McHugh, Megan; Brown, Tiffany; Liss, David T; Walunas, Theresa L; Persell, Stephen D

    2018-04-01

    Practice facilitation is a promising approach to helping practices implement quality improvements. Our purpose was to describe practice facilitators' and practice leaders' perspectives on implementation of a practice facilitator-supported quality improvement program and describe where their perspectives aligned and diverged. We conducted interviews with practice leaders and practice facilitators who participated in a program that included 35 improvement strategies aimed at the ABCS of heart health (aspirin use in high-risk individuals, blood pressure control, cholesterol management, and smoking cessation). Rapid qualitative analysis was used to collect, organize, and analyze the data. We interviewed 17 of the 33 eligible practice leaders, and the 10 practice facilitators assigned to those practices. Practice leaders and practice facilitators both reported value in the program's ability to bring needed, high-quality resources to practices. Practice leaders appreciated being able to set the schedule for facilitation and select among the 35 interventions. According to practice facilitators, however, relying on practice leaders to set the pace of the intervention resulted in a lower level of program intensity than intended. Practice leaders preferred targeted assistance, particularly electronic health record documentation guidance and linkages to state smoking cessation programs. Practice facilitators reported that the easiest interventions were those that did not alter care practices. The dual perspectives of practice leaders and practice facilitators provide a more holistic picture of enablers and barriers to program implementation. There may be greater opportunities to assist small practices through simple, targeted practice facilitator-supported efforts rather than larger, comprehensive quality improvement projects. © 2018 Annals of Family Medicine, Inc.

  17. Facilitating the implementation of pharmacokinetic-guided dosing of prophylaxis in haemophilia care by discrete choice experiment.

    PubMed

    Lock, J; de Bekker-Grob, E W; Urhan, G; Peters, M; Meijer, K; Brons, P; van der Meer, F J M; Driessens, M H E; Collins, P W; Fijnvandraat, K; Leebeek, F W G; Cnossen, M H

    2016-01-01

    Patients', parents' and providers' preferences with regard to medical innovations may have a major impact on their implementation. To evaluate barriers and facilitators for individualized pharmacokinetic (PK)-guided dosing of prophylaxis in haemophilia patients, parents of young patients, and treating professionals by discrete choice experiment (DCE) questionnaire. The study population consisted of patients with haemophilia currently or previously on prophylactic treatment with factor concentrate (n = 114), parents of patients aged 12-18 years (n = 19) and haemophilia professionals (n = 91). DCE data analysis was performed, taking preference heterogeneity into account. Overall, patients and parents, and especially professionals were inclined to opt for PK-guided dosing of prophylaxis. In addition, if bleeding was consequently reduced, more frequent infusions were acceptable. However, daily dosing remained an important barrier for all involved. 'Reduction of costs for society' was a facilitator for implementation in all groups. To achieve implementation of individualized PK-guided dosing of prophylaxis in haemophilia, reduction of bleeding risk and reduction of costs for society should be actively discussed as they are motivating for implementation; daily dosing is still reported to be a barrier for all groups. The knowledge of these preferences will enlarge support for this innovation, and aid in the drafting of implementable guidelines and information brochures for patients, parents and professionals. © 2015 John Wiley & Sons Ltd.

  18. Implementation of a Substance Use Recovery Support Mobile Phone App in Community Settings: Qualitative Study of Clinician and Staff Perspectives of Facilitators and Barriers

    PubMed Central

    Moore, Sarah K; Ramsey, Alex; Dinauer, Susan; Johnson, Kimberly

    2016-01-01

    Background Research supports the effectiveness of technology-based treatment approaches for substance use disorders. These approaches have the potential to broaden the reach of evidence-based care. Yet, there is limited understanding of factors associated with implementation of technology-based care approaches in different service settings. Objectives In this study, we explored provider and staff perceptions of facilitators and barriers to implementation of a mobile phone substance use recovery support app with clients in 4 service settings. Methods Interviews were conducted with leadership and provider stakeholders (N=12) from 4 agencies in the first year of an implementation trial of the mobile phone app. We used the Consolidated Framework for Implementation Research as the conceptual foundation for identifying facilitators and barriers to implementation. Results Implementation process facilitators included careful planning of all aspects of implementation before launch, engaging a dedicated team to implement and foster motivation, working collaboratively with the app development team to address technical barriers and adapt the app to meet client and agency needs, and consistently reviewing app usage data to inform progress. Implementation support strategies included training all staff to promote organization awareness about the recovery support app and emphasize its priority as a clinical care tool, encouraging clients to try the technology before committing to use, scaling rollout to clients, setting clear expectations with clients about use of the app, and using peer coaches and consistent client-centered messaging to promote engagement. Perceived compatibility of the mobile phone app with agency and client needs and readiness to implement emerged as salient agency-level implementation facilitators. Facilitating characteristics of the recovery support app itself included evidence of its impact for recovery support, perceived relative advantage of the app over

  19. Addiction treatment staff perceptions of training as a facilitator or barrier to implementing evidence-based practices: a national qualitative research study.

    PubMed

    D'Ippolito, Melinda; Lundgren, Lena; Amodeo, Maryann; Beltrame, Clelia; Lim, Lynn; Chassler, Deborah

    2015-01-01

    This qualitative effort examines training-related facilitators and barriers to implementing evidence-based practices (EBPs) in 285 community-based addiction treatment organizations (CBOs) nationwide that were funded by the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment (SAMHSA/CSAT) to implement EBPs. Using qualitative interviews, the authors explored staff (N = 514) descriptions of training as a facilitator or barrier to implementation. Training-related factors were described 663 times as facilitators (by 440 staff) and 233 times as barriers (by 170 staff). Responses were coded using content analysis. Specific characteristics of the training received, such as access to expert knowledge and quality, as well as ongoing training were described as central facilitating factors to EBP implementation. Key reasons training was perceived as a barrier included the amount of training; the training did not fit current staff and/or organizational needs; the training for some EBPs was perceived to be too demanding; and the difficulty accessing training. Since government funders of addiction treatments require that CBOs implement EBPs and they provide training resources, the quality, flexibility, and accessibility of the available training needs to be promoted throughout the addiction treatment network. Only 17% of CBOs reported that they used the SAMHSA-funded ATTC (Addiction Technology Transfer Center) training centers and 42% used SAMHSA technical assistance. Hence, federally funded resources for training were not always used.

  20. A theoretical analysis of the barriers and facilitators to the implementation of school-based physical activity policies in Canada: a mixed methods scoping review.

    PubMed

    Weatherson, Katie A; Gainforth, Heather L; Jung, Mary E

    2017-03-27

    Given the potential impact school-based daily physical activity (DPA) policies can have on the health outcomes of Canadian children, it is surprising that such little research has examined the implementation and student-level effectiveness of these policies, and that even less have used theory to understand the barriers and facilitators affecting uptake of this policy by teachers. This review descriptively summarizes the implementation status, approaches used to implement DPA, and the effectiveness of DPA at increasing the physical activity of children at school. In addition, the Theoretical Domains Framework (TDF) was used to explore the barriers and facilitators to DPA implementation. A scoping review of English articles using ERIC, CINAHL, and Google Scholar (2005 to 2016) was conducted. Only studies that evaluated the implementation and/or student-level effectiveness of DPA policies in Canadian elementary schools were included. Only articles that examined DPA implementation barriers and facilitators by teachers, principals, and/or administration were eligible for the TDF analysis. Data on study characteristics and major findings regarding implementation status, implementation approach used, and impact on student's physical activity were extracted and were summarized descriptively, including study quality indicators. Two coders extracted and categorized implementation barriers and facilitators into TDF domains. The search resulted in 66 articles being retrieved and 38 being excluded for not meeting the eligibility criteria, leaving 15 eligible for review (10 of which examined barriers and facilitators to implementation from DPA deliverers' perspective). Eleven of 15 studies examined the Ontario DPA policy, and 2 studies were from both Alberta and British Columbia. Thirteen studies examined implementation, and only two examined effectiveness. DPA implementation status, approaches to delivery, and effectiveness on student's PA levels are inconsistent across the

  1. Barriers and facilitators to implementing cancer survivorship care plans.

    PubMed

    Dulko, Dorothy; Pace, Claire M; Dittus, Kim L; Sprague, Brian L; Pollack, Lori A; Hawkins, Nikki A; Geller, Berta M

    2013-11-01

    To evaluate the process of survivorship care plan (SCP) completion and to survey oncology staff and primary care physicians (PCPs) regarding challenges of implementing SCPs. Descriptive pilot study. Two facilities in Vermont, an urban academic medical center and a rural community academic cancer center. 17 oncology clinical staff created SCPs, 39 PCPs completed surveys, and 58 patients (breast or colorectal cancer) participated in a telephone survey. Using Journey Forward tools, SCPs were created and presented to patients. PCPs received the SCP with a survey assessing its usefulness and barriers to delivery. Oncology staff were interviewed to assess perceived challenges and benefits of SCPs. Qualitative and quantitative data were used to identify challenges to the development and implementation process as well as patient perceptions of the SCP visit. SCP, healthcare provider perception of barriers to completion and implementation, and patient perception of SCP visit. Oncology staff cited the time required to obtain information for SCPs as a challenge. Completing SCPs 3-6 months after treatment ended was optimal. All participants felt advanced practice professionals should complete and review SCPs with patients. The most common challenge for PCPs to implement SCP recommendations was insufficient knowledge of cancer survivor issues. Most patients found the care plan visit very useful, particularly within six months of diagnosis. Creation time may be a barrier to widespread SCP implementation. Cancer survivors find SCPs useful, but PCPs feel insufficient knowledge of cancer survivor issues is a barrier to providing best follow-up care. Incorporating SCPs in electronic medical records may facilitate patient identification, appropriate staff scheduling, and timely SCP creation. Oncology nurse practitioners are well positioned to create and deliver SCPs, transitioning patients from oncology care to a PCP in a shared-care model of optimal wellness. Institution support for

  2. Barriers to and facilitators of implementing shared decision making and decision support in a paediatric hospital: A descriptive study.

    PubMed

    Boland, Laura; McIsaac, Daniel I; Lawson, Margaret L

    2016-04-01

    To explore multiple stakeholders' perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital. An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators', clinicians', parents' and youths' perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis. Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders' knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital's culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term. Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors' paediatric hospital.

  3. Implementing clinical guidelines in stroke: a qualitative study of perceived facilitators and barriers.

    PubMed

    Donnellan, Claire; Sweetman, S; Shelley, E

    2013-08-01

    Clinical guidelines are frequently used as a mechanism for implementing evidence-based practice. However research indicates that health professionals vary in the extent to which they adhere to these guidelines. This study aimed to study the perceptions of stakeholders and health professionals on the facilitators and barriers to implementing national stroke guidelines in Ireland. Qualitative interviews using focus groups were conducted with stakeholders (n=3) and multidisciplinary team members from hospitals involved in stroke care (n=7). All focus group interviews were semi-structured, using open-ended questions. Data was managed and analysed using NVivo 9 software. The main themes to emerge from the focus groups with stakeholders and hospital multidisciplinary teams were very similar in terms of topics discussed. These were resources, national stroke guidelines as a tool for change, characteristics of national stroke guidelines, advocacy at local level and community stroke care challenges. Facilitators perceived by stakeholders and health professionals included having dedicated resources, user-friendly guidelines relevant at local level and having supportive advocates on the ground. Barriers were inadequate resources, poor guideline characteristics and insufficient training and education. This study highlights health professionals' perspectives regarding many key concepts which may affect the implementation of stroke care guidelines. The introduction of stroke clinical guidelines at a national level is not sufficient to improve health care quality as they should be incorporated in a quality assurance cycle with education programmes and feedback from surveys of clinical practice. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  4. Provider Perspectives on Evidence-Based HIV Prevention Interventions: Barriers and Facilitators to Implementation

    PubMed Central

    Dickson-Gomez, Julia

    2011-01-01

    Abstract Since the beginning of the HIV/AIDS epidemic, community-based organizations (CBOs) have been key players in combating this disease through grassroots prevention programs and close ties to at-risk populations. Increasingly, both funding agencies and public health institutions require that CBOs implement evidence-based HIV prevention interventions, most of which are researcher developed. However, after completing training for these evidence-based interventions (EBIs), agencies may either abandon plans to implement them or significantly modify the intervention. Based on 22 semistructured interviews with HIV prevention service providers, this article explores the barriers and facilitators to dissemination and implementation of EBIs included in the Centers for Disease Control and Prevention's (CDC) Diffusion of Effective Behavioral Interventions (DEBI) program. Results suggest that there is a tension between the need to implement interventions with fidelity and the lack of guidance on how to adapt the interventions for their constituencies and organizational contexts. Findings suggest the need for HIV prevention intervention development and dissemination that integrate community partners in all phases of research and dissemination. PMID:21323564

  5. Patient-perceived barriers and facilitators to the implementation of a medication review in primary care: a qualitative thematic analysis.

    PubMed

    Uhl, Mirella Carolin; Muth, Christiane; Gerlach, Ferdinand Michael; Schoch, Goentje-Gesine; Müller, Beate Sigrid

    2018-01-05

    Although polypharmacy can cause adverse health outcomes, patients often know little about their medication. A regularly conducted medication review (MR) can help provide an overview of a patient's medication, and benefit patients by enhancing their knowledge of their drugs. As little is known about patient attitudes towards MRs in primary care, the objective of this study was to gain insight into patient-perceived barriers and facilitators to the implementation of an MR. We conducted a qualitative study with a convenience sample of 31 patients (age ≥ 60 years, ≥3 chronic diseases, taking ≥5 drugs/d); in Hesse, Germany, in February 2016. We conducted two focus groups and, in order to ensure the participation of elderly patients with reduced mobility, 16 telephone interviews. Both relied on a semi-structured interview guide dealing with the following subjects: patients' experience of polypharmacy, general design of MRs, potential barriers and facilitators to implementation etc. Interviews were audio-recorded, transcribed verbatim, and analysed by two researchers using thematic analysis. Patients' average age was 74 years (range 62-88 years). We identified barriers and facilitators for four main topics regarding the implementation of MRs in primary care: patient participation, GP-led MRs, pharmacist-led MRs, and the involvement of healthcare assistants in MRs. Barriers to patient participation concerned patient autonomy, while facilitators involved patient awareness of medication-related problems. Barriers to GP-led MRs concerned GP's lack of resources while facilitators related to the trusting relationship between patient and GP. Pharmacist-led MRs might be hindered by a lack of patients' confidence in pharmacists' expertise, but facilitated by pharmacies' digital records of the patients' medications. Regarding the involvement of healthcare assistants in MRs, a potential barrier was patients' uncertainty regarding the extent of their training. Patients

  6. Implementing a Lean Management System in Primary Care: Facilitators and Barriers From the Front Lines.

    PubMed

    Hung, Dorothy; Martinez, Meghan; Yakir, Maayan; Gray, Caroline

    2015-01-01

    Although Lean management techniques are increasingly used in health care to improve quality and reduce costs, lessons about how to successfully implement this approach on the front lines of care delivery are not well documented. In this study, we highlight key facilitators and barriers to implementing Lean among frontline primary care providers. This case study took place at a large, ambulatory care delivery system serving nearly 1 million patients. In-depth interviews were conducted with primary care physicians, staff, and administrators to identify key factors impacting Lean redesigns in primary care. Overall, staff engagement and performance management, sensitivity to the professional values and culture of medicine, and perceived adequacy of organizational resources were critical when introducing Lean changes. Specific drivers of change included empowerment of staff at all levels, visual display of performance metrics, and a culture of innovation and collaboration. Barriers included physician resistance to standardized work, difficulty transferring management responsibilities to non-physician staff, and time and staffing required for participating in improvement efforts. Although Lean offers a new approach to delivering care, the implementation process itself is both complex and crucial to success. Understanding early facilitators and barriers can maximize Lean's, potential to improve health care delivery.

  7. A multi-institutional study of the perceived barriers and facilitators to implementing evidence-based practice.

    PubMed

    Duncombe, Daphne C

    2018-03-01

    To examine perceived barriers and facilitators to implementing evidence-based practice among nurses working in psychiatric, geriatric, hospital and community settings in The Bahamas. It is evident from previous studies that a number of factors exist which either obstruct or promote the utilisation of research evidence in nursing practice. Identifying these factors is vital to the successful uptake of evidence-based practice in nursing. Descriptive, comparative study. Data were collected using self-administered questionnaires. A stratified random sample (n = 100) of registered nurses participated; 5-point Likert-like scales were used to examine nurses' perceptions of barriers and facilitators of evidence-based practice. Descriptive statistics were used to describe demographic characteristics and to compare responses of nurses. Participants were predominantly female (98.4%), in the 25 to <35 years age group (45.9%). Of nurses surveyed, 72.1% had never tried to implement evidence-based practice previously. The greatest barriers identified were as follows: "Inadequate resources for implementing research findings" (85.2%; n = 52) and "Inadequate training in research methods" (83.6%; n = 51). The top facilitators identified were as follows: "Training in research methods" (88.5%; n = 54) and "Organisational policies and protocols that are evidence-based" (86.9%; n = 53). Nurses generally expressed that they required additional training in research and evidence-based practice concepts. Although some nurses had a desire to implement evidence-based practice to provide quality care and improve patient outcomes, many expressed that they lacked the required resources. The study draws attention to the need for prioritisation of evidence-based practice both at institutional and governmental levels. Successful adoption of evidence-based practice implies combined efforts of nurses, healthcare providers and policymakers. Further research is needed to determine the best

  8. Barriers and facilitators to the implementation of a school-based physical activity policy in Canada: application of the theoretical domains framework.

    PubMed

    Weatherson, Katie A; McKay, Rhyann; Gainforth, Heather L; Jung, Mary E

    2017-10-23

    In British Columbia Canada, a Daily Physical Activity (DPA) policy was mandated that requires elementary school teachers to provide students with opportunities to achieve 30 min of physical activity during the school day. However, the implementation of school-based physical activity policies is influenced by many factors. A theoretical examination of the factors that impede and enhance teachers' implementation of physical activity policies is necessary in order to develop strategies to improve policy practice and achieve desired outcomes. This study used the Theoretical Domains Framework (TDF) to understand teachers' barriers and facilitators to the implementation of the DPA policy in one school district. Additionally, barriers and facilitators were examined and compared according to how the teacher implemented the DPA policy during the instructional school day. Interviews were conducted with thirteen teachers and transcribed verbatim. One researcher performed barrier and facilitator extraction, with double extraction occurring across a third of the interview transcripts by a second researcher. A deductive and inductive analytical approach in a two-stage process was employed whereby barriers and facilitators were deductively coded using TDF domains (content analysis) and analyzed for sub-themes within each domain. Two researchers performed coding. A total of 832 items were extracted from the interview transcripts. Some items were coded into multiple TDF domains, resulting in a total of 1422 observations. The most commonly coded TDF domains accounting for 75% of the total were Environmental context and resources (ECR; n = 250), Beliefs about consequences (n = 225), Social influences (n = 193), Knowledge (n = 100), and Intentions (n = 88). Teachers who implemented DPA during instructional time differed from those who relied on non-instructional time in relation to Goals, Behavioural regulation, Social/professional role and identity, Beliefs about

  9. Barriers to and facilitators of implementing shared decision making and decision support in a paediatric hospital: A descriptive study

    PubMed Central

    Boland, Laura; McIsaac, Daniel I; Lawson, Margaret L

    2016-01-01

    OBJECTIVE: To explore multiple stakeholders’ perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital. METHODS: An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators’, clinicians’, parents’ and youths’ perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis. RESULTS: Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders’ knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital’s culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term. CONCLUSIONS: Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors’ paediatric hospital. PMID:27398058

  10. Geological modeling of submeter scale heterogeneity and its influence on tracer transport in a fluvial aquifer

    NASA Astrophysics Data System (ADS)

    Ronayne, Michael J.; Gorelick, Steven M.; Zheng, Chunmiao

    2010-10-01

    We developed a new model of aquifer heterogeneity to analyze data from a single-well injection-withdrawal tracer test conducted at the Macrodispersion Experiment (MADE) site on the Columbus Air Force Base in Mississippi (USA). The physical heterogeneity model is a hybrid that combines 3-D lithofacies to represent submeter scale, highly connected channels within a background matrix based on a correlated multivariate Gaussian hydraulic conductivity field. The modeled aquifer architecture is informed by a variety of field data, including geologic core sampling. Geostatistical properties of this hybrid heterogeneity model are consistent with the statistics of the hydraulic conductivity data set based on extensive borehole flowmeter testing at the MADE site. The representation of detailed, small-scale geologic heterogeneity allows for explicit simulation of local preferential flow and slow advection, processes that explain the complex tracer response from the injection-withdrawal test. Based on the new heterogeneity model, advective-dispersive transport reproduces key characteristics of the observed tracer recovery curve, including a delayed concentration peak and a low-concentration tail. Importantly, our results suggest that intrafacies heterogeneity is responsible for local-scale mass transfer.

  11. Pharmacists' Perceptions of the Barriers and Facilitators to the Implementation of Clinical Pharmacy Key Performance Indicators

    PubMed Central

    Minard, Laura V; Deal, Heidi; Harrison, Megan E; Toombs, Kent; Neville, Heather; Meade, Andrea

    2016-01-01

    Background In hospitals around the world, there has been no consensus regarding which clinical activities a pharmacist should focus on until recently. In 2011, a Canadian clinical pharmacy key performance indicator (cpKPI) collaborative was formed. The goal of the collaborative was to advance pharmacy practice in order to improve patient outcomes and enhance the quality of care provided to patients by hospital pharmacists. Following a literature review, which indicated that pharmacists can improve patient outcomes by carrying out specific activities, and an evidence-informed consensus process, a final set of eight cpKPIs were established. Canadian hospitals leading the cpKPI initiative are currently in the early stages of implementing these indicators. Objective To explore pharmacists' perceptions of the barriers and facilitators to the implementation of cpKPIs. Methods Clinical pharmacists employed by the Nova Scotia Health Authority were invited to participate in focus groups. Focus group discussions were audio-recorded and transcribed, and data was analyzed using thematic analysis. Findings Three focus groups, including 26 pharmacists, were conducted in February 2015. Three major themes were identified. Resisting the change was comprised of documentation challenges, increased workload, practice environment constraints, and competing priorities. Embracing cpKPIs was composed of seeing the benefit, demonstrating value, and existing supports. Navigating the unknown was made up of quality versus quantity battle, and insights into the future. Conclusions Although pharmacists were challenged by documentation and other changes associated with the implementation of cpKPIs, they demonstrated significant support for cpKPIs and were able to see benefits of the implementation. Pharmacists came up with suggestions for overcoming resistance associated with the implementation of cpKPIs and provided insights into the future of pharmacy practice. The identification of barriers

  12. Pharmacists' Perceptions of the Barriers and Facilitators to the Implementation of Clinical Pharmacy Key Performance Indicators.

    PubMed

    Minard, Laura V; Deal, Heidi; Harrison, Megan E; Toombs, Kent; Neville, Heather; Meade, Andrea

    2016-01-01

    In hospitals around the world, there has been no consensus regarding which clinical activities a pharmacist should focus on until recently. In 2011, a Canadian clinical pharmacy key performance indicator (cpKPI) collaborative was formed. The goal of the collaborative was to advance pharmacy practice in order to improve patient outcomes and enhance the quality of care provided to patients by hospital pharmacists. Following a literature review, which indicated that pharmacists can improve patient outcomes by carrying out specific activities, and an evidence-informed consensus process, a final set of eight cpKPIs were established. Canadian hospitals leading the cpKPI initiative are currently in the early stages of implementing these indicators. To explore pharmacists' perceptions of the barriers and facilitators to the implementation of cpKPIs. Clinical pharmacists employed by the Nova Scotia Health Authority were invited to participate in focus groups. Focus group discussions were audio-recorded and transcribed, and data was analyzed using thematic analysis. Three focus groups, including 26 pharmacists, were conducted in February 2015. Three major themes were identified. Resisting the change was comprised of documentation challenges, increased workload, practice environment constraints, and competing priorities. Embracing cpKPIs was composed of seeing the benefit, demonstrating value, and existing supports. Navigating the unknown was made up of quality versus quantity battle, and insights into the future. Although pharmacists were challenged by documentation and other changes associated with the implementation of cpKPIs, they demonstrated significant support for cpKPIs and were able to see benefits of the implementation. Pharmacists came up with suggestions for overcoming resistance associated with the implementation of cpKPIs and provided insights into the future of pharmacy practice. The identification of barriers and facilitators to cpKPI implementation will be

  13. Implementing patient-reported outcome measures in palliative care clinical practice: a systematic review of facilitators and barriers.

    PubMed

    Antunes, Bárbara; Harding, Richard; Higginson, Irene J

    2014-02-01

    Many patient-reported outcome measures have been developed in the past two decades, playing an increasingly important role in palliative care. However, their routine use in practice has been slow and difficult to implement. To systematically identify facilitators and barriers to the implementation of patient-reported outcome measures in different palliative care settings for routine practice, and to generate evidence-based recommendations, to inform the implementation process in clinical practice. Systematic literature review and narrative synthesis. Medline, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Embase and British Nursing Index were systematically searched from 1985. Hand searching of reference lists for all included articles and relevant review articles was performed. A total of 3863 articles were screened. Of these, 31 articles met the inclusion criteria. First, data were integrated in the main themes: facilitators, barriers and lessons learned. Second, each main theme was grouped into either five or six categories. Finally, recommendations for implementation on outcome measures at management, health-care professional and patient levels were generated for three different points in time: preparation, implementation and assessment/improvement. Successful implementation of patient-reported outcome measures should be tailored by identifying and addressing potential barriers according to setting. Having a coordinator throughout the implementation process seems to be key. Ongoing cognitive and emotional processes of each individual should be taken into consideration during changes. The educational component prior to the implementation is crucial. This could promote ownership and correct use of the measure by clinicians, potentially improving practice and the quality of care provided through patient-reported outcome measure data use in clinical decision-making.

  14. Facilitators for the development and implementation of health promoting policy and programs - a scoping review at the local community level.

    PubMed

    Weiss, Daniel; Lillefjell, Monica; Magnus, Eva

    2016-02-11

    Health promotion, with a focus on multidimensional upstream factors and an ecological, life-course approach, is establishing itself as the guiding philosophy for addressing public health. Action at the political and programmatic level on the Social Determinants of Health has proven effective for promoting and building public health at all levels but has been particularly evident at the national and international levels - due in large part to available documents and guidelines. Although research and experience establish that health promotion is most effective when settings-based, the development of health promoting policies and programs at the local level is still difficult. This study intended to investigate available knowledge on the development and implementation of health promoting policies and programs at the local level and identify factors most important for facilitating capacity building and outcome achievement. We used a scoping review in order to review the current literature on local policy development and program implementation. Keywords were chosen based on results of a previous literature review. A total of 53 articles were divided into two categories: policy and implementation. Critical analysis was conducted for each article and a summary assembled. Data was charted with specific focus on the aims of the study, data acquisition, key theories/concepts/frameworks used, outcome measures, results, and conclusions. The articles included in this study primarily focused on discussing factors that facilitate the development of health promoting policy and the implementation of health promotion programs. Most significant facilitators included: collaborative decision-making, agreement of objectives and goals, local planning and action, effective leadership, building and maintaining trust, availability of resources, a dynamic approach, a realistic time-frame, and trained and knowledgeable staff. Within each of these important facilitating factors, various

  15. Implementing family involvement in the treatment of patients with psychosis: a systematic review of facilitating and hindering factors

    PubMed Central

    Eassom, Erica; Giacco, Domenico; Dirik, Aysegul; Priebe, Stefan

    2014-01-01

    Objective To synthesise the evidence on implementing family involvement in the treatment of patients with psychosis with a focus on barriers, problems and facilitating factors. Design Systematic review of studies evaluating the involvement of families in tripartite communication between health professionals, ‘families’ (or other unpaid carers) and adult patients, in a single-family context. A theoretical thematic analysis approach and thematic synthesis were used. Data sources A systematic electronic search was carried out in seven databases, using database-specific search strategies and controlled vocabulary. A secondary manual search of grey literature was performed as well as using forwards and backwards snowballing techniques. Results A total of 43 studies were included. The majority featured qualitative data (n=42), focused solely on staff perspectives (n=32) and were carried out in the UK (n=23). Facilitating the training and ongoing supervision needs of staff are necessary but not sufficient conditions for a consistent involvement of families. Organisational cultures and paradigms can work to limit family involvement, and effective implementation appears to operate via a whole team coordinated effort at every level of the organisation, supported by strong leadership. Reservations about family involvement regarding power relations, fear of negative outcomes and the need for an exclusive patient–professional relationship may be explored and addressed through mutually trusting relationships. Conclusions Implementing family involvement carries additional challenges beyond those generally associated with translating research to practice. Implementation may require a cultural and organisational shift towards working with families. Family work can only be implemented if this is considered a shared goal of all members of a clinical team and/or mental health service, including the leaders of the organisation. This may imply a change in the ethos and practices

  16. The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework

    PubMed Central

    2013-01-01

    Background The case has been made for more and better theory-informed process evaluations within trials in an effort to facilitate insightful understandings of how interventions work. In this paper, we provide an explanation of implementation processes from one of the first national implementation research randomized controlled trials with embedded process evaluation conducted within acute care, and a proposed extension to the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Methods The PARIHS framework was prospectively applied to guide decisions about intervention design, data collection, and analysis processes in a trial focussed on reducing peri-operative fasting times. In order to capture a holistic picture of implementation processes, the same data were collected across 19 participating hospitals irrespective of allocation to intervention. This paper reports on findings from data collected from a purposive sample of 151 staff and patients pre- and post-intervention. Data were analysed using content analysis within, and then across data sets. Results A robust and uncontested evidence base was a necessary, but not sufficient condition for practice change, in that individual staff and patient responses such as caution influenced decision making. The implementation context was challenging, in which individuals and teams were bounded by professional issues, communication challenges, power and a lack of clarity for the authority and responsibility for practice change. Progress was made in sites where processes were aligned with existing initiatives. Additionally, facilitators reported engaging in many intervention implementation activities, some of which result in practice changes, but not significant improvements to outcomes. Conclusions This study provided an opportunity for reflection on the comprehensiveness of the PARIHS framework. Consistent with the underlying tenant of PARIHS, a multi-faceted and dynamic story of

  17. [Barriers and facilitators to implementing shared decision-making in oncology: Patient perceptions].

    PubMed

    Ortega-Moreno, M; Padilla-Garrido, N; Huelva-López, L; Aguado-Correa, F; Bayo-Calero, J; Bayo-Lozano, E

    To determine, from the point of view of the oncological patient, who made the decision about their treatment, as well as the major barriers and facilitators that enabled Shared Decision Making to be implemented. A cross-sectional, descriptive, sand association study using a self-report questionnaire to selected cancer patients, with casual sampling in different oncology clinics and random time periods. A total of 108 patients provided analysable data. The information was collected on sociodemographic and clinical variables, who made the decision about treatment, and level of agreement or disagreement with various barriers and facilitators. More than one-third (38.1%) of patients claimed to have participated in shared decision making with their doctor. Barriers such as, time, the difficulty of understanding, the paternalism, lack of fluid communication, and having preliminary and often erroneous information influenced the involvement in decision-making. However, to have or not have sufficient tools to aid decision making or the patient's interest to participate had no effect. As regards facilitators, physician motivation, their perception of improvement, and the interest of the patient had a positive influence. The exception was the possibility of financial incentives to doctors. The little, or no participation perceived by cancer patients in decisions about their health makes it necessary to introduce improvements in the health care model to overcome barriers and promote a more participatory attitude in the patient. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Study of the Effects on Student Knowledge and Perceptions of Activities Related to Submetering the 6th Grade Wing of a Middle School, to Displaying the Carbon Footprint, and to Efforts to Reduce Energy Consumption and Greenhouse Gases

    ERIC Educational Resources Information Center

    Peck, Rick

    2009-01-01

    The purpose of the study was to determine the effects upon student knowledge and perceptions regarding greenhouse gas emissions as a result of an intervention relying upon the submetering the 6th grade wing of a Middle School, displaying the information regarding electrical consumption and carbon footprint, and reducing the electrical consumption…

  19. The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework.

    PubMed

    Rycroft-Malone, Jo; Seers, Kate; Chandler, Jackie; Hawkes, Claire A; Crichton, Nicola; Allen, Claire; Bullock, Ian; Strunin, Leo

    2013-03-09

    The case has been made for more and better theory-informed process evaluations within trials in an effort to facilitate insightful understandings of how interventions work. In this paper, we provide an explanation of implementation processes from one of the first national implementation research randomized controlled trials with embedded process evaluation conducted within acute care, and a proposed extension to the Promoting Action on Research Implementation in Health Services (PARIHS) framework. The PARIHS framework was prospectively applied to guide decisions about intervention design, data collection, and analysis processes in a trial focussed on reducing peri-operative fasting times. In order to capture a holistic picture of implementation processes, the same data were collected across 19 participating hospitals irrespective of allocation to intervention. This paper reports on findings from data collected from a purposive sample of 151 staff and patients pre- and post-intervention. Data were analysed using content analysis within, and then across data sets. A robust and uncontested evidence base was a necessary, but not sufficient condition for practice change, in that individual staff and patient responses such as caution influenced decision making. The implementation context was challenging, in which individuals and teams were bounded by professional issues, communication challenges, power and a lack of clarity for the authority and responsibility for practice change. Progress was made in sites where processes were aligned with existing initiatives. Additionally, facilitators reported engaging in many intervention implementation activities, some of which result in practice changes, but not significant improvements to outcomes. This study provided an opportunity for reflection on the comprehensiveness of the PARIHS framework. Consistent with the underlying tenant of PARIHS, a multi-faceted and dynamic story of implementation was evident. However, the

  20. Barriers and facilitators to implementing a patient-centered model of contraceptive provision in community health centers.

    PubMed

    Politi, Mary C; Estlund, Amy; Milne, Anne; Buckel, Christina M; Peipert, Jeffrey F; Madden, Tessa

    2016-01-01

    The Contraceptive CHOICE Project developed a patient-centered model for contraceptive provision including: (1) structured, evidence-based counseling; (2) staff and health care provider education; and (3) removal of barriers such as cost and multiple appointments to initiate contraception. In preparation for conducting a research study of the CHOICE model in three community health settings, we sought to identify potential barriers and facilitators to implementation. Using a semi-structured interview guide guided by a framework of implementation research, we conducted 31 qualitative interviews with female patients, staff, and health care providers assessing attitudes, beliefs, and barriers to receiving contraception. We also asked about current contraceptive provision and explored organizational practices relevant to implementing the CHOICE model. We used a grounded theory approach to identify major themes. Many participants felt that current contraceptive provision could be improved by the CHOICE model. Potential facilitators included agreement about the necessity for improved contraceptive knowledge among patients and staff; importance of patient-centered contraceptive counseling; and benefits to same-day insertion of long-acting reversible contraception (LARC). Potential barriers included misconceptions about contraception held by staff and providers; resistance to new practices; costs associated with LARC; and scheduling challenges required for same-day insertion of LARC. In addition to staff and provider training, implementing a patient-centered model of contraceptive provision needs to be supplemented by strategies to manage patient and system-level barriers. Community health center staff, providers, and patients support patient-centered contraceptive counseling to improve contraception provision if organizations can address these barriers.

  1. Following a natural experiment of guideline adaptation and early implementation: a mixed-methods study of facilitation

    PubMed Central

    2012-01-01

    Background Facilitation is emerging as an important strategy in the uptake of evidence. However, it is not entirely clear from a practical perspective how facilitation occurs to help move research evidence into nursing practice. The Canadian Partnership Against Cancer, also known as the 'Partnership,' is a Pan-Canadian initiative supporting knowledge translation activity for improved care through guideline use. In this case-series study, five self-identified groups volunteered to use a systematic methodology to adapt existing clinical practice guidelines for Canadian use. With 'Partnership' support, local and external facilitators provided assistance for groups to begin the process by adapting the guidelines and planning for implementation. Methods To gain a more comprehensive understanding of the nature of facilitation, we conducted a mixed-methods study. Specifically, we examined the role and skills of individuals actively engaged in facilitation as well as the actual facilitation activities occurring within the 'Partnership.' The study was driven by and builds upon a focused literature review published in 2010 that examined facilitation as a role and process in achieving evidence-based practice in nursing. An audit tool outlining 46 discrete facilitation activities based on results of this review was used to examine the facilitation noted in the documents (emails, meeting minutes, field notes) of three nursing-related cases participating in the 'Partnership' case-series study. To further examine the concept, six facilitators were interviewed about their practical experiences. The case-audit data were analyzed through a simple content analysis and triangulated with participant responses from the focus group interview to understand what occurred as these cases undertook guideline adaptation. Results The analysis of the three cases revealed that almost all of the 46 discrete, practical facilitation activities from the literature were evidenced. Additionally, case

  2. Implementation of Environmental Flows for Intermittent River Systems: Adaptive Management and Stakeholder Participation Facilitate Implementation

    NASA Astrophysics Data System (ADS)

    Conallin, John; Wilson, Emma; Campbell, Josh

    2018-03-01

    Anthropogenic pressure on freshwater ecosystems is increasing, and often leading to unacceptable social-ecological outcomes. This is even more prevalent in intermittent river systems where many are already heavily modified, or human encroachment is increasing. Although adaptive management approaches have the potential to aid in providing the framework to consider the complexities of intermittent river systems and improve utility within the management of these systems, success has been variable. This paper looks at the application of an adaptive management pilot project within an environmental flows program in an intermittent stream (Tuppal Creek) in the Murray Darling Basin, Australia. The program focused on stakeholder involvement, participatory decision-making, and simple monitoring as the basis of an adaptive management approach. The approach found that by building trust and ownership through concentrating on inclusiveness and transparency, partnerships between government agencies and landholders were developed. This facilitated a willingness to accept greater risks and unintended consequences allowing implementation to occur.

  3. Implementing Family-Centered Care Through Facilitated Sensemaking.

    PubMed

    Davidson, Judy E; Zisook, Sidney

    2017-01-01

    The Society of Critical Care Medicine has released updated recommendations for care of the family in neonatal, pediatric, and adult intensive care units. Translation of the recommendations into practice may benefit from a supporting theoretical framework. Facilitated sensemaking is a mid-range theory built from the same literature that formed the basis for recommendations within the guidelines. The process of facilitated sensemaking may be used to help nurses adopt the SCCM recommendations into practice through the development of caring relationships, promoting family presence, teaching family engagement strategies, and supporting families with communication, information gathering, and participation in decision-making. ©2017 American Association of Critical-Care Nurses.

  4. Could accreditation bodies facilitate the implementation of medical guidelines in laboratories?

    PubMed

    Aakre, Kristin M; Oosterhuis, Wytze P; Misra, Shivani; Langlois, Michel R; Joseph, Watine; Twomey, Patrick J; Barth, Julian H

    2017-05-01

    Several studies have shown that recommendations related to how laboratory testing should be performed and results interpreted are limited in medical guidelines and that the uptake and implementation of the recommendations that are available need improvement. The EFLM/UEMS Working Group on Guidelines conducted a survey amongst the national societies for clinical chemistry in Europe regarding development of laboratory-related guidelines. The results showed that most countries have guidelines that are specifically related to laboratory testing; however, not all countries have a formal procedure for accepting such guidelines and few countries have guideline committees. Based on this, the EFLM/UEMS Working Group on Guidelines conclude that there is still room for improvement regarding these processes in Europe and raise the question if the accreditation bodies could be a facilitator for an improvement.

  5. Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness

    PubMed Central

    Tistad, Malin; Palmcrantz, Susanne; Wallin, Lars; Ehrenberg, Anna; Olsson, Christina B.; Tomson, Göran; Holmqvist, Lotta Widén; Gifford, Wendy; Eldh, Ann Catrine

    2016-01-01

    Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future

  6. Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness.

    PubMed

    Tistad, Malin; Palmcrantz, Susanne; Wallin, Lars; Ehrenberg, Anna; Olsson, Christina B; Tomson, Göran; Holmqvist, Lotta Widén; Gifford, Wendy; Eldh, Ann Catrine

    2016-04-11

    Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers' leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention's potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers' behaviors or clinical practice at the units. Future interventions directed towards managers should have a

  7. Implementing family involvement in the treatment of patients with psychosis: a systematic review of facilitating and hindering factors.

    PubMed

    Eassom, Erica; Giacco, Domenico; Dirik, Aysegul; Priebe, Stefan

    2014-10-03

    To synthesise the evidence on implementing family involvement in the treatment of patients with psychosis with a focus on barriers, problems and facilitating factors. Systematic review of studies evaluating the involvement of families in tripartite communication between health professionals, 'families' (or other unpaid carers) and adult patients, in a single-family context. A theoretical thematic analysis approach and thematic synthesis were used. A systematic electronic search was carried out in seven databases, using database-specific search strategies and controlled vocabulary. A secondary manual search of grey literature was performed as well as using forwards and backwards snowballing techniques. A total of 43 studies were included. The majority featured qualitative data (n=42), focused solely on staff perspectives (n=32) and were carried out in the UK (n=23). Facilitating the training and ongoing supervision needs of staff are necessary but not sufficient conditions for a consistent involvement of families. Organisational cultures and paradigms can work to limit family involvement, and effective implementation appears to operate via a whole team coordinated effort at every level of the organisation, supported by strong leadership. Reservations about family involvement regarding power relations, fear of negative outcomes and the need for an exclusive patient-professional relationship may be explored and addressed through mutually trusting relationships. Implementing family involvement carries additional challenges beyond those generally associated with translating research to practice. Implementation may require a cultural and organisational shift towards working with families. Family work can only be implemented if this is considered a shared goal of all members of a clinical team and/or mental health service, including the leaders of the organisation. This may imply a change in the ethos and practices of clinical teams, as well as the establishment of

  8. Barriers and facilitators to implementing family support and education in Early Psychosis Intervention programmes: A systematic review.

    PubMed

    Selick, Avra; Durbin, Janet; Vu, Nhi; O'Connor, Karen; Volpe, Tiziana; Lin, Elizabeth

    2017-10-01

    Family support is a core component of the Early Psychosis Intervention (EPI) model, yet it continues to have relatively low rates of implementation in practice. This paper reports results of a literature review on facilitators and barriers to delivering family interventions in EPI programmes. A search was conducted of 4 electronic databases, Medline, EMBASE, PsycINFO and Joanna Briggs, from 2000 to 2015 using terms related to early onset psychosis, family work and implementation. Four thousand four hundred and two unique studies were identified, 7 of which met inclusion criteria. Barriers and facilitators were coded and aggregated to higher-level themes using a consensus approach. Five of 7 studies examined structured multifamily psychoeducation. Uptake by families was affected by: family/client interest and readiness to participate; ability to access supports; and support needs/preferences. Implementation by programmes was affected by staff access to training and resources to provide family support. A key finding across the identified studies was that families have different needs and preferences regarding the timing, length, intensity and content of the intervention. One size does not fit all and many families do not require the intensive psychoeducational programmes typically provided. The reviewed literature suggests that flexible, tiered approaches to care may better meet family needs and increase rates of uptake of family support. However, more research is needed on the effectiveness of different models of family support in early psychosis and how they can be successfully implemented. © 2017 John Wiley & Sons Australia, Ltd.

  9. Barriers to and facilitators for implementing quality improvements in palliative care - results from a qualitative interview study in Norway.

    PubMed

    Sommerbakk, Ragni; Haugen, Dagny Faksvåg; Tjora, Aksel; Kaasa, Stein; Hjermstad, Marianne Jensen

    2016-07-15

    Implementation of quality improvements in palliative care (PC) is challenging, and detailed knowledge about factors that may facilitate or hinder implementation is essential for success. One part of the EU-funded IMPACT project (IMplementation of quality indicators in PAlliative Care sTudy) aiming to increase the knowledge base, was to conduct national studies in PC services. This study aims to identify factors perceived as barriers or facilitators for improving PC in cancer and dementia settings in Norway. Individual, dual-participant and focus group interviews were conducted with 20 employees working in different health care services in Norway: two hospitals, one nursing home, and two local medical centers. Thematic analysis with a combined inductive and theoretical approach was applied. Barriers and facilitators were connected to (1) the innovation (e.g. credibility, advantage, accessibility, attractiveness); (2) the individual professional (e.g. motivation, PC expertise, confidence); (3) the patient (e.g. compliance); (4) the social context (e.g. leadership, culture of change, face-to-face contact); (5) the organizational context (e.g. resources, structures/facilities, expertise); (6) the political and economic context (e.g. policy, legislation, financial arrangements) and (7) the implementation strategy (e.g. educational, meetings, reminders). Four barriers that were particular to PC were identified: the poor general condition of patients in need of PC, symptom assessment tools that were not validated in all patient groups, lack of PC expertise and changes perceived to be at odds with staff's philosophy of care. When planning an improvement project in PC, services should pay particular attention to factors associated with their chosen implementation strategy. Leaders should also involve staff early in the improvement process, ensure that they have the necessary training in PC and that the change is consistent with the staff's philosophy of care. An important

  10. Implementing a university-community-retail partnership model to facilitate community education on universal design.

    PubMed

    Price, Christine A; Zavotka, Susan L; Teaford, Margaret H

    2004-10-01

    A collaborative partnership model was used to develop and implement a state-wide community education program on universal design. University faculty, extension professionals, older adult service agencies, service learning students, and a community retail chain made up the original partnership. This collaboration resulted in a five-stage partnership model. The model was used to develop and disseminate a consumer education program to promote aging in place. The five stages include (a) identifying partner strengths and shared learning, (b) program development, (c) implementing the universal design program, (d) facilitating collaborative outreach, and (e) shifting toward sustainable outreach. A lack of knowledge exists among consumers, builders, and health care professionals regarding strategies for aging in place. Collaborations between educators, outreach professionals, students, and a retail partner resulted in increased interest and awareness about universal design changes that enable seniors to age in place.

  11. Automated protocols for spaceborne sub-meter resolution "Big Data" products for Earth Science

    NASA Astrophysics Data System (ADS)

    Neigh, C. S. R.; Carroll, M.; Montesano, P.; Slayback, D. A.; Wooten, M.; Lyapustin, A.; Shean, D. E.; Alexandrov, O.; Macander, M. J.; Tucker, C. J.

    2017-12-01

    The volume of available remotely sensed data has grown exceeding Petabytes per year and the cost for data, storage systems and compute power have both dropped exponentially. This has opened the door for "Big Data" processing systems with high-end computing (HEC) such as the Google Earth Engine, NASA Earth Exchange (NEX), and NASA Center for Climate Simulation (NCCS). At the same time, commercial very high-resolution (VHR) satellites have grown into a constellation with global repeat coverage that can support existing NASA Earth observing missions with stereo and super-spectral capabilities. Through agreements with the National Geospatial-Intelligence Agency NASA-Goddard Space Flight Center is acquiring Petabytes of global sub-meter to 4 meter resolution imagery from WorldView-1,2,3 Quickbird-2, GeoEye-1 and IKONOS-2 satellites. These data are a valuable no-direct cost for the enhancement of Earth observation research that supports US government interests. We are currently developing automated protocols for generating VHR products to support NASA's Earth observing missions. These include two primary foci: 1) on demand VHR 1/2° ortho mosaics - process VHR to surface reflectance, orthorectify and co-register multi-temporal 2 m multispectral imagery compiled as user defined regional mosaics. This will provide an easy access dataset to investigate biodiversity, tree canopy closure, surface water fraction, and cropped area for smallholder agriculture; and 2) on demand VHR digital elevation models (DEMs) - process stereo VHR to extract VHR DEMs with the NASA Ames stereo pipeline. This will benefit Earth surface studies on the cryosphere (glacier mass balance, flow rates and snow depth), hydrology (lake/water body levels, landslides, subsidence) and biosphere (forest structure, canopy height/cover) among others. Recent examples of products used in NASA Earth Science projects will be provided. This HEC API could foster surmounting prior spatial-temporal limitations while

  12. BARRIERS AND FACILITATORS TO THE IMPLEMENTATION OF A NATIONAL HIV LINKAGE, RE-ENGAGEMENT, AND RETENTION IN CARE PROGRAM

    PubMed Central

    Maulsby, Cathy; Sacamano, Paul; Jain, Kriti M.; Enobun, Blessing; Brantley, Meredith L.; Kim, Hae-Young; Riordan, Morey; Werner, Melissa; Holtgrave, David R.

    2018-01-01

    The 2020 National HIV AIDS Strategy (NHAS) sets a target of 90% of diagnosed people living with HIV (PLWH) retained in HIV care. Access to Care (A2C) was a national HIV linkage, re-engagement, and retention in care program funded by AIDS United with support from the Corporation for National and Community Service that aimed to link and retain the most vulnerable PLWH into high-quality HIV care. This study explores the barriers and facilitators of implementing the A2C program from the perspective of program staff. Ninety-eight qualitative interviews were conducted with staff at implementing organizations over the 5 years of the project. Barriers included challenges with recruiting and retaining participants, staffing and administration, harmonizing partnerships, and addressing the basic and psychosocial needs of participants. Facilitators included strong relationships with partner organizations, flexible program models, and the passion and dedication of staff. Findings will inform the development of future programs and policy. PMID:29068718

  13. Barriers, facilitators and views about next steps to implementing supports for evidence-informed decision-making in health systems: a qualitative study.

    PubMed

    Ellen, Moriah E; Léon, Grégory; Bouchard, Gisèle; Ouimet, Mathieu; Grimshaw, Jeremy M; Lavis, John N

    2014-12-05

    Mobilizing research evidence for daily decision-making is challenging for health system decision-makers. In a previous qualitative paper, we showed the current mix of supports that Canadian health-care organizations have in place and the ones that are perceived to be helpful to facilitate the use of research evidence in health system decision-making. Factors influencing the implementation of such supports remain poorly described in the literature. Identifying the barriers to and facilitators of different interventions is essential for implementation of effective, context-specific, supports for evidence-informed decision-making (EIDM) in health systems. The purpose of this study was to identify (a) barriers and facilitators to implementing supports for EIDM in Canadian health-care organizations, (b) views about emerging development of supports for EIDM, and (c) views about the priorities to bridge the gaps in the current mix of supports that these organizations have in place. This qualitative study was conducted in three types of health-care organizations (regional health authorities, hospitals, and primary care practices) in two Canadian provinces (Ontario and Quebec). Fifty-seven in-depth semi-structured telephone interviews were conducted with senior managers, library managers, and knowledge brokers from health-care organizations that have already undertaken strategic initiatives in knowledge translation. The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. Limited resources (i.e., money or staff), time constraints, and negative attitudes (or resistance) toward change were the most frequently identified barriers to implementing supports for EIDM. Genuine interest from health system decision-makers, notably their willingness to invest money and resources and to create a knowledge translation culture over time in health-care organizations, was the most frequently identified facilitator to

  14. Barriers and facilitators to implementation of VA home-based primary care on American Indian reservations: a qualitative multi-case study.

    PubMed

    Kramer, B Josea; Cote, Sarah D; Lee, Diane I; Creekmur, Beth; Saliba, Debra

    2017-09-02

    Veterans Health Affairs (VA) home-based primary care (HBPC) is an evidence-based interdisciplinary approach to non-institutional long-term care that was developed in urban settings to provide longitudinal care for vulnerable older patients. Under the authority of a Memorandum of Understanding between VA and Indian Health Service (IHS) to improve access to healthcare, 14 VA medical centers (VAMC) independently initiated plans to expand HBPC programs to rural American Indian reservations and 12 VAMC successfully implemented programs. The purpose of this study is to describe barriers and facilitators to implementation in rural Native communities with the aim of informing planners and policy-makers for future program expansions. A qualitative comparative case study approach was used, treating each of the 14 VAMC as a case. Using the Consolidated Framework for Implementation Research (CFIR) to inform an open-ended interview guide, telephone interviews (n = 37) were conducted with HBPC staff and clinicians and local/regional managers, who participated or oversaw implementation. The interviews were transcribed, coded, and then analyzed using CFIR domains and constructs to describe and compare experiences and to identify facilitators, barriers, and adaptations that emerged in common across VAMC and HBPC programs. There was considerable variation in local contexts across VAMC. Nevertheless, implementation was typically facilitated by key individuals who were able to build trust and faith in VA healthcare among American Indian communities. Policy promoted clinical collaboration but collaborations generally occurred on an ad hoc basis between VA and IHS clinicians to optimize patient resources. All programs required some adaptations to address barriers in rural areas, such as distances, caseloads, or delays in hiring additional clinicians. VA funding opportunities facilitated expansion and sustainment of these programs. Since program expansion is a responsibility of the

  15. Policies and Procedures That Facilitate Implementation of Evidence-Based Clinical Guidelines in U.S. Dental Schools.

    PubMed

    Polk, Deborah E; Nolan, Beth A D; Shah, Nilesh H; Weyant, Robert J

    2016-01-01

    The aim of this study was to determine the degree to which dental schools in the United States have policies and procedures in place that facilitate the implementation of evidence-based clinical guidelines. The authors sent surveys to all 65 U.S. dental schools in 2014; responses were obtained from 38 (58%). The results showed that, of the nine policies and procedures examined, only two were fully implemented by 50% or more of the responding schools: guidelines supported through clinical faculty education or available chairside (50%), and students informed of guidelines in both the classroom and clinic (65.8%). Although 92% of the respondents reported having an electronic health record, 80% of those were not using it to track compliance with guidelines. Five schools reported implementing more policies than the rest of the schools. The study found that the approach to implementing guidelines at most of the responding schools did not follow best practices although five schools had an exemplary set of policies and procedures to support guideline implementation. These results suggest that most dental schools are currently not implementing guidelines effectively and efficiently, but that the goal of schools' having a comprehensive implementation program for clinical guidelines is achievable since some are doing so. Future studies should determine whether interventions to improve implementation in dental schools are needed.

  16. The most used and most helpful facilitators for patient-centered medical home implementation.

    PubMed

    Gale, Randall C; Asch, Steven M; Taylor, Thomas; Nelson, Karin M; Luck, Jeff; Meredith, Lisa S; Helfrich, Christian D

    2015-04-19

    Like other transformative healthcare initiatives, patient-centered medical home (PCMH) implementation requires substantial investments of time and resources. Even though PCMH and PCMH-like models are being implemented by multiple provider practices and health systems, little is known about what facilitates their implementation. The purpose of this study was to assess which PCMH-implementation resources are most widely used, by whom, and which resources primary care personnel find most helpful. This study is an analysis of data from a cross-sectional survey of primary care personnel in the Veterans Health Administration in 2012, in which respondents were asked to rate whether they were aware of and accessed PCMH-implementation resources, and to rate their helpfulness. Logistic regression was used to produce odds ratios for the outcomes (1) resource use and (2) resource helpfulness. Respondents were nested within clinics, nested, in turn, within 135 parent hospitals. Teamlet huddles were the most widely accessed (80.4% accessed) and most helpful (90.4% rated helpful) resource; quality-improvement methods to conduct small tests of change were the least frequently accessed (42.4% accessed) resource though two-thirds (66.7%) of users reported as helpful. Supervisors were significantly more likely (ORs, 1.46 to 1.86) to use resources than non-supervisors but were less likely to rate the majority (8 out of 10) of resources as "somewhat/very helpful" than non-supervisors (ORs, 0.72 to 0.84). Longer-tenured employees tended to rate resources as more helpful. These findings are the first in the PCMH literature that we are aware of that systematically assesses primary care staff's access to and the helpfulness of PCMH implementation resources. Supervisors generally reported greater access to resources, relative to non-supervisors, but rated resources as less helpful, suggesting that information about them may not have been optimally disseminated. Knowing what resources

  17. Barriers and Facilitating Factors for Implementation of Genetic Services: A Public Health Perspective.

    PubMed

    Cornel, Martina C; van El, Carla G

    2017-01-01

    More than 15 years after the publication of the sequence of the human genome, the resulting changes in health care have been modest. At the same time, some promising examples in genetic services become visible, which contribute to the prevention of chronic disease such as cancer. These are discussed to identify barriers and facilitating factors for the implementation of genetic services. Examples from oncogenetics illustrate a high risk of serious disease where prevention is possible, especially in relatives. Some 5% of breast cancers and colorectal cancers are attributable to an inherited predisposition. These cancers occur at a relatively young age. DNA testing of relatives of affected patients may facilitate primary and secondary prevention. Training of non-genetic health care workers and health technology assessment are needed, as is translational research in terms of bringing genomics to health care practice while monitoring and evaluating. Stratified screening programs could include cascade screening and risk assessment based on family history. New roles and responsibilities will emerge. A clear assessment of the values implied is needed allowing to balance the pros and cons of interventions to further the responsible innovation of genetic services.

  18. Development and implementation of a navigator-facilitated care coordination algorithm to improve clinical outcomes of underserved Latino patients with uncontrolled diabetes.

    PubMed

    Congdon, Heather Brennan; Eldridge, Barbara Hoffman; Truong, Hoai-An

    2013-11-01

    Development and implementation of an interprofessional navigator-facilitated care coordination algorithm (NAVCOM) for low-income, uninsured patients with uncontrolled diabetes at a safety-net clinic resulted in improvement of disease control as evidenced by improvement in hemoglobin A1C. This report describes the process and lessons learned from the development and implementation of NAVCOM and patient success stories.

  19. Barriers and facilitators to the implementation of orthodontic mini implants in clinical practice: a systematic review.

    PubMed

    Meursinge Reynders, Reint; Ronchi, Laura; Ladu, Luisa; Di Girolamo, Nicola; de Lange, Jan; Roberts, Nia; Mickan, Sharon

    2016-09-23

    Numerous surveys have shown that orthodontic mini implants (OMIs) are underused in clinical practice. To investigate this implementation issue, we conducted a systematic review to (1) identify barriers and facilitators to the implementation of OMIs for all potential stakeholders and (2) quantify these implementation constructs, i.e., record their prevalence. We also recorded the prevalence of clinicians in the eligible studies that do not use OMIs. Methods were based on our published protocol. Broad-spectrum eligibility criteria were defined. A barrier was defined as any variable that impedes or obstructs the use of OMIs and a facilitator as any variable that eases and promotes their use. Over 30 databases including gray literature were searched until 15 January 2016. The Joanna Briggs Institute tool for studies reporting prevalence and incidence data was used to critically appraise the included studies. Outcomes were qualitatively synthesized, and meta-analyses were only conducted when pre-set criteria were fulfilled. Three reviewers conducted all research procedures independently. We also contacted authors of eligible studies to obtain additional information. Three surveys fulfilled the eligibility criteria. Seventeen implementation constructs were identified in these studies and were extracted from a total of 165 patients and 1391 clinicians. Eight of the 17 constructs were scored by more than 50 % of the pertinent stakeholders. Three of these constructs overlapped between studies. Contacting of authors clarified various uncertainties but was not always successful. Limitations of the eligible studies included (1) the small number of studies; (2) not defining the research questions, i.e., the primary outcomes; (3) the research design (surveys) of the studies and the exclusive use of closed-ended questions; (4) not consulting standards for identifying implementation constructs; (5) the lack of pilot testing; (6) high heterogeneity; (7) the risk of reporting bias

  20. Facilitators and barriers to implementing electronic referral and/or consultation systems: a qualitative study of 16 health organizations.

    PubMed

    Tuot, Delphine S; Leeds, Kiren; Murphy, Elizabeth J; Sarkar, Urmimala; Lyles, Courtney R; Mekonnen, Tekeshe; Chen, Alice H M

    2015-12-19

    Access to specialty care remains a challenge for primary care providers and patients. Implementation of electronic referral and/or consultation (eCR) systems provides an opportunity for innovations in the delivery of specialty care. We conducted key informant interviews to identify drivers, facilitators, barriers and evaluation metrics of diverse eCR systems to inform widespread implementation of this model of specialty care delivery. Interviews were conducted with leaders of 16 diverse health care delivery organizations between January 2013 and April 2014. A limited snowball sampling approach was used for recruitment. Content analysis was used to examine key informant interview transcripts. Electronic referral systems, which provide referral management and triage by specialists, were developed to enhance tracking and operational efficiency. Electronic consultation systems, which encourage bi-directional communication between primary care and specialist providers facilitating longitudinal virtual co-management, were developed to improve access to specialty expertise. Integrated eCR systems leverage both functionalities to enhance the delivery of coordinated, specialty care at the population level. Elements of successful eCR system implementation included executive and clinician leadership, established funding models for specialist clinician reimbursement, and a commitment to optimizing clinician workflows. eCR systems have great potential to streamline access to and enhance the coordination of specialty care delivery. While different eCR models help solve different organizational challenges, all require institutional investments for successful implementation, such as funding for program management, leadership and clinician incentives.

  1. A Descriptive Study on the Barriers and Facilitators to Implementation of the NSW (Australia) Healthy School Canteen Strategy

    ERIC Educational Resources Information Center

    Ardzejewska, K.; Tadros, R.; Baxter, D.

    2013-01-01

    Objective: The study investigated the barriers and facilitators to, and the extent of the implementation of, the New South Wales (Australia) "Healthy School Canteen Strategy". Design: A purposeful sample was used and data were collected using a mixed method approach. Setting: Two primary and two secondary government schools from a low…

  2. Implementation of a Tool to Enhance Evidence-Informed Decision Making in Public Health: Identifying Barriers and Facilitating Factors

    ERIC Educational Resources Information Center

    van der Heide, Iris; van der Noordt, Maaike; Proper, Karin I.; Schoemaker, Casper; van den Berg, Matthijs; Hamberg-van Reenen, Heleen H.

    2016-01-01

    One of the barriers regarding evidence-informed decision making is the gap between the needs of policy makers and the ways researchers present evidence. This pilot study evaluates the barriers and facilitators to the implementation of a tool to enhance transparent and unambiguous communication on scientific evidence by knowledge workers.…

  3. Facilitators and Barriers to Implementing Church-Based Adolescent Sexual Health Programs in Baltimore City.

    PubMed

    Powell, Terrinieka W; Weeks, Fiona H; Illangasekare, Samantha; Rice, Eric; Wilson, James; Hickman, Debra; Blum, Robert W

    2017-02-01

    Black churches are an important community resource and a potentially powerful actor in adolescent health promotion. However, limited research exists describing the factors that may influence the successful implementation of evidence-based adolescent sexual health programs in churches. In the present study, a multi-informant approach was used to identify facilitators and barriers to implementing adolescent sexual health programs in black churches. Nine Black churches located in Baltimore, MD, were recruited to participate in this study. The senior pastor and youth minster from each congregation participated in an in-depth interview (N = 18). A total of 45 youth (ages 13-19 years) and 38 parents participated in 15 focus groups. Qualitative data were transcribed verbatim and analyzed using a qualitative content analytic approach. Participants agreed that comprehensive adolescent sexual health education should be available for youth in black churches. They also believed that abstaining from sex should be discussed in all adolescent sexual health programs. Three facilitators were discussed: widespread endorsement of church-based adolescent sexual health education, positive influence of youth ministers on youth, and life lessons as teaching tools. Four barriers are described: perceived resistance from congregants, discomfort among youth, lack of financial resources, and competing messages at home about sexual health. Our findings suggest that churches are a preferred place for adolescent sexual health education among some parents and youth. Study findings also reinforce the feasibility and desirably of church-based adolescent sexual health programs. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  4. Barriers and facilitators to the implementation of SPNS interventions designed to engage and retain HIV positive women of color in medical care.

    PubMed

    Garcia, Iliana A; Blank, Arthur E; Eastwood, Elizabeth A; Karasz, Alison

    2015-04-01

    The use of evidence-based strategies to increase access to medical care and improve health outcomes for people living with HIV is a major public health priority in the United States. As part of a multi-site evaluation funded under the Health Resources and Services Administration (HRSA), a process evaluation was conducted with the goal of understanding barriers and facilitators to the implementation of eleven heterogeneous interventions designed to engage and retain HIV positive women of color (WoC) in medical care. Findings identified barriers and facilitators to program implementation at five levels: (1) program; (2) team; (3) agency; (4) partner network; and (5) the larger socio-ecological context. We conclude with a series of recommendations that may be useful for the implementation of similar interventions focused on recruitment and retention of WoC in HIV medical care.

  5. Facilitating the implementation of evidence- based practice through contextual support and nursing leadership.

    PubMed

    Kueny, Angela; Shever, Leah L; Lehan Mackin, Melissa; Titler, Marita G

    2015-01-01

    Nurse managers (NMs) play an important role promoting evidence-based practice (EBP) on clinical units within hospitals. However, there is a dearth of research focused on NM perspectives about institutional contextual factors to support the goal of EBP on the clinical unit. The purpose of this article is to identify contextual factors described by NMs to drive change and facilitate EBP at the unit level, comparing and contrasting these perspectives across nursing units. This study employed a qualitative descriptive design using interviews with nine NMs who were participating in a large effectiveness study. To stratify the sample, NMs were selected from nursing units designated as high or low performing based on implementation of EBP interventions, scores on the Meyer and Goes research use scale, and fall rates. Descriptive content analysis was used to identify themes that reflect the complex nature of infrastructure described by NMs and contextual influences that supported or hindered their promotion of EBP on the clinical unit. NMs perceived workplace culture, structure, and resources as facilitators or barriers to empowering nurses under their supervision to use EBP and drive change. A workplace culture that provides clear communication of EBP goals or regulatory changes, direct contact with CEOs, and clear expectations supported NMs in their promotion of EBP on their units. High-performing unit NMs described a structure that included nursing-specific committees, allowing nurses to drive change and EBP from within the unit. NMs from high-performing units were more likely to articulate internal resources, such as quality-monitoring departments, as critical to the implementation of EBP on their units. This study contributes to a deeper understanding of institutional contextual factors that can be used to support NMs in their efforts to drive EBP changes at the unit level.

  6. Barriers and facilitators related to implementation of regulated midwifery in Manitoba: a case study.

    PubMed

    Thiessen, Kellie; Heaman, Maureen; Mignone, Javier; Martens, Patricia; Robinson, Kristine

    2016-03-15

    In 2000, midwifery was regulated in the Canadian Province of Manitoba. Since the establishment of the midwifery program, little formal research has analyzed the utilization of regulated midwifery services. In Manitoba, the demand for midwifery services has exceeded the number of midwives in practice. The specific objective of this study was to explore factors influencing the implementation and utilization of regulated midwifery services in Manitoba. The case study design incorporated qualitative exploratory descriptive methods, using data derived from two sources: interviews and public documents. Twenty-four key informants were purposefully selected to participate in semi-structured in-depth interviews. All documents analyzed were in the public domain. Content analysis was employed to analyze the documents and transcripts of the interviews. The results of the study were informed by the Behavioral Model of Health Services Use. Three main topic areas were explored: facilitators, barriers, and future strategies and recommendations. The most common themes arising under facilitators were funding of midwifery services and strategies to integrate the profession. Power and conflict, and lack of a productive education program emerged as the most prominent themes under barriers. Finally, future strategies for sustaining the midwifery profession focused on ensuring avenues for registration and education, improving management strategies and accountability frameworks within the employment model, enhancing the work environment, and evaluating both the practice and employment models. Results of the document analysis supported the themes arising from the interviews. These findings on factors that influenced the implementation and integration of midwifery in Manitoba may provide useful information to key stakeholders in Manitoba, as well as other provinces as they work toward successful implementation of regulated midwifery practice. Funding for new positions and programs was

  7. Mental Health Facilitator (MHF) Service Implementation in Schools in Malawi, Africa: A Strategy for Increasing Community Human Resources

    ERIC Educational Resources Information Center

    Luke, Melissa; Hinkle, J. Scott; Schweiger, Wendi; Henderson, Donna

    2016-01-01

    The Mental Health Facilitator (MHF) program utilizes a population-based curriculum and has been implemented in Malawi for the past seven years. This article reports findings from an ethnographic study that explored how 40 MHF stakeholders have experienced the MHF program. This transdisciplinary program is a 30-hour training in community mental…

  8. A deployable telescope for sub-meter resolutions from microsatellite platforms

    NASA Astrophysics Data System (ADS)

    Dolkens, D.; Kuiper, J. M.

    2017-11-01

    Sub-meter resolution imagery has become increasingly important for disaster response, defence and security applications. Earth Observation (EO) at these resolutions has long been the realm of large and heavy telescopes, which results in high image costs, limited availability and long revisit times. Using synthetic aperture technology, instruments can now be developed that can reach these resolutions using a substantially smaller launch volume and mass. To obtain a competitive MicroSatellite telescope design, a concept study was performed to develop a deployable instrument that can reach a ground resolution of 25 cm from an orbital altitude of 500 km. Two classes of instruments were analysed: the Fizeau synthetic aperture, a telescope that uses a segmented primary mirror, and a Michelson synthetic aperture, an instrument concept that combines the light of a distributed array of afocal telescopes into a final image. In a trade-off the Fizeau synthetic aperture was selected as the most promising concept for obtaining high resolution imagery from a Low Earth Orbit. The optical design of the Fizeau synthetic aperture is based on a full-field Korsch telescope that has been optimized for compactness and an excellent wavefront quality. It uses three aperture segments in a tri-arm configuration that can be folded alongside the instrument during launch. The secondary mirror is mounted on a deployable boom, further decreasing the launch volume. To maintain a high image quality while operating in the harsh and dynamic space environment, one of the most challenging obstacles that must be addressed is the very tight tolerance on the positioning of the three primary mirror segments and the secondary mirror. Following a sensitivity analysis, systems engineering budgets have been defined. The instrument concept features a robust thermo-mechanical design, aimed at reducing the mechanical uncertainties to a minimum. Silicon Carbide mirror segments, the use of Invar for the deployable

  9. Pressure Injury Prevention in a Saudi Arabian Intensive Care Unit: Registered Nurse Attitudes Toward Prevention Strategies and Perceived Facilitators and Barriers to Evidence Implementation.

    PubMed

    Tayyib, Nahla; Coyer, Fiona; Lewis, Peter

    2016-01-01

    The purpose of this study was to examine RNs' attitudes toward pressure injury (PI) prevention strategies. Barriers and facilitators perceived by RNs to potentially impact on the adoption and implementation of PI prevention interventions in the intensive care unit (ICU) were examined. Descriptive cross-sectional survey. The target population was RNs practicing in an intensive care unit (ICU) of a major tertiary hospital, King Abdul-Aziz, Mecca, in Saudi Arabia. Fifty-six of the available 60 ICU RNs participated in this study. Data were collected via survey using the Attitude towards Pressure injury Prevention instrument, which included 13 items rated with 4-point Likert scale, and the modified Barriers and Facilitators tool, which included 27 items. The survey was organized into 3 parts: demographic information, potential barriers to optimal skin care, and potential facilitators to skin care. The survey took 10 to 15 minutes to complete. Data were analyzed with descriptive-correlation statistics and multiple regression analysis. Thematic analysis was undertaken for qualitative data. Participants demonstrated positive attitudes toward PI prevention (μ = 38.19/52; 73.44%). No significant differences were found between demographic characteristics of the participants with the RNs' Attitude subscale and perceived barriers and facilitators associated with implementing PI prevention in the critical care setting. Several barriers influenced the ability of RNs to implement PI prevention strategies including time demands (β = .388; P = .011), limitation of RNs' knowledge (β = -.632; P = .022), and current documentation format (β = .344; P = .046). Statistically significant facilitating factors that increased respondents ability to undertake PI prevention were ease of obtaining pressure-reduction surfaces (β = -.388; P = .007), collaboration with interdisciplinary teams (β = .37; P = .02), and availability of appropriate skin care products (β = .44; P = .015). Thematic

  10. Facilitators and barriers of implementing enhanced recovery in colorectal surgery at a safety net hospital: A provider and patient perspective.

    PubMed

    Alawadi, Zeinab M; Leal, Isabel; Phatak, Uma R; Flores-Gonzalez, Juan R; Holihan, Julie L; Karanjawala, Burzeen E; Millas, Stefanos G; Kao, Lillian S

    2016-03-01

    Enhanced Recovery After Surgery (ERAS) pathways are known to decrease complications and duration of stay in colorectal surgery patients. However, it is unclear whether an ERAS pathway would be feasible and effective at a safety-net hospital. The aim of this study was to identify local barriers and facilitators before the adoption of an ERAS pathway for patients undergoing colorectal operations at a safety-net hospital. Semistructured interviews were conducted to assess the perceived barriers and facilitators before ERAS adoption. Stratified purposive sampling was used. Interviews were audiotaped, transcribed verbatim, and analyzed using content analysis. Analytic and investigator triangulation were used to establish credibility. Interviewees included 8 anesthesiologists, 5 surgeons, 6 nurses, and 18 patients. Facilitators identified across the different medical professions were (1) feasibility and alignment with current practice, (2) standardization of care, (3) smallness of community, (4) good teamwork and communication, and (5) caring for patients. The barriers were (1) difficulty in adapting to change, (2) lack of coordination between different departments, (3) special needs of a highly comorbid and socioeconomically disadvantaged patient population, (4) limited resources, and (5) rotating residents. Facilitators identified by the patients were (1) welcoming a speedy recovery, (2) being well-cared for and satisfied with treatment, (3) adequate social support, (4) welcoming early mobilization, and (5) effective pain management. The barriers were (1) lack of quiet and private space, (2) need for more patient education and counseling, and (3) unforeseen complications. Although limited hospital resources are perceived as a barrier to ERAS implementation at a safety-net hospital, there is strong support for such pathways and multiple factors were identified that may facilitate change. Inclusion of patient perspectives is critical to identifying challenges and

  11. Going beyond the identification of change facilitators to effectively implement a new model of services: lessons learned from a case example in paediatric rehabilitation.

    PubMed

    Camden, Chantal; Swaine, Bonnie; Tétreault, Sylvie; Carrière, Monique

    2011-01-01

    To identify facilitators and barriers to service reorganization, how they evolved and interacted to influence change during the implementation of a new service delivery model of paediatric rehabilitation. Over 3 years, different stakeholders responded to SWOT questionnaires (n = 139) and participated in focus groups (n = 19) and telephone interviews (n = 13). A framework based on socio constructivist theories made sense of the data. Facilitators related to the programme's structure (e.g. funding), the actors (e.g. willingness to test the new service model) and the change management process (e.g. participative approach). Some initial facilitators became barriers (e.g. leadership lacked at the end), while other barriers emerged (e.g. lack of tools). Understanding factor interactions requires examining the multiple actors' intentions, actions and consequences and their relations with structural elements. Analysing facilitators and barriers helped better understand the change processes, but this must be followed by concrete actions to successfully implement new paediatric rehabilitation models.

  12. Factors that Facilitate and Barriers towards the Implementation of Health Educational Programmes in Primary Education Schools of the Prefecture of Achaia, Greece

    ERIC Educational Resources Information Center

    Cholevas, Nikolaos K.; Loucaides, Constantinos A.

    2012-01-01

    Aim: The purpose of this study was to explore the factors that facilitate and barriers towards the implementation of health education programmes in primary education schools of the prefecture of Achaia, Greece. Methods: The sample of the study included 141 educators from a total population of 218 educators who dealt with the implementation of…

  13. Barriers and facilitators to HPV vaccination in primary care practices: a mixed methods study using the Consolidated Framework for Implementation Research.

    PubMed

    Garbutt, Jane M; Dodd, Sherry; Walling, Emily; Lee, Amanda A; Kulka, Katharine; Lobb, Rebecca

    2018-05-07

    In the United States, the effective, safe huma papilloma virus (HPV) vaccine is underused and opportunities to prevent cancer continue to be missed. National guidelines recommend completing the 2-3 dose HPV vaccine series by age 13, well before exposure to the sexually transmitted virus. Accurate characterization of the facilitators and barriers to full implementation of HPV vaccine recommendations in the primary care setting could inform effective implementation strategies. We used the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors that influence HPV vaccine use in 10 primary care practices (16 providers) using a concurrent mixed methods design. The CFIR was used to guide collection and analysis of qualitative data collected through in-person semi-structured interviews with the primary care providers. We analyzed HPV vaccine use with data abstracted from medical charts. Constructs that most strongly influenced vaccine use were identified by integrating the qualitative and quantitative data. Of the 72 CFIR constructs assessed, seven strongly distinguished and seven weakly distinguished between providers with higher versus lower HPV vaccine coverage. The majority of strongly distinguishing constructs were facilitators and were related to characteristics of the providers (knowledge and beliefs; self-efficacy; readiness for change), their perception of the intervention (relative advantage of vaccinating younger vs. older adolescents), and their process to deliver the vaccine (executing). Additional weakly distinguishing constructs that were facilitators were from outer setting (peer pressure; financial incentives), inner setting (networks and communications and readiness for implementation) and process (planning; engaging, and reflecting and evaluating). Two strongly distinguishing constructs were barriers to use, one from the intervention (adaptability of the age of initiation) and the other from outer

  14. Facilitators and barriers to implementation of the AIDES initiative, a social innovation for participative assessment of children in need and for coordination of services.

    PubMed

    Dufour, Sarah; Lessard, Danielle; Chamberland, Claire

    2014-12-01

    As part of an implementation evaluation, this study aims to identify the conditions of practice that facilitated or hindered implementation of the AIDES initiative, a social innovation to support collaboration between partners involved with vulnerable children. Evaluators conducted qualitative telephone interviews with 36 respondents (19 practitioners and 17 managers) who participated in the AIDES initiative trial. Respondents were chosen to include all participating organisations (child protection services, prevention social services). Participants' comments were submitted to descriptive content analysis. Conditions facilitating or hindering implementation of the initiative included the following dimensions: (1) implementation quality; (2) organisational elements (organisational functioning, cooperation between organisations); (3) socio-political issues; and (4) personal and professional characteristics. The study highlights critical elements to consider in implementing and maintaining significant changes in practice in organisations providing assistance to vulnerable children and their families. Social innovations that do not consider such elements are likely to compromise their implementation and sustainability. We must prevent promising social changes from being considered unrealistic or inappropriate due to contextual barriers. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. VHA mental health information system: applying health information technology to monitor and facilitate implementation of VHA Uniform Mental Health Services Handbook requirements.

    PubMed

    Trafton, Jodie A; Greenberg, Greg; Harris, Alex H S; Tavakoli, Sara; Kearney, Lisa; McCarthy, John; Blow, Fredric; Hoff, Rani; Schohn, Mary

    2013-03-01

    To describe the design and deployment of health information technology to support implementation of mental health services policy requirements in the Veterans Health Administration (VHA). Using administrative and self-report survey data, we developed and fielded metrics regarding implementation of the requirements delineated in the VHA Uniform Mental Health Services Handbook. Finalized metrics were incorporated into 2 external facilitation-based quality improvement programs led by the VHA Mental Health Operations. To support these programs, tailored site-specific reports were generated. Metric development required close collaboration between program evaluators, policy makers and clinical leadership, and consideration of policy language and intent. Electronic reports supporting different purposes required distinct formatting and presentation features, despite their having similar general goals and using the same metrics. Health information technology can facilitate mental health policy implementation but must be integrated into a process of consensus building and close collaboration with policy makers, evaluators, and practitioners.

  16. Glacier topography and elevation changes derived from Pléiades sub-meter stereo images

    NASA Astrophysics Data System (ADS)

    Berthier, E.; Vincent, C.; Magnússon, E.; Gunnlaugsson, Á. Þ.; Pitte, P.; Le Meur, E.; Masiokas, M.; Ruiz, L.; Pálsson, F.; Belart, J. M. C.; Wagnon, P.

    2014-12-01

    In response to climate change, most glaciers are losing mass and hence contribute to sea-level rise. Repeated and accurate mapping of their surface topography is required to estimate their mass balance and to extrapolate/calibrate sparse field glaciological measurements. In this study we evaluate the potential of sub-meter stereo imagery from the recently launched Pléiades satellites to derive digital elevation models (DEMs) of glaciers and their elevation changes. Our five evaluation sites, where nearly simultaneous field measurements were collected, are located in Iceland, the European Alps, the central Andes, Nepal and Antarctica. For Iceland, the Pléiades DEM is also compared to a lidar DEM. The vertical biases of the Pléiades DEMs are less than 1 m if ground control points (GCPs) are used, but reach up to 7 m without GCPs. Even without GCPs, vertical biases can be reduced to a few decimetres by horizontal and vertical co-registration of the DEMs to reference altimetric data on ice-free terrain. Around these biases, the vertical precision of the Pléiades DEMs is ±1 m and even ±0.5 m on the flat glacier tongues (1σ confidence level). Similar precision levels are obtained in the accumulation areas of glaciers and in Antarctica. We also demonstrate the high potential of Pléiades DEMs for measuring seasonal, annual and multi-annual elevation changes with an accuracy of 1 m or better if cloud-free images are available. The negative region-wide mass balances of glaciers in the Mont-Blanc area (-1.04 ± 0.23 m a-1 water equivalent, w.e.) are revealed by differencing Satellite pour l'Observation de la Terre 5 (SPOT 5) and Pléiades DEMs acquired in August 2003 and 2012, confirming the accelerated glacial wastage in the European Alps.

  17. Identifying facilitators and barriers for implementation of interprofessional education: Perspectives from medical educators in the Netherlands.

    PubMed

    de Vries-Erich, Joy; Reuchlin, Kirsten; de Maaijer, Paul; van de Ridder, J M Monica

    2017-03-01

    Patient care and patient safety can be compromised by the lack of interprofessional collaboration and communication between healthcare providers. Interprofessional education (IPE) should therefore start during medical training and not be postponed until after graduation. This case study explored the current situation in the Dutch context and interviewed experts within medical education and with pioneers of successful best practices to learn more about their experiences with IPE. Data analysis started while new data were still collected, resulting in an iterative, constant comparative process. Using a strengths, weaknesses, opportunities, and threats (SWOT) analysis framework, we identified barriers and facilitators such as lack of a collective professional language, insufficient time or budget, stakeholders' resistance, and hierarchy. Opportunities and strengths identified were developing a collective vision, more attention for patient safety, and commitment of teachers. The facilitators and barriers relate to the organisational level of IPE and the educational content and practice. In particular, communication, cohesiveness, and support are influenced by these facilitators. An adequate identification of the SWOT elements in the current situation could prove beneficial for a successful implementation of IPE within the healthcare educational system.

  18. Implementation of evidence-based stroke care: enablers, barriers, and the role of facilitators

    PubMed Central

    Purvis, Tara; Moss, Karen; Denisenko, Sonia; Bladin, Chris; Cadilhac, Dominique A

    2014-01-01

    A stroke care strategy was developed in 2007 to improve stroke services in Victoria, Australia. Eight stroke network facilitators (SNFs) were appointed in selected hospitals to enable the establishment of stroke units, develop thrombolysis services, and implement protocols. We aimed to explain the main issues being faced by clinicians in providing evidence-based stroke care, and to determine if the appointment of an SNF was perceived as an acceptable strategy to improve stroke care. Face-to-face semistructured interviews were used in a qualitative research design. Interview transcripts were verified by respondents prior to coding. Two researchers conducted thematic analysis of major themes and subthemes. Overall, 84 hospital staff participated in 33 interviews during 2008. The common factors found to impact on stroke care included staff and equipment availability, location of care, inconsistent use of clinical pathways, and professional beliefs. Other barriers included limited access to specialist clinicians and workload demands. The establishment of dedicated stroke units was considered essential to improve the quality of care. The SNF role was valued for identifying gaps in care and providing capacity to change clinical processes. This is the first large, qualitative multicenter study to describe issues associated with delivering high-quality stroke care and the potential benefits of SNFs to facilitate these improvements. PMID:25246799

  19. Facilitating police recording of the alcohol‐related characteristics of assault incidents: A stepped wedge implementation trial

    PubMed Central

    Hacker, Andrew; Kingsland, Melanie; Lecathelinais, Christophe; Tindall, Jennifer; Bowman, Jennifer A.; Wolfenden, Luke

    2015-01-01

    Abstract Introduction and Aims Enforcement of liquor licensing laws is limited by inadequate police information systems. This study aimed to: (i) determine the effectiveness of an intervention in facilitating police recording of the alcohol consumption characteristics of people involved in assaults; and (ii) describe such characteristics by geographic area and setting of alcohol consumption. Design and Methods A stepped wedge trial was conducted across New South Wales, Australia. An intervention to facilitate police recording of alcohol consumption information for people involved in incidents was implemented. For people involved in an assault the proportion for which alcohol consumption information was recorded was assessed. The proportion of assaults that were alcohol related, the proportions of people that consumed alcohol prior to the assault, were intoxicated, and had consumed alcohol in various settings, are described. Results Post‐intervention, alcohol consumption information was recorded for 85–100% of people involved in an assault incident. The proportion of incidents recorded as alcohol‐related increased significantly (26–44.5%; P < 0.0001). The proportion of assaults classified as alcohol related was significantly greater in regional/rural areas (50–47%) than in metropolitan areas (38%). More people in metropolitan areas (54%) consumed alcohol on licensed premises prior to an assault than in regional/rural areas (39–42%), with approximately 70% of persons intoxicated regardless of setting of alcohol consumption. Twenty per cent of premises accounted for 60% of assaults linked to licensed premises. Discussion and Conclusions The intervention was effective in enhancing the recording of alcohol‐related information for assault incidents. Such information could enhance targeted policing of liquor licensing laws. [Wiggers JH, Hacker A, Kingsland M, Lecathelinais C, Tindall J, Bowman JA, Wolfenden L. Facilitating police recording of the

  20. Barriers, Facilitators and Priorities for Implementation of WHO Maternal and Perinatal Health Guidelines in Four Lower-Income Countries: A GREAT Network Research Activity.

    PubMed

    Vogel, Joshua P; Moore, Julia E; Timmings, Caitlyn; Khan, Sobia; Khan, Dina N; Defar, Atkure; Hadush, Azmach; Minwyelet Terefe, Marta; Teshome, Luwam; Ba-Thike, Katherine; Than, Kyu Kyu; Makuwani, Ahmad; Mbaruku, Godfrey; Mrisho, Mwifadhi; Mugerwa, Kidza Yvonne; Puchalski Ritchie, Lisa M; Rashid, Shusmita; Straus, Sharon E; Gülmezoglu, A Metin

    2016-01-01

    Health systems often fail to use evidence in clinical practice. In maternal and perinatal health, the majority of maternal, fetal and newborn mortality is preventable through implementing effective interventions. To meet this challenge, WHO's Department of Reproductive Health and Research partnered with the Knowledge Translation Program at St. Michael's Hospital (SMH), University of Toronto, Canada to establish a collaboration on knowledge translation (KT) in maternal and perinatal health, called the GREAT Network (Guideline-driven, Research priorities, Evidence synthesis, Application of evidence, and Transfer of knowledge). We applied a systematic approach incorporating evidence and theory to identifying barriers and facilitators to implementation of WHO maternal heath recommendations in four lower-income countries and to identifying implementation strategies to address these. We conducted a mixed-methods study in Myanmar, Uganda, Tanzania and Ethiopia. In each country, stakeholder surveys, focus group discussions and prioritization exercises were used, involving multiple groups of health system stakeholders (including administrators, policymakers, NGOs, professional associations, frontline healthcare providers and researchers). Despite differences in guideline priorities and contexts, barriers identified across countries were often similar. Health system level factors, including health workforce shortages, and need for strengthened drug and equipment procurement, distribution and management systems, were consistently highlighted as limiting the capacity of providers to deliver high-quality care. Evidence-based health policies to support implementation, and improve the knowledge and skills of healthcare providers were also identified. Stakeholders identified a range of tailored strategies to address local barriers and leverage facilitators. This approach to identifying barriers, facilitators and potential strategies for improving implementation proved feasible in

  1. Barriers and facilitators towards implementing the Sepsis Six care bundle (BLISS-1): a mixed methods investigation using the theoretical domains framework.

    PubMed

    Roberts, Neil; Hooper, Guy; Lorencatto, Fabiana; Storr, Wendell; Spivey, Michael

    2017-09-19

    The 'Sepsis 6', a care bundle of basic, but vital, measures (e.g. intravenous fluid, antibiotics) has been implemented to improve sepsis treatment. However, uptake has been variable. Tools from behavioral sciences, such as the Theoretical Domains Framework (TDF) may be used to understand and address such implementation issues. This study used a behavioral science approach to identify barriers and facilitators towards Sepsis Six implementation at a case study hospital. Semi-structured interviews based on the TDF were conducted with a sample group of consultants, junior doctors and nurses from Emergency Department, Medical and Surgical Admissions, to explore barriers/facilitators to Sepsis Six performance. Transcripts were analyzed following the combined principles of content and framework analysis. Emerging themes informed a questionnaire to explore generalizability and importance across a sample of 261 stakeholders. Median importance and agreement ratings for each theme were calculated overall and for each role and clinical area. These were used to identify important barriers and important facilitators as targets for performance improvement. No new belief statements were discovered and data saturation was deemed achieved after 10 interviews. 1699 utterances were coded into 64 belief statements, then collated into a 51-item questionnaire. 113 questionnaire responses were obtained (44.3% response rate). Important barriers included insufficient audit and feedback, poor teamwork and communication, concerns about using the Sepsis Six in certain patients, insufficient training, and resource concerns. Facilitators included confidence in knowledge and skills, beliefs in overall benefits of the bundle, beliefs that identification and management of septic patients fell within everyone's role, and that regular use of the bundle made it easier to remember. Some beliefs were applicable for the entire group, others were specific to particular staff groups. A range of barriers

  2. Implementation of the guidelines for targeted temperature management after cardiac arrest: a longitudinal qualitative study of barriers and facilitators perceived by hospital resuscitation champions

    PubMed Central

    Kim, Young-Min; Lee, Seung Joon; Jo, Sun Jin; Park, Kyu Nam

    2016-01-01

    Objectives To identify the barriers to and facilitators of implementing guidelines for targeted temperature management (TTM) after cardiac arrest perceived by hospital resuscitation champions and to investigate the changes in their perceptions over the early implementation period. Design A longitudinal qualitative study (up to 2 serial semistructured interviews over 1 year and focus groups). The individual interviews and focus groups were transcribed and coded by 2 independent assessors. Contents were analysed thematically; group interaction was also examined. Setting 21 hospitals, including community and tertiary care centres in South Korea. Participants 21 hospital champions (14 acting champions and 7 managerial champions). Results The final data set included 40 interviews and 2 focus groups. The identified barriers and facilitators could be classified into 3 major themes: (1) healthcare professionals’ perceptions of the guidelines and protocols, (2) interdisciplinary and interprofessional collaboration and (3) organisational resources. Lack of resources was the most commonly agreed on barrier for the acting champions, whereas lack of interdisciplinary collaboration was the most common barrier for the managerial champions. Educational activities and sharing successfully treated cases were the most frequently identified facilitators. Most of the participants identified and agreed that cooling equipment was an important barrier as well as a facilitator of successful TTM implementation. Perception of the guidelines and protocols has improved with the accumulation of clinical experience over the study period. Conclusions Healthcare professionals’ internal barriers to TTM implementation may be influenced by new guidelines and can be changed with the accumulation of successful clinical experiences during the early implementation period. Promoting interprofessional and interdisciplinary collaboration through educational activities and the use of cooling equipment

  3. Barriers and facilitators for the implementation of primary prevention and health promotion activities in primary care: a synthesis through meta-ethnography.

    PubMed

    Rubio-Valera, Maria; Pons-Vigués, Mariona; Martínez-Andrés, María; Moreno-Peral, Patricia; Berenguera, Anna; Fernández, Ana

    2014-01-01

    Evidence supports the implementation of primary prevention and health promotion (PP&HP) activities but primary care (PC) professionals show resistance to implementing these activities. The aim was to synthesize the available qualitative research on barriers and facilitators identified by PC physicians and nurses in the implementation of PP&HP in adults. A systematic search of three databases was conducted and supported by manual searches. The 35 articles included were translated into each other and a new interpretation of the concepts extracted was generated. The factors affecting the implementation of PP&HP activities in PC according to professionals were fitted into a five-level ecological model: intrapersonal factors, interpersonal processes, institutional factors, community factors and public policy. At the intrapersonal level we find professionals' beliefs about PP&HP, experiences, skills and knowledge, and selfconcept. The attitudes and behavior towards PP&HP of patients, specialists, practice managers and colleagues (interpersonal factors) affect the feasibility of implementing PP&HP. Institutional level: PC is perceived as well-placed to implement PP&HP but workload, lack of time and referral resources, and the predominance of the biomedical model (which prioritizes disease treatment) hamper the implementation of PP&HP. The effectiveness of financial incentives and tools such as guidelines and alarms/reminders is conditioned by professionals' attitudes to them. Community factors include patients' social and cultural characteristics (religion, financial resources, etc.), local referral resources, mass-media messages and pharmaceutical industry campaigns, and the importance given to PP&HP in the curriculum in university. Finally, policies affect the distribution of resources, thus affecting the implementation of PP&HP. Research on barriers and facilitators in the implementation of PP&HP activities in multirisk management is scarce. The conceptual overview

  4. Barriers, Facilitators and Priorities for Implementation of WHO Maternal and Perinatal Health Guidelines in Four Lower-Income Countries: A GREAT Network Research Activity

    PubMed Central

    Vogel, Joshua P.; Moore, Julia E.; Timmings, Caitlyn; Khan, Sobia; Khan, Dina N.; Defar, Atkure; Hadush, Azmach; Minwyelet Terefe, Marta; Teshome, Luwam; Ba-Thike, Katherine; Than, Kyu Kyu; Makuwani, Ahmad; Mbaruku, Godfrey; Mrisho, Mwifadhi; Mugerwa, Kidza Yvonne; Puchalski Ritchie, Lisa M.; Rashid, Shusmita; Straus, Sharon E.; Gülmezoglu, A. Metin

    2016-01-01

    Background Health systems often fail to use evidence in clinical practice. In maternal and perinatal health, the majority of maternal, fetal and newborn mortality is preventable through implementing effective interventions. To meet this challenge, WHO’s Department of Reproductive Health and Research partnered with the Knowledge Translation Program at St. Michael’s Hospital (SMH), University of Toronto, Canada to establish a collaboration on knowledge translation (KT) in maternal and perinatal health, called the GREAT Network (Guideline-driven, Research priorities, Evidence synthesis, Application of evidence, and Transfer of knowledge). We applied a systematic approach incorporating evidence and theory to identifying barriers and facilitators to implementation of WHO maternal heath recommendations in four lower-income countries and to identifying implementation strategies to address these. Methods We conducted a mixed-methods study in Myanmar, Uganda, Tanzania and Ethiopia. In each country, stakeholder surveys, focus group discussions and prioritization exercises were used, involving multiple groups of health system stakeholders (including administrators, policymakers, NGOs, professional associations, frontline healthcare providers and researchers). Results Despite differences in guideline priorities and contexts, barriers identified across countries were often similar. Health system level factors, including health workforce shortages, and need for strengthened drug and equipment procurement, distribution and management systems, were consistently highlighted as limiting the capacity of providers to deliver high-quality care. Evidence-based health policies to support implementation, and improve the knowledge and skills of healthcare providers were also identified. Stakeholders identified a range of tailored strategies to address local barriers and leverage facilitators. Conclusion This approach to identifying barriers, facilitators and potential strategies for

  5. A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs.

    PubMed

    Simmons, Molly M; Gabrielian, Sonya; Byrne, Thomas; McCullough, Megan B; Smith, Jeffery L; Taylor, Thom J; O'Toole, Tom P; Kane, Vincent; Yakovchenko, Vera; McInnes, D Keith; Smelson, David A

    2017-04-04

    Homeless veterans often have multiple health care and psychosocial needs, including assistance with access to housing and health care, as well as support for ongoing treatment engagement. The Department of Veterans Affairs (VA) developed specialized Homeless Patient Alignment Care Teams (HPACT) with the goal of offering an integrated, "one-stop program" to address housing and health care needs of homeless veterans. However, while 70% of HPACT's veteran enrollees have co-occurring mental health and substance use disorders, HPACT does not have a uniform, embedded treatment protocol for this subpopulation. One wraparound intervention designed to address the needs of homeless veterans with co-occurring mental health and substance use disorders which is suitable to be integrated into HPACT clinic sites is the evidence-based practice called Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Veterans Edition, or MISSION-Vet. Despite the promise of MISSION-Vet within HPACT clinics, implementation of an evidence-based intervention within a busy program like HPACT can be difficult. The current study is being undertaken to identify an appropriate implementation strategy for MISSION-Vet within HPACT. The study will test the implementation platform called Facilitation and compared to implementation as usual (IU). The aims of this study are as follows: (1) Compare the extent to which IU or Facilitation strategies achieve fidelity to the MISSION-Vet intervention as delivered by HPACT homeless provider staff. (2) Compare the effects of Facilitation and IU strategies on the National HPACT Performance Measures. (3) Compare the effects of IU and Facilitation on the permanent housing status. (4) Identify and describe key stakeholders' (patients, providers, staff) experiences with, and perspectives on, the barriers to, and facilitators of implementing MISSION. Type III Hybrid modified stepped wedge implementation comparing IU to Facilitation

  6. ASSESSING BARRIERS AND FACILITATORS OF IMPLEMENTING AN INTEGRATED HIV PREVENTION AND PROPERTY RIGHTS PROGRAM IN WESTERN KENYA

    PubMed Central

    Lu, Tiffany; Zwicker, Lindsey; Kwena, Zachary; Bukusi, Elizabeth; Mwaura-Muiru, Esther; Dworkin, Shari L.

    2013-01-01

    Despite the recognized need for structural HIV prevention interventions, few scientific programs have integrated women’s property and inheritance rights with HIV prevention and treatment. The current study focused on a community-led land and property rights intervention that was implemented in two rural areas of Western Kenya with high HIV prevalence rates (24–30%). The program was designed to respond to women’s property rights violations in order to reduce HIV risk at the local level. Through in-depth interviews with twenty program leaders, we identified several facilitators to program implementation, including the leadership of home-based HIV caregivers and involvement of traditional leaders in mediating property rights disputes. We also identified the voluntary basis of the intervention and its lack of integration with the formal justice system as implementation barriers. Our findings can guide future research and design of structural HIV prevention strategies that integrate women’s economic empowerment through property and inheritance rights. PMID:23514082

  7. Assessing barriers and facilitators of implementing an integrated HIV prevention and property rights program in Western Kenya.

    PubMed

    Lu, Tiffany; Zwicker, Lindsey; Kwena, Zachary; Bukusi, Elizabeth; Mwaura-Muiru, Esther; Dworkin, Shari L

    2013-04-01

    Despite the recognized need for structural HIV prevention interventions, few scientific programs have integrated women's property and inheritance rights with HIV prevention and treatment. The current study focused on a community-led land and property rights intervention that was implemented in two rural areas of Western Kenya with high HIV prevalence rates (24-30%). The program was designed to respond to women's property rights violations in order to reduce HIV risk at the local level. Through in-depth interviews with twenty program leaders, we identified several facilitators to program implementation, including the leadership of home-based HIV caregivers and involvement of traditional leaders in mediating property rights disputes. We also identified the voluntary basis of the intervention and its lack of integration with the formal justice system as implementation barriers. Our findings can guide future research and design of structural HIV prevention strategies that integrate women's economic empowerment through property and inheritance rights.

  8. Linking HIV-Negative Youth to Prevention Services in 12 U.S. Cities: Barriers and Facilitators to Implementing the HIV Prevention Continuum.

    PubMed

    Doll, Mimi; Fortenberry, J Dennis; Roseland, Denise; McAuliff, Kathleen; Wilson, Craig M; Boyer, Cherrie B

    2018-04-01

    Linkage of HIV-negative youth to prevention services is increasingly important with the development of effective pre-exposure prophylaxis that complements behavioral and other prevention-focused interventions. However, effective infrastructure for delivery of prevention services does not exist, leaving many programs to address HIV prevention without data to guide program development/implementation. The objective of this study was to provide a qualitative description of barriers and facilitators of linkage to prevention services among high-risk, HIV-negative youth. Thematic analysis of structured interviews with staff implementing linkage to prevention services programs for youth aged 12-24 years. Twelve adolescent medicine HIV primary care programs as part of larger testing research program focused on young sexual minority men of color. The study included staff implementing linkage to prevention services programs along with community-based HIV testing programs. The main outcomes of the study were key barriers/facilitators to linkage to prevention services. Eight themes summarized perspectives on linkage to prevention services: (1) relationships with community partners, (2) trust between providers and youth, (3) youth capacity to navigate prevention services, (4) pre-exposure prophylaxis specific issues, (5) privacy issues, (6) gaps in health records preventing tailored services, (7) confidentiality of care for youth accessing services through parents'/caretakers' insurance, and (8) need for health-care institutions to keep pace with models that prioritize HIV prevention among at-risk youth. Themes are discussed in the context of factors that facilitated/challenged linkage to prevention services. Several evidence-based HIV prevention tools are available; infrastructures for coordinated service delivery to high-risk youth have not been developed. Implementation of such infrastructures requires attention to community-, provider-, and youth-related issues. Copyright

  9. The Essential Elements of Facilitation.

    ERIC Educational Resources Information Center

    Priest, Simon; Gass, Michael; Gillis, Lee

    Most organizations find it difficult to implement change, and only about 10 percent of learning from training and development experiences is actually applied in the workplace. This book advocates facilitation as a means of enhancing change and increasing productivity. Facilitation engages employees by enhancing the processes associated with their…

  10. Using the Consolidated Framework for Implementation Research to Identify Barriers and Facilitators for the Implementation of an Internet-Based Patient-Provider Communication Service in Five Settings: A Qualitative Study

    PubMed Central

    Varsi, Cecilie; Ekstedt, Mirjam; Gammon, Deede

    2015-01-01

    Background Although there is growing evidence of the positive effects of Internet-based patient-provider communication (IPPC) services for both patients and health care providers, their implementation into clinical practice continues to be a challenge. Objective The 3 aims of this study were to (1) identify and compare barriers and facilitators influencing the implementation of an IPPC service in 5 hospital units using the Consolidated Framework for Implementation Research (CFIR), (2) assess the ability of the different constructs of CFIR to distinguish between high and low implementation success, and (3) compare our findings with those from other studies that used the CFIR to discriminate between high and low implementation success. Methods This study was based on individual interviews with 10 nurses, 6 physicians, and 1 nutritionist who had used the IPPC to answer messages from patients. Results Of the 36 CFIR constructs, 28 were addressed in the interviews, of which 12 distinguished between high and low implementation units. Most of the distinguishing constructs were related to the inner setting domain of CFIR, indicating that institutional factors were particularly important for successful implementation. Health care providers’ beliefs in the intervention as useful for themselves and their patients as well as the implementation process itself were also important. A comparison of constructs across ours and 2 other studies that also used the CFIR to discriminate between high and low implementation success showed that 24 CFIR constructs distinguished between high and low implementation units in at least 1 study; 11 constructs distinguished in 2 studies. However, only 2 constructs (patient need and resources and available resources) distinguished consistently between high and low implementation units in all 3 studies. Conclusions The CFIR is a helpful framework for illuminating barriers and facilitators influencing IPPC implementation. However, CFIR’s strength

  11. Cognitive-behavioral treatments for criminogenic thinking: Barriers and facilitators to implementation within the Veterans Health Administration.

    PubMed

    Blonigen, Daniel M; Rodriguez, Allison L; Manfredi, Luisa; Nevedal, Andrea; Rosenthal, Joel; McGuire, James F; Smelson, David; Timko, Christine

    2018-02-01

    Cognitive-behavioral treatments for criminogenic thinking (i.e., antisocial cognitions, attitudes, and traits) are regarded as best practices for reducing criminal recidivism among justice-involved adults. However, the barriers and facilitators to implementation of these treatments within large health care systems such as the Veterans Health Administration (VHA) are largely unknown. To address this gap, we conducted qualitative interviews with 22 Specialists from the VHA's Veterans Justice Programs who had been trained in a cognitive-behavioral treatment for criminogenic thinking (i.e., Moral Reconation Therapy [MRT], Thinking for a Change [T4C]). The time-intensiveness of these treatments emerged as a barrier to implementation. Potential solutions identified were patient incentives for treatment engagement, streamlining the curriculum, and implementing the treatments within long-term/residential programs. At the program level, providers' stigma/bias toward patients with antisocial tendencies was seen as a barrier to implementation, as were time/resource constraints on providers. To address the latter, use of peer providers to deliver the treatments and partnerships between justice programs and behavioral health services were suggested. At the system level, lack of recognition of criminogenic treatments as evidence based, and uncertainty of sustained funds to support ongoing costs of these treatments emerged as implementation barriers. To address the latter, a train-the-trainers model was suggested. Our findings serve as a guide for implementation of criminogenic treatments for providers and policymakers in VHA and other large health care systems, which are increasingly called upon to provide care to justice-involved adults in the community. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  12. A Survey to Evaluate Facilitators and Barriers to Quality Measurement and Improvement: Adapting Tools for Implementation Research in Palliative Care Programs.

    PubMed

    Dy, Sydney M; Al Hamayel, Nebras Abu; Hannum, Susan M; Sharma, Ritu; Isenberg, Sarina R; Kuchinad, Kamini; Zhu, Junya; Smith, Katherine; Lorenz, Karl A; Kamal, Arif H; Walling, Anne M; Weaver, Sallie J

    2017-12-01

    Although critical for improving patient outcomes, palliative care quality indicators are not yet widely used. Better understanding of facilitators and barriers to palliative care quality measurement and improvement might improve their use and program quality. Development of a survey tool to assess palliative care team perspectives on facilitators and barriers to quality measurement and improvement in palliative care programs. We used the adapted Consolidated Framework for Implementation Research to define domains and constructs to select instruments. We assembled a draft survey and assessed content validity through pilot testing and cognitive interviews with experts and frontline practitioners for key items. We analyzed responses using a constant comparative process to assess survey item issues and potential solutions. We developed a final survey using these results. The survey includes five published instruments and two additional item sets. Domains include organizational characteristics, individual and team characteristics, intervention characteristics, and process of implementation. Survey modules include Quality Improvement in Palliative Care, Implementing Quality Improvement in the Palliative Care Program, Teamwork and Communication, Measuring the Quality of Palliative Care, and Palliative Care Quality in Your Program. Key refinements from cognitive interviews included item wording on palliative care team members, programs, and quality issues. This novel, adaptable instrument assesses palliative care team perspectives on barriers and facilitators for quality measurement and improvement in palliative care programs. Next steps include evaluation of the survey's construct validity and how survey results correlate with findings from program quality initiatives. Copyright © 2017 American Academy of Hospice and Palliative Medicine. All rights reserved.

  13. Facilitators and barriers to implementing a local policy to reduce sodium consumption in the County of Los Angeles government, California, 2009.

    PubMed

    Gase, Lauren N; Kuo, Tony; Dunet, Diane O; Simon, Paul A

    2011-03-01

    This qualitative study explores facilitators and barriers to a proposed food procurement policy that would require food purchasers, distributors, and vendors of food service in the County of Los Angeles government to meet specified nutrition standards, including limits on sodium content. We conducted 30 key informant interviews. Interviewees represented 18 organizations from the County of Los Angeles government departments that purchased, distributed, or sold food; public and private non-County entities that had previously implemented food procurement policies in their organizations; and large organizations that catered food to the County. Study participants reported 3 key facilitators: their organization's authority to impose nutrition standards, their organization's desire to provide nutritious food, and the opportunity to build on existing nutrition policies. Eight key barriers were identified: 1) unique features among food service settings, 2) costs and unavailability of low-sodium foods, 3) complexity of food service arrangements, 4) lack of consumer demand for low-sodium foods, 5) undesirable taste of low-sodium foods, 6) preference for prepackaged products, 7) lack of knowledge and experience in operationalizing sodium standards, and 8) existing multiyear contracts that are difficult to change. Despite perceived barriers, several participants indicated that their organizations have successfully implemented nutritional standards that include limits on sodium. Developing or changing policies for procuring food represents a potentially feasible strategy for reducing sodium consumption in food service venues controlled by the County of Los Angeles. The facilitators and barriers identified here can inform the formulation, adoption, implementation, and evaluation of sodium reduction policies in other jurisdictions.

  14. Barriers to and facilitators of the implementation of health promoting hospitals in Taiwan: a top-down movement in need of ground support.

    PubMed

    Lee, Chiachi Bonnie; Chen, Michael S; Wang, Ying Wei

    2014-01-01

    This study investigates barriers to and facilitators of health promoting hospitals (HPH) in Taiwan. The findings are based on a cross-sectional questionnaire survey involving 55 hospitals committed to health promotion (HP) as of the end of 2009, and 52 of them completed the questionnaire. The five most reported barriers are inadequate national health insurance coverage of HP, staff detachment, incoherence of government policies, weak inter-sectoral link and resistance to change. The five most reported facilitators are support from hospital superintendents, support from unit/department directors, HP-inclusive hospital development mission and goals, funding from the government, founding of HP-related committees, resources and healthy policies. The study also found that organizational capacity building (OCB) had a significantly negative association with the number of barriers and a positive association with the number of facilitators. Stepwise linear regressions further found that OCB in structure was a significant predictor of the fewer number of barriers and that in-staff participation was a significant predictor of the more perceived facilitators. It also confirmed the significant role of organizational capacity building and that of coordinators in the effective implementation of HPH. The transformational factors as well as transactional factors are very much at work as facilitators, but the transactional factors are trapped in a less-than-friendly environment. Comprehensive support from transformational factors as well as transactional factors is essential and further support for daily routine operations and staff participation are required to sustain the implementation of HPH in Taiwan. Copyright © 2012 John Wiley & Sons, Ltd.

  15. Implementation of the guidelines for targeted temperature management after cardiac arrest: a longitudinal qualitative study of barriers and facilitators perceived by hospital resuscitation champions.

    PubMed

    Kim, Young-Min; Lee, Seung Joon; Jo, Sun Jin; Park, Kyu Nam

    2016-01-05

    To identify the barriers to and facilitators of implementing guidelines for targeted temperature management (TTM) after cardiac arrest perceived by hospital resuscitation champions and to investigate the changes in their perceptions over the early implementation period. A longitudinal qualitative study (up to 2 serial semistructured interviews over 1 year and focus groups). The individual interviews and focus groups were transcribed and coded by 2 independent assessors. Contents were analysed thematically; group interaction was also examined. 21 hospitals, including community and tertiary care centres in South Korea. 21 hospital champions (14 acting champions and 7 managerial champions). The final data set included 40 interviews and 2 focus groups. The identified barriers and facilitators could be classified into 3 major themes: (1) healthcare professionals' perceptions of the guidelines and protocols, (2) interdisciplinary and interprofessional collaboration and (3) organisational resources. Lack of resources was the most commonly agreed on barrier for the acting champions, whereas lack of interdisciplinary collaboration was the most common barrier for the managerial champions. Educational activities and sharing successfully treated cases were the most frequently identified facilitators. Most of the participants identified and agreed that cooling equipment was an important barrier as well as a facilitator of successful TTM implementation. Perception of the guidelines and protocols has improved with the accumulation of clinical experience over the study period. Healthcare professionals' internal barriers to TTM implementation may be influenced by new guidelines and can be changed with the accumulation of successful clinical experiences during the early implementation period. Promoting interprofessional and interdisciplinary collaboration through educational activities and the use of cooling equipment with an automated feedback function can improve adherence to

  16. Psychosocial Interventions for Families with Parental Cancer and Barriers and Facilitators to Implementation and Use – A Systematic Review

    PubMed Central

    Inhestern, Laura; Haller, Anne-Catherine; Wlodarczyk, Olga; Bergelt, Corinna

    2016-01-01

    Background Parental cancer has a significant impact on minor children and families. Psychosocial interventions for affected families can provide support where necessary. This systematic review aims at providing an overview of existing interventions and support programs and focuses on the systematic investigation of barriers and facilitators for using psychosocial interventions for families affected by parental cancer (PROSPERO; registration number CRD42014013020). Methods A search of five electronic databases (EMBASE, MEDLINE, PsycInfo, Psyndex, CINAHL) was conducted in June 2014, and updated in September 2015. We included any kind of studies reporting psychosocial support services or interventions for families affected by parental cancer. Study quality was assessed using the Mixed Method Assessment Tool. Narrative synthesis and thematic analyses were undertaken to examine the included interventions and to identify barriers and facilitators for use and implementation. Results A total of 36 studies covering 19 interventions and support services were included in the systematic review. Interventions focused on children, parents or several family members and analyses revealed a broad picture of theoretical background and primary aims. Several studies focused on developmental or implementation phases or descriptions of interventions. Other included studies reported results of evaluations using qualitative and quantitative methods. Results suggest that interventions are helpful and that participants improved in various outcomes. The thematic analyses indicate that barriers for use of support services refer to aspects concerning the patients and families, such as practical difficulties, perceived need for support or fear of stigma. Cancer patients who understood the need and benefit of support services may have used them more often. Additionally, intervention characteristics such as a flexible structure and accessibility were important to reach families affected by

  17. Barriers and Facilitators for the Implementation of Primary Prevention and Health Promotion Activities in Primary Care: A Synthesis through Meta-Ethnography

    PubMed Central

    Rubio-Valera, Maria; Pons-Vigués, Mariona; Martínez-Andrés, María; Moreno-Peral, Patricia; Berenguera, Anna; Fernández, Ana

    2014-01-01

    Background Evidence supports the implementation of primary prevention and health promotion (PP&HP) activities but primary care (PC) professionals show resistance to implementing these activities. The aim was to synthesize the available qualitative research on barriers and facilitators identified by PC physicians and nurses in the implementation of PP&HP in adults. Methods and Findings A systematic search of three databases was conducted and supported by manual searches. The 35 articles included were translated into each other and a new interpretation of the concepts extracted was generated. The factors affecting the implementation of PP&HP activities in PC according to professionals were fitted into a five-level ecological model: intrapersonal factors, interpersonal processes, institutional factors, community factors and public policy. At the intrapersonal level we find professionals' beliefs about PP&HP, experiences, skills and knowledge, and selfconcept. The attitudes and behavior towards PP&HP of patients, specialists, practice managers and colleagues (interpersonal factors) affect the feasibility of implementing PP&HP. Institutional level: PC is perceived as well-placed to implement PP&HP but workload, lack of time and referral resources, and the predominance of the biomedical model (which prioritizes disease treatment) hamper the implementation of PP&HP. The effectiveness of financial incentives and tools such as guidelines and alarms/reminders is conditioned by professionals' attitudes to them. Community factors include patients' social and cultural characteristics (religion, financial resources, etc.), local referral resources, mass-media messages and pharmaceutical industry campaigns, and the importance given to PP&HP in the curriculum in university. Finally, policies affect the distribution of resources, thus affecting the implementation of PP&HP. Conclusions Research on barriers and facilitators in the implementation of PP&HP activities in multirisk

  18. Using a knowledge transfer framework to identify factors facilitating implementation of family-based treatment.

    PubMed

    Couturier, Jennifer; Kimber, Melissa; Jack, Susan; Niccols, Alison; Van Blyderveen, Sherry; McVey, Gail

    2014-05-01

    To conduct a qualitative study to identify factors that would facilitate the transfer of the research evidence on Family-Based Treatment (FBT) into clinical practice. Fundamental qualitative description guided sampling, data collection, and analytic decisions for this study. Forty therapists who treat children and adolescents under the age of 18 with Anorexia Nervosa (AN) and belong to Ontario's provincial network of specialized eating disorder services completed an in-depth interview focusing on elements proposed by the Lavis knowledge transfer framework. An experienced coder conducted content analysis, with 20% of the interviews double-coded for reliability purposes. Participants requested training in the FBT model, including the provision of research evidence (i.e., journal articles), as well as the specific tenets of the model according to the FBT manual. The suggested audience for implementation included not only therapists themselves, but administrators, physicians, and community members. The development of best practice guidelines was also supported. Local FBT experts were suggested as credible messengers. Infrastructure relating to financial support and time away from clinical duties were reported to be essential for training. Ongoing supervision and mentorship were reported to be important elements of implementation and evaluation processes. Suggestions for moving FBT into practice were consistent with previous research, however, the importance of obtaining the evidence in the form of primary research articles and obtaining team buy-in were remarkable. Developing context-specific training programs and administrative processes for the implementation of FBT are warranted. Copyright © 2013 Wiley Periodicals, Inc.

  19. Implementing a psycho-educational intervention for care assistants working with people with dementia in aged-care facilities: facilitators and barriers.

    PubMed

    Barbosa, Ana; Nolan, Mike; Sousa, Liliana; Figueiredo, Daniela

    2017-06-01

    Many intervention studies lack an investigation and description of the factors that are relevant to its success or failure, despite its relevance to inform future interventions. This study aimed to explore the facilitators and barriers to the implementation of a psycho-educational intervention for care assistants caring for people with dementia in aged-care facilities. A process evaluation was carried out alongside a pretest/post-test controlled study conducted in aged-care facilities. Seven focus-group interviews involving 21 care assistants (female; mean age 43.37 ± 10.0) and individual semi-structured interviews with two managers (female; mean age 45.5 ± 10.26) were conducted 2 weeks and 6 months after the intervention, in two aged-care facilities. Interviews were recorded, transcribed and submitted to content analysis by two independent researchers. Results were organised into implementer, participant and organisation level hindered and facilitator factors. Findings enable the interpretation of the experimental results and underscore the importance of collecting the perception of different grades of staff to obtain information relevant to plan effective interventions. © 2016 Nordic College of Caring Science.

  20. Improving Implementation of eMental Health for Mood Disorders in Routine Practice: Systematic Review of Barriers and Facilitating Factors

    PubMed Central

    Mol, Mayke; Kleiboer, Annet; Bührmann, Leah; Finch, Tracy; Smit, Jan; Riper, Heleen

    2018-01-01

    Background Electronic mental health interventions (eMental health or eMH) can be used to increase accessibility of mental health services for mood disorders, with indications of comparable clinical outcomes as face-to-face psychotherapy. However, the actual use of eMH in routine mental health care lags behind expectations. Identifying the factors that might promote or inhibit implementation of eMH in routine care may help to overcome this gap between effectiveness studies and routine care. Objective This paper reports the results of a systematic review of the scientific literature identifying those determinants of practices relevant to implementing eMH for mood disorders in routine practice. Methods A broad search strategy was developed with high sensitivity to four key terms: implementation, mental health care practice, mood disorder, and eMH. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was applied to guide the review and structure the results. Thematic analysis was applied to identify the most important determinants that facilitate or hinder implementation of eMH in routine practice. Results A total of 13,147 articles were screened, of which 48 studies were included in the review. Most studies addressed aspects of the reach (n=33) of eMH, followed by intervention adoption (n=19), implementation of eMH (n=6), and maintenance (n=4) of eMH in routine care. More than half of the studies investigated the provision of mental health services through videoconferencing technologies (n=26), followed by Internet-based interventions (n=20). The majority (n=44) of the studies were of a descriptive nature. Across all RE-AIM domains, we identified 37 determinants clustered in six main themes: acceptance, appropriateness, engagement, resources, work processes, and leadership. The determinants of practices are expressed at different levels, including patients, mental health staff, organizations, and health care system level. Depending on

  1. Experiences of leaders in the implementation of Lean in a teaching hospital—barriers and facilitators in clinical practices: a qualitative study

    PubMed Central

    Aij, Kjeld Harald; Simons, Frederique Elisabeth; Widdershoven, Guy A M; Visse, Merel

    2013-01-01

    Objectives To date, experiences of leaders in the implementation of Lean after a Lean Training Programme have not been systematically investigated within teaching hospitals. Existing studies have identified barriers and facilitators only from an improvement programme perspective and have not considered the experiences of leaders themselves. This study aims to bridge this gap. Design Semistructured, indepth interviews. Setting One of largest teaching hospitals in the Netherlands. Participants 31 medical, surgical and nursing professionals with an average of 19.2 years of supervisory experience. All professionals were appointed to a Lean Training Programme and were directly involved in the implementation of Lean. Results The evidence obtained in this study shows that, from the perspectives of participants, leadership management support, a continuous learning environment and cross-departmental cooperation play a significant role in successful Lean implementation. The results suggest that a Lean Training Programme contributed to positive outcomes in personal and professional skills that were evident during the first 4 months after programme completion. Conclusions Implementing Lean in a teaching hospital setting is a challenge because of the ambiguous and complex environment of a highly professionalised organisation. The study found that leadership management support and a continuous learning environment are important facilitators of Lean implementation. To increase the successful outcomes of leadership actions, training should be supplemented with actions to remove perceived barriers. This requires the involvement of all professionals, the crossing of departmental boundaries and a focus on meaning-making processes rather than simply ‘implementing’ facts. Therefore, this research suggests that programme participants, such as staff members and leaders, can mutually explore the meanings of Lean thinking and working for their own contexts. By entering this shared

  2. Stakeholder perspectives on implementing a universal Lynch syndrome screening program: a qualitative study of early barriers and facilitators.

    PubMed

    Schneider, Jennifer L; Davis, James; Kauffman, Tia L; Reiss, Jacob A; McGinley, Cheryl; Arnold, Kathleen; Zepp, Jamilyn; Gilmore, Marian; Muessig, Kristin R; Syngal, Sapna; Acheson, Louise; Wiesner, Georgia L; Peterson, Susan K; Goddard, Katrina A B

    2016-02-01

    Evidence-based guidelines recommend that all newly diagnosed colon cancer be screened for Lynch syndrome (LS), but best practices for implementing universal tumor screening have not been extensively studied. We interviewed a range of stakeholders in an integrated health-care system to identify initial factors that might promote or hinder the successful implementation of a universal LS screening program. We conducted interviews with health-plan leaders, managers, and staff. Interviews were audio-recorded and transcribed. Thematic analysis began with a grounded approach and was also guided by the Practical Robust Implementation and Sustainability Model (PRISM). We completed 14 interviews with leaders/managers and staff representing involved clinical and health-plan departments. Although stakeholders supported the concept of universal screening, they identified several internal (organizational) and external (environment) factors that promote or hinder implementation. Facilitating factors included perceived benefits of screening for patients and organization, collaboration between departments, and availability of organizational resources. Barriers were also identified, including: lack of awareness of guidelines, lack of guideline clarity, staffing and program "ownership" concerns, and cost uncertainties. Analysis also revealed nine important infrastructure-type considerations for successful implementation. We found that clinical, laboratory, and administrative departments supported universal tumor screening for LS. Requirements for successful implementation may include interdepartmental collaboration and communication, patient and provider/staff education, and significant infrastructure and resource support related to laboratory processing and systems for electronic ordering and tracking.

  3. Self‐reported use of shared decision‐making among breast cancer specialists and perceived barriers and facilitators to implementing this approach

    PubMed Central

    Charles, Cathy; Gafni, Amiram; Whelan, Tim

    2004-01-01

    Abstract Background  Physicians are increasingly urged to practice shared decision‐making with their patients. Using a cross‐sectional survey, we explored the extent to which Ontario breast cancer specialists report practising shared decision‐making with their patients, their comfort level with this approach, and perceived barriers and facilitators to implementation. Participants and methods  All Ontario surgeons and oncologists (radiation and medical) treating women with early‐stage breast cancer were eligible for this study. Likert scales were used to measure physicians’ comfort level with and self‐reported use of different treatment decision‐making approaches as well as perceived barriers and facilitators to treatment decision‐making with patients. Results  The response rate was 79% for oncologists and 72% for surgeons. More physicians from each specialty (87% of oncologists and 89% of surgeons) expressed high levels of comfort with clinical example 4 (designed to illustrate a shared approach) than with any of the other examples presented (e.g. the informed and paternalistic approach). Similarly, more oncologists and surgeons reported that their usual approach to treatment decision‐making was like example 4 than like any other approach presented (56% of oncologists and 69% of surgeons, respectively). Comfort levels with example 4 for oncologists and surgeons were 31% and 20% higher, respectively, than the reported use of this approach. Lack of time and patient anxiety, patient lack of information and/or misinformation, and patient unwillingness or inability to participate were perceived by a substantial minority of both oncologists and surgeons as barriers to patient involvement in treatment decision‐making. Key facilitators identified included patients’ emotional readiness, support, information and trust in the physician. More research is needed to identify contextual, physician, patient, and interaction factors that will facilitate

  4. Understanding innovators' experiences of barriers and facilitators in implementation and diffusion of healthcare service innovations: a qualitative study

    PubMed Central

    2011-01-01

    Background Healthcare service innovations are considered to play a pivotal role in improving organisational efficiency and responding effectively to healthcare needs. Nevertheless, healthcare organisations encounter major difficulties in sustaining and diffusing innovations, especially those which concern the organisation and delivery of healthcare services. The purpose of the present study was to explore how healthcare innovators of process-based initiatives perceived and made sense of factors that either facilitated or obstructed the innovation implementation and diffusion. Methods A qualitative study was designed. Fifteen primary and secondary healthcare organisations in the UK, which had received health service awards for successfully generating and implementing service innovations, were studied. In-depth, semi structured interviews were conducted with the organisational representatives who conceived and led the development process. The data were recorded, transcribed and thematically analysed. Results Four main themes were identified in the analysis of the data: the role of evidence, the function of inter-organisational partnerships, the influence of human-based resources, and the impact of contextual factors. "Hard" evidence operated as a proof of effectiveness, a means of dissemination and a pre-requisite for the initiation of innovation. Inter-organisational partnerships and people-based resources, such as champions, were considered an integral part of the process of developing, establishing and diffusing the innovations. Finally, contextual influences, both intra-organisational and extra-organisational were seen as critical in either impeding or facilitating innovators' efforts. Conclusions A range of factors of different combinations and co-occurrence were pointed out by the innovators as they were reflecting on their experiences of implementing, stabilising and diffusing novel service initiatives. Even though the innovations studied were of various

  5. Understanding innovators' experiences of barriers and facilitators in implementation and diffusion of healthcare service innovations: a qualitative study.

    PubMed

    Barnett, Julie; Vasileiou, Konstantina; Djemil, Fayika; Brooks, Laurence; Young, Terry

    2011-12-16

    Healthcare service innovations are considered to play a pivotal role in improving organisational efficiency and responding effectively to healthcare needs. Nevertheless, healthcare organisations encounter major difficulties in sustaining and diffusing innovations, especially those which concern the organisation and delivery of healthcare services. The purpose of the present study was to explore how healthcare innovators of process-based initiatives perceived and made sense of factors that either facilitated or obstructed the innovation implementation and diffusion. A qualitative study was designed. Fifteen primary and secondary healthcare organisations in the UK, which had received health service awards for successfully generating and implementing service innovations, were studied. In-depth, semi structured interviews were conducted with the organisational representatives who conceived and led the development process. The data were recorded, transcribed and thematically analysed. Four main themes were identified in the analysis of the data: the role of evidence, the function of inter-organisational partnerships, the influence of human-based resources, and the impact of contextual factors. "Hard" evidence operated as a proof of effectiveness, a means of dissemination and a pre-requisite for the initiation of innovation. Inter-organisational partnerships and people-based resources, such as champions, were considered an integral part of the process of developing, establishing and diffusing the innovations. Finally, contextual influences, both intra-organisational and extra-organisational were seen as critical in either impeding or facilitating innovators' efforts. A range of factors of different combinations and co-occurrence were pointed out by the innovators as they were reflecting on their experiences of implementing, stabilising and diffusing novel service initiatives. Even though the innovations studied were of various contents and originated from diverse

  6. Implementation of Integrated Service Networks under the Quebec Mental Health Reform: Facilitators and Barriers associated with Different Territorial Profiles.

    PubMed

    Fleury, Marie-Josée; Grenier, Guy; Vallée, Catherine; Aubé, Denise; Farand, Lambert

    2017-03-10

    This study evaluates implementation of the Quebec Mental Health Reform (2005-2015), which promoted the development of integrated service networks, in 11 local service networks organized into four territorial groups according to socio-demographic characteristics and mental health services offered. Data were collected from documents concerning networks; structured questionnaires completed by 90 managers and by 16 respondent-psychiatrists; and semi-structured interviews with 102 network stakeholders. Factors associated with implementation and integration were organized according to: 1) reform characteristics; 2) implementation context; 3) organizational characteristics; and 4) integration strategies. While local networks were in a process of development and expansion, none were fully integrated at the time of the study. Facilitators and barriers to implementation and integration were primarily associated with organizational characteristics. Integration was best achieved in larger networks including a general hospital with a psychiatric department, followed by networks with a psychiatric hospital. Formalized integration strategies such as service agreements, liaison officers, and joint training reduced some barriers to implementation in networks experiencing less favourable conditions. Strategies for the implementation of healthcare reform and integrated service networks should include sustained support and training in best-practices, adequate performance indicators and resources, formalized integration strategies to improve network coordination and suitable initiatives to promote staff retention.

  7. Views of policy makers and health promotion professionals on factors facilitating implementation and maintenance of interventions and policies promoting physical activity and healthy eating: results of the DEDIPAC project.

    PubMed

    Muellmann, Saskia; Steenbock, Berit; De Cocker, Katrien; De Craemer, Marieke; Hayes, Catherine; O'Shea, Miriam P; Horodyska, Karolina; Bell, Justyna; Luszczynska, Aleksandra; Roos, Gun; Langøien, Lars Jørun; Rugseth, Gro; Terragni, Laura; De Bourdeaudhuij, Ilse; Brug, Johannes; Pischke, Claudia R

    2017-12-06

    The uptake, implementation, and maintenance of effective interventions promoting physical activity (PA) and a healthy diet and the implementation of policies targeting these behaviors are processes not well understood. We aimed to gain a better understanding of what health promotion professionals and policy makers think are important factors facilitating adoption, implementation, and maintenance of multi-level interventions and policies promoting healthy eating and PA in Belgium, Germany, Ireland, Norway, and Poland. Six interventions and six policies were identified based on pre-defined criteria. Forty semi-structured interviews were conducted with stakeholders from various sectors to elicit information on factors impacting adoption, implementation, and maintenance of these interventions and policies. All interview transcripts were coded in NVivo, using a common categorization matrix. Coding in the respective countries was done by one researcher and validated by a second researcher. Active involvement of relevant stakeholders and good communication between coordinating organizations were described as important factors contributing to successful adoption and implementation of both interventions and policies. Additional facilitating factors included sufficient training of staff and tailoring of materials to match needs of various target groups. The respondents indicated that maintenance of implemented interventions/policies depended on whether they were embedded in existing or newly created organizational structures in different settings and whether continued funding was secured. Despite considerable heterogeneity of interventions and health policies in the five countries, stakeholders across these countries identify similar factors facilitating adoption, implementation, and maintenance of these interventions and policies.

  8. Facilitating interprofessional evidence-based practice in paediatric rehabilitation: development, implementation and evaluation of an online toolkit for health professionals.

    PubMed

    Glegg, Stephanie M N; Livingstone, Roslyn; Montgomery, Ivonne

    2016-01-01

    Lack of time, competencies, resources and supports are documented as barriers to evidence-based practice (EBP). This paper introduces a recently developed web-based toolkit designed to assist interprofessional clinicians in implementing EBP within a paediatric rehabilitation setting. EBP theory, models, frameworks and tools were applied or adapted in the development of the online resources, which formed the basis of a larger support strategy incorporating interactive workshops, knowledge broker facilitation and mentoring. The highly accessed toolkit contains flowcharts with embedded information sheets, resources and templates to streamline, quantify and document outcomes throughout the EBP process. Case examples relevance to occupational therapy and physical therapy highlight the utility and application of the toolkit in a clinical paediatric setting. Workshops were highly rated by learners for clinical relevance, presentation level and effectiveness. Eight evidence syntheses have been created and 79 interventions have been evaluated since the strategy's inception in January 2011. The toolkit resources streamlined and supported EBP processes, promoting consistency in quality and presentation of outputs. The online toolkit can be a useful tool to facilitate clinicians' use of EBP in order to meet the needs of the clients and families whom they support. Implications for Rehabilitation A comprehensive online EBP toolkit for interprofessional clinicians is available to streamline the EBP process and to support learning needs regardless of competency level. Multi-method facilitation support, including interactive education, e-learning, clinical librarian services and knowledge brokering, is a valued but cost-restrictive supplement to the implementation of online EBP resources. EBP resources are not one-size-fits-all; targeted appraisal tools, models and frameworks may be integrated to improve their utility for specific sectors, which may limit them for others.

  9. "Just Add Facilitators and Stir": Stimulating Policy Uptake in Schools

    ERIC Educational Resources Information Center

    Abbott, Rebecca; Macdonald, Doune; Hay, Peter; McCuaig, Louise

    2011-01-01

    This article presents the evaluation findings of an education policy initiative that involved the employment of facilitators to broker the policy and its implementation. An Australian state's education authority piloted the employment of physical activity facilitators to expedite the implementation of "Smart Moves" in schools, a…

  10. Barriers to and facilitators of implementing quality standards in Hospital Day Care Units in Rheumatology: Qualitative approach to the VALORA study.

    PubMed

    Martín Martínez, María Auxiliadora; Zaragoza Gaynor, Gustavo Andrés; Martínez Fernández, Carmen; Gobbo Montoya, Milena; García-Vicuña, Rosario

    2017-01-30

    To identify barriers and facilitators in the implementation of quality standards in hospital day care units (HDCU) in rheumatology. We analyzed appraisals of HDCU in terms of standards for structure, processes and results. The qualitative approach was conducted through 13 discussion groups created by rheumatology health professionals (7), nursing professionals (4) and HDCU patients (2). The recruitment of informants was done through purposive sampling, attending to variables that form the perceptions of the HDCU. Data analysis was performed using a descriptive-interpretive method. The specialization of the HDCU and specific training in rheumatology for nursing are perceived as the main facilitator for the implementation of standards. Conversely, the delay in the availability of medicines at the HDCU is identified as a barrier that prolongs patient stay and wastes resources. Differences in local regulations are perceived as a potential barrier to equitable access to medicines. The patients gave higher ratings to the care received than to structural variables or those related to process. The findings of this study suggest that improvements in the implementation of quality standards in HDCU may include three levels of action: the HDCU, the hospital and a third related to local regulations to access to medicines. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  11. A qualitative study of the anticipated barriers and facilitators to the implementation of a lifestyle intervention in the Dutch construction industry.

    PubMed

    Tonnon, S C; Proper, K I; van der Ploeg, H P; Westerman, M J; Sijbesma, E; van der Beek, A J

    2014-12-23

    Lifestyle interventions have proven effective for lowering a cardiovascular risk profile by improving lifestyle behaviors, blood glucose and blood cholesterol levels. However, implementation of lifestyle interventions is often met with barriers. This qualitative study sought to determine anticipated barriers and facilitators to the nationwide implementation of an effective lifestyle intervention in the construction industry in the Netherlands. Prior to implementation, focus groups were held with 8 lifestyle counselors and semi-structured interviews with 20 employees of the construction industry, 4 occupational physicians, 4 medical assistants, and 1 manager of an occupational health service. The transcripts were coded by two coders and analyzed by constant comparison. Hypothetical employee willingness to sign up for the intervention was facilitated by a high level of perceived risk, perceived added value of the intervention, and perceived social support. It was hampered by a preference for independence and perceived interference with their work. All professionals named a lack of time as an anticipated barrier to implementation. Lifestyle counselors suggested several strategies to improve the proficiency of their counseling technique, such as training in small groups and a continuous stream of employee referrals. Occupational physicians thought they would be hampered in screening employees and referring them to a lifestyle counselor by the perception that addressing employee lifestyles was not their task, and by a counter-productive relationship with other stakeholders. The manager addressed financial incentives and a good intervention fit with the current approach of the OHS. The findings suggest that employees can be motivated to sign up for a lifestyle intervention by tailoring the implementation strategy to various subgroups within the target group. Occupational physicians can be motivated to refer employees for the intervention by making a referral personally

  12. A qualitative, interprofessional analysis of barriers to and facilitators of implementation of the Department of Veterans Affairs' Clostridium difficile prevention bundle using a human factors engineering approach.

    PubMed

    Yanke, Eric; Moriarty, Helene; Carayon, Pascale; Safdar, Nasia

    2018-03-01

    Clostridium difficile infection (CDI) is increasingly prevalent, severe, and costly. Adherence to infection prevention practices remains suboptimal. More effective strategies to implement guidelines and evidence are needed. Interprofessional focus groups consisting of physicians, resident physicians, nurses, and health technicians were conducted for a quality improvement project evaluating adherence to the Department of Veterans Affairs' (VA) nationally mandated C difficile prevention bundle. Qualitative analysis with a visual matrix display identified barrier and facilitator themes guided by the Systems Engineering Initiative for Patient Safety model, a human factors engineering approach. Several themes, encompassing both barriers and facilitators to bundle adherence, emerged. Rapid turnaround time of C difficile polymerase chain reaction testing was a facilitator of timely diagnosis. Too few, poorly located, and cluttered sinks were barriers to appropriate hand hygiene. Patient care workload and the time-consuming process of contact isolation precautions were also barriers to adherence. Multiple work system components serve as barriers to and facilitators of adherence to the VA CDI prevention bundle among an interprofessional group of health care workers. Organizational factors appear to significantly influence bundle adherence. Interprofessional perspectives are needed to identify barriers to and facilitators of bundle implementation, which is a necessary first step to address adherence to bundled infection prevention practices. Published by Elsevier Inc.

  13. Implementation of a mental health medication management intervention in Australian community pharmacies: Facilitators and challenges.

    PubMed

    Hattingh, H Laetitia; Kelly, Fiona; Fowler, Jane; Wheeler, Amanda J

    Community pharmacists are in an ideal position to promote and provide mental health medication management services. However, formalised or structured pharmacy services to support consumers with mental health conditions are scarce. Australian mental health consumers indicated a need for targeted community pharmacy mental health services which presented an opportunity to develop an intervention that were integrated with remunerated professional services. The study aimed to pilot a mental health medication management intervention in Australian community pharmacies. Pharmacists worked in partnership with consumers, carers and mental health workers over three to six months to set and support achievement of individual goals related to medicines use, physical health and mental wellbeing. This paper provides a comparison of community pharmacies that successfully delivered the intervention with those that did not and identifies facilitators and challenges to service implementation. One hundred pharmacies opted to pilot the delivery of the intervention in three Australian states (Queensland, Western Australia and northern New South Wales). Of those, 55 successfully delivered the intervention (completers) whilst 45 were unsuccessful (non-completers). A mixed methods approach, including quantitative pharmacy surveys and qualitative semi-structured interviews, was used to gather data from participating pharmacies. Following intervention development, 142 pharmacists and 21 pharmacy support staff attended training workshops, received resource kits and ongoing support from consumer and pharmacist mentors throughout intervention implementation. Baseline quantitative data was collected from each pharmacy on staff profile, volume of medicines dispensed, the range of professional services delivered and relationships with health professionals. At the completion of the study participants were invited to complete an online exit survey and take part in a semi-structured interview that

  14. Barriers and facilitators to the implementation of person-centred care in different healthcare contexts.

    PubMed

    Moore, Lucy; Britten, Nicky; Lydahl, Doris; Naldemirci, Öncel; Elam, Mark; Wolf, Axel

    2017-12-01

    To empower patients and improve the quality of care, policy-makers increasingly adopt systems to enhance person-centred care. Although models of person-centredness and patient-centredness vary, respecting the needs and preferences of individuals receiving care is paramount. In Sweden, as in other countries, healthcare providers seek to improve person-centred principles and address gaps in practice. Consequently, researchers at the University of Gothenburg Centre for Person-Centred Care are currently delivering person-centred interventions employing a framework that incorporates three routines. These include eliciting the patient's narrative, agreeing a partnership with shared goals between patient and professional, and safeguarding this through documentation. To explore the barriers and facilitators to the delivery of person-centred care interventions, in different contexts. Qualitative interviews were conducted with a purposeful sample of 18 researchers from seven research studies across contrasting healthcare settings. Interviews were transcribed, translated and thematically analysed, adopting some basic features of grounded theory. The ethical code of conduct was followed and conformed to the ethical guidelines adopted by the Swedish Research Council. Barriers to the implementation of person-centred care covered three themes: traditional practices and structures; sceptical, stereotypical attitudes from professionals; and factors related to the development of person-centred interventions. Facilitators included organisational factors, leadership and training and an enabling attitude and approach by professionals. Trained project managers, patients taking an active role in research and adaptive strategies by researchers all helped person-centred care delivery. At the University of Gothenburg, a model of person-centred care is being initiated and integrated into practice through research. Knowledgeable, well-trained professionals facilitate the routines of narrative

  15. Perceptions of Barriers and Facilitators During Implementation of a Complex Model of Group Prenatal Care in Six Urban Sites

    PubMed Central

    Novick, Gina; Womack, Julie A.; Lewis, Jessica; Stasko, Emily C.; Rising, Sharon S.; Sadler, Lois S.; Cunningham, Shayna C.; Tobin, Jonathan N.; Ickovics, Jeannette R.

    2016-01-01

    Group prenatal care improves perinatal outcomes, but implementing this complex model places substantial demands on settings designed for individual care. To describe perceived barriers and facilitators to implementing and sustaining Centering Pregnancy Plus (CP+) group prenatal care, 24 in-depth interviews were conducted with 22 clinicians, staff, administrators, and study personnel in six of the 14 sites of a randomized trial of the model. All sites served low-income, minority women. Sites for the present evaluation were selected for variation in location, study arm, and initial implementation response. Implementing CP+ was challenging in all sites, requiring substantial adaptations of clinical systems. All sites had barriers to meeting the model’s demands, but how sites responded to these barriers affected whether implementation thrived or struggled. Thriving sites had organizational cultures that supported innovation, champions who advocated for CP+, and staff who viewed logistical demands as manageable hurdles. Struggling sites had bureaucratic organizational structures and lacked buy-in and financial resources, and staff were overwhelmed by the model’s challenges. Findings suggested that implementing and sustaining health care innovation requires new practices and different ways of thinking, and health systems may not fully recognize the magnitude of change required. Consequently, evidence-based practices are modified or discontinued, and outcomes may differ from those in the original controlled studies. Before implementing new models of care, clinical settings should anticipate model demands and assess capacity for adapting to the disruptions of innovation. PMID:26340483

  16. Implementation of a Personalized, Cost-Effective Physical Therapy Approach (Coach2Move) for Older Adults: Barriers and Facilitators.

    PubMed

    van de Sant, Arjan J W; de Vries, Nienke M; Hoogeboom, Thomas J; Nijhuis-van der Sanden, Maria W G

    2017-07-27

    This article reports on a recent randomized clinical trial that showed a personalized approach to physical therapy (Coach2Move) by a physical therapist specialized in geriatrics (PTG) to be more cost-effective than usual physical therapy care in people with mobility problems (n = 130, mean age = 78 years). We used an explanatory mixed-methods sequential design alongside the randomized clinical trial to gain insight into (a) the contrast between the 2 interventions, (b) the fidelity of the Coach2Move delivery; (c) PTGs' experiences of Coach2Move; and (d) possible barriers and facilitators for future implementation. The study included 13 PTGs educated in the strategy and 13 physical therapists with expertise in geriatrics delivering the usual care. In total, 106 medical records were available for assessment: 57 (85%) Coach2Move, 49 (75%) usual care. Quantitative process indicators were used to analyze electronic medical records to determine contrasts in the phases of clinical reasoning. The fidelity of the delivery was tested using indicator scores focusing on 4 key elements of Coach2Move. In-depth interviews with Coach2Move therapists were thematically analyzed to explore experiences and facilitators/barriers related to implementation. Indicator scores showed significant and clinically relevant contrasts in all phases of clinical reasoning, with consistently higher scores among PTGs, except for the treatment plan. Moreover, the fidelity of Coach2Move delivery was more than 70% in all phases, except the evaluation phase (53%). Experiences of Coach2Move were positive. In particular, extended intake allowing motivational interviewing, physical examination and an in-depth problem analysis, and shared goal setting were considered valuable. Facilitators for implementation were the addition of a Coach2Move medical record, frequent coaching by the researcher, and readiness to change in the therapist. Barriers were (1) having to use 2 parallel electronic medical record

  17. The Role of Facilitators in Project Action Learning Implementation

    ERIC Educational Resources Information Center

    Cao, Rui; Chuah, Kong Bieng; Chao, Yiu Chung; Kwong, Kar Fai; Law, Mo Yin

    2012-01-01

    Purpose: This paper addresses the importance of a more proactive role of organizational learning (OL) facilitators, learning motivation reinforcer, through a two-part longitudinal study in a case company. The first part of this study aims to investigate and analyze some unexpected challenges in the project action learning-driven (PAL) OL…

  18. The development of a highly constrained health level 7 implementation guide to facilitate electronic laboratory reporting to ambulatory electronic health record systems.

    PubMed

    Sujansky, Walter V; Overhage, J Marc; Chang, Sophia; Frohlich, Jonah; Faus, Samuel A

    2009-01-01

    Electronic laboratory interfaces can significantly increase the value of ambulatory electronic health record (EHR) systems by providing laboratory result data automatically and in a computable form. However, many ambulatory EHRs cannot implement electronic laboratory interfaces despite the existence of messaging standards, such as Health Level 7, version 2 (HL7). Among several barriers to implementing laboratory interfaces is the extensive optionality within the HL7 message standard. This paper describes the rationale for and development of an HL7 implementation guide that seeks to eliminate most of the optionality inherent in HL7, but retain the information content required for reporting outpatient laboratory results. A work group of heterogeneous stakeholders developed the implementation guide based on a set of design principles that emphasized parsimony, practical requirements, and near-term adoption. The resulting implementation guide contains 93% fewer optional data elements than HL7. This guide was successfully implemented by 15 organizations during an initial testing phase and has been approved by the HL7 standards body as an implementation guide for outpatient laboratory reporting. Further testing is required to determine whether widespread adoption of the implementation guide by laboratories and EHR systems can facilitate the implementation of electronic laboratory interfaces.

  19. What can we learn from facilitator and student perceptions of facilitation skills and roles in the first year of a problem-based learning curriculum?

    PubMed Central

    McLean, Michelle

    2003-01-01

    Background The small group tutorial is a cornerstone of problem-based learning. By implication, the role of the facilitator is of pivotal importance. The present investigation canvassed perceptions of facilitators with differing levels of experience regarding their roles and duties in the tutorial. Methods In January 2002, one year after problem-based learning implementation at the Nelson R. Mandela School of Medicine, facilitators with the following experience were canvassed: trained and about to facilitate, facilitated once only and facilitated more than one six-week theme. Student comments regarding facilitator skills were obtained from a 2001 course survey. Results While facilitators generally agreed that the three-day training workshop provided sufficient insight into the facilitation process, they become more comfortable with increasing experience. Many facilitators experienced difficulty not providing content expertise. Again, this improved with increasing experience. Most facilitators saw students as colleagues. They agreed that they should be role models, but were less enthusiastic about being mentors. Students were critical of facilitators who were not up to date with curriculum implementation or who appeared disinterested. While facilitator responses suggest that there was considerable intrinsic motivation, this might in fact not be the case. Conclusions Even if they had facilitated on all six themes, facilitators could still be considered as novices. Faculty support is therefore critical for the first few years of problem-based learning, particularly for those who had facilitated once only. Since student and facilitator expectations in the small group tutorial may differ, roles and duties of facilitators must be explicit for both parties from the outset. PMID:14585108

  20. What can we learn from facilitator and student perceptions of facilitation skills and roles in the first year of a problem-based learning curriculum?

    PubMed

    McLean, Michelle

    2003-10-30

    The small group tutorial is a cornerstone of problem-based learning. By implication, the role of the facilitator is of pivotal importance. The present investigation canvassed perceptions of facilitators with differing levels of experience regarding their roles and duties in the tutorial. In January 2002, one year after problem-based learning implementation at the Nelson R. Mandela School of Medicine, facilitators with the following experience were canvassed: trained and about to facilitate, facilitated once only and facilitated more than one six-week theme. Student comments regarding facilitator skills were obtained from a 2001 course survey. While facilitators generally agreed that the three-day training workshop provided sufficient insight into the facilitation process, they become more comfortable with increasing experience. Many facilitators experienced difficulty not providing content expertise. Again, this improved with increasing experience. Most facilitators saw students as colleagues. They agreed that they should be role models, but were less enthusiastic about being mentors. Students were critical of facilitators who were not up to date with curriculum implementation or who appeared disinterested. While facilitator responses suggest that there was considerable intrinsic motivation, this might in fact not be the case. Even if they had facilitated on all six themes, facilitators could still be considered as novices. Faculty support is therefore critical for the first few years of problem-based learning, particularly for those who had facilitated once only. Since student and facilitator expectations in the small group tutorial may differ, roles and duties of facilitators must be explicit for both parties from the outset.

  1. Implementing a free school-based fruit and vegetable programme: barriers and facilitators experienced by pupils, teachers and produce suppliers in the Boost study

    PubMed Central

    2014-01-01

    Background Multi-component interventions which combine educational and environmental strategies appear to be most effective in increasing fruit and vegetable (FV) intake in adolescents. However, multi-component interventions are complex to implement and often poorly implemented. Identification of barriers and facilitators for implementation is warranted to improve future interventions. This study aimed to explore implementation of two intervention components which addressed availability and accessibility of FV in the multi-component, school-based Boost study which targeted FV intake among Danish 13-year-olds and to identify barriers and facilitators for implementation among pupils, teachers and FV suppliers. Methods We conducted focus group interviews with 111 13-year-olds and 13 teachers, completed class observations at six schools, and conducted telephone interviews with all involved FV suppliers. Interviews were transcribed, coded and analysed using qualitative analytical procedures. Results FV suppliers affected the implementation of the FV programme at schools and thereby pupils’ intake through their timing of delivery and through the quality, quantity and variety of the delivered FV. Teachers influenced the accessibility and appearance of FV by deciding if and when the pupils could eat FV and whether FV were cut up. Different aspects of time acted as barriers for teachers’ implementation of the FV programme: time spent on having a FV break during lessons, time needed to prepare FV and time spent on pupils’ misbehaviour and not being able to handle getting FV. Teacher timing of cutting up and serving FV could turn into a barrier for pupils FV intake due to enzymatic browning. The appearance of FV was important for pupils’ intake, especially for girls. FV that did not appeal to the pupils e.g. had turned brown after being cut up were thrown around as a part of a game by the pupils, especially boys. Girls appreciated the social dimension of eating FV

  2. Implementing a free school-based fruit and vegetable programme: barriers and facilitators experienced by pupils, teachers and produce suppliers in the Boost study.

    PubMed

    Aarestrup, Anne Kristine; Krølner, Rikke; Jørgensen, Thea Suldrup; Evans, Alexandra; Due, Pernille; Tjørnhøj-Thomsen, Tine

    2014-02-11

    Multi-component interventions which combine educational and environmental strategies appear to be most effective in increasing fruit and vegetable (FV) intake in adolescents. However, multi-component interventions are complex to implement and often poorly implemented. Identification of barriers and facilitators for implementation is warranted to improve future interventions.This study aimed to explore implementation of two intervention components which addressed availability and accessibility of FV in the multi-component, school-based Boost study which targeted FV intake among Danish 13-year-olds and to identify barriers and facilitators for implementation among pupils, teachers and FV suppliers. We conducted focus group interviews with 111 13-year-olds and 13 teachers, completed class observations at six schools, and conducted telephone interviews with all involved FV suppliers. Interviews were transcribed, coded and analysed using qualitative analytical procedures. FV suppliers affected the implementation of the FV programme at schools and thereby pupils' intake through their timing of delivery and through the quality, quantity and variety of the delivered FV. Teachers influenced the accessibility and appearance of FV by deciding if and when the pupils could eat FV and whether FV were cut up. Different aspects of time acted as barriers for teachers' implementation of the FV programme: time spent on having a FV break during lessons, time needed to prepare FV and time spent on pupils' misbehaviour and not being able to handle getting FV. Teacher timing of cutting up and serving FV could turn into a barrier for pupils FV intake due to enzymatic browning. The appearance of FV was important for pupils' intake, especially for girls. FV that did not appeal to the pupils e.g. had turned brown after being cut up were thrown around as a part of a game by the pupils, especially boys. Girls appreciated the social dimension of eating FV together to a larger extent than boys

  3. A qualitative analysis of implementing shared decision making in Child and Adolescent Mental Health Services in the United Kingdom: Stages and facilitators.

    PubMed

    Abrines-Jaume, Neus; Midgley, Nick; Hopkins, Katy; Hoffman, Jasmine; Martin, Kate; Law, Duncan; Wolpert, Miranda

    2016-01-01

    To explore the implementation of shared decision making (SDM) in Child and Adolescent Mental Health Services (CAMHS), and identify clinician-determined facilitators to SDM. Professionals from four UK CAMHS tried a range of tools to support SDM. They reflected on their experiences using plan-do-study-act log books. A total of 23 professionals completed 307 logs, which were transcribed and analysed using Framework Analysis in Atlas.Ti. Three states of implementation (apprehension, feeling clunky, and integration) and three aspects of clinician behavior or approach (effort, trust, and flexibility) were identified. Implementation of SDM in CAMHS requires key positive clinician behaviors, including preparedness to put in effort, trust in young people, and use of the approach flexibly. Implementation of SDM in CAMHS is effortful, and while tools may help support SDM, clinicians need to be allowed to use the tools flexibly to allow them to move from a state of apprehension through a sense of feeling "clunky" to integration in practice. © The Author(s) 2014.

  4. Barriers and facilitators to implementing an evidence-based woman-focused intervention in South African health services.

    PubMed

    Howard, Brittni N; Van Dorn, Richard; Myers, Bronwyn J; Zule, William A; Browne, Felicia A; Carney, Tara; Wechsberg, Wendee M

    2017-11-21

    Since the beginning of the HIV epidemic, numerous behavior change, risk-reduction, and biomedical interventions have been developed and tested. While some of these interventions have shown to be efficacious in randomized trials, it often takes almost two decades for an intervention to be translated into practice. Meanwhile, South Africa continues to have among the highest prevalence of HIV globally, with women of childbearing age bearing the burden of the epidemic. Given the urgency of the HIV epidemic among vulnerable women in South Africa, it is imperative that evidence-based interventions be implemented rapidly into practice. This study presents a first step toward examining the acceptability and feasibility of implementing the Women's Health CoOp (WHC) in clinics and substance abuse rehab settings in Cape Town, South Africa. We conducted focus group discussions with women who use substances and with service providers, we also conducted in-depth interviews with health service planners. Our goal was to examine implementation and clinical outcomes associated with delivery of the WHC across clinics and substance abuse rehab programs. All participants agreed on the need for the WHC. Perceived facilitators to implementing the WHC included the recognizable need for programs to empower women and to build the capacity of staff to address issues of substance use, sexual risk, and intimate partner violence. Participants also identified potential barriers to women engaging with this program, including the stigma women experience when seeking services and the lack of person-centered care at healthcare facilities. In a country with the largest number of women of childbearing age living with HIV, an evidence-based woman-focused intervention that comprehensively addresses women's risk for suboptimal antiretroviral adherence may be essential for reducing HIV incidence. However, potential barriers to implementing the WHC successfully must be addressed before the program can be

  5. Barriers and Facilitators to Implementing Functional Family Therapy in a Community Setting: Client and Practitioner Perspectives.

    PubMed

    McPherson, Kerri E; Kerr, Susan; Casey, Beth; Marshall, John

    2017-10-01

    While Functional Family Therapy (FFT) is known to be effective in addressing adolescent behavioral problems, there has been little exploration of issues relevant to its transport from the tightly controlled setting of clinical trials into routine service delivery. This study sought the views of key stakeholders, clients, and practitioners, on barriers and facilitators to the successful implementation of FFT. Undertaken in a community setting in Scotland, interviews were carried out with 12 adolescents, 14 parents/caregivers, and 6 practitioners. Results focus on: Referral process and pre-intervention contact; Engagement of families; Structure and delivery; Organizational factors. Although barriers to engagement were identified, FFT was viewed as an acceptable, appropriate and feasible intervention with the potential to improve adolescent wellbeing in 'real-world' settings. © 2017 American Association for Marriage and Family Therapy.

  6. Barriers and facilitators for the implementation of an online clinical health community in addition to usual fertility care: a cross-sectional study.

    PubMed

    Aarts, Johanna W M; Faber, Marjan J; den Boogert, Anne G; Cohlen, Ben J; van der Linden, Paul J Q; Kremer, Jan A M; Nelen, Willianne L D M

    2013-08-30

    Online health communities are becoming more popular in health care. Patients and professionals can communicate with one another online, patients can find peer support, and professionals can use it as an additional information channel to their patients. However, the implementation of online health communities into daily practice is challenging. These challenges relate to the fact that patients need to be activated to (1) become a member (ie, subscription) and (2) participate actively within the community before any effect can be expected. Therefore, we aimed at answering 2 research questions: (1) what factors are associated with subscription to an online health community, and (2) which are associated with becoming an active participant within an online health community. To identify barriers and facilitators as perceived by patients for the implementation of an online health community. We performed a cross-sectional study. Three Dutch fertility clinics (2 IVF-licensed) offered their patients a secure online clinical health community through which clinicians can provide online information and patients can ask questions to the medical team or share experiences and find support from peers. We randomly selected and invited 278 men and women suffering from infertility and attending 1 of the participating clinics. Participants filled out a questionnaire about their background characteristics and current use of the online community. Possible barriers and facilitators were divided into 2 parts: (1) those for subscription to the community, and (2) those for active participation in the community. We performed 2 multivariate logistic regression analyses to calculate determinants for both subscription and active participation. Subscription appeared to be associated with patients' background characteristics (eg, gender, treatment phase), intervention-related facilitators (odds ratio [OR] 2.45, 95% CI 1.14-5.27), and patient-related barriers (OR 0.20, 95% CI 0.08-0.54), such as

  7. Institutionalizing Health Impact Assessment: A consultation with experts on the barriers and facilitators to implementing HIA in Italy.

    PubMed

    Linzalone, Nunzia; Ballarini, Adele; Piccinelli, Cristiano; Viliani, Francesca; Bianchi, Fabrizio

    2018-07-15

    A Health Impact Assessment (HIA) is an evidence-based methodology that includes health promotion and protection goals in decision-making. HIA has been introduced and/or institutionalized to various extents in different countries. In order to promote HIA and preventive health assessments in Italy, a research methodology was followed to identify specific obstacles or facilitators. The experiences of various countries reported in the literature were analyzed in terms of facilitating or hindering the introduction and institutionalization of HIA. A consultation with the proponents of projects and plans in Italy was carried out with a multi-approach methodology in order to characterize the national context. A general implementation plan was drawn up from the international experiences. In Italy this is not yet in place. Specific areas of intervention need to be addressed, including: 1) data availability; 2) tools and methods; 3) engagement of stakeholders; 4) capacity building. The research suggests that the institutionalization of HIA in Italy rests on the government's commitment to providing specific legislation regarding HIA so that skills, intersectoral coordination and dedicated budgets can be built and maintained. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. Barriers and facilitators to the implementation of an evidence-based electronic minimum dataset for nursing team leader handover: A descriptive survey.

    PubMed

    Spooner, Amy J; Aitken, Leanne M; Chaboyer, Wendy

    2017-11-15

    There is widespread use of clinical information systems in intensive care units however, the evidence to support electronic handover is limited. The study aim was to assess the barriers and facilitators to use of an electronic minimum dataset for nursing team leader shift-to-shift handover in the intensive care unit prior to its implementation. The study was conducted in a 21-bed medical/surgical intensive care unit, specialising in cardiothoracic surgery at a tertiary referral hospital, in Queensland, Australia. An established tool was modified to the intensive care nursing handover context and a survey of all 63 nursing team leaders was undertaken. Survey statements were rated using a 6-point Likert scale with selections from 'strongly disagree' to 'strongly agree', and open-ended questions. Descriptive statistics were used to summarise results. A total of 39 team leaders responded to the survey (62%). Team leaders used general intensive care work unit guidelines to inform practice however they were less familiar with the intensive care handover work unit guideline. Barriers to minimum dataset uptake included: a tool that was not user friendly, time consuming and contained too much information. Facilitators to minimum dataset adoption included: a tool that was user friendly, saved time and contained relevant information. Identifying the complexities of a healthcare setting prior to the implementation of an intervention assists researchers and clinicians to integrate new knowledge into healthcare settings. Barriers and facilitators to knowledge use focused on usability, content and efficiency of the electronic minimum dataset and can be used to inform tailored strategies to optimise team leaders' adoption of a minimum dataset for handover. Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  9. Barriers and facilitators for implementing a new screening tool in an emergency department: A qualitative study applying the Theoretical Domains Framework.

    PubMed

    Kirk, Jeanette W; Sivertsen, Ditte M; Petersen, Janne; Nilsen, Per; Petersen, Helle V

    2016-10-01

    The aim was to identify the factors that were perceived as most important as facilitators or barriers to the introduction and intended use of a new tool in the emergency department among nurses and a geriatric team. A high incidence of functional decline after hospitalisation for acute medical illness has been shown in the oldest patients and those who are physically frail. In Denmark, more than 35% of older medical patients acutely admitted to the emergency department are readmitted within 90 days after discharge. A new screening tool for use in the emergency department aiming to identify patients at particularly high risk of functional decline and readmission was developed. Qualitative study based on semistructured interviews with nurses and a geriatric team in the emergency department and semistructured single interviews with their managers. The Theoretical Domains Framework guided data collection and analysis. Content analysis was performed whereby new themes and themes already existing within each domain were described. Six predominant domains were identified: (1) professional role and identity; (2) beliefs about consequences; (3) goals; (4) knowledge; (5) optimism and (6) environmental context and resources. The content analysis identified three themes, each containing two subthemes. The themes were professional role and identity, beliefs about consequences and preconditions for a successful implementation. Two different cultures were identified in the emergency department. These cultures applied to different professional roles and identity, different actions and sense making and identified how barriers and facilitators linked to the new screening tool were perceived. The results show that different cultures exist in the same local context and influence the perception of barriers and facilitators differently. These cultures must be identified and addressed when implementation is planned. © 2016 The Authors. Journal of Clinical Nursing Published by John

  10. Factors Affecting the Implementation of Policy 2450, Distance Education and the West Virginia Virtual School, as Perceived by Principals/Assistant Principals, Counselors, and Distance Learning Contacts and/or Course Facilitators

    ERIC Educational Resources Information Center

    Burdette, Keith R.

    2013-01-01

    This study examined the factors important to the implementation of West Virginia Board of Education Policy 2450, Distance Learning and the West Virginia Virtual School. The purpose of this study was to determine the factors that facilitated and impeded implementation of the policy, as perceived by principals/assistant principals, counselors, and…

  11. Play@home in practice: health visitors' views of perceived facilitators and barriers to programme implementation.

    PubMed

    Miller, Irene; Barton, Gil

    2013-07-01

    Health visitors in Scotland gift 'play@home', a book-based early intervention programme, to parents as part of the universal health visiting service. The provision of health improvement information to parents is recognised as a core function of health visiting and yet evidence shows that not every family receives the play@home resources. This paper discusses the perceived facilitators and barriers to implementing this programme through exploring the views of ten health visitors and four health visiting managers in two health board areas in Scotland. The findings conclude that increasingly vulnerable families, supported by fewer qualified health visitors, present challenges to the health visiting service. The play@home programme is valued by health visitors as a flexible tool with which to engage with families. Collaborative working with other services enhances provision and play@home does become embedded in practice over time. Strategic policy links to raise the profile of play@home are improving.

  12. The New England School Effectiveness Project: A Facilitator's Sourcebook.

    ERIC Educational Resources Information Center

    Northeast Regional Exchange, Inc., Chelmsford, MA.

    The School Team Facilitator assists participating New England secondary schools in planning and implementing improvement efforts based on school effectiveness research. This publication, distributed at a team training conference, begins with the conference schedule, a list of facilitators, instructions on choosing a school team, and letters to…

  13. Species Composition at the Sub-Meter Level in Discontinuous Permafrost in Subarctic Sweden

    NASA Astrophysics Data System (ADS)

    Anderson, S. M.; Palace, M. W.; Layne, M.; Varner, R. K.; Crill, P. M.

    2013-12-01

    Northern latitudes are experiencing rapid warming. Wetlands underlain by permafrost are particularly vulnerable to warming which results in changes in vegetative cover. Specific species have been associated with greenhouse gas emissions therefore knowledge of species compositional shift allows for the systematic change and quantification of emissions and changes in such emissions. Species composition varies on the sub-meter scale based on topography and other microsite environmental parameters. This complexity and the need to scale vegetation to the landscape level proves vital in our estimation of carbon dioxide (CO2) and methane (CH4) emissions and dynamics. Stordalen Mire (68°21'N, 18°49'E) in Abisko and is located at the edge of discontinuous permafrost zone. This provides a unique opportunity to analyze multiple vegetation communities in a close proximity. To do this, we randomly selected 25 1x1 meter plots that were representative of five major cover types: Semi-wet, wet, hummock, tall graminoid, and tall shrub. We used a quadrat with 64 sub plots and measured areal percent cover for 24 species. We collected ground based remote sensing (RS) at each plot to determine species composition using an ADC-lite (near infrared, red, green) and GoPro (red, blue, green). We normalized each image based on a Teflon white chip placed in each image. Textural analysis was conducted on each image for entropy, angular second momentum, and lacunarity. A logistic regression was developed to examine vegetation cover types and remote sensing parameters. We used a multiple linear regression using forwards stepwise variable selection. We found statistical difference in species composition and diversity indices between vegetation cover types. In addition, we were able to build regression model to significantly estimate vegetation cover type as well as percent cover for specific key vegetative species. This ground-based remote sensing allows for quick quantification of vegetation

  14. Facilitators: One Key Factor in Implementing Successful Experience-Based Training and Development Programs.

    ERIC Educational Resources Information Center

    Wagner, Richard J.; Roland, Christopher C.

    An increasing number of corporations are using some form of experience-based outdoor training and development. Most of these programs follow a general process that includes: (1) introduction of the activity by the facilitator; (2) the experiential activity (during which the facilitator is observer or safety monitor); and (3) debriefing or…

  15. Portal for Families Overcoming Neurodevelopmental Disorders (PFOND): Implementation of a Software Framework for Facilitated Community Website Creation by Nontechnical Volunteers.

    PubMed

    Ye, Xin Cynthia; Ng, Isaiah; Seid-Karbasi, Puya; Imam, Tuhina; Lee, Cheryl E; Chen, Shirley Yu; Herman, Adam; Sharma, Balraj; Johal, Gurinder; Gu, Bobby; Wasserman, Wyeth W

    2013-08-06

    The Portal for Families Overcoming Neurodevelopmental Disorders (PFOND) provides a structured Internet interface for the sharing of information with individuals struggling with the consequences of rare developmental disorders. Large disease-impacted communities can support fundraising organizations that disseminate Web-based information through elegant websites run by professional staff. Such quality resources for families challenged by rare disorders are infrequently produced and, when available, are often dependent upon the continued efforts of a single individual. The project endeavors to create an intuitive Web-based software system that allows a volunteer with limited technical computer skills to produce a useful rare disease website in a short time period. Such a system should provide access to emerging news and research findings, facilitate community participation, present summary information about the disorder, and allow for transient management by volunteers who are likely to change periodically. The prototype portal was implemented using the WordPress software system with both existing and customized supplementary plug-in software modules. Gamification scoring features were implemented in a module, allowing editors to measure progress. The system was installed on a Linux-based computer server, accessible across the Internet through standard Web browsers. A prototype PFOND system was implemented and tested. The prototype system features a structured organization with distinct partitions for background information, recent publications, and community discussions. The software design allows volunteer editors to create a themed website, implement a limited set of topic pages, and connect the software to dynamic RSS feeds providing information about recent news or advances. The prototype was assessed by a fraction of the disease sites developed (8 out of 27), including Aarskog-Scott syndrome, Aniridia, Adams-Oliver syndrome, Cat Eye syndrome, Kabuki syndrome

  16. Portal for Families Overcoming Neurodevelopmental Disorders (PFOND): Implementation of a Software Framework for Facilitated Community Website Creation by Nontechnical Volunteers

    PubMed Central

    Imam, Tuhina; Lee, Cheryl E; Chen, Shirley Yu; Herman, Adam; Sharma, Balraj; Johal, Gurinder; Gu, Bobby

    2013-01-01

    Background The Portal for Families Overcoming Neurodevelopmental Disorders (PFOND) provides a structured Internet interface for the sharing of information with individuals struggling with the consequences of rare developmental disorders. Large disease-impacted communities can support fundraising organizations that disseminate Web-based information through elegant websites run by professional staff. Such quality resources for families challenged by rare disorders are infrequently produced and, when available, are often dependent upon the continued efforts of a single individual. Objective The project endeavors to create an intuitive Web-based software system that allows a volunteer with limited technical computer skills to produce a useful rare disease website in a short time period. Such a system should provide access to emerging news and research findings, facilitate community participation, present summary information about the disorder, and allow for transient management by volunteers who are likely to change periodically. Methods The prototype portal was implemented using the WordPress software system with both existing and customized supplementary plug-in software modules. Gamification scoring features were implemented in a module, allowing editors to measure progress. The system was installed on a Linux-based computer server, accessible across the Internet through standard Web browsers. Results A prototype PFOND system was implemented and tested. The prototype system features a structured organization with distinct partitions for background information, recent publications, and community discussions. The software design allows volunteer editors to create a themed website, implement a limited set of topic pages, and connect the software to dynamic RSS feeds providing information about recent news or advances. The prototype was assessed by a fraction of the disease sites developed (8 out of 27), including Aarskog-Scott syndrome, Aniridia, Adams-Oliver syndrome

  17. Identifying Barriers and Facilitators in Implementing Schoolwide Positive Behavior Support

    ERIC Educational Resources Information Center

    Kincaid, Don; Childs, Karen; Blase, Karen A.; Wallace, Frances

    2007-01-01

    As the number of schools implementing systemic, schoolwide positive behavior support (PBS) processes expands (nationally, at least 5,000 schools are participating), increasing attention is being paid to the efficacy of implementation. This article describes a case study of the experiences of Florida's Positive Behavior Support Project, which used…

  18. Supervision of Facilitators in a Multisite Study: Goals, Process, and Outcomes

    PubMed Central

    2010-01-01

    Objective To describe the aims, implementation, and desired outcomes of facilitator supervision for both interventions (treatment and control) in Project Eban and to present the Eban Theoretical Framework for Supervision that guided the facilitators’ supervision. The qualifications and training of supervisors and facilitators are also described. Design This article provides a detailed description of supervision in a multisite behavioral intervention trial. The Eban Theoretical Framework for Supervision is guided by 3 theories: cognitive behavior therapy, the Life-long Model of Supervision, and “Empowering supervisees to empower others: a culturally responsive supervision model.” Methods Supervision is based on the Eban Theoretical Framework for Supervision, which provides guidelines for implementing both interventions using goals, process, and outcomes. Results Because of effective supervision, the interventions were implemented with fidelity to the protocol and were standard across the multiple sites. Conclusions Supervision of facilitators is a crucial aspect of multisite intervention research quality assurance. It provides them with expert advice, optimizes the effectiveness of facilitators, and increases adherence to the protocol across multiple sites. Based on the experience in this trial, some of the challenges that arise when conducting a multisite randomized control trial and how they can be handled by implementing the Eban Theoretical Framework for Supervision are described. PMID:18724192

  19. Why is it so hard to implement change? A qualitative examination of barriers and facilitators to distribution of naloxone for overdose prevention in a safety net environment.

    PubMed

    Drainoni, Mari-Lynn; Koppelman, Elisa A; Feldman, James A; Walley, Alexander Y; Mitchell, Patricia M; Ellison, Jacqueline; Bernstein, Edward

    2016-10-18

    The increase in opioid overdose deaths has become a national public health crisis. Naloxone is an important tool in opioid overdose prevention. Distribution of nasal naloxone has been found to be a feasible, and effective intervention in community settings and may have potential high applicability in the emergency department, which is often the initial point of care for persons at high risk of overdose. One safety net hospital introduced an innovative policy to offer take-home nasal naloxone via a standing order to ensure distribution to patients at risk for overdose. The aims of this study were to examine acceptance and uptake of the policy and assess facilitators and barriers to implementation. After obtaining pre-post data on naloxone distribution, we conducted a qualitative study. The PARiHS framework steered development of the qualitative guide. We used theoretical sampling in order to include the range of types of emergency department staff (50 total). The constant comparative method was initially used to code the transcripts and identify themes; the themes that emerged from the coding were then mapped back to the evidence, context and facilitation constructs of the PARiHS framework. Acceptance of the policy was good but uptake was low. Primary themes related to facilitators included: real-world driven intervention with philosophical, clinician and leadership support; basic education and training efforts; availability of resources; and ability to leave the ED with the naloxone kit in hand. Barriers fell into five general categories: protocol and policy; workflow and logistical; patient-related; staff roles and responsibilities; and education and training. The actual implementation of a new innovation in healthcare delivery is largely driven by factors beyond acceptance. Despite support and resources, implementation was challenging, with low uptake. While the potential of this innovation is unknown, understanding the experience is important to improve uptake

  20. Practice change in community pharmacy: quantification of facilitators.

    PubMed

    Roberts, Alison S; Benrimoj, Shalom I; Chen, Timothy F; Williams, Kylie A; Aslani, Parisa

    2008-06-01

    There has been an increasing international trend toward the delivery of cognitive pharmaceutical services (CPS) in community pharmacy. CPS have been developed and disseminated individually, without a framework underpinning their implementation and with limited knowledge of factors that might assist practice change. The implementation process is complex, involving a range of internal and external factors. To quantify facilitators of practice change in Australian community pharmacies. We employed a literature review and qualitative study to facilitate the design of a 43-item "facilitators of practice change" scale as part of a quantitative survey instrument, using a framework of organizational theory. The questionnaire was pilot-tested (n = 100), then mailed to a random sample of 2000 community pharmacies, with a copy each for the pharmacy owner, employed pharmacist, and pharmacy assistant. The construct validity and reliability of the scale were established using exploratory factor analysis and Cronbach's alpha, respectively. A total of 735 (37%) pharmacies responded, with 1303 individual questionnaires. Factor analysis of the scale yielded 7 factors, explaining 48.8% of the total variance. The factors were: relationship with physicians (item loading range 0.59-0.85; Cronbach's alpha 0.90), remuneration (0.52-0.74; 0.82), pharmacy layout (0.52-0.79; 0.81), patient expectation (0.52-0.85; 0.82), manpower/staff (0.49-0.66; 0.80), communication and teamwork (0.37-0.65; 0.77), and external support/assistance (0.47-0.69; 0.74). All of the factors demonstrated good reliability and construct validity and explained approximately half of the variance. Implementing CPS requires support not only with the clinical aspects of service delivery, but also for the process of implementation itself, and remuneration models must reflect this. The identified facilitators should be used in a multilevel strategy to integrate professional services into the community pharmacy business

  1. Mapping and monitoring small stakholder agriculture in Tigray, Ethiopia using sub-meter Worldview and Landsat imagery and high performance computing.

    NASA Astrophysics Data System (ADS)

    Carroll, M.; McCarty, J. L.; Neigh, C. S. R.; Wooten, M.

    2016-12-01

    Very high resolution (VHR) satellite data is experiencing rapid annual growth, producing petabytes of remotely sensed data per year. The WorldView constellation, operated by DigitalGlobe, images over 1.2 billion km2 annually at a > 2 m spatial resolution. Due to computation, data cost, and methodological concerns, VHR satellite data has mainly been used to produce needed geospatial information for site-specific phenomenon. This project produced a VHR spatiotemporally-explicit wall-to-wall cropland area map for the rainfed residential cropland mosaic of Tigray Region, Ethiopia, which is comprised entirely of smallholder farms. Moderate resolution satellite data is not adequate in spatial or temporal resolution to capture total area occupied by smallholder farms, i.e., farms with agricultural fields of ≥ 45 × 45 m in dimension. In order to accurately map smallholder crop area over a large region, hundreds of VHR images spanning two or more years are needed. Sub-meter WorldView-1 and WorldView-2 segmentation results were combined median phenology amplitude from Landsat 8 data. VHR WorldView-1, -2 data were obtained from the U.S. National Geospatial-Intelligence Agency (NGA) Commercial Archive Data at NASA Goddard Space Flight Center (GSFC) (http://cad4nasa.gsfc.nasa.gov/). Over 2700 scenes were processed from raw imagery to completed crop map in 1 week in a semi-automated method using the large computing capacity of the Advanced Data Analytics Platform (ADAPT) at NASA GSFC's NCCS (http://www.nccs.nasa.gov/services/adapt). This methodology is extensible to any land cover type and can easily be expanded to run on much larger regions.

  2. Using Getting To Outcomes to facilitate the use of an evidence-based practice in VA homeless programs: a cluster-randomized trial of an implementation support strategy.

    PubMed

    Chinman, Matthew; McCarthy, Sharon; Hannah, Gordon; Byrne, Thomas Hugh; Smelson, David A

    2017-03-09

    Incorporating evidence-based integrated treatment for dual disorders into typical care settings has been challenging, especially among those serving Veterans who are homeless. This paper presents an evaluation of an effort to incorporate an evidence-based, dual disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) into case management teams serving Veterans who are homeless, using an implementation strategy called Getting To Outcomes (GTO). This Hybrid Type III, cluster-randomized controlled trial assessed the impact of GTO over and above MISSION-Vet Implementation as Usual (IU). Both conditions received standard MISSION-Vet training and manuals. The GTO group received an implementation manual, training, technical assistance, and data feedback. The study occurred in teams at three large VA Medical Centers over 2 years. Within each team, existing sub-teams (case managers and Veterans they serve) were the clusters randomly assigned. The trial assessed MISSION-Vet services delivered and collected via administrative data and implementation barriers and facilitators, via semi-structured interview. No case managers in the IU group initiated MISSION-Vet while 68% in the GTO group did. Seven percent of Veterans with case managers in the GTO group received at least one MISSION-Vet session. Most case managers appreciated the MISSION-Vet materials and felt the GTO planning meetings supported using MISSION-Vet. Case manager interviews also showed that MISSION-Vet could be confusing; there was little involvement from leadership after their initial agreement to participate; the data feedback system had a number of difficulties; and case managers did not have the resources to implement all aspects of MISSION-Vet. This project shows that GTO-like support can help launch new practices but that multiple implementation facilitators are needed for successful execution of a complex evidence

  3. Barriers and facilitators to the implementation of orthodontic mini-implants in clinical practice: a protocol for a systematic review and meta-analysis.

    PubMed

    Meursinge Reynders, Reint; Ronchi, Laura; Ladu, Luisa; Di Girolamo, Nicola; de Lange, Jan; Roberts, Nia; Mickan, Sharon

    2016-02-05

    Most orthodontic treatment plans need some form of anchorage to control the reciprocal forces of tooth movement. Orthodontic mini implants (OMIs) have been hailed for having revolutionized orthodontics, because they provide anchorage without depending on the collaboration of patients, they have a favorable effectiveness compared with conventional anchorage devices, and they can be used for a wide scale of treatment objectives. However, surveys have shown that many orthodontists never or rarely use them. To understand the rationale behind this knowledge-to-action gap, we will conduct a systematic review that will identify and quantify potential barriers and facilitators to the implementation of OMIs in clinical practice for all potential stakeholders, i.e., patients, family members, clinicians, office staff, clinic owners, policy makers, etc. The prevalence of clinicians that do not use OMIs will be our secondary outcome. The Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 Statement was adopted as the framework for reporting this manuscript. We will apply broad-spectrum search strategies and will search MEDLINE and more than 40 other databases. We will conduct searches in the gray literature, screen reference lists, and hand-search 12 journals. All study designs, stakeholders, interventions, settings, and languages will be eligible. We will search studies that report on barriers or facilitators to the implementation of orthodontic mini implants (OMIs) in clinical practice. Implementation constructs and their prevalence among pertinent stakeholders will be our primary outcomes. All searching and data extraction procedures will be conducted by three experienced reviewers. We will also contact authors and investigators to obtain additional information on data items and unidentified studies. Risk of bias will be scored with tools designed for the specific study designs. We will assess heterogeneity, meta-biases, and the

  4. Incorporating immunizations into routine obstetric care to facilitate Health Care Practitioners in implementing maternal immunization recommendations

    PubMed Central

    Webb, Heather; Street, Jackie; Marshall, Helen

    2014-01-01

    Immunization against pertussis, influenza, and rubella reduces morbidity and mortality in pregnant women and their offspring. Health care professionals (HCPs) caring for women perinatally are uniquely placed to reduce maternal vaccine preventable diseases (VPDs). Despite guidelines recommending immunization during the perinatal period, maternal vaccine uptake remains low. This qualitative study explored the role of obstetricians, general practitioners, and midwives in maternal vaccine uptake. Semi-structured interviews (n = 15) were conducted with perinatal HCPs at a tertiary maternity hospital in South Australia. HCPs were asked to reflect on their knowledge, beliefs, and practice relating to immunization advice and vaccine provision. Interviews were transcribed and coded using thematic analysis. Data collection and analysis was an iterative process, with collection ceasing with theoretical saturation. Participants unanimously supported maternal vaccination as an effective way of reducing risk of disease in this vulnerable population, however only rubella immunity detection and immunization is embedded in routine care. Among these professionals, delegation of responsibility for maternal immunization was unclear and knowledge about maternal immunization was variable. Influenza and pertussis vaccine prevention measures were not included in standard pregnancy record documentation, information provision to patients was “ad hoc” and vaccinations not offered on-site. The key finding was that the incorporation of maternal vaccinations into standard care through a structured process is an important facilitator for immunization uptake. Incorporating vaccine preventable disease management measures into routine obstetric care including incorporation into the Pregnancy Record would facilitate HCPs in implementing recommendations. Rubella prevention provides a useful “template” for other vaccines. PMID:24509790

  5. Incorporating immunizations into routine obstetric care to facilitate Health Care Practitioners in implementing maternal immunization recommendations.

    PubMed

    Webb, Heather; Street, Jackie; Marshall, Helen

    2014-01-01

    Immunization against pertussis, influenza, and rubella reduces morbidity and mortality in pregnant women and their offspring. Health care professionals (HCPs) caring for women perinatally are uniquely placed to reduce maternal vaccine preventable diseases (VPDs). Despite guidelines recommending immunization during the perinatal period, maternal vaccine uptake remains low. This qualitative study explored the role of obstetricians, general practitioners, and midwives in maternal vaccine uptake. Semi-structured interviews (n = 15) were conducted with perinatal HCPs at a tertiary maternity hospital in South Australia. HCPs were asked to reflect on their knowledge, beliefs, and practice relating to immunization advice and vaccine provision. Interviews were transcribed and coded using thematic analysis. Data collection and analysis was an iterative process, with collection ceasing with theoretical saturation. Participants unanimously supported maternal vaccination as an effective way of reducing risk of disease in this vulnerable population, however only rubella immunity detection and immunization is embedded in routine care. Among these professionals, delegation of responsibility for maternal immunization was unclear and knowledge about maternal immunization was variable. Influenza and pertussis vaccine prevention measures were not included in standard pregnancy record documentation, information provision to patients was "ad hoc" and vaccinations not offered on-site. The key finding was that the incorporation of maternal vaccinations into standard care through a structured process is an important facilitator for immunization uptake. Incorporating vaccine preventable disease management measures into routine obstetric care including incorporation into the Pregnancy Record would facilitate HCPs in implementing recommendations. Rubella prevention provides a useful 'template' for other vaccines.

  6. Experiences of practice facilitators working on the Improved Delivery of Cardiovascular Care project: Retrospective case study.

    PubMed

    Liddy, Clare; Rowan, Margo; Valiquette-Tessier, Sophie-Claire; Drosinis, Paul; Crowe, Lois; Hogg, William

    2018-01-01

    To examine the barriers to and facilitators of practice facilitation experienced by participants in the Improving Delivery of Cardiovascular Care (IDOCC) project. Case studies of practice facilitators' narrative reports. Eastern Ontario. Primary care practices that participated in the IDOCC project. Cases were identified by calculating sum scores in order to determine practices' performance relative to their peers. Two case exemplars were selected that scored within ± 1 SD of the total mean score, and a qualitative analysis of practice facilitators' narrative reports was conducted using a 5-factor implementation framework to identify barriers and facilitators. Narratives were divided into 3 phases: planning, implementation, and sustainability. Barriers and facilitators fluctuated over the intervention's 3 phases. Site A reported more barriers (n = 47) than facilitators (n = 38), while site B reported a roughly equal number of barriers (n = 144) and facilitators (n = 136). In both sites, the most common barriers involved organizational and provider factors and the most common facilitators were associated with innovation and structural factors. Both practices encountered various barriers and facilitators throughout the IDOCC's 3 phases. The case studies reveal the complex interactions of these factors over time, and provide insight into the implementation of practice facilitation programs. Copyright© the College of Family Physicians of Canada.

  7. Facilitating change from a distance - a story of success? A discussion on leaders' styles in facilitating change in four nursing homes in Norway.

    PubMed

    Øye, Christine; Mekki, Tone Elin; Jacobsen, Frode Fadnes; Førland, Oddvar

    2016-09-01

    To examine the influence of leadership when facilitating change in nursing homes. The study is a part of an education intervention for care staff to prevent the use of restraint in nursing home residents with dementia in 24 nursing homes (NHs) in Norway. Leadership is known to be a fundamental factor for success of evidence-based practice (EBP) implementation in health services. However, the type of leadership that strengthens the processes of change remains to be clarified. A multi-site comparative ethnography was performed in four nursing homes to investigate how contextual factors influenced the implementation. The analysis was informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework, and in particular the sub-element of leadership. Different leadership styles to facilitate change were identified. Paradoxically, a strong collective and collaborative leadership style was found to hamper change in one particular home, whereas a remote leadership style combined with almost no cooperation with staff proved successful in another setting. The study indicates that leadership cannot be understood on a low-high continuum as suggested by the PARIHS framework, but rather as a factor characterised by diversity. Our study indicates, as a minimum, that a leader's presence is necessary to facilitate the internal processes in order more successfully to implement EBP. © 2016 John Wiley & Sons Ltd.

  8. Facilitation of an end-of-life care programme into practice within UK nursing care homes: A mixed-methods study.

    PubMed

    Kinley, Julie; Preston, Nancy; Froggatt, Katherine

    2018-06-01

    The predicted demographic changes internationally have implications for the nature of care that older people receive and place of care as they age. Healthcare policy now promotes the implementation of end-of-life care interventions to improve care delivery within different settings. The Gold Standards Framework in Care Homes (GSFCH) programme is one end-of-life care initiative recommended by the English Department of Health. Only a small number of care homes that start the programme complete it, which raises questions about the implementation process. To identify the type, role, impact and cost of facilitation when implementing the GSFCH programme into nursing care home practice. A mixed-methods study. Nursing care homes in south-east England. Staff from 38 nursing care homes undertaking the GSFCH programme. Staff in 24 nursing care homes received high facilitation. Of those, 12 also received action learning. The remaining 14 nursing care homes received usual local facilitation of the GSFCH programme. Study data were collected from staff employed within nursing care homes (home managers and GSFCH coordinators) and external facilitators associated with the homes. Data collection included interviews, surveys and facilitator activity logs. Following separate quantitative (descriptive statistics) and qualitative (template) data analysis the data sets were integrated by 'following a thread'. This paper reports study data in relation to facilitation. Three facilitation approaches were provided to nursing home staff when implementing the GSFCH programme: 'fitting it in' facilitation; 'as requested' facilitation; and 'being present' facilitation. 'Being present' facilitation most effectively enabled the completion of the programme, through to accreditation. However, it was not sufficient to just be present. Without mastery and commitment, from all participants, including the external facilitator, learning and initiation of change failed to occur. Implementation of the

  9. Protocol for a qualitative synthesis of barriers and facilitators in implementing guidelines for diagnosis of tuberculosis.

    PubMed

    Ochodo, Eleanor; Kredo, Tamara; Young, Taryn; Wiysonge, Charles Shey

    2017-06-09

    Despite the introduction of new tests and guidelines for diagnosis of tuberculosis (TB), worldwide case detection rate of TB is still suboptimal. This could be in part explained by the poor implementation of TB diagnostic guidelines. We aim to identify, appraise and synthesise qualitative evidence exploring the barriers and facilitators to implementing TB diagnostic guidelines. A systematic review of qualitative studies will be conducted. Relevant electronic databases will be searched and studies included based on predefined inclusion criteria. We will also search reference lists, grey literature, conduct forward citation searches and contact relevant content experts. An adaptation of the Critical Appraisal Skills Programme tool will be used to assess the methodological quality of included studies. Two authors will review the search output, extract data and assess methodological quality independently, resolving any disagreements by consensus. We will use the thematic framework analysis approach based on the Supporting the Use of Research Evidence thematic framework to analyse and synthesise our data. We will apply the Confidence in the Evidence from Reviews of Qualitative research approach to transparently assess our confidence in the findings of the systematic review. This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42016039790 TRIAL REGISTRATION NUMBER: PROSPERO 2016: CRD42016039790. Available from http://www.crd.york.ac.uk/PROSPERO/. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Facilitated family presence at resuscitation: effectiveness of a nursing student toolkit.

    PubMed

    Kantrowitz-Gordon, Ira; Bennett, Deborah; Wise Stauffer, Debra; Champ-Gibson, Erla; Fitzgerald, Cynthia; Corbett, Cynthia

    2013-10-01

    Facilitated family presence at resuscitation is endorsed by multiple nursing and specialty practice organizations. Implementation of this practice is not universal so there is a need to increase familiarity and competence with facilitated family presence at resuscitation during this significant life event. One strategy to promote this practice is to use a nursing student toolkit for pre-licensure and graduate nursing students. The toolkit includes short video simulations of facilitated family presence at resuscitation, a PowerPoint presentation of evidence-based practice, and questions to facilitate guided discussion. This study tested the effectiveness of this toolkit in increasing nursing students' knowledge, perceptions, and confidence in facilitated family presence at resuscitation. Nursing students from five universities in the United States completed the Family Presence Risk-Benefit Scale, Family Presence Self-Confidence Scale, and a knowledge test before and after the intervention. Implementing the facilitated family presence at resuscitation toolkit significantly increased nursing students' knowledge, perceptions, and confidence related to facilitated family presence at resuscitation (p<.001). The effect size was large for knowledge (d=.90) and perceptions (d=1.04) and moderate for confidence (d=.51). The facilitated family presence at resuscitation toolkit used in this study had a positive impact on students' knowledge, perception of benefits and risks, and self-confidence in facilitated family presence at resuscitation. The toolkit provides students a structured opportunity to consider the presence of family members at resuscitation prior to encountering this situation in clinical practice. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Barriers and facilitators to reducing frequent laboratory testing for patients who are stable on warfarin: a mixed methods study of de-implementation in five anticoagulation clinics.

    PubMed

    Barnes, Geoffrey D; Misirliyan, Sevan; Kaatz, Scott; Jackson, Elizabeth A; Haymart, Brian; Kline-Rogers, Eva; Kozlowski, Jay; Krol, Gregory; Froehlich, James B; Sales, Anne

    2017-07-14

    Patients on chronic warfarin therapy require regular laboratory monitoring to safely manage warfarin. Recent studies have challenged the need for routine monthly blood draws in the most stable warfarin-treated patients, suggesting the safety of less frequent laboratory testing (up to every 12 weeks). De-implementation efforts aim to reduce the use of low-value clinical practices. To explore barriers and facilitators of a de-implementation effort to reduce the use of frequent laboratory tests for patients with stable warfarin management in nurse/pharmacist-run anticoagulation clinics, we performed a mixed-methods study conducted within a state-wide collaborative quality improvement collaborative. Using a mixed-methods approach, we conducted post-implementation semi-structured interviews with a total of eight anticoagulation nurse or pharmacist staff members at five participating clinic sites to assess barriers and facilitators to de-implementing frequent international normalized ratio (INR) laboratory testing among patients with stable warfarin control. Interview guides were based on the Tailored Implementation for Chronic Disease (TICD) framework. Informed by interview themes, a survey was developed and administered to all anticoagulation clinical staff (n = 62) about their self-reported utilization of less frequent INR testing and specific barriers to de-implementing the standard (more frequent) INR testing practice. From the interviews, four themes emerged congruent with TICD domains: (1) staff overestimating their actual use of less frequent INR testing (individual health professional factors), (2) barriers to appropriate patient engagement (incentives and resources), (3) broad support for an electronic medical record flag to identify potentially eligible patients (incentives and resources), and (4) the importance of personalized nurse/pharmacist feedback (individual health professional factors). In the survey (65% response rate), staff report offering less

  12. Study protocol: Addressing evidence and context to facilitate transfer and uptake of consultation recording use in oncology: A knowledge translation implementation study

    PubMed Central

    2011-01-01

    Background The time period from diagnosis to the end of treatment is challenging for newly diagnosed cancer patients. Patients have a substantial need for information, decision aids, and psychosocial support. Recordings of initial oncology consultations improve information recall, reduce anxiety, enhance patient satisfaction with communication, and increase patients' perceptions that the essential aspects of their disease and treatment have been addressed during the consultation. Despite the research evidence supporting the provision of consultation recordings, uptake of this intervention into oncology practice has been slow. The primary aim of this project is to conduct an implementation study to explicate the contextual factors, including use of evidence, that facilitate and impede the transfer and uptake of consultation-recording use in a sample of patients newly diagnosed with breast or prostate cancer. Methods Sixteen oncologists from cancer centres in three Canadian cities will participate in this three-phase study. The preimplementation phase will be used to identify and address those factors that are fundamental to facilitating the smooth adoption and delivery of the intervention during the implementation phase. During the implementation phase, breast and prostate cancer patients will receive a recording of their initial oncology consultation to take home. Patient interviews will be conducted in the days following the consultation to gather feedback on the benefits of the intervention. Patients will complete the Digital Recording Use Semi-Structured Interview (DRUSSI) and be invited to participate in focus groups in which their experiences with the consultation recording will be explored. Oncologists will receive a summary letter detailing the benefits voiced by their patients. The postimplementation phase includes a conceptual framework development meeting and a seven-point dissemination strategy. Discussion Consultation recording has been used in oncology

  13. Sustainability of knowledge implementation in a low- and middle- income context: Experiences from a facilitation project in Vietnam targeting maternal and neonatal health

    PubMed Central

    Bergström, Anna; Hoa, Dinh Thi Phuong; Nga, Nguyen Thu; Eldh, Ann Catrine

    2017-01-01

    Background In a previous trial in Vietnam, a facilitation strategy to secure evidence-based practice in primary care resulted in reduced neonatal mortality over a period of three years. While little is known as to what ensures sustainability in the implementation of community-based strategies, the aim of this study was to investigate factors promoting or hindering implementation, and sustainability of knowledge implementation strategies, by means of the former Neonatal Knowledge Into Practice (NeoKIP) trial. Methods In 2014 we targeted all levels in the Vietnamese healthcare system: six individual interviews with representatives at national, provincial and district levels, and six focus group discussions with representatives at the commune level. The interviews were transcribed verbatim, translated to English, and analysed using inductive and deductive thematic analysis. Results To achieve successful implementation and sustained effect of community-based knowledge implementation strategies, engagement of leaders and key stakeholders at all levels of the healthcare system is vital–prior to, during and after a project. Implementation and sustainability require thorough needs assessment, tailoring of the intervention, and consideration of how to attain and manage funds. The NeoKIP trial was characterised by a high degree of engagement at the primary healthcare system level. Further, three years post trial, maternal and neonatal care was still high on the agenda for healthcare workers and leaders, even though primary aspects such as stakeholder engagement at all levels, and funding had been incomplete or lacking. Conclusions The current study illustrates factors to support successful implementation and sustain effects of community-based strategies in projects in low- and middle-income settings; some but not all factors were represented during the post-NeoKIP era. Most importantly, trials in this and similar contexts require deliberate management throughout and beyond

  14. Management Basics for Minority Women. Facilitator's Manual.

    ERIC Educational Resources Information Center

    Jackson, Stanlie M., Ed.

    This facilitator's manual consists of guidelines and materials for use in conducting a workshop dealing with three management basics for minority women--communication, decision making, and interpersonal skills. Covered in the first half of the manual are the following aspects of implementing the workshop: background on the need for and development…

  15. Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: a systematic review.

    PubMed

    Fadlallah, Racha; El-Jardali, Fadi; Hemadi, Nour; Morsi, Rami Z; Abou Samra, Clara Abou; Ahmad, Ali; Arif, Khurram; Hishi, Lama; Honein-AbouHaidar, Gladys; Akl, Elie A

    2018-01-29

    Community-based health insurance (CBHI) has evolved as an alternative health financing mechanism to out of pocket payments in low- and middle-income countries (LMICs), particularly in areas where government or employer-based health insurance is minimal. This systematic review aimed to assess the barriers and facilitators to implementation, uptake and sustainability of CHBI schemes in LMICs. We searched six electronic databases and grey literature. We included both quantitative and qualitative studies written in English language and published after year 1992. Two reviewers worked in duplicate and independently to complete study selection, data abstraction, and assessment of methodological features. We synthesized the findings based on thematic analysis and categorized according to the ecological model into individual, interpersonal, community and systems levels. Of 15,510 citations, 51 met the eligibility criteria. Individual factors included awareness and understanding of the concept of CBHI, trust in scheme and scheme managers, perceived service quality, and demographic characteristics, which influenced enrollment and sustainability. Interpersonal factors such as household dynamics, other family members enrolled in the scheme, and social solidarity influenced enrollment and renewal of membership. Community-level factors such as culture and community involvement in scheme development influenced enrollment and sustainability of scheme. Systems-level factors encompassed governance, financial and delivery arrangement. Government involvement, accountability of scheme management, and strong policymaker-implementer relation facilitated implementation and sustainability of scheme. Packages that covered outpatient and inpatient care and those tailored to community needs contributed to increased enrollment. Amount and timing of premium collection was reported to negatively influence enrollment while factors reported as threats to sustainability included facility

  16. Making cognitive decision support work: Facilitating adoption, knowledge and behavior change through QI.

    PubMed

    Weir, Charlene; Brunker, Cherie; Butler, Jorie; Supiano, Mark A

    2017-07-01

    This paper evaluates the role of facilitation in the successful implementation of Computerized Decision Support (CDS). Facilitation processes include education, specialized computerized decision support, and work process reengineering. These techniques, as well as modeling and feedback enhance self-efficacy, which we propose is one of the factors that mediate the effectiveness of any CDS. In this study, outpatient clinics implemented quality improvement (QI) projects focused on improving geriatric care. Quality Improvement is the systematic process of improving quality through continuous measurement and targeted actions. The program, entitled "Advancing Geriatric Education through Quality Improvement" (AGE QI), consisted of a 6-month, QI based, intervention: (1) 2h didactic session, (2) 1h QI planning session, (3) computerized decision support design and implementation, (4) QI facilitation activities, (5) outcome feedback, and (6) 20h of CME. Specifically, we examined the impact of the QI based program on clinician's perceived self-efficacy in caring for older adults and the relationship of implementation support and facilitation on perceived success. The intervention was implemented at 3 institutions, 27 community healthcare system clinics, and 134 providers. This study reports the results of pre/post surveys for the forty-nine clinicians who completed the full CME program. Self-efficacy ratings for specific clinical behaviors related to care of older adults were assessed using a Likert based instrument. Self-ratings of efficacy improved across the following domains (depression, falls, end-of-life, functional status and medication management) and specifically in QI targeted domains and were associated with overall clinic improvements. Published by Elsevier Inc.

  17. CRM System Implementation in a Multinational Enterprise

    NASA Astrophysics Data System (ADS)

    Mishra, Alok; Mishra, Deepti

    The concept of customer relationship management (CRM) resonates with managers in today's competitive economy. As more and more organizations realize the significance of becoming customer-centric in today's competitive era, they embrace CRM as a core business strategy. CRM an integration of information technology and relationship marketing provides the infrastructure that facilitates long-term relationship building with customers at an enterprise-wide level. Successful CRM implementation is a complex, expensive and rarely technical projects. This paper presents the successful implementation of CRM in a multinational organization. This study will facilitate in understanding transition, constraints and implementation of CRM in multinational enterprises.

  18. Implementation of the BETTER 2 program: a qualitative study exploring barriers and facilitators of a novel way to improve chronic disease prevention and screening in primary care.

    PubMed

    Sopcak, Nicolette; Aguilar, Carolina; O'Brien, Mary Ann; Nykiforuk, Candace; Aubrey-Bassler, Kris; Cullen, Richard; Grunfeld, Eva; Manca, Donna Patricia

    2016-12-01

    BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) is a patient-based intervention to improve chronic disease prevention and screening (CDPS) for cardiovascular disease, diabetes, cancer, and associated lifestyle factors in patients aged 40 to 65. The key component of BETTER is a prevention practitioner (PP), a health care professional with specialized skills in CDPS who meets with patients to develop a personalized prevention prescription, using the BETTER toolkit and Brief Action Planning. The purpose of this qualitative study was to understand facilitators and barriers of the implementation of the BETTER 2 program among clinicians, patients, and stakeholders in three (urban, rural, and remote) primary care settings in Newfoundland and Labrador, Canada. We collected and analyzed responses from 20 key informant interviews and 5 focus groups, as well as memos and field notes. Data were organized using Nvivo 10 software and coded using constant comparison methods. We then employed the Consolidated Framework for Implementation Research (CFIR) to focus our analysis on the domains most relevant for program implementation. The following key elements, within the five CFIR domains, were identified as impacting the implementation of BETTER 2: (1) intervention characteristics-complexity and cost of the intervention; (2) outer setting-perception of fit including lack of remuneration, lack of resources, and duplication of services, as well as patients' needs as perceived by physicians and patients; (3) characteristics of prevention practitioners-interest in prevention and ability to support and motivate patients; (4) inner setting-the availability of a local champion and working in a team versus working as a team; and (5) process-planning and engaging, collaboration, and teamwork. The implementation of a novel CDPS program into new primary care settings is a complex, multi-level process. This study identified key elements

  19. [Priorization of facilitators for the implementation of medication review with follow-up service in Spanish community pharmacies through exploratory factor analysis].

    PubMed

    Gil, Modesta Inmaculada; Benrimoj, Shalom Isaac; Martínez-Martínez, Fernando; Cardero, Manuel; Gastelurrutia, Miguel Ángel

    2013-01-01

    to prioritize previously identified in Spain facilitators for the implementation of new Pharmaceutical Services that allow designing strategies for the implementation of Medication Review with follow-up (MRFup) service. Exploratory factor analysis (EFA). A draft of a questionnaire was performed based on a previous literature review and following the RAND/UCLA methodology. An expert panel worked with it and generated a definitive questionnaire which, after piloting, was used with a representative sample of pharmacists, owners or staff members, who were working in community pharmacy, using computer-assisted telephone interviewing (CATI) methodology. To understand underlying constructs in the questionnaire an EFA was performed. Different approaches were tested such as principal components factor analysis and principal axis factoring method. The best interpretability was achieved using the Factorization of Principal axis method with Direct Oblimin rotation, which explained the 40.0% of total variance. This produced four factors defined as: «Incentives», «External campaigns», «Expert in MRFup» and «Professionalism of the pharmacist». It can be stated that for implementation and sustainability of MRFup Service it is necessary being paid; also it must be explained to health professional and society in general. Practice of MRFup service demands pharmacists receiving a more clinical education and assuming more responsibilities as health professionals. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  20. Implementation of internet-delivered cognitive behavior therapy within community mental health clinics: a process evaluation using the consolidated framework for implementation research.

    PubMed

    Hadjistavropoulos, H D; Nugent, M M; Dirkse, D; Pugh, N

    2017-09-12

    Depression and anxiety are prevalent and under treated conditions that create enormous burden for the patient and the health system. Internet-delivered cognitive behavior therapy (ICBT) improves patient access to treatment by providing therapeutic information via the Internet, presented in sequential lessons, accompanied by brief weekly therapist support. While there is growing research supporting ICBT, use of ICBT within community mental health clinics is limited. In a recent trial, an external unit specializing in ICBT facilitated use of ICBT in community mental health clinics in one Canadian province (ISRCTN42729166; registered November 5, 2013). Patient outcomes were very promising and uptake was encouraging. This paper reports on a parallel process evaluation designed to understand facilitators and barriers impacting the uptake and implementation of ICBT. Therapists (n = 22) and managers (n = 11) from seven community mental health clinics dispersed across one Canadian province who were involved in implementing ICBT over ~2 years completed an online survey (including open and closed-ended questions) about ICBT experiences. The questions were based on the Consolidated Framework for Implementation Research (CFIR), which outlines diverse constructs that have the potential to impact program implementation. Analyses suggested ICBT implementation was perceived to be most prominently facilitated by intervention characteristics (namely the relative advantages of ICBT compared to face-to-face therapy, the quality of the ICBT program that was delivered, and evidence supporting ICBT) and implementation processes (namely the use of an external facilitation unit that aided with engaging patients, therapists, and managers and ICBT implementation). The inner setting was identified as the most significant barrier to implementation as a result of limited resources for ICBT combined with greater priority given to face-to-face care. The results contribute to understanding

  1. Implementation of consumer providers into mental health intensive case management teams.

    PubMed

    Hamilton, Alison B; Chinman, Matthew; Cohen, Amy N; Oberman, Rebecca Shoai; Young, Alexander S

    2015-01-01

    In mental health care, consumer providers (CPs) are individuals with serious mental illness (SMI) who draw upon their lived experiences while providing services to others with SMI. Implementation of CPs has proven to be challenging in a variety of settings. The PEER project (Peers Enhancing Recovery) involved rolling out CPs using an implementation science model and evaluating implementation and impact in mental health treatment settings (three intervention, three control). In qualitative interviews, facilitators and challenges to implementation were described by the CPs, their team members, clients, and study researchers. Site preparation, external facilitation, and positive, reinforcing experiences with CPs facilitated implementation. Role definitions and deficiencies in CPs' technical knowledge posed challenges to implementation. Sustainability was not realized due to insufficient resources. However, implementation was positive overall, characterized by diffusion of innovation concepts of high relative advantage, strong trialability, compatibility with prevailing norms, compelling observability, and relatively low complexity. By preparing and working systematically with intervention sites to incorporate new services, implementation was strengthened and challenges were minimized.

  2. Using Technology To Facilitate Learning for Minority Students.

    ERIC Educational Resources Information Center

    Palma-Rivas, Nilda

    2000-01-01

    Examines the implementation of technology-based educational programs in a college environment from the perspective of minority student instruction. Outlines the possibilities inherent in programs integrating technology and minority student learning styles and suggests that instructors utilize technology to facilitate their efforts of making…

  3. Food Service Perspectives on National School Lunch Program Implementation.

    PubMed

    Tabak, Rachel G; Moreland-Russell, Sarah

    2015-09-01

    Explore barriers and facilitators to implementation of the new National School Lunch Program (NSLP) policy guidelines. Interviews with eight food service directors using an interview guide informed by the Consolidated Framework for Implementation Research. Food service personnel; parents, teachers, school staff; and students were important stakeholders. Characteristics of the new NSLP policy guidelines were reported to create increased demands; resources alleviated some barriers. Directors reported increased food and labor costs, food sourcing challenges, decreased student participation, and organizational constraints as barriers to implementation. Creativity in menu planning facilitated success. Factors within the food service department, characteristics of implementing individuals and the new NSLP policy guidelines, and stakeholder involvement in the implementation process relate to successful implementation.

  4. Implementation of pregnancy weight management and obesity guidelines: a meta-synthesis of healthcare professionals' barriers and facilitators using the Theoretical Domains Framework.

    PubMed

    Heslehurst, N; Newham, J; Maniatopoulos, G; Fleetwood, C; Robalino, S; Rankin, J

    2014-06-01

    Obesity in pregnancy is rising and is associated with severe health consequences for both the mother and the child. There is an increasing international focus on guidelines to manage the clinical risks of maternal obesity, and for pregnancy weight management. However, passive dissemination of guidelines is not effective and more active strategies are required for effective guideline implementation into practice. Implementation of guidelines is a form of healthcare professional behaviour change, and therefore implementation strategies should be based on appropriate behaviour change theory. This systematic review aimed to identify the determinants of healthcare professionals' behaviours in relation to maternal obesity and weight management. Twenty-five studies were included. Data synthesis of the existing international qualitative and quantitative evidence base used the Theoretical Domains Framework to identify the barriers and facilitators to healthcare professionals' maternal obesity and weight management practice. The domains most frequently identified included 'knowledge', 'beliefs about consequences' and 'environmental context and resources'. Healthcare professionals' weight management practice had the most barriers compared with any other area of maternal obesity practice. The results of this review will be used to inform the development of an intervention to support healthcare professional behaviour change. © 2014 The Authors. obesity reviews © 2014 International Association for the Study of Obesity.

  5. Implementation of web-based interventions by Dutch occupational health centers.

    PubMed

    Walthouwer, Michel Jean Louis; Oenema, Anke; Soetens, Katja; Lechner, Lilian; de Vries, Hein

    2017-10-01

    The aim of this qualitative study was to identify barriers and facilitators to the adoption and particularly the implementation of a web-based computer-tailored obesity prevention intervention by occupational health centers. Participants were directors of Dutch occupational health centers who had adopted and implemented the intervention for the corresponding efficacy study (n = 8) as well as non-adopters (n = 12). Individual semi-structured interviews were carried out to study barriers and facilitators related to the intervention, the user, the organization, and the socio-political environment. All interviews were carried out by telephone, audio-recorded and transcribed verbatim. The transcripts were analyzed using a directed-content approach and coded by two persons. There were important differences in perceptions between adopters and non-adopters, particularly on barriers and facilitators related to the intervention and the personal beliefs of the implementer. The relative advantages of the intervention were considered to be most important. Participants also indicated that their personal attitudinal and self-efficacy beliefs influenced their implementation efforts. Regarding the organization, the possibilities to increase profits and integrate the intervention within the organization were considered to be important facilitators for the implementation. Participants mentioned few implementation barriers and facilitators related to the socio-political environment. Strategies to improve the implementation of web-based computer-tailored interventions by occupational health centers should be tailored to implementers' unique perceptions and particularly address the perceived advantages and disadvantages of the intervention, attitudinal and self-efficacy beliefs, and the potential to increase organizations' profits and competitiveness. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. A randomised controlled trial of an intervention to facilitate the implementation of healthy eating and physical activity policies and practices in childcare services

    PubMed Central

    Jones, Jannah; Wolfenden, Luke; Wyse, Rebecca; Finch, Meghan; Yoong, Sze Lin; Dodds, Pennie; Pond, Nicole; Gillham, Karen; Freund, Megan; McElduff, Patrick; Wye, Paula; Wiggers, John

    2014-01-01

    Introduction Childhood overweight and obesity tracks into adulthood, increasing the risk of developing future chronic disease. Implementing initiatives promoting healthy eating and physical activity in childcare settings has been identified as a priority to prevent excessive child weight gain. Despite this, few trials have been conducted to assess the effectiveness of interventions to support population-wide implementation of such initiatives. The aim of this study is to assess the effectiveness of a multicomponent intervention in increasing the implementation of healthy eating and physical activity policies and practices by centre-based childcare services. Methods and analysis The study will employ a parallel group randomised controlled trial design. A sample of 128 childcare services in the Hunter region of New South Wales, Australia, will be recruited to participate in the trial. 64 services will be randomly allocated to a 12-month implementation intervention. The remaining 64 services will be allocated to a usual care control group. The intervention will consist of a number of strategies to facilitate childcare service implementation of healthy eating and physical activity policies and practices. Intervention strategies will include implementation support staff, securing executive support, consensus processes, staff training, academic detailing visits, performance monitoring and feedback, tools and resources, and a communications strategy. The primary outcome of the trial will be the prevalence of services implementing all healthy eating and physical activity policies and practices targeted by the intervention. To assess the effectiveness of the intervention, telephone surveys with nominated supervisors and room leaders of childcare services will be conducted at baseline and immediately postintervention. Ethics and dissemination The study was approved by the Hunter New England Human Research Ethics Committee and the University of Newcastle Human Research Ethics

  7. Career Planning for Minority Women. Facilitator's Manual.

    ERIC Educational Resources Information Center

    Jackson, Stanlie M., Ed.

    This facilitator's manual consists of guidelines and materials for use in conducting a workshop dealing with career planning for minority women. Covered in the first half of the manual are the following aspects of implementing the workshop: background on the need for and development of the workshop, a workshop outline and time schedule, the…

  8. Implementation of a Medication Reconciliation Assistive Technology: A Qualitative Analysis

    PubMed Central

    Wright, Theodore B.; Adams, Kathleen; Church, Victoria L.; Ferraro, Mimi; Ragland, Scott; Sayers, Anthony; Tallett, Stephanie; Lovejoy, Travis; Ash, Joan; Holahan, Patricia J.; Lesselroth, Blake J.

    2017-01-01

    Objective: To aid the implementation of a medication reconciliation process within a hybrid primary-specialty care setting by using qualitative techniques to describe the climate of implementation and provide guidance for future projects. Methods: Guided by McMullen et al’s Rapid Assessment Process1, we performed semi-structured interviews prior to and iteratively throughout the implementation. Interviews were coded and analyzed using grounded theory2 and cross-examined for validity. Results: We identified five barriers and five facilitators that impacted the implementation. Facilitators identified were process alignment with user values, and motivation and clinical champions fostered by the implementation team rather than the administration. Barriers included a perceived limited capacity for change, diverging priorities, and inconsistencies in process standards and role definitions. Discussion: A more complete, qualitative understanding of existing barriers and facilitators helps to guide critical decisions on the design and implementation of a successful medication reconciliation process. PMID:29854251

  9. An Assessment of Sub-Meter Scale Spatial Variability of Arcellinida (Testate Lobose Amoebae) Assemblages in a Temperate Lake: Implications for Limnological Studies.

    PubMed

    Steele, Riley E; Nasser, Nawaf A; Patterson, R Timothy; Gregory, Braden R B; Roe, Helen M; Reinhardt, Eduard G

    2018-03-04

    Arcellinida (testate lobose amoebae), a group of benthic protists, were examined from 46 sediment-water interface samples collected from oligotrophic Oromocto Lake, New Brunswick, Canada. To assess (1) assemblage homogeneity at a sub-meter spatial scale and (2) the necessity for collecting samples from multiple stations during intra-lake surveys; multiple samples were collected from three stations (quadrats 1, 2, and 3) across the north basin of Oromocto Lake, with quadrat 1 (n = 16) being the furthest to the west, quadrat 2 (n = 15) situated closer to the center of the basin, and quadrat 3 (n = 15) positioned 300 m south of the mouth of Dead Brook, an inlet stream. Results from cluster analysis and non-metric multidimensional scaling (NMDS) analysis identified two major Arcellinida assemblages, A1 and A2, the latter containing two sub-assemblages (A2a and A2b). Redundancy analysis and variance partitioning results indicated that seven statistically significant environmental variables (K, S, Sb, Ti, Zn, Fe, and Mn) explained 41.5% of the total variation in the Arcellinida distribution. Iron, Ti and K, indicators of detrital runoff, had the greatest influence on assemblage variance. The results of this study reveal that closely spaced samples (~ 10 cm) in an open-water setting are comprised of homogenous arcellinidan assemblages, indicating that replicate sampling is not required. The results, however, must be tempered with respect to the various water properties and physical characteristics that comprise individual lakes as collection of several samples may likely be necessary when sampling multiple sites of a lake basin characterized by varying water depths (e.g., littoral zone vs. open water), or lakes impacted by geogenic or anthropogenic stressors (e.g., eutrophication, or industrial contamination).

  10. Shared learning in general practice--facilitators and barriers.

    PubMed

    van de Mortel, Thea; Silberberg, Peter; Ahern, Christine

    2013-03-01

    Capacity for teaching in general practice clinics is limited. Shared learning sessions are one form of vertically integrated teaching that may ameliorate capacity constraints. This study sought to understand the perceptions of general practitioner supervisors, learners and practice staff of the facilitators of shared learning in general practice clinics. Using a grounded theory approach, semistructured interviews were conducted and analysed to generate a theory about the topic. Thirty-five stakeholders from nine general practices participated. Facilitators of shared learning included enabling factors such as small group facilitation skills, space, administrative support and technological resources; reinforcing factors such as targeted funding, and predisposing factors such as participant attributes. Views from multiple stakeholders suggest that the implementation of shared learning in general practice clinics would be supported by an ecological approach that addresses all these factors.

  11. Food Service Perspectives on National School Lunch Program Implementation

    PubMed Central

    Tabak, Rachel G.; Moreland-Russell, Sarah

    2015-01-01

    Objectives Explore barriers and facilitators to implementation of the new National School Lunch Program (NSLP) policy guidelines. Methods Interviews with eight food service directors using an interview guide informed by the Consolidated Framework for Implementation Research. Results Food service personnel; parents, teachers, school staff; and students were important stakeholders. Characteristics of the new NSLP policy guidelines were reported to create increased demands; resources alleviated some barriers. Directors reported increased food and labor costs, food sourcing challenges, decreased student participation, and organizational constraints as barriers to implementation. Creativity in menu planning facilitated success. Conclusions Factors within the food service department, characteristics of implementing individuals and the new NSLP policy guidelines, and stakeholder involvement in the implementation process relate to successful implementation. PMID:26417607

  12. What Facilitates and Impedes Collaborative Work during Higher Education Software Implementation Projects?

    ERIC Educational Resources Information Center

    Cramer, Sharon F.; Tetewsky, Sheldon J.; Marczynski, Kelly S.

    2010-01-01

    Implementations of new or major upgrades of existing student information systems require incorporation of new paradigms and the exchange of familiar routines for new methods. As a result, implementations are almost always time consuming and expensive. Many people in the field of information technology have identified some of the challenges faced…

  13. Reframing implementation as an organisational behaviour problem.

    PubMed

    Clay-Williams, Robyn; Braithwaite, Jeffrey

    2015-01-01

    The purpose of this paper is to report on a process evaluation of a randomised controlled trial (RCT) intervention study that tested the effectiveness of classroom- and simulation-based crew resource management courses, alone and in combination, and identifies organisational barriers and facilitators to implementation of team training programmes in healthcare. The RCT design consisted of a before and after study with a team training intervention. Quantitative data were gathered on utility and affective reactions to training, and on teamwork knowledge, attitudes, and behaviours of the learners. A sample of participants was interviewed at the conclusion of the study. Interview responses were analysed, alongside qualitative elements of the classroom course critique, to search for evidence, context, and facilitation clues to the implementation process. The RCT method provided scientifically robust data that supported the benefits of classroom training. Qualitative data identified a number of facilitators to implementation of team training, and shed light on some of the ways that learning was diffused throughout the organisation. Barriers to successful implementation were also identified, including hospital time and resource constraints and poor organisational communication. Quantitative randomised methods have intermittently been used to evaluate team training interventions in healthcare. Despite two decades of team training trials, however, the authors do not know as well as the authors would like what goes on inside the "black box" of such RCTs. While results are usually centred on outcomes, this study also provides insight into the context and mechanisms associated with those outcomes and identifies barriers and facilitators to successful intervention implementation.

  14. Promoting Action on Research Implementation in Health Services framework applied to TeamSTEPPS implementation in small rural hospitals.

    PubMed

    Ward, Marcia M; Baloh, Jure; Zhu, Xi; Stewart, Greg L

    A particularly useful model for examining implementation of quality improvement interventions in health care settings is the PARIHS (Promoting Action on Research Implementation in Health Services) framework developed by Kitson and colleagues. The PARIHS framework proposes three elements (evidence, context, and facilitation) that are related to successful implementation. An evidence-based program focused on quality enhancement in health care, termed TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), has been widely promoted by the Agency for Healthcare Research and Quality, but research is needed to better understand its implementation. We apply the PARIHS framework in studying TeamSTEPPS implementation to identify elements that are most closely related to successful implementation. Quarterly interviews were conducted over a 9-month period in 13 small rural hospitals that implemented TeamSTEPPS. Interview quotes that were related to each of the PARIHS elements were identified using directed content analysis. Transcripts were also scored quantitatively, and bivariate regression analysis was employed to explore relationships between PARIHS elements and successful implementation related to planning activities. The current findings provide support for the PARIHS framework and identified two of the three PARIHS elements (context and facilitation) as important contributors to successful implementation. This study applies the PARIHS framework to TeamSTEPPS, a widely used quality initiative focused on improving health care quality and patient safety. By focusing on small rural hospitals that undertook this quality improvement activity of their own accord, our findings represent effectiveness research in an understudied segment of the health care delivery system. By identifying context and facilitation as the most important contributors to successful implementation, these analyses provide a focus for efficient and effective sustainment of Team

  15. Project WET: Facilitator Handbook for Implementation of Activities in Virginia.

    ERIC Educational Resources Information Center

    Sevebeck, Kathryn P.

    This handbook features ideas for implementing Project WET activities in Virginia. Project WET activities are designed for a variety of educational programs and can be used to complement existing curricula while addressing curricular objectives and educational standards nationwide. Activities include: (1) "Life Systems"; (2)…

  16. Scaling up kangaroo mother care in South Africa: 'on-site' versus 'off-site' educational facilitation

    PubMed Central

    Bergh, Anne-Marie; van Rooyen, Elise; Pattinson, Robert C

    2008-01-01

    Background Scaling up the implementation of new health care interventions can be challenging and demand intensive training or retraining of health workers. This paper reports on the results of testing the effectiveness of two different kinds of face-to-face facilitation used in conjunction with a well-designed educational package in the scaling up of kangaroo mother care. Methods Thirty-six hospitals in the Provinces of Gauteng and Mpumalanga in South Africa were targeted to implement kangaroo mother care and participated in the trial. The hospitals were paired with respect to their geographical location and annual number of births. One hospital in each pair was randomly allocated to receive either 'on-site' facilitation (Group A) or 'off-site' facilitation (Group B). Hospitals in Group A received two on-site visits, whereas delegates from hospitals in Group B attended one off-site, 'hands-on' workshop at a training hospital. All hospitals were evaluated during a site visit six to eight months after attending an introductory workshop and were scored by means of an existing progress-monitoring tool with a scoring scale of 0–30. Successful implementation was regarded as demonstrating evidence of practice (score >10) during the site visit. Results There was no significant difference between the scores of Groups A and B (p = 0.633). Fifteen hospitals in Group A and 16 in Group B demonstrated evidence of practice. The median score for Group A was 16.52 (range 00.00–23.79) and that for Group B 14.76 (range 07.50–23.29). Conclusion A previous trial illustrated that the implementation of a new health care intervention could be scaled up by using a carefully designed educational package, combined with face-to-face facilitation by respected resource persons. This study demonstrated that the site of facilitation, either on site or at a centre of excellence, did not influence the ability of a hospital to implement KMC. The choice of outreach strategy should be guided by

  17. "During early implementation you just muddle through": factors that impacted a statewide arthritis program's implementation.

    PubMed

    Conte, Kathleen P; Marie Harvey, S; Turner Goins, R

    2017-12-01

    The need to scale-up effective arthritis self-management programs is pressing as the prevalence of arthritis increases. The CDC Arthritis Program funds state health departments to work with local delivery systems to embed arthritis programs into their day-to-day work. To encourage organizational ownership and sustainability of programs, funding is restricted to offset program start-up costs. The purpose of this study was to identify factors that impacted the success of implementing an evidence-based arthritis self-management program, funded by the CDC Arthritis Program, into the Oregon Extension Service. We interviewed staff and partners involved in implementation who had and had not successfully delivered Walk With Ease (N = 12) to identify barriers and facilitators to scaling-up. Document analysis of administrative records was used to triangulate and expand on findings. Delivery goals defined by the funder were not met in Year 1: only 3 of the expected 28 programs were delivered. Barriers to implementation included insufficient planning for implementation driven by pressure to deliver programs and insufficient resources to support staff time. Facilitators included centralized administration of key implementation activities and staffs' previous experience implementing new programs. The importance of planning and preparing for implementation cannot be overlooked. Funders, however, eager to see deliverables, continue to define implementation goals in terms of program reach, exclusive of capacity-building. Lack of capacity-building can jeopardize staff buy-in, implementation quality, and sustainability. Based on our findings coupled with support from implementation literature, we offer recommendations for future large-scale implementation efforts operating under such funding restrictions.

  18. Facilitators for practice change in Spanish community pharmacy.

    PubMed

    Gastelurrutia, Miguel A; Benrimoj, S I Charlie; Castrillon, Carla C; de Amezua, María J Casado; Fernandez-Llimos, Fernando; Faus, Maria J

    2009-02-01

    To identify and prioritise facilitators for practice change in Spanish community pharmacy. Spanish community pharmacies. Qualitative study. Thirty-three semi-structured interviews were conducted with community pharmacists (n = 15) and pharmacy strategists (n = 18), and the results were examined using the content analysis method. In addition, two nominal groups (seven community pharmacists and seven strategists) were formed to identify and prioritise facilitators. Results of both techniques were then triangulated. Facilitators for practice change. Twelve facilitators were identified and grouped into four domains (D1: Pharmacist; D2: Pharmacy as an organisation; D3: Pharmaceutical profession; D4: Miscellaneous). Facilitators identified in D1 include: the need for more clinical education at both pre- and post-graduate levels; the need for clearer and unequivocal messages from professional leaders about the future of the professional practice; and the need for a change in pharmacists' attitudes. Facilitators in D2 are: the need to change the reimbursement system to accommodate cognitive service delivery as well as dispensing; and the need to change the front office of pharmacies. Facilitators identified in D3 are: the need for the Spanish National Professional Association to take a leadership role in the implementation of cognitive services; the need to reduce administrative workload; and the need for universities to reduce the gap between education and research. Other facilitators identified in this study include: the need to increase patients' demand for cognitive services at pharmacies; the need to improve pharmacist-physician relationships; the need for support from health care authorities; and the need for improved marketing of cognitive services and their benefits to society, including physicians and health care authorities. Twelve facilitators were identified. Strategists considered clinical education and pharmacists' attitude as the most important, and

  19. Design Research as a Mechanism for Consultants to Facilitate and Evaluate Educational Innovations

    ERIC Educational Resources Information Center

    Castillo, Jose M.; Dorman, Clark; Gaunt, Brian; Hardcastle, Beth; Justice, Kelly; March, Amanda L.

    2016-01-01

    Schools across the nation are implementing innovative practices; however, questions remain regarding how to facilitate quality implementation. Research designs that emphasize high degrees of control over independent variables result in findings with internal validity, but that may not generalize to complex, dynamic educational systems. The purpose…

  20. Development of biology student worksheets to facilitate science process skills of student

    NASA Astrophysics Data System (ADS)

    Rahayu, Y. S.; Pratiwi, R.; Indana, S.

    2018-01-01

    This research aims to describe development of Biology student worksheets to facilitate science process skills of student, at the same time to facilitate thinking skills of students in senior high school are equipped with Assesment Sheets. The worksheets development refers to cycle which includes phase analysis (analysis), planning (planning), design (design), development (development), implementation (implementation), evaluation and revision (evaluation and revision). Phase evaluation and revision is an ongoing activity conducted in each phase of the development cycle. That is, after the evaluation of the results of these activities and make revisions at any phase, then continue to the next phase. Based on the test results for grade X, XI, and XII in St. Agnes Surabaya high school, obtained some important findings. The findings are as follows. (1) Developed biology student worksheets could be used to facilitate thinking ability of students in particular skills integrated process that includes components to formulate the problem, formulate hypotheses, determine the study variables, formulate an operational definition of variables, determine the steps in the research, planning data tables, organizing Data in the form of tables/charts, drawing conclusions, (2) Developed biology student worksheets could also facilitate the development of social interaction of students such as working together, listening/respect the opinions of others, assembling equipment and materials, discuss and share information and facilitate the upgrading of skills hands-on student activity. (3) Developed biology worksheets basically could be implemented with the guidance of the teacher step by step, especially for students who have never used a similar worksheet. Guidance at the beginning of this need, especially for worksheets that require special skills or understanding of specific concepts as a prerequisite, such as using a microscope, determine the heart rate, understand the mechanism of

  1. Facilitating Facilitators: Enhancing PBL through a Structured Facilitator Development Program

    ERIC Educational Resources Information Center

    Salinitri, Francine D.; Wilhelm, Sheila M.; Crabtree, Brian L.

    2015-01-01

    With increasing adoption of the problem-based learning (PBL) model, creative approaches to enhancing facilitator training and optimizing resources to maintain effective learning in small groups is essential. We describe a theoretical framework for the development of a PBL facilitator training program that uses the constructivist approach as the…

  2. Using distance technologies to facilitate a learning collaborative to implement stagewise treatment.

    PubMed

    Covell, Nancy H; Foster, Forrest P; Margolies, Paul J; Lopez, Luis O; Dixon, Lisa B

    2015-06-01

    This report describes experiences and outcomes of an online learning collaborative focused on implementation of stagewise treatment. Eleven participating programs convened online monthly for a year. Between meetings, program staff created an implementation plan and programs collected performance indicator data, including assessment of staff knowledge of integrated treatment for people with co-occurring disorders, whether a person's current stage of treatment was documented in his or her chart, and whether the treatments were appropriate for the stage of treatment. Descriptive statistics were used to characterize performance indicators and feedback. Wilcoxon matched-pairs signed-rank tests examined changes in performance indicators over time. Program staff generally demonstrated significant improvements in performance indicators over time and rated the distance learning collaborative favorably. Distance learning collaboratives can be structured to provide opportunities for program staff to interact and learn from one another and to implement and sustain changes.

  3. Collaboration around Facilitating Emergent Literacy: Role of Occupational Therapy

    ERIC Educational Resources Information Center

    Asher, Asha; Nichols, Joy D.

    2016-01-01

    The article uses a case study to illustrate transdisciplinary perspectives on facilitating emergent literacy skills of Elsa, a primary grade student with autism. The study demonstrates how a professional learning community implemented motor, sensory, and speech/language components to generate a classroom model supporting emergent literacy skills.…

  4. Using Technology to Facilitate Differentiated High School Science Instruction

    ERIC Educational Resources Information Center

    Maeng, Jennifer L.

    2017-01-01

    This qualitative investigation explored the beliefs and practices of one secondary science teacher, Diane, who differentiated instruction and studied how technology facilitated her differentiation. Diane was selected based on the results of a previous study, in which data indicated that Diane understood how to design and implement proactively…

  5. A comprehensive space management model for facilitating programmatic research.

    PubMed

    Libecap, Ann; Wormsley, Steven; Cress, Anne; Matthews, Mary; Souza, Angie; Joiner, Keith A

    2008-03-01

    In FY04, the authors developed and implemented models to manage existing and incremental research space, and to facilitate programmatic research, at the University of Arizona College of Medicine. Benchmarks were set for recovery of total sponsored research dollars and for facilities and administrative (F&A) dollars/net square foot (nsf) of space, based on college-wide metrics. Benchmarks were applied to units (departments, centers), rather than to individual faculty. Performance relative to the benchmark was assessed using three-year moving averages, and applied to existing blocks of space. Space was recaptured or allocated, in all cases to programmatic themes, using uniform policies. F&A revenues were returned on the basis of performance relative to a benchmark. During the first two years after implementation of the model (FY05 and FY06), and for the 24 units occupying research space, median total sponsored research revenue/nsf increased from $393.96 to $474.46 (20.4%), and median F&A revenue/nsf increased from $57.42 to $91.86 (60.0%). These large increases in median values are driven primarily from redistribution and recapturing of space. Recruiting policies for unit heads were developed to facilitate joint hires among units. In combination, these policies created a comprehensive space management model for facilitating programmatic research. Although challenges remain in implementing the programmatic recruitment strategy, and selected modifications to the original policy were introduced later (e.g., research space for newly recruited junior faculty is now exempted from calculations for three years), overall, the models have created a climate of transparency that is now accepted and that allows efficient and equitable management of research space.

  6. Energy Savings and Persistence from an Energy Services Performance Contract at an Army Base

    DTIC Science & Technology

    2011-10-01

    control system upgrades, lighting retrofits, vending machine controls, and cooling tower variable frequency drivers (VFDs). To accomplish the...controls were installed in the vending machines , and for the 87018 thermal plant, cooling tower VFDs were implemented. To develop baseline models...identify the reasons of improved or deteriorated energy performance of the buildings. For example, periodic submetering of the vending machines

  7. Curricular Influences on Female Afterschool Facilitators' Computer Science Interests and Career Choices

    NASA Astrophysics Data System (ADS)

    Koch, Melissa; Gorges, Torie

    2016-10-01

    Underrepresented populations such as women, African-Americans, and Latinos/as often come to STEM (science, technology, engineering, and mathematics) careers by less traditional paths than White and Asian males. To better understand how and why women might shift toward STEM, particularly computer science, careers, we investigated the education and career direction of afterschool facilitators, primarily women of color in their twenties and thirties, who taught Build IT, an afterschool computer science curriculum for middle school girls. Many of these women indicated that implementing Build IT had influenced their own interest in technology and computer science and in some cases had resulted in their intent to pursue technology and computer science education. We wanted to explore the role that teaching Build IT may have played in activating or reactivating interest in careers in computer science and to see whether in the years following implementation of Build IT, these women pursued STEM education and/or careers. We reached nine facilitators who implemented the program in 2011-12 or shortly after. Many indicated that while facilitating Build IT, they learned along with the participants, increasing their interest in and confidence with technology and computer science. Seven of the nine participants pursued further STEM or computer science learning or modified their career paths to include more of a STEM or computer science focus. Through interviews, we explored what aspects of Build IT influenced these facilitators' interest and confidence in STEM and when relevant their pursuit of technology and computer science education and careers.

  8. Effect of Facilitation on Practice Outcomes in the National Demonstration Project Model of the Patient-Centered Medical Home

    PubMed Central

    Nutting, Paul A.; Crabtree, Benjamin F.; Stewart, Elizabeth E.; Miller, William L.; Palmer, Raymond F.; Stange, Kurt C.; Jaén, Carlos Roberto

    2010-01-01

    PURPOSE The objective of this study was to elucidate the effect of facilitation on practice outcomes in the 2-year patient-centered medical home (PCMH) National Demonstration Project (NDP) intervention, and to describe practices’ experience in implementing different components of the NDP model of the PCMH. METHODS Thirty-six family practices were randomized to a facilitated intervention group or a self-directed intervention group. We measured 3 practice-level outcomes: (1) the proportion of 39 components of the NDP model that practices implemented, (2) the aggregate patient rating of the practices’ PCMH attributes, and (3) the practices’ ability to make and sustain change, which we term adaptive reserve. We used a repeated-measures analysis of variance to test the intervention effects. RESULTS By the end of the 2 years of the NDP, practices in both facilitated and self-directed groups had at least 70% of the NDP model components in place. Implementation was relatively harder if the model component affected multiple roles and processes, required coordination across work units, necessitated additional resources and expertise, or challenged the traditional model of primary care. Electronic visits, group visits, team-based care, wellness promotion, and proactive population management presented the greatest challenges. Controlling for baseline differences and practice size, facilitated practices had greater increases in adaptive reserve (group difference by time, P = .005) and the proportion of NDP model components implemented (group difference by time, P=.02); the latter increased from 42% to 72% in the facilitated group and from 54% to 70% in the self-directed group. Patient ratings of the practices’ PCMH attributes did not differ between groups and, in fact, diminished in both of them. CONCLUSIONS Highly motivated practices can implement many components of the PCMH in 2 years, but apparently at a cost of diminishing the patient’s experience of care. Intense

  9. Implementing Innovations in Global Women's, Children's, and Adolescents' Health: Realizing the Potential for Implementation Science.

    PubMed

    Peterson, Herbert B; Haidar, Joumana; Fixsen, Dean; Ramaswamy, Rohit; Weiner, Bryan J; Leatherman, Sheila

    2018-03-01

    The launch of the United Nations Sustainable Development Goals and the new Secretary General's Global Strategy for Women's, Children's, and Adolescents' Health are a window of opportunity for improving the health and well-being of women, children, and adolescents in the United States and around the world. Realizing the full potential of this historic moment will require that we improve our ability to successfully implement life-saving and life-enhancing innovations, particularly in low-resource settings. Implementation science, a new and rapidly evolving field that addresses the "how-to" component of providing sustainable quality services at scale, can make an important contribution on this front. A synthesis of the implementation science evidence indicates that three interrelated factors are required for successful, sustainable outcomes at scale: 1) effective innovations, 2) effective implementation, and 3) enabling contexts. Implementation science addresses the interaction among these factors to help make innovations more usable, to build ongoing capacity to assure the effective implementation of these innovations, and to ensure enabling contexts to sustain their full and effective use in practice. Improving access to quality services will require transforming health care systems and, therefore, much of the focus of implementation science in global health is on improving the ability of health systems to serve as enabling contexts. The field of implementation science is inherently interdisciplinary and academe will need to respond by facilitating collaboration among scientists from relevant disciplines, including evaluation, improvement, and systems sciences. Platforms and programs to facilitate collaborations among researchers, practitioners, policymakers, and funders are likewise essential.

  10. If a Student Takes Control: Facilitator's Tasks and Responsibilities

    NASA Astrophysics Data System (ADS)

    Väljataga, Terje

    This paper presents initial research results of an intervention into higher educational teaching and studying practices from facilitators‘ point of view. The intervention was implemented into an international Master’s level online course mediated by landscapes of social media tools and services. In this course more emphasis was put on a shift of control from a facilitator to a student or a group of students in the following aspects: setting up one’s study goals, choosing activities, selecting appropriate resources, including technology and defining one’s evaluation criteria. The initial analysis showed that the facilitators gained a lot in terms of understanding the benefits of exploiting social media tools and services for their teaching practices, perceiving a need of having a different role as well as the shortages and problems while being a facilitator in such a course.

  11. Why (we think) facilitation works: insights from organizational learning theory.

    PubMed

    Berta, Whitney; Cranley, Lisa; Dearing, James W; Dogherty, Elizabeth J; Squires, Janet E; Estabrooks, Carole A

    2015-10-06

    Facilitation is a guided interactional process that has been popularized in health care. Its popularity arises from its potential to support uptake and application of scientific knowledge that stands to improve clinical and managerial decision-making, practice, and ultimately patient outcomes and organizational performance. While this popular concept has garnered attention in health services research, we know that both the content of facilitation and its impact on knowledge implementation vary. The basis of this variation is poorly understood, and understanding is hampered by a lack of conceptual clarity. In this paper, we argue that our understanding of facilitation and its effects is limited in part by a lack of clear theoretical grounding. We propose a theoretical home for facilitation in organizational learning theory. Referring to extant literature on facilitation and drawing on theoretical literature, we discuss the features of facilitation that suggest its role in contributing to learning capacity. We describe how facilitation may contribute to generating knowledge about the application of new scientific knowledge in health-care organizations. Facilitation's promise, we suggest, lies in its potential to stimulate higher-order learning in organizations through experimenting with, generating learning about, and sustaining small-scale adaptations to organizational processes and work routines. The varied effectiveness of facilitation observed in the literature is associated with the presence or absence of factors known to influence organizational learning, since facilitation itself appears to act as a learning mechanism. We offer propositions regarding the relationships between facilitation processes and key organizational learning concepts that have the potential to guide future work to further our understanding of the role that facilitation plays in learning and knowledge generation.

  12. Navigating change: how outreach facilitators can help clinicians improve patient outcomes.

    PubMed

    Laferriere, Dianne; Liddy, Clare; Nash, Kate; Hogg, William

    2012-01-01

    The objective of this study was to describe outreach facilitation as an effective method of assisting and supporting primary care practices to improve processes and delivery of care. We spent 4 years working with 83 practices in Eastern Ontario, Canada, on the Improved Delivery of Cardiovascular Care through the Outreach Facilitation program. Primary care practices, even if highly motivated, face multiple challenges when providing quality patient care. Outreach facilitation can be an effective method of assisting and supporting practices to make the changes necessary to improve processes and delivery of care. Multiple jurisdictions use outreach facilitation for system redesign, improved efficiencies, and advanced access. The development and implementation of quality improvement programs using practice facilitation can be challenging. Our research team has learned valuable lessons in developing tools, finding resources, and assisting practices to reach their quality improvement goals. These lessons can lead to improved experiences for the practices and overall improved outcomes for the patients they serve.

  13. Motor experience with a sport-specific implement affects motor imagery

    PubMed Central

    Zhu, Hua; Shen, Cheng; Zhang, Jian

    2018-01-01

    The present study tested whether sport-specific implements facilitate motor imagery, whereas nonspecific implements disrupt motor imagery. We asked a group of basketball players (experts) and a group of healthy controls (novices) to physically perform (motor execution) and mentally simulate (motor imagery) basketball throws. Subjects produced motor imagery when they were holding a basketball, a volleyball, or nothing. Motor imagery performance was measured by temporal congruence, which is the correspondence between imagery and execution times estimated as (imagery time minus execution time) divided by (imagery time plus execution time), as well as the vividness of motor imagery. Results showed that experts produced greater temporal congruence and vividness of kinesthetic imagery while holding a basketball compared to when they were holding nothing, suggesting a facilitation effect from sport-specific implements. In contrast, experts produced lower temporal congruence and vividness of kinesthetic imagery while holding a volleyball compared to when they were holding nothing, suggesting the interference effect of nonspecific implements. Furthermore, we found a negative correlation between temporal congruence and the vividness of kinesthetic imagery in experts while holding a basketball. On the contrary, the implement manipulation did not modulate the temporal congruence of novices. Our findings suggest that motor representation in experts is built on motor experience associated with specific-implement use and thus was subjected to modulation of the implement held. We conclude that sport-specific implements facilitate motor imagery, whereas nonspecific implements could disrupt motor representation in experts. PMID:29719738

  14. Sub-hectare crop area mapped wall-to-wall in Tigray Ethiopia with HEC processing of WorldView sub-meter panchromatic image texture

    NASA Astrophysics Data System (ADS)

    Neigh, C. S. R.; Carroll, M.; Wooten, M.; McCarty, J. L.; Powell, B.; Husak, G. J.; Enenkel, M.; Hain, C.

    2017-12-01

    Global food production in the developing world occurs within sub-hectare fields that are difficult to identify with moderate resolution satellite imagery. Knowledge about the distribution of these fields is critical in food security programs. We developed a semi-automated image segmentation approach using wall-to-wall sub-meter imagery with high-end computing (HEC) to map crop area (CA) throughout Tigray, Ethiopia that encompasses over 41,000 km2. Our approach tested multiple HEC processing streams to reduce processing time and minimize mapping error. We applied multiple resolution smoothing kernels to capture differences in land surface texture associated to CA. Typically, very-small fields (mean < 2 ha) have a smooth image roughness compared to natural scrub/shrub woody vegetation at the 1 m scale and these features can be segmented in panchromatic imagery with multi-level histogram thresholding. We found multi-temporal very-high resolution (VHR) panchromatic imagery with multi-spectral VHR and moderate resolution imagery are sufficient in extracting critical CA information needed in food security programs. We produced a 2011 ‒ 2015 CA map using over 3,000 WorldView-1 panchromatic images wall-to-wall in 1/2° mosaics for Tigray, Ethiopia in 1 week. We evaluated CA estimates with nearly 3,000 WorldView-2 2 m multispectral 250 × 250 m image subsets, with seven expert interpretations, and with in-situ global positioning system (GPS) photography. Our CA estimates ranged from 32 to 41% in sub-regions of Tigray with median maximum per bin commission and omission errors of 11% and 1% respectively, with most of the error occurring in bins less than 15%. This empirical, simple, and low direct cost approach via U.S. government license agreement and HEC could be a viable big-data methodology to extract wall-to-wall CA for other regions of the world that have very-small agriculture fields with similar image texture.

  15. Understanding Policy Implementation: District-Level Leaders' Perceptions of Reading Policy Implementation Efforts

    ERIC Educational Resources Information Center

    Hall, Charles Dana

    2013-01-01

    Research investigating the complex, multi-directional relationships inherent to public education has become a focal point of reform research. This study investigated the perceptions held by district-level leaders regarding the Colorado Department of Education's efforts to facilitate the successful implementation of reading policy. In addition, it…

  16. Understanding Implementation of Complex Interventions in Primary Care Teams.

    PubMed

    Luig, Thea; Asselin, Jodie; Sharma, Arya M; Campbell-Scherer, Denise L

    2018-01-01

    The implementation of interventions to support practice change in primary care settings is complex. Pragmatic strategies, grounded in empiric data, are needed to navigate real-world challenges and unanticipated interactions with context that can impact implementation and outcomes. This article uses the example of the "5As Team" randomized control trial to explore implementation strategies to promote knowledge transfer, capacity building, and practice integration, and their interaction within the context of an interdisciplinary primary care team. We performed a qualitative evaluation of the implementation process of the 5As Team intervention study, a randomized control trial of a complex intervention in primary care. We conducted thematic analysis of field notes of intervention sessions, log books of the practice facilitation team members, and semistructured interviews with 29 interdisciplinary clinician participants. We used and further developed the Interactive Systems Framework for dissemination and implementation to interpret and structure findings. Three themes emerged that illuminate interactions between implementation processes, context, and outcomes: (1) facilitating team communication supported collective and individual sense-making and adoption of the innovation, (2) iterative evaluation of the implementation process and real-time feedback-driven adaptions of the intervention proved crucial for sustainable, context-appropriate intervention impact, (3) stakeholder engagement led to both knowledge exchange that contributes to local problem solving and to shaping a clinical context that is supportive to practice change. Our findings contribute pragmatic strategies that can help practitioners and researchers to navigate interactions between context, intervention, and implementation factors to increase implementation success. We further developed an implementation framework that includes sustained engagement with stakeholders, facilitation of team sense

  17. Peers for Promotion: Achieving Academic Advancement through Facilitated Peer Mentoring

    ERIC Educational Resources Information Center

    Ockene, Judith K.; Milner, Robert J.; Thorndyke, Luanne E.; Congdon, John; Cain, Joanna M.

    2017-01-01

    The promotion process is challenging, particularly for non-tenure track faculty in academic medicine. To address this challenge, we implemented a facilitated peer mentoring program that included a structured curriculum with regular meetings, guided by two senior faculty mentors. Participants expressed satisfaction with the program, showed…

  18. Knowing the Ropes and Showing the Ropes. Facilitator's Guide.

    ERIC Educational Resources Information Center

    Storer, John H.

    This document consists of a facilitator's guide and related materials for implementing a program that teaches social, communication, and study skills to middle school and junior high school students. The goal of the program, which incorporates peer tutoring, is the prevention of drug and alcohol abuse. This program was developed in Iowa to address…

  19. Factors affecting speech pathologists' implementation of stroke management guidelines: a thematic analysis.

    PubMed

    Miao, Melissa; Power, Emma; O'Halloran, Robyn

    2015-01-01

    Although clinical practice guidelines can facilitate evidence-based practice and improve the health outcomes of stroke patients, they continue to be underutilised. There is limited research into the reasons for this, especially in speech pathology. This study provides the first in-depth, qualitative examination of the barriers and facilitators that speech pathologists perceive and experience when implementing guidelines. A maximum variation sample of eight speech pathologists participated in a semi-structured interview concerning the implementation of the National Stroke Foundation's Clinical Guidelines for Stroke Management 2010. Interviews were transcribed, thematically analysed and member checked before overall themes were identified. Three main themes and ten subthemes were identified. The first main theme, making implementation explicit, reflected the necessity of accessing and understanding guideline recommendations, and focussing specifically on implementation in context. In the second theme, demand versus ability to change, the size of changes required was compared with available resources and collaboration. The final theme, Speech pathologist motivation to implement guidelines, demonstrated the influence of individual perception of the guidelines and personal commitment to improved practice. Factors affecting implementation are complex, and are not exclusively barriers or facilitators. Some potential implementation strategies are suggested. Further research is recommended. In most Western nations, stroke remains the single greatest cause of disability, including communication and swallowing disabilities. Although adherence to stroke clinical practice guidelines improves stroke patient outcomes, guidelines continue to be underutilised, and the reasons for this are not well understood. This is the first in-depth qualitative study identifying the complex barriers and facilitators to guideline implementation as experienced by speech pathologists in stroke care

  20. Strategies to facilitate implementation and sustainability of large system transformations: a case study of a national program for improving quality of care for elderly people.

    PubMed

    Nyström, Monica Elisabeth; Strehlenert, Helena; Hansson, Johan; Hasson, Henna

    2014-09-18

    Large-scale change initiatives stimulating change in several organizational systems in the health and social care sector are challenging both to lead and evaluate. There is a lack of systematic research that can enrich our understanding of strategies to facilitate large system transformations in this sector. The purpose of this study was to examine the characteristics of core activities and strategies to facilitate implementation and change of a national program aimed at improving life for the most ill elderly people in Sweden. The program outcomes were also addressed to assess the impact of these strategies. A longitudinal case study design with multiple data collection methods was applied. Archival data (n = 795), interviews with key stakeholders (n = 11) and non-participant observations (n = 23) were analysed using content analysis. Outcome data was obtained from national quality registries. This study presents an approach for implementing a large national change program that is characterized by initial flexibility and dynamism regarding content and facilitation strategies and a growing complexity over time requiring more structure and coordination. The description of activities and strategies show that the program management team engaged a variety of stakeholders and actor groups and accordingly used a palate of different strategies. The main strategies used to influence change in the target organisations were to use regional improvement coaches, regional strategic management teams, national quality registries, financial incentives and annually revised agreements. Interactive learning sessions, intense communication, monitor and measurements, and active involvement of different experts and stakeholders, including elderly people, complemented these strategies. Program outcomes showed steady progress in most of the five target areas, less so for the target of achieving coordinated care. There is no blue-print on how to approach the challenging task of

  1. Barriers and facilitators to electronic documentation in a rural hospital.

    PubMed

    Whittaker, Alice A; Aufdenkamp, Marilee; Tinley, Susan

    2009-01-01

    The purpose of the study was to explore nurses' perceptions of barriers and facilitators to adoption of an electronic health record (EHR) in a rural Midwestern hospital. This study was a qualitative, descriptive design. The Staggers and Parks Nurse-Computer Interaction Framework was used to guide directed content analysis. Eleven registered nurses from oncology and medical-surgical units were interviewed using three semistructured interview questions. Predetermined codes and operational definitions were developed from the Staggers and Parks framework. Narrative data were analyzed by each member of the research team and group consensus on coding was reached through group discussions. Participants were able to identify computer-related, nurse-related, and contextual barriers and facilitators to implementation of EHR. In addition, two distinct patterns of perceptions and acceptance were identified. The Staggers and Parks Nurse-Computer Interaction framework was found to be useful in identifying computer, nurse, and contextual characteristics that act as facilitators or barriers to adoption of an EHR system. Acceptance and use of an EHR are enhanced when barriers are managed and facilitators are supported. Understanding and management of facilitators and barriers to EHR adoption may impact nurses' ability to provide and document nursing care.

  2. Realistic nurse-led policy implementation, optimization and evaluation: novel methodological exemplar.

    PubMed

    Noyes, Jane; Lewis, Mary; Bennett, Virginia; Widdas, David; Brombley, Karen

    2014-01-01

    To report the first large-scale realistic nurse-led implementation, optimization and evaluation of a complex children's continuing-care policy. Health policies are increasingly complex, involve multiple Government departments and frequently fail to translate into better patient outcomes. Realist methods have not yet been adapted for policy implementation. Research methodology - Evaluation using theory-based realist methods for policy implementation. An expert group developed the policy and supporting tools. Implementation and evaluation design integrated diffusion of innovation theory with multiple case study and adapted realist principles. Practitioners in 12 English sites worked with Consultant Nurse implementers to manipulate the programme theory and logic of new decision-support tools and care pathway to optimize local implementation. Methods included key-stakeholder interviews, developing practical diffusion of innovation processes using key-opinion leaders and active facilitation strategies and a mini-community of practice. New and existing processes and outcomes were compared for 137 children during 2007-2008. Realist principles were successfully adapted to a shorter policy implementation and evaluation time frame. Important new implementation success factors included facilitated implementation that enabled 'real-time' manipulation of programme logic and local context to best-fit evolving theories of what worked; using local experiential opinion to change supporting tools to more realistically align with local context and what worked; and having sufficient existing local infrastructure to support implementation. Ten mechanisms explained implementation success and differences in outcomes between new and existing processes. Realistic policy implementation methods have advantages over top-down approaches, especially where clinical expertise is low and unlikely to diffuse innovations 'naturally' without facilitated implementation and local optimization. © 2013

  3. Implementing evidence-based practice in community mental health agencies: a multiple stakeholder analysis.

    PubMed

    Aarons, Gregory A; Wells, Rebecca S; Zagursky, Karen; Fettes, Danielle L; Palinkas, Lawrence A

    2009-11-01

    We sought to identify factors believed to facilitate or hinder evidence-based practice (EBP) implementation in public mental health service systems as a step in developing theory to be tested in future studies. Focusing across levels of an entire large public sector mental health service system for youths, we engaged participants from 6 stakeholder groups: county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. Participants generated 105 unique statements identifying implementation barriers and facilitators. Participants rated each statement on importance and changeability (i.e., the degree to which each barrier or facilitator is considered changeable). Data analyses distilled statements into 14 factors or dimensions. Descriptive analyses suggest that perceptions of importance and changeability varied across stakeholder groups. Implementation of EBP is a complex process. Cross-system-level approaches are needed to bring divergent and convergent perspectives to light. Examples include agency and program directors facilitating EBP implementation by supporting staff, actively sharing information with policymakers and administrators about EBP effectiveness and fit with clients' needs and preferences, and helping clinicians to present and deliver EBPs and address consumer concerns.

  4. Society for Academic Continuing Medical Education Intervention Guideline Series: Guideline 2, Practice Facilitation.

    PubMed

    Van Hoof, Thomas J; Grant, Rachel E; Campbell, Craig; Colburn, Lois; Davis, David; Dorman, Todd; Fischer, Michael; Horsley, Tanya; Jacobs-Halsey, Virginia; Kane, Gabrielle; LeBlanc, Constance; Moore, Donald E; Morrow, Robert; Olson, Curtis A; Silver, Ivan; Thomas, David C; Turco, Mary; Kitto, Simon

    2015-01-01

    The Society for Academic Continuing Medical Education commissioned a study to clarify and, if possible, standardize the terminology for a set of important educational interventions. In the form of a guideline, this article describes one such intervention, practice facilitation, which is a common strategy in primary care to help practices develop capacity and infrastructure to support their ability to improve patient care. Based on a review of recent evidence and a facilitated discussion with US and Canadian experts, we describe practice facilitation, its terminology, and other important information about the intervention. We encourage leaders and researchers to consider and build on this guideline as they plan, implement, evaluate, and report practice facilitation efforts. Clear and consistent use of terminology is imperative, along with complete and accurate descriptions of interventions, to improve the use and study of practice facilitation.

  5. The development and implementation of a theory-informed, integrated mother-child intervention in rural Uganda.

    PubMed

    Singla, Daisy R; Kumbakumba, Elias

    2015-12-01

    A randomised cluster effectiveness trial of a parenting intervention in rural Uganda found benefits to child development among children 12-36 months, relevant parenting practices related to stimulation, hygiene and diet, and prevented the worsening of mothers' depressive symptoms. An examination of underlying implementation processes allows researchers and program developers to determine whether the program was implemented as intended and highlight barriers and facilitators that may influence replication and scale-up. The objectives of this study were to describe and critically examine (a) perceived barriers and facilitators related to implementation processes of intervention content, training and supervision and delivery from the perspectives of delivery agents and supervisors; (b) perceived barriers and facilitators related to enactment of practices from the perspective of intervention mothers participating in the parenting program; and c) whether the program was implemented as intended. Semi-structured interviews were conducted at midline with peer delivery agents (n = 12) and intervention mothers (n = 31) and at endline with supervisors (n = 4). Content analysis was used to analyze qualitative data in terms of barriers and facilitators of intervention content, training and supervision, delivery and enactment. Additionally, mothers' recall and enactment of practices were coded and analyzed statistically. Monitoring of group sessions and home visits were examined to reveal whether the program was implemented as intended. Among the program's five key messages, 'love and respect' targeting maternal psychological well-being was the most practiced by mothers, easiest to implement by delivery agents, and mothers reported the most internal facilitators for this message. A detailed manual and structured monitoring forms were perceived to facilitate training, intervention delivery, and supervision. Interactive and active strategies based on social-cognitive learning

  6. [The implementation of Individual Placement and Support in the Netherlands].

    PubMed

    Giesen, F; van Erp, N; van Weeghel, J; Michon, H; Kroon, H

    2007-01-01

    Individual Placement and Support is a vocational rehabilitation programme for people with severe mental illness, which was implemented during the period 2003-2005 at four locations in the Netherlands. To investigate the degree of compliance with the Individual Placement and Support programme, the factors that hindered or facilitated its implementation, and the results. The degree of compliance was assessed using the Individual Placement and Support fidelity scale. Data regarding the factors that hindered or facilitated the implementation were collected via interviews and monitoring. In addition, data were collected on patient characteristics, the support provided and the jobs found. None of the locations achieved the highest level of compliance, although two locations came close. Eighteen per cent of the 316 patients were helped to find a regular job. The most important obstacles to implementation were loss of vocational team members, project leaders' lack of time, lack of finance, and insufficient cooperation between the organisations involved. The most important facilitating factors were the skills and commitment of the vocational team member(s) and the integration of the vocational teammember(s) and the mental health team. It is not easy to implement Individual Placement and Support. However, if more attention is given to good project management, Individual Placement and Support can succeed in the Netherlands.

  7. Process and implementation of participatory ergonomic interventions: a systematic review.

    PubMed

    van Eerd, Dwayne; Cole, Donald; Irvin, Emma; Mahood, Quenby; Keown, Kiera; Theberge, Nancy; Village, Judy; St Vincent, Marie; Cullen, Kim

    2010-10-01

    Participatory ergonomic (PE) interventions may vary in implementation. A systematic review was done to determine the evidence regarding context, barriers and facilitators to the implementation of participatory ergonomic interventions in workplaces. In total, 17 electronic databases were searched. Data on PE process and implementation were extracted from documents meeting content and quality criteria and synthesised. The search yielded 2151 references. Of these, 190 documents were relevant and 52 met content and quality criteria. Different ergonomic teams were described in the documents as were the type, duration and content of ergonomic training. PE interventions tended to focus on physical and work process changes and report positive impacts. Resources, programme support, ergonomic training, organisational training and communication were the most often noted facilitators or barriers. Successful PE interventions require the right people to be involved, appropriate ergonomic training and clear responsibilities. Addressing key facilitators and barriers such as programme support, resources, and communication is paramount. STATEMENT OF RELEVANCE: A recent systematic review has suggested that PE has some effect on reducing symptoms, lost days of work and claims. Systematic reviews of effectiveness provide practitioners with the desire to implement but do not provide clear information about how. This article reviews the literature on process and implementation of PE.

  8. Implementation of an electromagnetic imaging system to facilitate nasogastric and post-pyloric feeding tube placement in patients with and without critical illness.

    PubMed

    Windle, E M; Beddow, D; Hall, E; Wright, J; Sundar, N

    2010-02-01

    Artificial nutrition support is required to optimise nutritional status in many patients. Traditional methods of placing feeding tubes may incur clinical risk and financial costs. A technique facilitating placement of nasogastric and post-pyloric tubes via electromagnetic visual guidance may reduce the need for X-ray exposure, endoscopy time and the use of parenteral nutrition. The present study aimed to audit use of such a system at initial implementation in patients within an acute NHS Trust. A retrospective review was undertaken of dietetic and medical records for the first 14 months of using the Cortrak system. Data were collected on referral origin, preparation of the patient prior to insertion, placement success rates and need for X-ray. Cost analysis was also performed. Referrals were received from primary consultants or consultant intensivists, often on the advice of the dietitian. Fifty-nine percent of patients received prokinetic therapy at the time of placement. Thirty-nine tube placements were attempted. Sixty-nine percent of referrals for post-pyloric tube placement resulted in successful placement. X-ray films were requested for 22% of all attempted post-pyloric placements. Less than half of nasogastric tubes were successfully passed, although none of these required X-ray confirmation. The mean cost per tube insertion attempt was 111 pounds. This system confers advantages, particularly in terms of post-pyloric tube placement, even at this early stage of implementation. A reduction in clinical risk and cost avoidance related to X-ray exposure, the need for endoscopic tube placement and parenteral nutrition have been achieved. The implementation of this system should be considered in other centres.

  9. Paediatric burns in LMICs: An evaluation of the barriers and facilitators faced by staff involved in burns education training programmes in Blantyre, Malawi.

    PubMed

    Harris, Lyndsey; Fioratou, Evridiki; Broadis, Emily

    2016-08-01

    A burn prevention and education programme - the Reduction of Burn and Scald Mortality and Morbidity in Children in Malawi project - was implemented from January 2010-2013 in Queen Elizabeth Central Hospital, Malawi. This study aimed to investigate the barriers and facilitators of implementing education-training programmes. Semi-structured interviews with 14 Scottish and Malawian staff delivering and receiving teaching at training education programmes were conducted. All interviews were recorded, transcribed and analysed using thematic analysis. Overarching barriers and facilitators were similar for both sets of staff. Scottish participants recognised that limited experience working in LMICs narrowed the challenges they anticipated. Time was a significant barrier to implementation of training courses for both sets of participants. Lack of hands on practical experience was the greatest barrier to implementing the skills learnt for Malawian staff. Sustainability was a significant facilitator to successful implementation of training programmes. Encouraging involvement of Malawian staff in the co-ordination and delivery of teaching enabled those who attend courses to teach others. A recognition of and response to the barriers and facilitators associated with introducing paediatric burn education training programmes can contribute to the development of sustainable programme implementation in Malawi and other LMICs. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  10. A Central Support System Can Facilitate Implementation and Sustainability of a Classroom-Based Undergraduate Research Experience (CURE) in Genomics

    PubMed Central

    Lopatto, David; Hauser, Charles; Jones, Christopher J.; Paetkau, Don; Chandrasekaran, Vidya; Dunbar, David; MacKinnon, Christy; Stamm, Joyce; Alvarez, Consuelo; Barnard, Daron; Bedard, James E. J.; Bednarski, April E.; Bhalla, Satish; Braverman, John M.; Burg, Martin; Chung, Hui-Min; DeJong, Randall J.; DiAngelo, Justin R.; Du, Chunguang; Eckdahl, Todd T.; Emerson, Julia; Frary, Amy; Frohlich, Donald; Goodman, Anya L.; Gosser, Yuying; Govind, Shubha; Haberman, Adam; Hark, Amy T.; Hoogewerf, Arlene; Johnson, Diana; Kadlec, Lisa; Kaehler, Marian; Key, S. Catherine Silver; Kokan, Nighat P.; Kopp, Olga R.; Kuleck, Gary A.; Lopilato, Jane; Martinez-Cruzado, Juan C.; McNeil, Gerard; Mel, Stephanie; Nagengast, Alexis; Overvoorde, Paul J.; Parrish, Susan; Preuss, Mary L.; Reed, Laura D.; Regisford, E. Gloria; Revie, Dennis; Robic, Srebrenka; Roecklien-Canfield, Jennifer A.; Rosenwald, Anne G.; Rubin, Michael R.; Saville, Kenneth; Schroeder, Stephanie; Sharif, Karim A.; Shaw, Mary; Skuse, Gary; Smith, Christopher D.; Smith, Mary; Smith, Sheryl T.; Spana, Eric P.; Spratt, Mary; Sreenivasan, Aparna; Thompson, Jeffrey S.; Wawersik, Matthew; Wolyniak, Michael J.; Youngblom, James; Zhou, Leming; Buhler, Jeremy; Mardis, Elaine; Leung, Wilson; Threlfall, Jennifer; Elgin, Sarah C. R.

    2014-01-01

    In their 2012 report, the President's Council of Advisors on Science and Technology advocated “replacing standard science laboratory courses with discovery-based research courses”—a challenging proposition that presents practical and pedagogical difficulties. In this paper, we describe our collective experiences working with the Genomics Education Partnership, a nationwide faculty consortium that aims to provide undergraduates with a research experience in genomics through a scheduled course (a classroom-based undergraduate research experience, or CURE). We examine the common barriers encountered in implementing a CURE, program elements of most value to faculty, ways in which a shared core support system can help, and the incentives for and rewards of establishing a CURE on our diverse campuses. While some of the barriers and rewards are specific to a research project utilizing a genomics approach, other lessons learned should be broadly applicable. We find that a central system that supports a shared investigation can mitigate some shortfalls in campus infrastructure (such as time for new curriculum development, availability of IT services) and provides collegial support for change. Our findings should be useful for designing similar supportive programs to facilitate change in the way we teach science for undergraduates. PMID:25452493

  11. Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version.

    PubMed

    Vlemmix, Floortje; Rosman, Ageeth N; Fleuren, Margot A H; Rijnders, Marlies E B; Beuckens, Antje; Haak, Monique C; Akerboom, Bettina M C; Bais, Joke M J; Kuppens, Simone M I; Papatsonis, Dimitri N; Opmeer, Brent C; van der Post, Joris A M; Mol, Ben Willem J; Kok, Marjolein

    2010-05-10

    Breech presentation occurs in 3 to 4% of all term pregnancies. External cephalic version (ECV) is proven effective to prevent vaginal breech deliveries and therefore it is recommended by clinical guidelines of the Royal Dutch Organisation for Midwives (KNOV) and the Dutch Society for Obstetrics and Gynaecology (NVOG). Implementation of ECV does not exceed 50 to 60% and probably less.We aim to improve the implementation of ECV to decrease maternal and neonatal morbidity and mortality due to breech presentations. This will be done by defining barriers and facilitators of implementation of ECV in the Netherlands. An innovative implementation strategy will be developed based on improved patient counselling and thorough instructions of health care providers for counselling. The ultimate purpose of this implementation study is to improve counselling of pregnant women and information of clinicians to realize a better implementation of ECV.The first phase of the project is to detect the barriers and facilitators of ECV. The next step is to develop an implementation strategy to inform and counsel pregnant women with a breech presentation, and to inform and educate care providers. In the third phase, the effectiveness of the developed implementation strategy will be evaluated in a randomised trial. The study population is a random selection of midwives and gynaecologists from 60 to 100 hospitals and practices. Primary endpoints are number of counselled women. Secondary endpoints are process indicators, the amount of fetes in cephalic presentation at birth, complications due to ECV, the number of caesarean sections and perinatal condition of mother and child. Cost effectiveness of the implementation strategy will be measured. This study will provide evidence for the cost effectiveness of a structural implementation of external cephalic versions to reduce the number of breech presentations at term. Dutch Trial Register (NTR): 1878.

  12. Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version

    PubMed Central

    2010-01-01

    Background Breech presentation occurs in 3 to 4% of all term pregnancies. External cephalic version (ECV) is proven effective to prevent vaginal breech deliveries and therefore it is recommended by clinical guidelines of the Royal Dutch Organisation for Midwives (KNOV) and the Dutch Society for Obstetrics and Gynaecology (NVOG). Implementation of ECV does not exceed 50 to 60% and probably less. We aim to improve the implementation of ECV to decrease maternal and neonatal morbidity and mortality due to breech presentations. This will be done by defining barriers and facilitators of implementation of ECV in the Netherlands. An innovative implementation strategy will be developed based on improved patient counselling and thorough instructions of health care providers for counselling. Method/design The ultimate purpose of this implementation study is to improve counselling of pregnant women and information of clinicians to realize a better implementation of ECV. The first phase of the project is to detect the barriers and facilitators of ECV. The next step is to develop an implementation strategy to inform and counsel pregnant women with a breech presentation, and to inform and educate care providers. In the third phase, the effectiveness of the developed implementation strategy will be evaluated in a randomised trial. The study population is a random selection of midwives and gynaecologists from 60 to 100 hospitals and practices. Primary endpoints are number of counselled women. Secondary endpoints are process indicators, the amount of fetes in cephalic presentation at birth, complications due to ECV, the number of caesarean sections and perinatal condition of mother and child. Cost effectiveness of the implementation strategy will be measured. Discussion This study will provide evidence for the cost effectiveness of a structural implementation of external cephalic versions to reduce the number of breech presentations at term. Trial Registration Dutch Trial Register

  13. Service Learning in Undergraduate Nursing Education: Strategies to Facilitate Meaningful Reflection.

    PubMed

    Schmidt, Nola A; Brown, Janet M

    2016-01-01

    Service learning is recognized as a valuable pedagogy involving experiential learning, reflection, and reciprocal learning. Students develop critical thinking and social awareness by using the crucial activity of reflecting upon their experiential learning with community partners. The purpose of this paper is to demystify the process of reflection by identifying best practices to enhance reflection and offering suggestions for grading. By understanding "the what" and "the how" of reflection, educators can implement service learning experiences designed to include the essential component of reflection. Strategies for facilitating meaningful reflection are described including descriptions of what students should reflect upon and how to initiate reflection through writing, reading, doing, and telling. Grading rubrics are suggested to facilitate evaluation of student reflection. When properly implemented, service learning encourages students to be good citizens of the world. By using best practices associated with reflection, students can be challenged to think critically about the world and how their service can achieve community goals. Copyright © 2016. Published by Elsevier Inc.

  14. Factors Facilitating the Implementation of Church-Based Heart Health Promotion Programs for Older Adults: A Qualitative Study Guided by the Precede-Proceed Model.

    PubMed

    Banerjee, Ananya Tina; Kin, R; Strachan, Patricia H; Boyle, Michael H; Anand, Sonia S; Oremus, Mark

    2015-01-01

    To describe the factors facilitating the implementation of heart health promotion programs for older adults in Anglican, United, and Catholic churches. The study used qualitative methods comprising semistructured interviews and focus groups. The interviews and focus groups were conducted in Anglican, Catholic, and United churches located in the Canadian cities of Toronto and Hamilton, Ontario. Twelve ordained pastors and 21 older parishioners who attended church regularly and who had no health conditions were recruited to best explain how churches could be suitable locations for health promotion activities targeting older adults. Twelve semistructured interviews with the pastors and three focus groups with the 21 parishioners were undertaken. A component of the Precede-Proceed model (a model for planning health education and health promotion programs and policies) was applied to the findings after direct content analysis of the data. Participants identified pastor leadership, funding for a parish nurse, community-focused interventions, secured infrastructure, and social support from congregation members as pertinent factors required for implementing health promotion programs in Anglican, United, and Catholic churches. The findings have particular relevance for health promotion and public health because they suggest factors that would be necessary to design church-based heart health promotion programs for older adults at risk of chronic diseases.

  15. Support Structures for Facilitators of Student Personal Development Planning: Lessons from Two Departmental Case Studies

    ERIC Educational Resources Information Center

    Hulme, Claire; Lisewski, Bernard

    2010-01-01

    In the UK, following guidelines set out by the Quality Assurance Agency, personal development planning (PDP) is now operational across all higher education (HE) awards. Like many policy initiatives, PDP requires change, and vital to its implementation are those who facilitate PDP at the grassroots level. Staff given the task of implementing PDP…

  16. The GETE approach to facilitating the commercialization and use of DOE-developed environmental technologies

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Harvey, T.N.

    The Global Environmental Technology Enterprise (GETE) was conceived to develop and implement strategies to facilitate the commercialization of innovative, cost-effective Department of Energy (DOE)-developed environmental technologies. These strategies are needed to aid DOE`s clean-up mission; to break down barriers to commercialization; and to build partnerships between the federal government and private industry in order to facilitate the development and use of innovative environmental technologies.

  17. Low- and middle-income countries face many common barriers to implementation of maternal health evidence products.

    PubMed

    Puchalski Ritchie, Lisa M; Khan, Sobia; Moore, Julia E; Timmings, Caitlyn; van Lettow, Monique; Vogel, Joshua P; Khan, Dina N; Mbaruku, Godfrey; Mrisho, Mwifadhi; Mugerwa, Kidza; Uka, Sami; Gülmezoglu, A Metin; Straus, Sharon E

    2016-08-01

    To explore similarities and differences in challenges to maternal health and evidence implementation in general across several low- and middle-income countries (LMICs) and to identify common and unique themes representing barriers to and facilitators of evidence implementation in LMIC health care settings. Secondary analysis of qualitative data. Meeting reports and articles describing projects undertaken by the authors in five LMICs on three continents were analyzed. Projects focused on identifying barriers to and facilitators of implementation of evidence products: five World Health Organization maternal health guidelines, and a knowledge translation strategy to improve adherence to tuberculosis treatment. Data were analyzed using thematic content analysis. Among identified barriers to evidence implementation, a high degree of commonality was found across countries and clinical areas, with lack of financial, material, and human resources most prominent. In contrast, few facilitators were identified varied substantially across countries and evidence implementation products. By identifying common barriers and areas requiring additional attention to ensure capture of unique barriers and facilitators, these findings provide a starting point for development of a framework to guide the assessment of barriers to and facilitators of maternal health and potentially to evidence implementation more generally in LMICs. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  18. Implementation of newly adopted technology in acute care settings: a qualitative analysis of clinical staff

    PubMed Central

    Langhan, Melissa L.; Riera, Antonio; Kurtz, Jordan C.; Schaeffer, Paula; Asnes, Andrea G.

    2015-01-01

    Objective Technologies are not always successfully implemented into practise. We elicited experiences of acute care providers with the introduction of technology and identified barriers and facilitators in the implementation process. Methods A qualitative study using one-on-one interviews among a purposeful sample of 19 physicians and nurses within ten emergency departments and intensive care units was performed. Grounded theory, iterative data analysis and the constant comparative method were used to inductively generate ideas and build theories. Results Five major categories emerged: decision-making factors, the impact on practise, technology's perceived value, facilitators and barriers to implementation. Barriers included negative experiences, age, infrequent use, and access difficulties. A positive outlook, sufficient training, support staff, and user friendliness were facilitators. Conclusions This study describes strategies implicated in the successful implementation of newly adopted technology in acute care settings. Improved implementation methods and evaluation of implementation processes are necessary for successful adoption of new technology. PMID:25367721

  19. Barriers and Facilitators for Guidelines with Depression and Anxiety in Parkinson's Disease or Dementia.

    PubMed

    Goodarzi, Zahra; Hanson, Heather M; Jette, Nathalie; Patten, Scott; Pringsheim, Tamara; Holroyd-Leduc, Jayna

    2018-06-01

    ABSTRACTOur primary objective was to understand the barriers and facilitators associated with the implementation of high-quality clinical practice guidelines (CPGs) for depression and anxiety in patients with dementia or Parkinson's disease (PD). We conducted focus groups or interviews with participants experiencing dementia or PD, their caregivers, and physicians in Calgary, Alberta, and applied the theoretical domains framework and behaviour change wheel to guide data collection and perform a framework analysis. Thirty-three physicians and seven PD patients/caregivers participated. We report barriers and facilitators to the implementation of guideline recommendations for diagnosis, management, and the use of the guidelines. An overarching theme was the lack of evidence for depression or anxiety disorders in dementia or PD, which was prominent for anxiety versus depression. Patients noted difficulties with communicating symptoms and accessing services. Although guidelines are available, physicians have difficulty implementing certain recommendations due primarily to a lack of evidence regarding efficacy.

  20. Osteoarthritis guidelines: Barriers to implementation and solutions.

    PubMed

    Ferreira de Meneses, Sarah; Rannou, Francois; Hunter, David J

    2016-06-01

    Osteoarthritis (OA) is a leading cause of disability worldwide. Clinical practice guidelines (CPGs) have been developed to facilitate improved OA management. Scientific communities worldwide have proposed CPGs for OA treatment. Despite the number of highly prominent guidelines available and their remarkable consistency, their uptake has been suboptimal. Possibly because of the multitude of barriers related to the implementation of CPGs. For example, different guidelines show contradictions, some lack evidence, and they lack a hierarchy or tools to facilitate their translation and application. Also, the guidelines do not acknowledge the effect of comorbidities on choosing the treatments. Finally, poor integration of multidisciplinary services within and across healthcare settings is a major barrier to the effective implementation of management guidelines. Here we describe the main problems related to the OA guidelines and some solutions so as to offer some guidance on the elaboration of future CPGs and their implementation in primary care. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  1. Implementing Evidence-Based Practice in Community Mental Health Agencies: A Multiple Stakeholder Analysis

    PubMed Central

    Wells, Rebecca S.; Zagursky, Karen; Fettes, Danielle L.; Palinkas, Lawrence A.

    2009-01-01

    Objectives. We sought to identify factors believed to facilitate or hinder evidence-based practice (EBP) implementation in public mental health service systems as a step in developing theory to be tested in future studies. Methods. Focusing across levels of an entire large public sector mental health service system for youths, we engaged participants from 6 stakeholder groups: county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. Results. Participants generated 105 unique statements identifying implementation barriers and facilitators. Participants rated each statement on importance and changeability (i.e., the degree to which each barrier or facilitator is considered changeable). Data analyses distilled statements into 14 factors or dimensions. Descriptive analyses suggest that perceptions of importance and changeability varied across stakeholder groups. Conclusions. Implementation of EBP is a complex process. Cross-system–level approaches are needed to bring divergent and convergent perspectives to light. Examples include agency and program directors facilitating EBP implementation by supporting staff, actively sharing information with policymakers and administrators about EBP effectiveness and fit with clients' needs and preferences, and helping clinicians to present and deliver EBPs and address consumer concerns. PMID:19762654

  2. Shared decision-making in dementia care planning: barriers and facilitators in two European countries.

    PubMed

    Mariani, Elena; Vernooij-Dassen, Myrra; Koopmans, Raymond; Engels, Yvonne; Chattat, Rabih

    2017-01-01

    Shared decision-making (SDM) is a means of allowing people with dementia to take part in making choices, be autonomous and participate in social activities. Involving them in SDM is an important way of promoting social health. However, including families and dementia residents in decision-making can be challenging for care staff working in nursing homes. The objective of this study was to identify barriers and facilitators regarding the implementation of an SDM framework for care planning in two nursing homes, one in Italy and one in the Netherlands. Focus group interviews were conducted with healthcare professionals who, after being trained, applied the SDM framework. Content analysis was used to analyze the data. Six months after the feasibility trial, focus group interviews with healthcare professionals (n = 10 in Italy; n = 9 in the Netherlands) were held. We found 6 themes and 15 categories. Within these themes, facilitators and barriers were identified. The categories of team collaboration, communication skills and nursing home policy were found to be facilitators to the implementation process, whereas regulations, lack of funding and of involvement of family caregivers were the main barriers. Family attitudes towards SDM could be both. The main difference between countries concerned the residents' cognitive status that influenced their degree of involvement. Communication skills training for professionals, training of family caregivers, and involvement of the management in the implementation process seem to be crucial factors in successfully implementing SDM in nursing homes, and increasing the involvement of families and dementia residents in decision-making.

  3. Key facilitators and best practices of hotel-style room service in hospitals.

    PubMed

    Sheehan-Smith, Lisa

    2006-04-01

    This qualitative study sought to identify the features, advantages, and disadvantages of hotel-style room service; the barriers to, and facilitators for, implementing the process; and "best practices." The study took place in four heterogeneous hospitals. Participants included hospital administrators, managers, and room-service employees. Data-collection methods included semi-structured interviews, observations, and document analysis. Common features of hotel-style room service were meal delivery within 30 to 45 minutes, a restaurant-style menu, procedures to feed ineligible patients, tray assembly on demand, scripting, and waitstaff uniforms for room-service employees. The major barrier to implementing room service was obtaining nursing support. The key facilitators were the hospital's service-oriented culture, using a multidisciplinary planning team, engaging nursing departments early in the planning stages, and intense customer-service training of room-service employees. The overwhelming advantage was patients' control over their food choices. The main disadvantage was cost. Initial best practices in hotel-style room service include: (a) taking a multidisciplinary team approach for developing and implementing the process, (b) customer-service training, (c) using a customer-driven menu, (d) wearing waitstaff uniforms, and (e) using carts with airpots for dispensing hot beverages.

  4. HIV Pre-exposure Prophylaxis Program Implementation Using Intervention Mapping.

    PubMed

    Flash, Charlene A; Frost, Elizabeth L T; Giordano, Thomas P; Amico, K Rivet; Cully, Jeffrey A; Markham, Christine M

    2018-04-01

    HIV pre-exposure prophylaxis has been proven to be an effective tool in HIV prevention. However, numerous barriers still exist in pre-exposure prophylaxis implementation. The framework of Intervention Mapping was used from August 2016 to October 2017 to describe the process of adoption, implementation, and maintenance of an HIV prevention program from 2012 through 2017 in Houston, Texas, that is nested within a county health system HIV clinic. Using the tasks outlined in the Intervention Mapping framework, potential program implementers were identified, outcomes and performance objectives established, matrices of change objectives created, and methods and practical applications formed. Results include the formation of three matrices that document program outcomes, change agents involved in the process, and the determinants needed to facilitate program adoption, implementation, and maintenance. Key features that facilitated successful program adoption and implementation were obtaining leadership buy-in, leveraging existing resources, systematic evaluation of operations, ongoing education for both clinical and nonclinical staff, and attention to emergent issues during launch. The utilization of Intervention Mapping to delineate the program planning steps can provide a model for pre-exposure prophylaxis implementation in other settings. Copyright © 2018. Published by Elsevier Inc.

  5. An exploration of the properties of the CORE problem list subset and how it facilitates the implementation of SNOMED CT

    PubMed Central

    Xu, Julia

    2015-01-01

    Objective Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) is the emergent international health terminology standard for encoding clinical information in electronic health records. The CORE Problem List Subset was created to facilitate the terminology’s implementation. This study evaluates the CORE Subset’s coverage and examines its growth pattern as source datasets are being incorporated. Methods Coverage of frequently used terms and the corresponding usage of the covered terms were assessed by “leave-one-out” analysis of the eight datasets constituting the current CORE Subset. The growth pattern was studied using a retrospective experiment, growing the Subset one dataset at a time and examining the relationship between the size of the starting subset and the coverage of frequently used terms in the incoming dataset. Linear regression was used to model that relationship. Results On average, the CORE Subset covered 80.3% of the frequently used terms of the left-out dataset, and the covered terms accounted for 83.7% of term usage. There was a significant positive correlation between the CORE Subset’s size and the coverage of the frequently used terms in an incoming dataset. This implies that the CORE Subset will grow at a progressively slower pace as it gets bigger. Conclusion The CORE Problem List Subset is a useful resource for the implementation of Systematized Nomenclature of Medicine Clinical Terms in electronic health records. It offers good coverage of frequently used terms, which account for a high proportion of term usage. If future datasets are incorporated into the CORE Subset, it is likely that its size will remain small and manageable. PMID:25725003

  6. Developing the Autism Model of Implementation for Autism spectrum disorder community providers: study protocol

    PubMed Central

    2012-01-01

    Background Currently, 1 out of 88 children are diagnosed with an autism spectrum disorder (ASD), and the estimated cost for treatment services is $126 billion annually. Typically, ASD community providers (ASD-CPs) provide services to children with any severity of ASD symptoms using a combination of various treatment paradigms, some with an evidence-base and some without. When evidence-based practices (EBPs) are successfully implemented by ASD-CPs, they can result in positive outcomes. Despite this promise, EBPs are often implemented unsuccessfully and other treatments used by ASD-CPs lack supportive evidence, especially for school-age children with ASD. While it is not well understood why ASD-CPs are not implementing EBPs, organizational and individual characteristics likely play a role. As a response to this need and to improve the lives of children with ASD and their families, this study aims to develop and test the feasibility and acceptability of the Autism Model of Implementation (AMI) to support the implementation of EBPs by ASD-CPs. Methods/design An academic-community collaboration developed to partner with ASD-CPs will facilitate the development of the AMI, a process specifically for use by ASD community-based agencies. Using a mixed methods approach, the project will assess agency and individual factors likely to facilitate or hinder implementing EBPs in this context; develop the AMI to address identified barriers and facilitators; and pilot test the AMI to examine its feasibility and acceptability using a specific EBP to treat anxiety disorders in school-age children with ASD. Discussion The AMI will represent a data-informed approach to facilitate implementation of EBPs by ASD-CPs by providing an implementation model specifically developed for this context. This study is designed to address the real-world implications of EBP implementation in ASD community-based agencies. In doing so, the AMI will help to provide children with ASD the best and most

  7. Facilitators and barriers to effective scale-up of an evidence-based multilevel HIV prevention intervention.

    PubMed

    Kegeles, Susan M; Rebchook, Gregory; Tebbetts, Scott; Arnold, Emily

    2015-04-17

    Since the scale-up of HIV/AIDS prevention evidence-based interventions (EBIs) has not been simple, it is important to examine processes that occur in the translation of the EBIs into practice that affect successful implementation. The goal of this paper is to examine facilitators and barriers to effective implementation that arose among 72 community-based organizations as they moved into practice a multilevel HIV prevention intervention EBI, the Mpowerment Project, for young gay and bisexual men. CBOs that were implementing the Mpowerment Project participated in this study and were assessed at baseline, and 6-months, 1 year, and 2 years post-baseline. Semi-structured telephone interviews were conducted separately with individuals at each CBO. Study data came from 647 semi-structured interviews and extensive notes and commentaries from technical assistance providers. Framework Analysis guided the analytic process. Barriers and facilitators to implementation was the overarching thematic framework used across all the cases in our analysis. Thirteen themes emerged regarding factors that influence the successful implementation of the MP. These were organized into three overarching themes: HIV Prevention System Factors, Community Factors, and Intervention Factors. The entire HIV Prevention System, including coordinators, supervisors, executive directors, funders, and national HIV prevention policies, all influenced implementation success. Other Prevention System Factors that affected the effective translation of the EBI into practice include Knowledge About Intervention, Belief in the Efficacy of the Intervention, Desire to Change Existing Prevention Approach, Planning for Intervention Before Implementation, Accountability, Appropriateness of Individuals for Coordinator Positions, Evaluation of Intervention, and Organizational Stability. Community Factors included Geography and Sociopolitical Climate. Intervention Factors included Intervention Characteristics and

  8. Implementation and de-implementation: two sides of the same coin?

    PubMed

    van Bodegom-Vos, Leti; Davidoff, Frank; Marang-van de Mheen, Perla J

    2017-06-01

    Avoiding low value care received increasing attention in many countries, as with the Choosing Wisely campaign and other initiatives to abandon care that wastes resources or delivers no benefit to patients. While an extensive literature characterises approaches to implementing evidence-based care, we have limited understanding of the process of de-implementation, such as abandoning existing low value practices. To learn more about the differences between implementation and de-implementation, we explored the literature and analysed data from two published studies (one implementation and one de-implementation) by the same orthopaedic surgeons. We defined 'leaders' as those orthopaedic surgeons who implemented, or de-implemented, the target processes of care and laggards as those who did not. Our findings suggest that leaders in implementation share some characteristics with leaders in de-implementation when comparing them with laggards, such as more open to new evidence, younger and less time in clinical practice. However, leaders in de-implementation and implementation differed in some other characteristics and were not the same persons. Thus, leading in implementation or de-implementation may depend to some degree on the type of intervention rather than entirely reflecting personal characteristics. De-implementation seemed to be hampered by motivational factors such as department priorities, and economic and political factors such as cost-benefit considerations in care delivery, whereas organisational factors were associated only with implementation. The only barrier or facilitator common to both implementation and de-implementation consisted of outcome expectancy (ie, the perceived net benefit to patients). Future studies need to test the hypotheses generated from this study and improve our understanding of differences between the processes of implementation and de-implementation in the people who are most likely to lead (or resist) these efforts. Published by the

  9. Maintaining gender sensitivity in the family practice: facilitators and barriers.

    PubMed

    Celik, Halime; Lagro-Janssen, Toine; Klinge, Ineke; van der Weijden, Trudy; Widdershoven, Guy

    2009-12-01

    This study aims to identify the facilitators and barriers perceived by General Practitioners (GPs) to maintain a gender perspective in family practice. Nine semi-structured interviews were conducted among nine pairs of GPs. The data were analysed by means of deductive content analysis using theory-based methods to generate facilitators and barriers to gender sensitivity. Gender sensitivity in family practice can be influenced by several factors which ultimately determine the extent to which a gender sensitive approach is satisfactorily practiced by GPs in the doctor-patient relationship. Gender awareness, repetition and reminders, motivation triggers and professional guidelines were found to facilitate gender sensitivity. On the other hand, lacking skills and routines, scepticism, heavy workload and the timing of implementation were found to be barriers to gender sensitivity. While the potential effect of each factor affecting gender sensitivity in family practice has been elucidated, the effects of the interplay between these factors still need to be determined.

  10. Implementing augmentative and alternative communication in inclusive educational settings: a case study.

    PubMed

    Stoner, Julia B; Angell, Maureen E; Bailey, Rita L

    2010-06-01

    The purpose of this study was to describe a single case of augmentative and alternative communication (AAC) implementation. Case study methodology was used to describe the perspectives of educational team members regarding AAC implementation for Joey, a high school junior with athetoid cerebral palsy. Benefits included greater intelligibility for Joey and subsequent comfort of the staff. Facilitators of Joey's AAC system use included the team's student-focused disposition and willingness to implement use of the device, Joey's increased intelligibility, peers' acceptance of the technology, and the resulting increase in Joey's socialization. Limited team cohesiveness, problem solving, and communication were the true barriers in this case. Implications of these facilitators and barriers are discussed and recommendations for school-based AAC implementation are made.

  11. E-consult implementation: lessons learned using consolidated framework for implementation research.

    PubMed

    Haverhals, Leah M; Sayre, George; Helfrich, Christian D; Battaglia, Catherine; Aron, David; Stevenson, Lauren D; Kirsh, Susan; Ho, Michael; Lowery, Julie

    2015-12-01

    In 2011, the Veterans Health Administration (VHA) implemented electronic consults (e-consults) as an alternative to in-person specialty visits to improve access and reduce travel for veterans. We conducted an evaluation to understand variation in the use of the new e-consult mechanism and the causes of variable implementation, guided by the Consolidated Framework for Implementation Research (CFIR). Qualitative case studies of 3 high- and 5 low-implementation e-consult pilot sites. Participants included e-consult site leaders, primary care providers, specialists, and support staff identified using a modified snowball sample. We used a 3-step approach, with a structured survey of e-consult site leaders to identify key constructs, based on the CFIR. We then conducted open-ended interviews, focused on key constructs, with all participants. Finally, we produced structured, site-level ratings of CFIR constructs and compared them between high- and low-implementation sites. Site leaders identified 14 initial constructs. We conducted 37 interviews, from which 4 CFIR constructs distinguished high implementation e-consult sites: compatibility, networks and communications, training, and access to knowledge and information. For example, illustrating compatibility, a specialist at a high-implementation site reported that the site changed the order of consult options so that all specialties listed e-consults first to maintain consistency. High-implementation sites also exhibited greater agreement on constructs. By using the CFIR to analyze results, we facilitate future synthesis with other findings, and we better identify common patterns of implementation determinants common across settings.

  12. Using Technology to Facilitate Collaboration in Community-Based Participatory Research (CBPR)

    PubMed Central

    Jessell, Lauren; Smith, Vivian; Jemal, Alexis; Windsor, Liliane

    2017-01-01

    This study explores the use of Computer-Supported Collaborative Work (CSCW) technologies, by way of a computer-based system called iCohere. This system was used to facilitate collaboration conducting Community-Based Participatory Research (CBPR). Data was gathered from 13 members of a Community Collaborative Board (CCB). Analysis revealed that iCohere served the following functions: facilitating communication, providing a depository for information and resource sharing, and allowing for remote meeting attendance. Results indicated that while iCohere was useful in performing these functions, less expensive technologies had the potential to achieve similar goals if properly implemented. Implications for future research on CSCW systems and CBPR are discussed. PMID:29056871

  13. A Middle School's Response-to-Intervention Journey: Building Systematic Processes of Facilitation, Collaboration, and Implementation

    ERIC Educational Resources Information Center

    Dulaney, Shannon K.

    2013-01-01

    This article discusses a qualitative case study examining one middle school's response to intervention (RtI) efforts. Study participants included the principal, assistant principal, and members of the school's leadership team. A description of the RtI consensus and infrastructure-building processes, consideration of the RtI facilitators, and a…

  14. The Brightly Illuminated Path: Facilitating an OER Program at Community College

    ERIC Educational Resources Information Center

    Blick, William; Marcus, Sandra

    2017-01-01

    The use of Open Education Resources represents a noble cause, but the idea often remains elusive for many faculty members. In 2015, librarians at Queensborough Community College of the City University of New York, implemented a campaign to promote and facilitate the use and development of OERs. The primary objective was to reduce the growing…

  15. ‘In the Moment’: An Analysis of Facilitator Impact During a Quality Improvement Process

    PubMed Central

    Shaw, Erik; Looney, Anna; Chase, Sabrina; Navalekar, Rohini; Stello, Brian; Lontok, Oliver; Crabtree, Benjamin

    2010-01-01

    Facilitators frequently act ‘in the moment’ – deciding if, when and how to intervene into group process discussions. This paper offers a unique look at how facilitators impacted eleven primary care teams engaged in a 12-week quality improvement (QI) process. Participating in a federally funded QI trial, primary care practices in New Jersey and Pennsylvania formed practice-based teams comprised of physicians, nurses, administrative staff, and patients. External facilitators met with each team to help them identify and implement changes aimed at improving the organization, work relationships, office functions, and patient care. Audio-recordings of the meetings and descriptive field notes were collected. These qualitative data provided information on how facilitators acted ‘in the moment’ and how their interventions impacted group processes over time. Our findings reveal that facilitators impacted groups in multiple ways throughout the QI process, rather than through a linear progression of stages or events. We present five case examples that show what acting ‘in the moment’ looked like during the QI meetings and how these facilitator actions/interventions impacted the primary care teams. These accounts provide practical lessons learned and insights into effective facilitation that may encourage others in their own facilitation work and offer beneficial strategies to facilitators in other contexts. PMID:22557936

  16. Knowledge translation and implementation in spinal cord injury: a systematic review

    PubMed Central

    Noonan, VK; Wolfe, DL; Thorogood, NP; Park, SE; Hsieh, JT; Eng, JJ

    2015-01-01

    Objective To conduct a systematic review examining the effectiveness of knowledge translation (KT) interventions in changing clinical practice and patient outcomes. Methods MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO were searched for studies published from January 1980 to July 2012 that reported and evaluated an implemented KT intervention in spinal cord injury (SCI) care. We reviewed and summarized results from studies that documented the implemented KT intervention, its impact on changing clinician behavior and patient outcomes as well as the facilitators and barriers encountered during the implementation. Results A total of 13 articles featuring 10 studies were selected and abstracted from 4650 identified articles. KT interventions included developing and implementing patient care protocols, providing clinician education and incorporating outcome measures into clinical practice. The methods (or drivers) to facilitate the implementation included organizing training sessions for clinical staff, introducing computerized reminders and involving organizational leaders. The methodological quality of studies was mostly poor. Only 3 out of 10 studies evaluated the success of the implementation using statistical analyses, and all 3 reported significant behavior change. Out of the 10 studies, 6 evaluated the effect of the implementation on patient outcomes using statistical analyses, with 4 reporting significant improvements. The commonly cited facilitators and barriers were communication and resources, respectively. Conclusion The field of KT in SCI is in its infancy with only a few relevant publications. However, there is some evidence that KT interventions may change clinician behavior and improve patient outcomes. Future studies should ensure rigorous study methods are used to evaluate KT interventions. PMID:24796445

  17. Knowledge translation and implementation in spinal cord injury: a systematic review.

    PubMed

    Noonan, V K; Wolfe, D L; Thorogood, N P; Park, S E; Hsieh, J T; Eng, J J

    2014-08-01

    To conduct a systematic review examining the effectiveness of knowledge translation (KT) interventions in changing clinical practice and patient outcomes. MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO were searched for studies published from January 1980 to July 2012 that reported and evaluated an implemented KT intervention in spinal cord injury (SCI) care. We reviewed and summarized results from studies that documented the implemented KT intervention, its impact on changing clinician behavior and patient outcomes as well as the facilitators and barriers encountered during the implementation. A total of 13 articles featuring 10 studies were selected and abstracted from 4650 identified articles. KT interventions included developing and implementing patient care protocols, providing clinician education and incorporating outcome measures into clinical practice. The methods (or drivers) to facilitate the implementation included organizing training sessions for clinical staff, introducing computerized reminders and involving organizational leaders. The methodological quality of studies was mostly poor. Only 3 out of 10 studies evaluated the success of the implementation using statistical analyses, and all 3 reported significant behavior change. Out of the 10 studies, 6 evaluated the effect of the implementation on patient outcomes using statistical analyses, with 4 reporting significant improvements. The commonly cited facilitators and barriers were communication and resources, respectively. The field of KT in SCI is in its infancy with only a few relevant publications. However, there is some evidence that KT interventions may change clinician behavior and improve patient outcomes. Future studies should ensure rigorous study methods are used to evaluate KT interventions.

  18. Quality Implementation in Transition: A Framework for Specialists and Administrators.

    ERIC Educational Resources Information Center

    Wald, Judy L.; Repetto, Jeanne B.

    1995-01-01

    Quality Implementation in Transition is a framework designed to guide transition specialists and administrators in the implementation of total quality management. The framework uses the tenets set forth by W. Edwards Deming and is intended to help professionals facilitate change within transition programs. (Author/JOW)

  19. A qualitative study of anticipated barriers and facilitators to the implementation of nurse-delivered alcohol screening, brief intervention, and referral to treatment for hospitalized patients in a Veterans Affairs medical center

    PubMed Central

    2012-01-01

    Background Unhealthy alcohol use includes the spectrum of alcohol consumption from risky drinking to alcohol use disorders. Routine alcohol screening, brief intervention (BI) and referral to treatment (RT) are commonly endorsed for improving the identification and management of unhealthy alcohol use in outpatient settings. However, factors which might impact screening, BI, and RT implementation in inpatient settings, particularly if delivered by nurses, are unknown, and must be identified to effectively plan randomized controlled trials (RCTs) of nurse-delivered BI. The purpose of this study was to identify the potential barriers and facilitators associated with nurse-delivered alcohol screening, BI and RT for hospitalized patients. Methods We conducted audio-recorded focus groups with nurses from three medical-surgical units at a large urban Veterans Affairs Medical Center. Transcripts were analyzed using modified grounded theory techniques to identify key themes regarding anticipated barriers and facilitators to nurse-delivered screening, BI and RT in the inpatient setting. Results A total of 33 medical-surgical nurses (97% female, 83% white) participated in one of seven focus groups. Nurses consistently anticipated the following barriers to nurse-delivered screening, BI, and RT for hospitalized patients: (1) lack of alcohol-related knowledge and skills; (2) limited interdisciplinary collaboration and communication around alcohol-related care; (3) inadequate alcohol assessment protocols and poor integration with the electronic medical record; (4) concerns about negative patient reaction and limited patient motivation to address alcohol use; (5) questionable compatibility of screening, BI and RT with the acute care paradigm and nursing role; and (6) logistical issues (e.g., lack of time/privacy). Suggested facilitators of nurse-delivered screening, BI, and RT focused on provider- and system-level factors related to: (1) improved provider knowledge, skills

  20. [A Matter of Balance: strategy for implementation in Dutch homecare organizations].

    PubMed

    de Jonge, M C; van der Poel, A; van Haastregt, J C M; Du Moulin, M F T M; Zijlstra, G A R; Voordouw, I

    2013-02-01

    The Dutch version of A Matter of Balance (AMB-NL) is a cognitive behavioral group program to reduce fear of falling and related activity avoidance in community-living older persons. This paper presents the strategy for implementation of AMB-NL in Dutch homecare organizations and the outcomes of this implementation. The aim was to implement AMB-NL in at least 50 % of 64 homecare organizations in The Netherlands in 2009 and 2010. The implementation strategy was based on the four phases of the Replicating Effective Interventions: pre-conditions, pre-implementation, implementation, and maintenance and evolution. After preparing the implementation activities, such as identifying implementation barriers, consulting stakeholders, preparing the materials involved in the implementation, and training the facilitators of the program (n = 53), AMB-NL was implemented in 16 of the 64 homecare organizations (25 %). Another five homecare organizations indicated that they would shortly include AMB-NL in their care program. These organizations conducted the intervention 19 times to a total of 178 participants. After the implementation phase another 16 facilitators were trained, and program materials were successfully disseminated. The implementation of AMB-NL was well performed. The targeted aim is not fully reached within the two-year timeframe, but the program is well received by participants, trainers and homecare organizations. Further implementation and maintenance of AMB-NL in primary health care is recommended.

  1. Transformative Parents: Facilitating Transformative Experiences and Interest with a Parent Involvement Intervention

    ERIC Educational Resources Information Center

    Heddy, Benjamin C.; Sinatra, Gale M.

    2017-01-01

    This study reports the implementation of a parental involvement intervention coupled with small group discussions aimed at facilitating transformative experiences (TEs) in science courses (biology and chemistry) in an all-girls middle and high school. Specifically, the goal was to generate parental involvement, TE, and interest. Analyses showed…

  2. To Assess Prerequisites Before an Implementation Strategy in an Orthopaedic Department in Sweden.

    PubMed

    Bahtsevani, Christel; Idvall, Ewa

    2016-01-01

    Promoting Action on Research Implementation in Health Services (PARiHS) asserts that the success of knowledge implementation relates to multiple factors in a complex and dynamic way, and therefore the effects of implementation strategies vary by method and context. An instrument based on the PARiHS framework was developed to help assess critical factors influencing implementation strategies so that strategies can be tailored to promote implementation.The purpose of this study was to use the Evaluation Before Implementation Questionnaire (EBIQ), to describe staff perceptions in one orthopaedic department, and to investigate differences between wards.Staff members in four different wards at one orthopaedic department at a university hospital in Sweden were invited to complete a questionnaire related to planning for the implementation of a clinical practice guideline. The 23 items in the EBIQ were expected to capture staff perceptions about the evidence, context, and facilitation factors that influence the implementation process. Descriptive statistics and differences between wards were analyzed. Although the overall response rate was low (n = 49), two of the four wards accounted for most of the completed questionnaires (n = 25 and n = 12, respectively), enabling a comparison of these wards. We found significant differences between respondents' perceptions at the two wards in six items regarding context and facilitation in terms of receptiveness to change, forms of leadership, and evaluation and presence of feedback and facilitators.The EBIQ instrument requires further testing, but there appears to be initial support for pre-implementation use of the EBIQ as a means to enhance planning for implementation.

  3. How nurse-led practices perceive implementation of the patient-centered medical home.

    PubMed

    Frasso, Rosemary; Golinkoff, A; Klusaritz, Heather; Kellom, Katherine; Kollar-McArthur, Helen; Miller-Day, Michelle; Gabbay, Robert; Cronholm, Peter F

    2017-04-01

    The Affordable Care Act (ACA) promotes the Patient-Centered Medical Home (PCMH) model as a way to improve healthcare quality, the patient experience, and has identified nurse-led primary care as a mechanism meeting the increasing demand for quality primary care. The purpose of this study was to investigate the implementation of a PCMH model in nurse-led primary care practices and to identify facilitators and barriers to the implementation of this model. Data were collected through in-depth interviews with providers and staff in nurse-led practices. These data suggest two categories of processes that facilitate the integration of PCMH in the nurse-led practice setting: patient-oriented facilitators and organizational facilitators. In addition, a number of barriers were identified to implementing the PCMH model. Overall, these practices creatively engaged in the transformation process by structuring themselves as a complex adaptive system and building upon the core principles of nurse-led care. Since the core principles of nurse-led care map onto many of the same principles of the PCMH model, this study discusses the possibility that nurse-led practices may experience fewer barriers when transitioning into PCMHs. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Characteristics and critical success factors for implementing problem-based learning in a human resource-constrained country.

    PubMed

    Giva, Karen R N; Duma, Sinegugu E

    2015-08-31

    Problem-based learning (PBL) was introduced in Malawi in 2002 in order to improve the nursing education system and respond to the acute nursing human resources shortage. However, its implementation has been very slow throughout the country. The objectives of the study were to explore and describe the goals that were identified by the college to facilitate the implementation of PBL, the resources of the organisation that facilitated the implementation of PBL, the factors related to sources of students that facilitated the implementation of PBL, and the influence of the external system of the organisation on facilitating the implementation of PBL, and to identify critical success factors that could guide the implementation of PBL in nursing education in Malawi. This is an ethnographic, exploratory and descriptive qualitative case study. Purposive sampling was employed to select the nursing college, participants and documents for review.Three data collection methods, including semi-structured interviews, participant observation and document reviews, were used to collect data. The four steps of thematic analysis were used to analyse data from all three sources. Four themes and related subthemes emerged from the triangulated data sources. The first three themes and their subthemes are related to the characteristics related to successful implementation of PBL in a human resource-constrained nursing college, whilst the last theme is related to critical success factors that contribute to successful implementation of PBL in a human resource-constrained country like Malawi. This article shows that implementation of PBL is possible in a human resource-constrained country if there is political commitment and support.

  5. The Influence of Facilitator and Facilitation Characteristics on Participants' Ratings of Stepfamily Education

    ERIC Educational Resources Information Center

    Higginbotham, Brian J.; Myler, Cory

    2010-01-01

    We examine the relative importance of facilitator and facilitation characteristics on participant ratings of a stepfamily education program. Data from 48 facilitators and 598 participants suggest that quality facilitation is more meaningful to participants than whether facilitators have comparable demographic characteristics or life experiences.…

  6. Organizational theory for dissemination and implementation research.

    PubMed

    Birken, Sarah A; Bunger, Alicia C; Powell, Byron J; Turner, Kea; Clary, Alecia S; Klaman, Stacey L; Yu, Yan; Whitaker, Daniel J; Self, Shannon R; Rostad, Whitney L; Chatham, Jenelle R Shanley; Kirk, M Alexis; Shea, Christopher M; Haines, Emily; Weiner, Bryan J

    2017-05-12

    Even under optimal internal organizational conditions, implementation can be undermined by changes in organizations' external environments, such as fluctuations in funding, adjustments in contracting practices, new technology, new legislation, changes in clinical practice guidelines and recommendations, or other environmental shifts. Internal organizational conditions are increasingly reflected in implementation frameworks, but nuanced explanations of how organizations' external environments influence implementation success are lacking in implementation research. Organizational theories offer implementation researchers a host of existing, highly relevant, and heretofore largely untapped explanations of the complex interaction between organizations and their environment. In this paper, we demonstrate the utility of organizational theories for implementation research. We applied four well-known organizational theories (institutional theory, transaction cost economics, contingency theories, and resource dependency theory) to published descriptions of efforts to implement SafeCare, an evidence-based practice for preventing child abuse and neglect. Transaction cost economics theory explained how frequent, uncertain processes for contracting for SafeCare may have generated inefficiencies and thus compromised implementation among private child welfare organizations. Institutional theory explained how child welfare systems may have been motivated to implement SafeCare because doing so aligned with expectations of key stakeholders within child welfare systems' professional communities. Contingency theories explained how efforts such as interagency collaborative teams promoted SafeCare implementation by facilitating adaptation to child welfare agencies' internal and external contexts. Resource dependency theory (RDT) explained how interagency relationships, supported by contracts, memoranda of understanding, and negotiations, facilitated SafeCare implementation by balancing

  7. Evidence implementation: Development of an online methodology from the knowledge-to-action model of knowledge translation.

    PubMed

    Lockwood, Craig; Stephenson, Matthew; Lizarondo, Lucylynn; van Den Hoek, Joan; Harrison, Margaret

    2016-08-01

    This paper describes an online facilitation for operationalizing the knowledge-to-action (KTA) model. The KTA model incorporates implementation planning that is optimally suited to the information needs of clinicians. The can-implement(©) is an evidence implementation process informed by the KTA model. An online counterpart, the can-implement.pro(©) , was developed to enable greater dissemination and utilization of the can-implement(©) process. The driver for this work was health professionals' need for facilitation that is iterative, informed by context and localized to the specific needs of users. The literature supporting this paper includes evaluation studies and theoretical concepts relevant to KTA model, evidence implementation and facilitation. Nursing and other health disciplines require a skill set and resources to successfully navigate the complexity of organizational requirements, inter-professional leadership and day-to-day practical management to implement evidence into clinical practice. The can-implement.pro(©) provides an accessible, inclusive system for evidence implementation projects. There is empirical support for evidence implementation informed by the KTA model, which in this phase of work has been developed for online uptake. Nurses and other clinicians seeking to implement evidence could benefit from the directed actions, planning advice and information embedded in the phases and steps of can-implement.pro(©) . © 2016 John Wiley & Sons Australia, Ltd.

  8. Implementing Innovation: An Exploration of a Learning Management System Transition

    ERIC Educational Resources Information Center

    Strawser, Michael G.; Apostel, Shawn; O' Keefe, Moira; Simons, Crystal

    2018-01-01

    Learning management systems (LMS) are fixtures on higher education campuses. As LMS use continues to increase, faculty development professionals should consider how system use is encouraged and implemented on campus, especially amongst faculty. Using Ely's (1990) technology-specific conditions that facilitate the implementation of an innovation,…

  9. Barriers and facilitators to exchanging health information: a systematic review.

    PubMed

    Eden, Karen B; Totten, Annette M; Kassakian, Steven Z; Gorman, Paul N; McDonagh, Marian S; Devine, Beth; Pappas, Miranda; Daeges, Monica; Woods, Susan; Hersh, William R

    2016-04-01

    We conducted a systematic review of studies assessing facilitators and barriers to use of health information exchange (HIE). We searched MEDLINE, PsycINFO, CINAHL, and the Cochrane Library databases between January 1990 and February 2015 using terms related to HIE. English-language studies that identified barriers and facilitators of actual HIE were included. Data on study design, risk of bias, setting, geographic location, characteristics of the HIE, perceived barriers and facilitators to use were extracted and confirmed. Ten cross-sectional, seven multiple-site case studies, and two before-after studies that included data from several sources (surveys, interviews, focus groups, and observations of users) evaluated perceived barriers and facilitators to HIE use. The most commonly cited barriers to HIE use were incomplete information, inefficient workflow, and reports that the exchanged information that did not meet the needs of users. The review identified several facilitators to use. Incomplete patient information was consistently mentioned in the studies conducted in the US but not mentioned in the few studies conducted outside of the US that take a collective approach toward healthcare. Individual patients and practices in the US may exercise the right to participate (or not) in HIE which effects the completeness of patient information available to be exchanged. Workflow structure and user roles are key but understudied. We identified several facilitators in the studies that showed promise in promoting electronic health data exchange: obtaining more complete patient information; thoughtful workflow that folds in HIE; and inclusion of users early in implementation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. A multisite study of implementing supported employment in the Netherlands.

    PubMed

    van Erp, Nicole H J; Giesen, Femke B M; van Weeghel, Jaap; Kroon, Hans; Michon, Harry W C; Becker, Deborah; McHugo, Gregory J; Drake, Robert E

    2007-11-01

    This article reports on the implementation of the individual placement and support model of supported employment in four Dutch regions. The authors used structured site visits, employment data, and semistructured interviews to assess fidelity, employment outcomes, and facilitators of and barriers to successful implementation. At 24 months, the four sites reached a mean+/-SD fidelity score of 4.1+/-.3 (possible scores range from 1 to 5, with higher scores indicating closer adherence to the model). Of the 316 persons with mental illnesses, 57 (18%) obtained competitive jobs. Barriers to implementation included lack of organizational standards, loss of vocational staff, funding problems, insufficient time for program leaders, and inadequate cooperation between the involved organizations. Important facilitators were the skills and commitment of the vocational team members and the integration of vocational and mental health staff. To implement evidence-based supported employment in the Netherlands will require changes in financing, organizational structures, attitudes, cultural beliefs, and labor and disability regulations.

  11. Implementing Competency-Based Medical Education in a Postgraduate Family Medicine Residency Training Program: A Stepwise Approach, Facilitating Factors, and Processes or Steps That Would Have Been Helpful.

    PubMed

    Schultz, Karen; Griffiths, Jane

    2016-05-01

    In 2009-2010, the postgraduate residency training program at the Department of Family Medicine, Queen's University, wrestled with the practicalities of competency-based medical education (CBME) implementation when its accrediting body, the College of Family Physicians of Canada, introduced the competency-based Triple C curriculum. The authors used a stepwise approach to implement CMBE; the steps were to (1) identify objectives, (2) identify competencies, (3) map objectives and competencies to learning experiences and assessment processes, (4) plan learning experiences, (5) develop an assessment system, (6) collect and interpret data, (7) adjust individual residents' training programs, and (8) distribute decisions to stakeholders. The authors also note overarching processes, costs, and facil itating factors and processes or steps that would have been helpful for CBME implementation. Early outcomes are encouraging. Residents are being directly observed more often with increased documented feedback about performance based on explicit competency standards (24,000 data points for 150 residents from 2013 to 2015). These multiple observations are being collated in a way that is allowing the identification of patterns of performance, red flags, and competency development trajectory. Outliers are being identified earlier, resulting in earlier individualized modification of their residency training program. The authors will continue to provide and refine faculty development, are developing an entrustable professional activity field note app for handheld devices, and are undertaking research to explore what facilitates learners' competency development, what increases assessors' confidence in making competence decisions, and whether residents are better trained as a result of CBME implementation.

  12. Using learning theory, interprofessional facilitation competencies, and behavioral indicators to evaluate facilitator training.

    PubMed

    LeGros, Theresa A; Amerongen, Helen M; Cooley, Janet H; Schloss, Ernest P

    2015-01-01

    Despite the increasing need for faculty and preceptors skilled in interprofessional facilitation (IPF), the relative novelty of the field poses a challenge to the development and evaluation of IPF programs. We use learning theory and IPF competencies with associated behavioral indicators to develop and evaluate six key messages in IPF training and experience. Our mixed methods approach included two phases: quantitative data collection with embedded qualitative data, followed by qualitative data collection in explanatory sequential fashion. This enabled triangulated analyses of both data types and of facilitation behaviors from facilitator and student perspectives. Results indicate the competency-based training was effective. Facilitators felt comfortable performing behaviors associated with IPF competencies; student observations of those behaviors supported facilitator self-reported performance. Overall, students perceived more facilitation opportunities than facilitators. Findings corroborate the importance of recruiting seasoned facilitators and establishing IPF guidelines that acknowledge variable team dynamics and help facilitators recognize teachable moments.

  13. BSCS BIOLOGY--IMPLEMENTATION IN THE SCHOOLS.

    ERIC Educational Resources Information Center

    GROBMAN, ARNOLD B.; AND OTHERS

    INFORMATION FOR TEACHERS AND PRINCIPALS IMPLEMENTING BIOLOGICAL SCIENCE CURRICULUM STUDY (BSCS) BIOLOGY IN THE SCHOOL PROGRAM IS INCLUDED IN THIS GUIDE. THE RATIONALE AND CONTENT OF THE BSCS VERSIONS ARE EXPLAINED. PHYSICAL FACILITIES, LABORATORY EQUIPMENT, AND LABORATORY MATERIALS THAT FACILITATE TEACHING BSCS BIOLOGY ARE ANALYZED. ADMINISTRATIVE…

  14. The Implementation of Program Evaluation Recommendations in Wisconsin Technical Colleges.

    ERIC Educational Resources Information Center

    Ruhland, Sheila K.

    Implementation of program evaluation recommendations should persuade people that the rewards of an evaluation outweigh the reasons for resistance. A study was undertaken with the following purposes: identify facilitators and barriers to the implementation of program evaluation; determine the proportion of recommendations made in each of the nine…

  15. De-implementation: A concept analysis.

    PubMed

    Upvall, Michele J; Bourgault, Annette M

    2018-04-25

    The purpose of this concept analysis is to explore the meaning of de-implementation and provide a definition that can be used by researchers and clinicians to facilitate evidence-based practice. De-implementation is a relatively unknown process overshadowed by the novelty of introducing new ideas and techniques into practice. Few studies have addressed the challenge of de-implementation and the cognitive processes involved when terminating harmful or unnecessary practices. Also, confusion exists regarding the myriad of terms used to describe de-implementation processes. Walker and Avant's method (2011) for describing concepts was used to clarify de-implementation. A database search limited to academic journals yielded 281 publications representing basic research, study protocols, and editorials/commentaries from implementation science experts. After applying exclusion criterion of English language only and eliminating overlap between databases, 41 articles were selected for review. Literature review and synthesis provided a concept analysis and a distinct definition of de-implementation. De-implementation was defined as the process of identifying and removing harmful, non-cost-effective, or ineffective practices based on tradition and without adequate scientific support. The analysis provided further refinement of de-implementation as a significant concept for ongoing theory development in implementation science and clinical practice. © 2018 Wiley Periodicals, Inc.

  16. Implementing Culture Change in Nursing Homes: An Adaptive Leadership Framework

    PubMed Central

    Corazzini, Kirsten; Twersky, Jack; White, Heidi K.; Buhr, Gwendolen T.; McConnell, Eleanor S.; Weiner, Madeline; Colón-Emeric, Cathleen S.

    2015-01-01

    Purpose of the Study: To describe key adaptive challenges and leadership behaviors to implement culture change for person-directed care. Design and Methods: The study design was a qualitative, observational study of nursing home staff perceptions of the implementation of culture change in each of 3 nursing homes. We conducted 7 focus groups of licensed and unlicensed nursing staff, medical care providers, and administrators. Questions explored perceptions of facilitators and barriers to culture change. Using a template organizing style of analysis with immersion/crystallization, themes of barriers and facilitators were coded for adaptive challenges and leadership. Results: Six key themes emerged, including relationships, standards and expectations, motivation and vision, workload, respect of personhood, and physical environment. Within each theme, participants identified barriers that were adaptive challenges and facilitators that were examples of adaptive leadership. Commonly identified challenges were how to provide person-directed care in the context of extant rules or policies or how to develop staff motivated to provide person-directed care. Implications: Implementing culture change requires the recognition of adaptive challenges for which there are no technical solutions, but which require reframing of norms and expectations, and the development of novel and flexible solutions. Managers and administrators seeking to implement person-directed care will need to consider the role of adaptive leadership to address these adaptive challenges. PMID:24451896

  17. An assistive control approach for a lower-limb exoskeleton to facilitate recovery of walking following stroke.

    PubMed

    Murray, Spencer A; Ha, Kevin H; Hartigan, Clare; Goldfarb, Michael

    2015-05-01

    This paper presents a control approach for a lower-limb exoskeleton intended to facilitate recovery of walking in individuals with lower-extremity hemiparesis after stroke. The authors hypothesize that such recovery is facilitated by allowing the patient rather than the exoskeleton to provide movement coordination. As such, an assistive controller that provides walking assistance without dictating the spatiotemporal nature of joint movement is described here. Following a description of the control laws and finite state structure of the controller, the authors present the results of an experimental implementation and preliminary validation of the control approach, in which the control architecture was implemented on a lower limb exoskeleton, and the exoskeleton implemented in an experimental protocol on three subjects with hemiparesis following stroke. In a series of sessions in which each patient used the exoskeleton, all patients showed substantial single-session improvements in all measured gait outcomes, presumably as a result of using the assistive controller and exoskeleton.

  18. From policy to practice: implementation of physical activity and food policies in schools

    PubMed Central

    2013-01-01

    Purpose Public policies targeting the school setting are increasingly being used to address childhood obesity; however, their effectiveness depends on their implementation. This study explores the factors which impeded or facilitated the implementation of publicly mandated school-based physical activity and nutrition guidelines in the province of British Columbia (BC), Canada. Methods Semi-structured interviews were conducted with 50 school informants (17 principals - 33 teacher/school informants) to examine the factors associated with the implementation of the mandated Daily Physical Activity (DPA) and Food and Beverage Sales in Schools (FBSS) guidelines. Coding used a constructivist grounded theory approach. The first five transcripts and every fifth transcript thereafter were coded by two independent coders with discrepancies reconciled by a third coder. Data was coded and analysed in the NVivo 9 software. Concept maps were developed and current theoretical perspectives were integrated in the later stages of analysis. Results The Diffusion of Innovations Model provided an organizing framework to present emergent themes. With the exception of triability (not relevant in the context of mandated guidelines/policies), the key attributes of the Diffusion of Innovations Model (relative advantage, compatibility, complexity, and observability) provided a robust framework for understanding themes associated with implementation of mandated guidelines. Specifically, implementation of the DPA and FBSS guidelines was facilitated by perceptions that they: were relatively advantageous compared to status quo; were compatible with school mandates and teaching philosophies; had observable positive impacts and impeded when perceived as complex to understand and implement. In addition, a number of contextual factors including availability of resources facilitated implementation. Conclusions The enactment of mandated policies/guidelines for schools is considered an essential step in

  19. From policy to practice: implementation of physical activity and food policies in schools.

    PubMed

    Mâsse, Louise C; Naiman, Daniel; Naylor, Patti-Jean

    2013-06-03

    Public policies targeting the school setting are increasingly being used to address childhood obesity; however, their effectiveness depends on their implementation. This study explores the factors which impeded or facilitated the implementation of publicly mandated school-based physical activity and nutrition guidelines in the province of British Columbia (BC), Canada. Semi-structured interviews were conducted with 50 school informants (17 principals - 33 teacher/school informants) to examine the factors associated with the implementation of the mandated Daily Physical Activity (DPA) and Food and Beverage Sales in Schools (FBSS) guidelines. Coding used a constructivist grounded theory approach. The first five transcripts and every fifth transcript thereafter were coded by two independent coders with discrepancies reconciled by a third coder. Data was coded and analysed in the NVivo 9 software. Concept maps were developed and current theoretical perspectives were integrated in the later stages of analysis. The Diffusion of Innovations Model provided an organizing framework to present emergent themes. With the exception of triability (not relevant in the context of mandated guidelines/policies), the key attributes of the Diffusion of Innovations Model (relative advantage, compatibility, complexity, and observability) provided a robust framework for understanding themes associated with implementation of mandated guidelines. Specifically, implementation of the DPA and FBSS guidelines was facilitated by perceptions that they: were relatively advantageous compared to status quo; were compatible with school mandates and teaching philosophies; had observable positive impacts and impeded when perceived as complex to understand and implement. In addition, a number of contextual factors including availability of resources facilitated implementation. The enactment of mandated policies/guidelines for schools is considered an essential step in improving physical activity and

  20. Identifying and Applying the Communicative and the Constructivist Approaches To Facilitate Transfer of Knowledge in the Bilingual Classroom.

    ERIC Educational Resources Information Center

    Olivares, Rafael A.; Lemberger, Nancy

    2002-01-01

    Provides recommendations for the implementation of the communication, constructivism, and transference of knowledge (CCT) model in the education of English language learners (ELLS). Describes how the CCT model is identified in research studies and suggests specific recommendations to facilitate the implementation of the model in the education of…

  1. Implementation of the CALM intervention for anxiety disorders: a qualitative study

    PubMed Central

    2012-01-01

    Background Investigators recently tested the effectiveness of a collaborative-care intervention for anxiety disorders: Coordinated Anxiety Learning and Management(CALM) []) in 17 primary care clinics around the United States. Investigators also conducted a qualitative process evaluation. Key research questions were as follows: (1) What were the facilitators/barriers to implementing CALM? (2) What were the facilitators/barriers to sustaining CALM after the study was completed? Methods Key informant interviews were conducted with 47 clinic staff members (18 primary care providers, 13 nurses, 8 clinic administrators, and 8 clinic staff) and 14 study-trained anxiety clinical specialists (ACSs) who coordinated the collaborative care and provided cognitive behavioral therapy. The interviews were semistructured and conducted by phone. Data were content analyzed with line-by-line analyses leading to the development and refinement of themes. Results Similar themes emerged across stakeholders. Important facilitators to implementation included the perception of "low burden" to implement, provider satisfaction with the intervention, and frequent provider interaction with ACSs. Barriers to implementation included variable provider interest in mental health, high rates of part-time providers in clinics, and high social stressors of lower socioeconomic-status patients interfering with adherence. Key sustainability facilitators were if a clinic had already incorporated collaborative care for another disorder and presence of onsite mental health staff. The main barrier to sustainability was funding for the ACS. Conclusions The CALM intervention was relatively easy to incorporate during the effectiveness trial, and satisfaction was generally high. Numerous implementation and sustainability barriers could limit the reach and impact of widespread adoption. Findings should be interpreted with the knowledge that the ACSs in this study were provided and trained by the study. Future

  2. Intervention Fidelity and Facilitator Training.

    PubMed

    Rew, Lynn; Banner, Matthew; Johnson, Karen; Slesnick, Natasha

    2018-01-01

    Intervention fidelity is an ongoing concern for rigorous research, from the initial stages of planning and study design to the maintenance of internal validity. An added concern is the balance between fidelity and design accommodation to better suit varied populations and individuals. In this article, we describe our process for monitoring intervention fidelity during an individualized, yet standardized, strengths-based intervention with homeless youths, in which we include periodic training of our professional intervention facilitators. In our ongoing study, which is based on a Solomon four-group design with repeated measures, monitoring and training are essential to ensure intervention fidelity. Despite a rich literature about intervention fidelity, little guidance is available to help researchers and practitioners implement fidelity strategies in the real world with vulnerable populations. This article addresses this gap.

  3. PILA: Sub-Meter Localization Using CSI from Commodity Wi-Fi Devices

    PubMed Central

    Tian, Zengshan; Li, Ze; Zhou, Mu; Jin, Yue; Wu, Zipeng

    2016-01-01

    The aim of this paper is to present a new indoor localization approach by employing the Angle-of-arrival (AOA) and Received Signal Strength (RSS) measurements in Wi-Fi network. To achieve this goal, we first collect the Channel State Information (CSI) by using the commodity Wi-Fi devices with our designed three antennas to estimate the AOA of Wi-Fi signal. Second, we propose a direct path identification algorithm to obtain the direct signal path for the sake of reducing the interference of multipath effect on the AOA estimation. Third, we construct a new objective function to solve the localization problem by integrating the AOA and RSS information. Although the localization problem is non-convex, we use the Second-order Cone Programming (SOCP) relaxation approach to transform it into a convex problem. Finally, the effectiveness of our approach is verified based on the prototype implementation by using the commodity Wi-Fi devices. The experimental results show that our approach can achieve the median error 0.7 m in the actual indoor environment. PMID:27735879

  4. PILA: Sub-Meter Localization Using CSI from Commodity Wi-Fi Devices.

    PubMed

    Tian, Zengshan; Li, Ze; Zhou, Mu; Jin, Yue; Wu, Zipeng

    2016-10-10

    The aim of this paper is to present a new indoor localization approach by employing the Angle-of-arrival (AOA) and Received Signal Strength (RSS) measurements in Wi-Fi network. To achieve this goal, we first collect the Channel State Information (CSI) by using the commodity Wi-Fi devices with our designed three antennas to estimate the AOA of Wi-Fi signal. Second, we propose a direct path identification algorithm to obtain the direct signal path for the sake of reducing the interference of multipath effect on the AOA estimation. Third, we construct a new objective function to solve the localization problem by integrating the AOA and RSS information. Although the localization problem is non-convex, we use the Second-order Cone Programming (SOCP) relaxation approach to transform it into a convex problem. Finally, the effectiveness of our approach is verified based on the prototype implementation by using the commodity Wi-Fi devices. The experimental results show that our approach can achieve the median error 0.7 m in the actual indoor environment.

  5. Trans individuals' facilitative coping: An analysis of internal and external processes.

    PubMed

    Budge, Stephanie L; Chin, Mun Yuk; Minero, Laura P

    2017-01-01

    Existing research on trans individuals has primarily focused on their negative experiences and has disproportionately examined coming-out processes and identity development stages. Using a grounded theory approach, this qualitative study sought to examine facilitative coping processes among trans-identified individuals. Facilitative coping was operationalized as processes whereby individuals seek social support, learn new skills, change behaviors to positively adapt, and find alternative means to seek personal growth and acceptance. The sample included 15 participants who self-identified with a gender identity that was different from their assigned sex at birth. Results yielded a total of nine overarching themes: Accepting Support from Others, Actions to Increase Protection, Active Engagement Throughout the Transition Process, Actively Seeking Social Interactions, Engaging in Exploration, Internal Processes Leading to Self-Acceptance, Self-Efficacy, Shifts Leading to Embracing Change and Flexibility, and Utilization of Agency. Based on the analysis, a theoretical model emerged that highlighted the importance of internal and external coping processes in facilitating gender identity development and navigating stressors among trans individuals. Clinical implications focusing on how to implement facilitative coping processes are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  6. Clinicians’ Perceptions of the Usefulness of a Communication Facilitator in the Intensive Care Unit

    PubMed Central

    Howell, Abby; Nielsen, Elizabeth L.; Turner, Anne M.; Curtis, J. Randall; Engelberg, Ruth A.

    2015-01-01

    Background Despite its documented importance, communication between clinicians and patients’ families in the intensive care unit often fails to meet families’ needs, and interventions to improve communication are needed. Use of a communication facilitator—an additional staff member—to improve communication between clinicians and patients’ families is the focus of an ongoing randomized trial. The clinical team’s acceptance of the communication facilitator as an integral part of the team is important. Objectives To explore clinicians’ perceptions of the usefulness of a communication facilitator in the intensive care unit. Methods Fourteen semistructured qualitative interviews to assess perspectives of physicians, nurses, and social workers who had experience with the communication facilitator intervention on the intervention and the role of the facilitator. Methods based on grounded theory were used to analyze the data. Results Clinicians’ perceived facilitators as (1) facilitating communication between patients’ families and clinicians, (2) providing practical and emotional support for patients’ families, and (3) providing practical and emotional support for clinicians. Clinicians were enthusiastic about the communication facilitator but concerned about overlapping or conflicting roles. Conclusions Clinicians in the intensive care unit saw the facilitator intervention as enhancing communication and supporting both patients’ families and clinicians. They also identified the importance of the facilitator within the interdisciplinary team. Negative perceptions about the use of a facilitator should be addressed before the intervention is implemented, in order to ensure its effectiveness. PMID:25179033

  7. Implementing high-performance work practices in healthcare organizations: qualitative and conceptual evidence.

    PubMed

    McAlearney, Ann Scheck; Robbins, Julie; Garman, Andrew N; Song, Paula H

    2013-01-01

    Studies across industries suggest that the systematic use of high-performance work practices (HPWPs) may be an effective but underused strategy to improve quality of care in healthcare organizations. Optimal use of HPWPs depends on how they are implemented, yet we know little about their implementation in healthcare. We conducted 67 key informant interviews in five healthcare organizations, each considered to have exemplary work practices in place and to deliver high-quality care, as part of an extensive study of HPWP use in healthcare. We analyzed interview transcripts inductively and deductively to examine why and how organizations implement HPWPs. We used an evidence-based model of complex innovation adoption to guide our exploration of factors that facilitate HPWP implementation. We found considerable variability in interviewees' reasons for implementing HPWPs, including macro-organizational (strategic level) and micro-organizational (individual level) reasons. This variability highlighted the complex context for HPWP implementation in many organizations. We also found that our application of an innovation implementation model helped clarify and categorize facilitators of HPWP implementation, thus providing insight on how these factors can contribute to implementation effectiveness. Focusing efforts on clarifying definitions, building commitment, and ensuring consistency in the application of work practices may be particularly important elements of successful implementation.

  8. Testing the implementation and sustainment facilitation (ISF) strategy as an effective adjunct to the Addiction Technology Transfer Center (ATTC) strategy: study protocol for a cluster randomized trial.

    PubMed

    Garner, Bryan R; Zehner, Mark; Roosa, Mathew R; Martino, Steve; Gotham, Heather J; Ball, Elizabeth L; Stilen, Patricia; Speck, Kathryn; Vandersloot, Denna; Rieckmann, Traci R; Chaple, Michael; Martin, Erika G; Kaiser, David; Ford, James H

    2017-11-17

    Improving the extent to which evidence-based practices (EBPs)-treatments that have been empirically shown to be efficacious or effective-are integrated within routine practice is a well-documented challenge across numerous areas of health. In 2014, the National Institute on Drug Abuse funded a type 2 effectiveness-implementation hybrid trial titled the substance abuse treatment to HIV Care (SAT2HIV) Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI) for substance use as an adjunct to usual care within AIDS service organizations (ASOs) as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center (ATTC) model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the ISF Experiment. Using a cluster randomized design, case management and leadership staff from 39 ASOs across the United States were randomized to receive either the ATTC strategy (control condition) or the ATTC + ISF strategy (experimental condition). The ATTC strategy is staff-focused and includes 10 discrete strategies (e.g., provide centralized technical assistance, conduct educational meetings, provide ongoing consultation). The ISF strategy is organization-focused and includes seven discrete strategies (e.g., use an implementation advisor, organize implementation team meetings, conduct cyclical small tests of change). Building upon the exploration-preparation-implementation-sustainment (EPIS) framework, the effectiveness of the ISF strategy is examined via three staff-level measures: (1) time-to-proficiency (i.e., preparation phase outcome), (2) implementation effectiveness (i.e., implementation phase outcome), and (3) level of sustainment (i.e., sustainment phase outcome). Although not without limitations, the ISF

  9. Factors Affecting Service Learning Implementation: A Comparison of Novice and Veteran Teachers

    ERIC Educational Resources Information Center

    Losser, Janet L.; Caldarella, Paul; Black, Sharon J.; Pate, P. Elizabeth

    2018-01-01

    This qualitative study investigated factors that facilitate and hinder implementation of service learning for novice and veteran teachers. We conducted case studies of three novice teachers and three veteran teachers, using a cross-case analysis within and across groups. Confirming prior research, facilitating factors included teachers' knowledge…

  10. Examining Behavioral Consultation plus Computer-Based Implementation Planning on Teachers' Intervention Implementation in an Alternative School

    ERIC Educational Resources Information Center

    Long, Anna C. J.; Sanetti, Lisa M. Hagermoser; Lark, Catherine R.; Connolly, Jennifer J. G.

    2018-01-01

    Students who demonstrate the most challenging behaviors are at risk of school failure and are often placed in alternative schools, in which a primary goal is remediating behavioral and academic concerns to facilitate students' return to their community school. Consistently implemented evidence-based classroom management is necessary toward this…

  11. The Effectiveness of Remote Facilitation in Simulation-Based Pediatric Resuscitation Training for Medical Students.

    PubMed

    Ohta, Kunio; Kurosawa, Hiroshi; Shiima, Yuko; Ikeyama, Takanari; Scott, James; Hayes, Scott; Gould, Michael; Buchanan, Newton; Nadkarni, Vinay; Nishisaki, Akira

    2017-08-01

    To assess the effectiveness of pediatric simulation by remote facilitation. We hypothesized that simulation by remote facilitation is more effective compared to simulation by an on-site facilitator. We defined remote facilitation as a facilitator remotely (1) introduces simulation-based learning and simulation environment, (2) runs scenarios, and (3) performs debriefing with an on-site facilitator. A remote simulation program for medical students during pediatric rotation was implemented. Groups were allocated to either remote or on-site facilitation depending on the availability of telemedicine technology. Both groups had identical 1-hour simulation sessions with 2 scenarios and debriefing. Their team performance was assessed with behavioral assessment tool by a trained rater. Perception by students was evaluated with Likert scale (1-7). Fifteen groups with 89 students participated in a simulation by remote facilitation, and 8 groups with 47 students participated in a simulation by on-site facilitation. Participant demographics and previous simulation experience were similar. Both groups improved their performance from first to second scenario: groups by remote simulation (first [8.5 ± 4.2] vs second [13.2 ± 6.2], P = 0.003), and groups by on-site simulation (first [6.9 ± 4.1] vs second [12.4 ± 6.4], P = 0.056). The performance improvement was not significantly different between the 2 groups (P = 0.94). Faculty evaluation by students was equally high in both groups (7 vs 7; P = 0.65). A pediatric acute care simulation by remote facilitation significantly improved students' performance. In this pilot study, remote facilitation seems as effective as a traditional, locally facilitated simulation. The remote simulation can be a strong alternative method, especially where experienced facilitators are limited.

  12. Sporting programs for inactive population groups: factors influencing implementation in the organized sports setting.

    PubMed

    Ooms, Linda; Veenhof, Cindy; Schipper-van Veldhoven, Nicolette; de Bakker, Dinny H

    2015-01-01

    The organized sports sector has received increased attention as a setting to promote health-enhancing physical activity (HEPA) to the general population. For significant public health impact, it is important that successful HEPA programs are widely adopted, implemented and continued as ongoing practice. The importance of evaluating the context in which programs are implemented has been identified as critical. However, little research has focused on understanding the organized sports implementation context, including factors facilitating and impeding implementation. In this study, the main factors influencing implementation of HEPA programs in the organized sports setting were studied. Fourteen sporting programs in the Netherlands aimed at increasing participation in sports by inactive population groups and funded within the National Action Plan for Sport and Exercise (NAPSE) were investigated. The programs were developed by ten Dutch National Sports Federations (NSFs) and implemented by different sports clubs in the Netherlands over a 3-year implementation period (June 2008-June 2011). The qualitative research component involved yearly face-to-face interviews (i.e. fourteen interviews each year, n = 12 program coordinators) and a group meeting with the program coordinators of the NSFs (n = 8). Cross-case comparisons and thematic analyses were performed to identify and categorize important facilitating and impeding factors respectively. The quantitative research component, used to identify the most important facilitating and impeding factors across all sporting programs, consisted of ranking of factors according to importance by the program coordinators (n = 12). Different factors act during six identified (implementation) phases. When comparing factors across phases, several key learnings were evident. Successful implementation relied, for example, on program design and enthusiastic individuals within sporting organizations. On the other hand, inactive

  13. Implementing the ABCDE Bundle into Everyday Care: Opportunities, Challenges and Lessons Learned for Implementing the ICU Pain, Agitation and Delirium (PAD) Guidelines

    PubMed Central

    Balas, Michele C.; Burke, William J.; Gannon, David; Cohen, Marlene Z.; Colburn, Lois; Bevil, Catherine; Franz, Doug; Olsen, Keith M.; Ely, E. Wesley; Vasilevskis, Eduard E.

    2014-01-01

    Objective The Awakening and Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle is an evidence-based, interprofessional, multicomponent strategy for minimizing sedative exposure, reducing duration of mechanical ventilation and managing intensive care unit (ICU) acquired delirium and weakness. The purpose of this study was to identify facilitators and barriers to ABCDE bundle adoption and to evaluate the extent to which bundle implementation was effective, sustainable, and conducive to dissemination. Design Prospective, before-after, mixed-methods study. Setting Five adult ICUs, 1 step-down unit, and a special care unit located in a 624 bed, academic medical center Subjects Interprofessional ICU team members at participating institution. Interventions and Measurements In collaboration with the participating institution, we developed, implemented, and refined an ABCDE bundle policy. Over the course of an 18 month period, all ICU team members were offered the opportunity to participate in numerous, multimodal educational efforts. Three focus group sessions, 3 online surveys, and 1 educational evaluation were administered in an attempt to identify facilitators and barriers to bundle adoption. Main Results Factors believed to facilitate bundle implementation included: 1) the performance of daily, interdisciplinary, rounds, 2) engagement of key implementation leaders, 3) sustained and diverse educational efforts, and 4) the bundle's quality and strength. Barriers identified included: 1) intervention related issues (e.g. timing of trials, fear of adverse events), 2) communication and care coordination challenges, 3) knowledge deficits, 4) workload concerns, and 5) documentation burden. Despite these challenges, participants believed implementation ultimately benefited patients, improved interdisciplinary communication, and empowered nurses and other ICU team members. Conclusions In this study of the implementation of the ABCDE

  14. Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach.

    PubMed

    Ayakaka, Irene; Ackerman, Sara; Ggita, Joseph M; Kajubi, Phoebe; Dowdy, David; Haberer, Jessica E; Fair, Elizabeth; Hopewell, Philip; Handley, Margaret A; Cattamanchi, Adithya; Katamba, Achilles; Davis, J Lucian

    2017-03-09

    The World Health Organization recommends routine household tuberculosis contact investigation in high-burden countries but adoption has been limited. We sought to identify barriers to and facilitators of TB contact investigation during its introduction in Kampala, Uganda. We collected cross-sectional qualitative data through focus group discussions and interviews with stakeholders, addressing three core activities of contact investigation: arranging household screening visits through index TB patients, visiting households to screen contacts and refer them to clinics, and evaluating at-risk contacts coming to clinics. We analyzed the data using a validated theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, and sought to identify targeted interventions using the related Behavior Change Wheel implementation framework. We led seven focus-group discussions with 61 health-care workers, two with 21 lay health workers (LHWs), and one with four household contacts of newly diagnosed TB patients. We, in addition, performed 32 interviews with household contacts from 14 households of newly diagnosed TB patients. Commonly noted barriers included stigma, limited knowledge about TB among contacts, insufficient time and space in clinics for counselling, mistrust of health-center staff among index patients and contacts, and high travel costs for LHWs and contacts. The most important facilitators identified were the personalized and enabling services provided by LHWs. We identified education, persuasion, enablement, modeling of health-positive behaviors, incentivization, and restructuring of the service environment as relevant intervention functions with potential to alleviate barriers to and enhance facilitators of TB contact investigation. The use of a behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and facilitators of TB contact

  15. What Will It Take To Ensure Implementation? A Content Literacy Dilemma.

    ERIC Educational Resources Information Center

    Rafferty, Cathleen D.

    A study attempted to determine a variety of facilitating and militating elements that influence Content Area Literacy/Learning Teaching Strategies (CAL/LTS) implementation. It investigated the impact of various contextual or ecological features embedded within the student teaching experience on student teachers' ability to implement various…

  16. Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework.

    PubMed

    Pfadenhauer, Lisa M; Gerhardus, Ansgar; Mozygemba, Kati; Lysdahl, Kristin Bakke; Booth, Andrew; Hofmann, Bjørn; Wahlster, Philip; Polus, Stephanie; Burns, Jacob; Brereton, Louise; Rehfuess, Eva

    2017-02-15

    The effectiveness of complex interventions, as well as their success in reaching relevant populations, is critically influenced by their implementation in a given context. Current conceptual frameworks often fail to address context and implementation in an integrated way and, where addressed, they tend to focus on organisational context and are mostly concerned with specific health fields. Our objective was to develop a framework to facilitate the structured and comprehensive conceptualisation and assessment of context and implementation of complex interventions. The Context and Implementation of Complex Interventions (CICI) framework was developed in an iterative manner and underwent extensive application. An initial framework based on a scoping review was tested in rapid assessments, revealing inconsistencies with respect to the underlying concepts. Thus, pragmatic utility concept analysis was undertaken to advance the concepts of context and implementation. Based on these findings, the framework was revised and applied in several systematic reviews, one health technology assessment (HTA) and one applicability assessment of very different complex interventions. Lessons learnt from these applications and from peer review were incorporated, resulting in the CICI framework. The CICI framework comprises three dimensions-context, implementation and setting-which interact with one another and with the intervention dimension. Context comprises seven domains (i.e., geographical, epidemiological, socio-cultural, socio-economic, ethical, legal, political); implementation consists of five domains (i.e., implementation theory, process, strategies, agents and outcomes); setting refers to the specific physical location, in which the intervention is put into practise. The intervention and the way it is implemented in a given setting and context can occur on a micro, meso and macro level. Tools to operationalise the framework comprise a checklist, data extraction tools for

  17. Facilitating superior chronic disease management through a knowledge-based systems development model.

    PubMed

    Wickramasinghe, Nilmini S; Goldberg, Steve

    2008-01-01

    To date, the adoption and diffusion of technology-enabled solutions to deliver better healthcare has been slow. There are many reasons for this. One of the most significant is that the existing methodologies that are normally used in general for Information and Communications Technology (ICT) implementations tend to be less successful in a healthcare context. This paper describes a knowledge-based adaptive mapping to realisation methodology to traverse successfully from idea to realisation rapidly and without compromising rigour so that success ensues. It is discussed in connection with trying to implement superior ICT-enabled approaches to facilitate superior Chronic Disease Management (CDM).

  18. Evidence and resources to implement Pharmacogenetic Knowledge for Precision Medicine

    PubMed Central

    Caudle, Kelly E.; Gammal, Roseann S.; Whirl-Carrillo, Michelle; Hoffman, James M.; Relling, Mary V.; Klein, Teri E.

    2016-01-01

    Purpose Implementation of pharmacogenetics into clinical practice has been relatively slow despite substantial scientific progress over the last decade. One barrier that inhibits uptake of pharmacogenetics into routine clinical practice is the lack of knowledge of how to translate a genetic test into a clinical action based on current evidence. The purpose of this paper is to describe the current state of pharmacogenetic evidence and evidence-based resources that facilitate the uptake of pharmacogenetics into clinical practice. Summary Controversy exists over the required evidence threshold needed for routine clinical implementation of pharmacogenetics. Large randomized controlled trials are not clinically feasible or necessary for many pharmacogenetic applications. Online resources exist like the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Pharmacogenomics Knowledgebase (PharmGKB) that provide freely available, evidence-based resources that facilitate the translation of genetic laboratory test results into actionable prescribing recommendations for specific drugs. Conclusion Resources provided by organizations such as CPIC and PharmGKB that use standardized approaches to evaluate the literature and provide clinical guidance are essential for the implementation of pharmacogenetics into routine clinical practice. PMID:27864205

  19. Facilitating the implementation of the American College of Surgeons/Association of Program Directors in Surgery phase III skills curriculum: training faculty in the assessment of team skills.

    PubMed

    Hull, Louise; Arora, Sonal; Stefanidis, Dimitrios; Sevdalis, Nick

    2015-11-01

    Effective teamwork is critical to safety in the operating room; however, implementation of phase III of the American College of Surgeons (ACS) and Association of Program Directors in Surgery (APDS) Curriculum that focuses on team-based skills remains worryingly low. Training and assessing the complexities of teamwork is challenging. The objective of this study was to establish guidelines and recommendations for training faculty in assessing/debriefing team skills. A multistage survey-based consensus study was completed by 108 experts responsible for training and assessing surgical residents from the ACS Accredited Educational Institutes. Experts agreed that a program to teach faculty to assess team-based skills should include training in the recognition of teamwork skills, practice rating these skills, and training in the provision of feedback/debriefing. Agreement was reached that faculty responsible for conducting team-based skills assessment should be revalidated every 2 years and stringent proficiency criteria should be met. Faculty development is critical to ensure high-quality, standardized training and assessment. Training faculty to assess team-based skills has the potential to facilitate the effective implementation of phase III of the ACS and APDS Curriculum. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Reduced prevalence and severity of wounds following implementation of the Champions for Skin Integrity model to facilitate uptake of evidence-based practice in aged care.

    PubMed

    Edwards, Helen E; Chang, Anne M; Gibb, Michelle; Finlayson, Kathleen J; Parker, Christina; O'Reilly, Maria; McDowell, Jan; Shuter, Patricia

    2017-12-01

    To evaluate the implementation of the Champions for Skin Integrity model on facilitating uptake of evidence-based wound management and improving skin integrity in residents of aged care facilities. The incidence of skin tears, pressure injuries and leg ulcers increases with age, and such wounds can be a serious issue in aged care facilities. Older adults are not only at higher risk for wounds related to chronic disease but also injuries related to falls and manual handling requirements. A longitudinal, pre-post design. The Champions for Skin Integrity model was developed using evidence-based strategies for transfer of evidence into practice. Data were collected before and six months after implementation of the model. Data on wound management and skin integrity were obtained from two random samples of residents (n = 200 pre; n = 201 post) from seven aged care facilities. A staff survey was also undertaken (n = 126 pre; n = 143 post) of experience, knowledge and evidence-based wound management. Descriptive statistics were calculated for all variables. Where relevant, chi-square for independence or t-tests were used to identify differences between the pre-/postdata. There was a significant decrease in the number of residents with a wound of any type (54% pre vs 43% post, χ 2 4·2, p = 0·041), as well as a significant reduction in specific wound types, for example pressure injuries (24% pre vs 10% post, χ 2 14·1, p < 0·001), following implementation of the model. An increase in implementation of evidence-based wound management and prevention strategies was observed in the postimplementation sample in comparison with the preimplementation sample. This included use of limb protectors and/or protective clothing 6% pre vs 20% post (χ 2 17·0, p < 0·001) and use of an emollient or soap alternative for bathing residents (50% pre vs 74% post, χ 2 13·9, p = 0·001). Implementation of the model in this sample fostered an increase in implementation of

  1. Implementing Culture Change in Nursing Homes: An Adaptive Leadership Framework.

    PubMed

    Corazzini, Kirsten; Twersky, Jack; White, Heidi K; Buhr, Gwendolen T; McConnell, Eleanor S; Weiner, Madeline; Colón-Emeric, Cathleen S

    2015-08-01

    To describe key adaptive challenges and leadership behaviors to implement culture change for person-directed care. The study design was a qualitative, observational study of nursing home staff perceptions of the implementation of culture change in each of 3 nursing homes. We conducted 7 focus groups of licensed and unlicensed nursing staff, medical care providers, and administrators. Questions explored perceptions of facilitators and barriers to culture change. Using a template organizing style of analysis with immersion/crystallization, themes of barriers and facilitators were coded for adaptive challenges and leadership. Six key themes emerged, including relationships, standards and expectations, motivation and vision, workload, respect of personhood, and physical environment. Within each theme, participants identified barriers that were adaptive challenges and facilitators that were examples of adaptive leadership. Commonly identified challenges were how to provide person-directed care in the context of extant rules or policies or how to develop staff motivated to provide person-directed care. Implementing culture change requires the recognition of adaptive challenges for which there are no technical solutions, but which require reframing of norms and expectations, and the development of novel and flexible solutions. Managers and administrators seeking to implement person-directed care will need to consider the role of adaptive leadership to address these adaptive challenges. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Barriers and Facilitators to Implementing the Uruguayan Dietary Guidelines in Everyday Life: A Citizen Perspective.

    PubMed

    Machín, Leandro; Aschemann-Witzel, Jessica; Patiño, Angelina; Moratorio, Ximena; Bandeira, Elisa; Curutchet, María Rosa; Martínez, Joseline; Bove, Isabel; Molina, Verónika; Giménez, Ana; Ares, Gastón

    2017-12-01

    An in-depth understanding of the citizen's perception and behavior is needed for the development of targeted public policies and interventions that can successfully encourage people to shift their dietary patterns and contribute to the prevention of non-communicable diseases. The present work aimed to identify barriers and facilitators for the adoption of the new Uruguayan dietary guidelines from a citizen perspective. Twelve semistructured focus groups were conducted with a total of 91 people (81% female, age 18-64 years) from 3 Uruguayan cities. Findings identified several multifaceted barriers, including lack of value given to food, meals and cooking, taste preferences for unhealthy foods, the unsupportive social context in terms of household preferences, customs and social norms, and lack of control of the situation through insufficient food capabilities, time scarcity, and an adverse food market environment. The potential facilitators discussed in the focus groups were mainly related to policies and regulations to discourage consumption of unhealthful products and the provision of more education and information. In addition, respondents acknowledged the need for own actions in terms of seeking greater cooking skills and enjoyment, incorporating changes in their daily routines and promoting a more supportive social environment. Results suggest that supportive actions are needed to support citizen's adoption of the new Uruguayan dietary guidelines.

  3. Introducing a multimedia course to enhance health professionals' skills to facilitate communities of practice.

    PubMed

    Jakubec, Sonya L; Parboosingh, John; Colvin, Barbara

    2014-01-01

    Scholarship about communities of practice (COP) is uncovering evidence that interactivity between community members contributes to improvement in practice. Leadership and facilitation are crucial elements of successful COP implementation. The purpose of this paper is to describe an innovative COP facilitator's course and report on the experiences of participants in the first course. In response to this need and emerging evidence, an on-line COP facilitator's course was developed and implemented in Alberta, Canada, in 2011. This course included a home-based COP practicum, introductory face-to-face session, an on-line discussion board moderated by faculty and on-line learning modules. Evaluation of the course was formalized in a qualitative study incorporating content analysis of postings, semi-structured interviews of successful participants and narrative responses to questions in a post course survey. A total of 15 of 22 participants perceived they acquired basic knowledge about community facilitation by completing the self-learning modules and assignments. Many did not establish home-based COP and only partially participated in the interactive components of the course. Six participants successfully completed the course by establishing home-based COP and actively participating in the social and interactive components of the course. They perceived they met course objectives and greatly benefited from participation in the course, in particular when they pushed themselves to facilitate in new and different ways, and when they were actively engaged with their home-based COP where they could practice and receive feedback. While the main reasons why participants dropped out or failed to complete all course components were reported, the experiences and perceptions of six participants who successfully completed all course components form the major part of the evaluation of the course and hence introduce bias. A more in depth analysis of why learners are reluctant to engage

  4. Embracing change: practical and theoretical considerations for successful implementation of technology assisting upper limb training in stroke

    PubMed Central

    2012-01-01

    Background Rehabilitation technology for upper limb training of stroke patients may play an important role as therapy tool in future, in order to meet the increasing therapy demand. Currently, implementation of this technology in the clinic remains low. This study aimed at identifying criteria and conditions that people, involved in development of such technology, should take into account to achieve a (more) successful implementation of the technology in the clinic. Methods A literature search was performed in PubMed and IEEE databases, and semi-structured interviews with therapists in stroke rehabilitation were held, to identify criteria and conditions technology should meet to facilitate (implementation of) technology-assisted arm-hand skills training in rehabilitation therapy of stroke patients. In addition, an implementation strategy frequently applied in general health care was used to compose a stepwise guidance to facilitate successful implementation of this technology in therapy of stroke patients. Implementation-related criteria mentioned by therapists during the interviews were integrated in this guidance. Results Results indicate that, related to therapy content, technology should facilitate repetition of task-related movements, tailored to the patient and patient’s goals, in a meaningful context. Variability and increasing levels of difficulty in exercises should be on offer. Regarding hardware and software design of technology, the system should facilitate quick familiarisation and be easily adjustable to individual patients during therapy by therapists (and assistants). The system should facilitate adaptation to individual patients’ needs and their progression over time, should be adjustable as to various task-related variables, should be able to provide instructions and feedback, and should be able to document patient’s progression. The implementation process of technology in the clinic is provided as a stepwise guidance that consists of five

  5. Learning to Lead, Leading to Learn: How Facilitators Learn to Lead Lesson Study

    ERIC Educational Resources Information Center

    Lewis, Jennifer M.

    2016-01-01

    This article presents research on how teacher developers in the United States learn to conduct lesson study. Although the practice of lesson study is expanding rapidly in the US, high-quality implementation requires skilled facilitation. In contexts such as the United States where this form of professional development is relatively novel, few…

  6. Minority Woman's Survival Kit: Personal and Professional Development for Minority Women. Facilitator's Manual.

    ERIC Educational Resources Information Center

    Jackson, Stanlie M., Ed.

    This facilitator's manual consists of guidelines and materials for use in conducting a workshop dealing with the professionl and personal development of minority women. Included in the first half of the manual are the following pieces of information pertaining to implementation of the workshop: background on the need for and development of the…

  7. Service Learning with Children Affected by Poverty: Facilitating Multicultural Competence in Counseling Education Students

    ERIC Educational Resources Information Center

    Baggerly, Jennifer

    2006-01-01

    The author defines and presents a rationale for service learning, provides procedures for implementing service learning with children affected by poverty, and describes methods of facilitating multicultural counseling competence. Examples are provided from a graduate counseling class that conducted group play therapy with 11 African American…

  8. Woman--A Sense of Identity: A Counseling Intervention to Facilitate Personal Growth in Women.

    ERIC Educational Resources Information Center

    Loeffler, Dorothy; Fiedler, Lois

    1979-01-01

    An intervention was designed, implemented, and evaluated with the goal of facilitating the psychological growth of women. Focus was on increased self-esteem and competence through self-awareness, skills development, cognitive changes, and changes in overt behavior. Evaluation studies described indicate the model's effectiveness with two…

  9. Challenges and Facilitators to the Implementation of a Sport Education Season: The Voices of Teacher Candidates

    ERIC Educational Resources Information Center

    Braga, Luciana; Liversedge, Philip

    2017-01-01

    Background/Purpose: Physical education teacher education (PETE) programs have been encouraged to provide teacher candidates (TCs) with the competencies and dispositions needed to implement a variety of curriculum and instructional models. Likewise, it has been suggested that TCs should have opportunities to practice implementing such models in…

  10. The Journey through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation

    PubMed Central

    McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia J; Huerta, Timothy R

    2015-01-01

    Objective To improve understanding of facilitators of EHR system implementation, paying particular attention to opportunities to maximize physician adoption and effective deployment. Data Sources/Study Setting Primary data collected from 47 physician and 35 administrative key informants from six U.S. health care organizations identified because of purported success with EHR implementation. Study Design We conducted interviews and focus groups in an extensive qualitative study. Data Collection/Extraction Methods Verbatim transcripts were analyzed both deductively and inductively using the constant comparative method. Principal Findings Conceptualizing EHR adoption as loss through the lens of Kübler-Ross's five stages of grief model may help individuals and organizations more effectively orient to the challenge of change. Coupled with Kotter's eight-step change management framework, we offer a structure to facilitate organizations' movement through the EHR implementation journey. Combining insights from these frameworks, we identify 10 EHR strategies that can help address EHR implementation barriers. Conclusions Loss is one part of change often overlooked. Addressing it directly and compassionately can potentially facilitate the EHR implementation journey. We offer a summarized list of deployment strategies that are sensitive to these issues to support physician transition to new technologies that will bring value to clinical practice. PMID:25219627

  11. Barriers and Facilitators to Self-Directed Learning in Continuing Professional Development for Physicians in Canada: A Scoping Review.

    PubMed

    Jeong, Dahn; Presseau, Justin; ElChamaa, Rima; Naumann, Danielle N; Mascaro, Colin; Luconi, Francesca; Smith, Karen M; Kitto, Simon

    2018-04-10

    This scoping review explored the barriers and facilitators that influence engagement in and implementation of self-directed learning (SDL) in continuing professional development (CPD) for physicians in Canada. This review followed the six-stage scoping review framework of Arksey and O'Malley and of Daudt et al. In 2015, the authors searched eight online databases for English-language Canadian articles published January 2005-December 2015. To chart and analyze the data from the 17 included studies, they employed two-step analysis process of conventional content analysis followed by directed coding guided by the Theoretical Domains Framework (TDF). Conventional content analysis generated five categories of barriers and facilitators: individual, program, technological, environmental, and workplace/organizational. Directed coding guided by the TDF allowed analysis of barriers and facilitators to behavior change according to two key groups: physicians engaging in SDL and SDL developers designing and implementing SDL programs. Of the 318 total barriers and facilitators coded, 290 (91.2%) were coded for physicians and 28 (8.8%) for SDL developers. The majority (209; 65.7%) were coded in four key TDF domains: environmental context and resources, social influences, beliefs about consequences, and behavioral regulation. This scoping review identified five categories of barriers and facilitators in the literature and four key TDF domains where most factors related to behavior change of physicians and SDL developers regarding SDL programs in CPD were coded. There was a significant gap in the literature about factors that may contribute to SDL developers' capacity to design and implement SDL programs in CPD.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way

  12. Implementation activities for the Wisconsin Highway Research Program (WHRP).

    DOT National Transportation Integrated Search

    2010-03-01

    The Wisconsin Highway Research Program (WHRP) Steering Committee commissioned an implementation pilot : program in 2006 to facilitate the incorporation of research results into the programs, standards, and processes of : the Wisconsin Department of T...

  13. Understanding Facilitation: Theory and Principles.

    ERIC Educational Resources Information Center

    Hogan, Christine

    This book introduces newcomers to the concept of facilitation, and it presents a critical analysis of established and current theory on facilitation for existing practitioners. The following are among the topics discussed: (1) emergence of the field of facilitation; (2) development of facilitation in management; (3) development of facilitation in…

  14. Facilitating the implementation and efficacy of health-promoting schools via an action-research approach in Taiwan.

    PubMed

    Chang, Fong-Ching; Liu, Chieh-Hsing; Liao, Li-Ling; Niu, Yu-Zhen; Cheng, Chi-Chia; Chou, Hsin-Pei; Chang, Tzu-Chau

    2014-06-01

    Taiwan launched its evidence-based health-promoting school (HPS) program via an action-research approach in 2010. The program featured a collaborative partnership between schools, local education authorities and university support networks. This study was focused on examining whether an HPS action-research approach was effective in advancing HPS implementation, perceived HPS impact and perceived HPS efficacy in Taiwan. In 2011, questionnaires were sent to 900 sample schools in Taiwan. A total of 621 schools returned the questionnaire, including 488 primary schools and 133 middle schools. The response rate was 69%. This study compared the difference in HPS implementation status, perceived HPS impact and perceived HPS efficacy between those schools that had implemented action-research HPS (138 schools) and those that had not (483 schools). The univariate analysis results indicated that the HPS implementation levels for components that included school health policies, physical environment, social environment, teaching activities and school-community relations were significantly higher in action-research schools than in non-action-research schools. Teachers in action-research schools reported significantly higher levels of HPS impact and HPS efficacy than non-action-research schools. The multivariate analysis results indicated that after controlling for school level and HPS funding, the HPS action-research approach was significantly positively related to greater levels of HPS implementation, perceived HPS impact and perceived HPS efficacy.

  15. Implementing Evidence-Based Practice: A Review of the Empirical Research Literature

    ERIC Educational Resources Information Center

    Gray, Mel; Joy, Elyssa; Plath, Debbie; Webb, Stephen A.

    2013-01-01

    The article reports on the findings of a review of empirical studies examining the implementation of evidence-based practice (EBP) in the human services. Eleven studies were located that defined EBP as a research-informed, clinical decision-making process and identified barriers and facilitators to EBP implementation. A thematic analysis of the…

  16. Specifying an implementation framework for Veterans Affairs antimicrobial stewardship programmes: using a factor analysis approach.

    PubMed

    Chou, Ann F; Graber, Christopher J; Zhang, Yue; Jones, Makoto; Goetz, Matthew Bidwell; Madaras-Kelly, Karl; Samore, Matthew; Glassman, Peter A

    2018-06-04

    Inappropriate antibiotic use poses a serious threat to patient safety. Antimicrobial stewardship programmes (ASPs) may optimize antimicrobial use and improve patient outcomes, but their implementation remains an organizational challenge. Using the Promoting Action on Research Implementation in Health Services (PARiHS) framework, this study aimed to identify organizational factors that may facilitate ASP design, development and implementation. Among 130 Veterans Affairs facilities that offered acute care, we classified organizational variables supporting antimicrobial stewardship activities into three PARiHS domains: evidence to encompass sources of knowledge; contexts to translate evidence into practice; and facilitation to enhance the implementation process. We conducted a series of exploratory factor analyses to identify conceptually linked factor scales. Cronbach's alphas were calculated. Variables with large uniqueness values were left as single factors. We identified 32 factors, including six constructs derived from factor analyses under the three PARiHS domains. In the evidence domain, four factors described guidelines and clinical pathways. The context domain was broken into three main categories: (i) receptive context (15 factors describing resources, affiliations/networks, formalized policies/practices, decision-making, receptiveness to change); (ii) team functioning (1 factor); and (iii) evaluation/feedback (5 factors). Within facilitation, two factors described facilitator roles and tasks and five captured skills and training. We mapped survey data onto PARiHS domains to identify factors that may be adapted to facilitate ASP uptake. Our model encompasses mostly mutable factors whose relationships with performance outcomes may be explored to optimize antimicrobial use. Our framework also provides an analytical model for determining whether leveraging existing organizational processes can potentially optimize ASP performance.

  17. Halal Logistics Implementation in Malaysia: A Practical View

    NASA Astrophysics Data System (ADS)

    Sham, Rohana; Zuraidah Rasi, Raja; Abdamia, Noranita; Mohamed, Suhana; Thahira Bibi, TKM

    2017-08-01

    Concept of halal is not only acceptable world wide by the Muslim society but also to the non Muslim. However, the implementing of halal logistics in daily operation experience a few difficulties especially on the implementation part. Although there are many academic research paper that highlight the issue of halal logistics and the critical success factor, until today, halal logistics in Malaysia is still experiencing a hiccup. This paper try to highlight a few simple ways of implementation of halal logistics that could enhance the total implementation concept at the very least cost to create benefit to all society. The Paper deals with a few aspect of possible implementation and practice to facilitate the halal logistics approach in daily operation. The main objective is to look at the possible method of implementation and critical success factors towards the implementation of halal logistics operation in daily goods movement in Malaysia.

  18. Facilitators and barriers HPV unvaccinated girls after 5 years of program implementation.

    PubMed

    Firenze, Alberto; Marsala, Maria Grazia Laura; Bonanno, Valentina; Maranto, Marianna; Ferrara, Clara; Giovannelli, Lucia; Restivo, Vincenzo

    2015-01-01

    Understanding perceptions and characteristics of human papillomavirus (HPV) vaccinated and non-vaccinated girls can inform communication activities and vaccine delivery strategies. The purpose of this study was to evaluate knowledge and factors associated with HPV unvaccinated girls after five years of vaccination program implementation in Sicily, an Italian region with low vaccination coverage (<50.0%). A cross-sectional study was conducted through a questionnaire designed to assess knowledge and vaccination status of girls of 1997, 1998, 1999, and 2000 birth cohorts. The sample consisted of 350 girls who attended three high schools. Multivariable logistic regression analysis was conducted to examine predictors of vaccine refusal. The survey sample of girls shows that the 43.1% were HPV unvaccinated. A significant increased risk of being unvaccinated originated from the belief that the vaccine was too new (AdjOR = 21.08, CI95% = 2.57-172.97) and that it may cause cervical cancer (AdjOR = 4.36, CI95% = 1.26-15.07), along with having friends as a source of information on the vaccine (AdjOR = 3.67, CI95% = 1.63-8.25). A significant inverse association was observed between being unvaccinated and having Pediatrician/General practitioner as a source of information on HPV vaccine (AdjOR = 0.40, CI95% = 0.24-0.68). Many girls lack the fundamental knowledge about the HPV vaccine. The key issue is the promotion and implementation of information programs to raise awareness of girls on the importance of the vaccine.

  19. Using appreciative inquiry to facilitate implementation of the recovery model in mental health agencies.

    PubMed

    Clossey, Laurene; Mehnert, Kevin; Silva, Sara

    2011-11-01

    This article describes an organizational development tool called appreciative inquiry (AI) and its use in mental health to aid agencies implementing recovery model services. AI is a discursive tool with the power to shift dominant organizational cultures. Its philosophical underpinnings emphasize values consistent with recovery: community, empowerment, and positive focus. Recent research in the field of mental health demonstrates the salience of organizational cultural context in affecting new service adoption. This article explores how AI could be helpful in shifting an organization's culture to render it compatible with recovery through descriptions of two mental health centers' use of the tool. The experiences described indicate that AI, if used consistently, empowers staff. The article concludes with consideration of the implications of this empowerment for recovery model implementation and directions for future research.

  20. Using a Virtual Environment to Deliver Evidence-Based Interventions: The Facilitator's Experience

    PubMed Central

    Villarruel, Antonia; Tschannen, Dana; Valladares, Angel; Yaksich, Joseph; Yeagley, Emily; Hawes, Armani

    2015-01-01

    Background Evidence-based interventions (EBIs) have the potential to maximize positive impact on communities. However, despite the quantity and quality of EBIs for prevention, the need for formalized training and associated training-related expenses, such as travel costs, program materials, and input of personnel hours, pose implementation challenges for many community-based organizations. In this study, the community of inquiry (CoI) framework was used to develop the virtual learning environment to support the adaptation of the ¡Cuídate! (Take Care of Yourself!) Training of Facilitators curriculum (an EBI) to train facilitators from community-based organizations. Objective The purpose of this study was to examine the feasibility of adapting a traditional face-to-face facilitator training program for ¡Cuídate!, a sexual risk reduction EBI for Latino youth, for use in a multi-user virtual environment (MUVE). Additionally, two aims of the study were explored: the acceptability of the facilitator training and the level of the facilitators’ knowledge and self-efficacy to implement the training. Methods A total of 35 facilitators were trained in the virtual environment. We evaluated the facilitators' experience in the virtual training environment and determined if the learning environment was acceptable and supported the acquisition of learning outcomes. To this end, the facilitators were surveyed using a modified community of inquiry survey, with questions specific to the Second Life environment and an open-ended questionnaire. In addition, a comparison to face-to-face training was conducted using survey methods. Results Results of the community of inquiry survey demonstrated a subscale mean of 23.11 (SD 4.12) out of a possible 30 on social presence, a subscale mean of 8.74 (SD 1.01) out of a possible 10 on teaching presence, and a subscale mean of 16.69 (SD 1.97) out of a possible 20 on cognitive presence. The comparison to face-to-face training showed no

  1. Collaboration between Mathematics Facilitators and Preschool Teachers Using the Innovative "Senso-Math" Preschool Program

    ERIC Educational Resources Information Center

    Hassidov, Dina; Ilany, Bat-Sheva

    2018-01-01

    This article presents a mixed-method study of the innovative "Senso-Math" preschool program and the reactions of both the facilitators, who underwent a special training program, and the preschool teachers in whose classes the program was implemented. The goal of the program is to enhance mathematical development in preschool children…

  2. Successful Transition to Elementary School and the Implementation of Facilitative Practices Specified in the Reggio-Emilia Philosophy

    ERIC Educational Resources Information Center

    Schneider, Barry H.; Manetti, Mara; Frattini, Laura; Rania, Nadia; Santo, Jonathan Bruce; Coplan, Robert J.; Cwinn, Eli

    2014-01-01

    Systematic, mandated facilitation of school transitions is an important but understudied aspect of the Reggio-Emilia approach to early childhood education admired internationally as best practice. We studied the links between Northern Italian transition practices and academic achievement, school liking, cooperativeness, and problem behaviors. We…

  3. Facilitated versus Non-Facilitated Online Case Discussions: Comparing Differences in Problem Space Coverage

    ERIC Educational Resources Information Center

    Ertmer, Peggy A.; Koehler, Adrie A.

    2015-01-01

    The facilitator plays a key role in guiding students' efforts during case discussions. However, few studies have compared differences in learning outcomes for students participating in facilitated versus non-facilitated discussions. In this research, we used "problem space coverage" as a learning measure to compare outcomes between…

  4. Physical Activity Promotion in Schools: Which Strategies Do Schools (Not) Implement and Which Socioecological Factors Are Associated with Implementation?

    ERIC Educational Resources Information Center

    Cardon, Greet M.; Van Acker, Ragnar; Seghers, Jan; De Martelaer, Kristine; Haerens, Leen L.; De Bourdeaudhuij, Ilse M. M.

    2012-01-01

    We studied the implementation and associated factors of strategies (e.g. sports after school and during lunch break, active schoolyards, active school commuting) and organizational principles (e.g. safe bike racks, pupil involvement) that facilitate the physical activity (PA)-promoting role of schools. Key representatives of 111 elementary and 125…

  5. Facilitators and barriers HPV unvaccinated girls after 5 years of program implementation

    PubMed Central

    Firenze, Alberto; Marsala, Maria Grazia Laura; Bonanno, Valentina; Maranto, Marianna; Ferrara, Clara; Giovannelli, Lucia; Restivo, Vincenzo

    2014-01-01

    Understanding perceptions and characteristics of human papillomavirus (HPV) vaccinated and non-vaccinated girls can inform communication activities and vaccine delivery strategies. The purpose of this study was to evaluate knowledge and factors associated with HPV unvaccinated girls after five years of vaccination program implementation in Sicily, an Italian region with low vaccination coverage (<50.0%). A cross-sectional study was conducted through a questionnaire designed to assess knowledge and vaccination status of girls of 1997, 1998, 1999, and 2000 birth cohorts. The sample consisted of 350 girls who attended three high schools. Multivariable logistic regression analysis was conducted to examine predictors of vaccine refusal. The survey sample of girls shows that the 43.1% were HPV unvaccinated. A significant increased risk of being unvaccinated originated from the belief that the vaccine was too new (AdjOR = 21.08, CI95% = 2.57–172.97) and that it may cause cervical cancer (AdjOR = 4.36, CI95% = 1.26–15.07), along with having friends as a source of information on the vaccine (AdjOR = 3.67, CI95% = 1.63–8.25). A significant inverse association was observed between being unvaccinated and having Pediatrician/General practitioner as a source of information on HPV vaccine (AdjOR = 0.40, CI95% = 0.24–0.68). Many girls lack the fundamental knowledge about the HPV vaccine. The key issue is the promotion and implementation of information programs to raise awareness of girls on the importance of the vaccine. PMID:25483543

  6. Supporting Community Pharmacies with Implementation of a Web-Based Medication Management Application.

    PubMed

    Turner, Kea; Renfro, Chelsea; Ferreri, Stefanie; Roberts, Kim; Pfeiffenberger, Trista; Shea, Christopher M

    2018-04-01

     Community pharmacists' role in clinical care is expanding in the United States and information systems are needed that extend beyond a dispensing workflow. As pharmacies adopt new systems, implementation support will be needed. This study identifies the barriers and facilitators experienced by community pharmacies in implementing a Web-based medication management application and describes the implementation strategies used to support these pharmacies.  Semistructured interviews were conducted with 28 program and research staff that provides support to community pharmacies participating in a statewide pharmacy network. Interviews were recorded, transcribed verbatim, and analyzed for themes using the Expert Recommendations for Implementing Change (ERIC).  Findings suggest that leadership support, clinical training, and computer literacy facilitated implementation, while lack of system integration, staff resistance to change, and provider reluctance to share data served as barriers. To overcome the barriers, implementation support was provided, such as assessing readiness for implementation, developing a standardized and interoperable care plan, and audit and feedback of documentation quality.  Participants used a wide array of strategies to support community pharmacies with implementation and tailored approaches to accommodate pharmacy-specific preferences. Most of the support was delivered preimplementation or in the early phase of implementation and by program or research staff rather than peer-to-peer. Implementing new pharmacy information system requires a significant amount of implementation support to help end-users learn about program features, how to integrate the software into workflow, and how to optimize the software to improve patient care. Future research should identify which implementation strategies are associated with program performance. Schattauer.

  7. The Use of Peer Facilitators To Enhance Self-Esteem Levels of At-Risk Students.

    ERIC Educational Resources Information Center

    Winkler, Joann B.

    This practicum addressed the problems of low self-esteem levels of at-risk students in kindergarten and in grades three and five by implementing a peer facilitator program. The Coopersmith Self-Esteem Inventory, the OUNCE Attitude Scale, and a Kindergarten Checklist of Low Self-Esteem Characteristics were used to determine the students'…

  8. SKITTER/implement mechanical interface

    NASA Technical Reports Server (NTRS)

    Cash, John Wilson, III; Cone, Alan E.; Garolera, Frank J.; German, David; Lindabury, David Peter; Luckado, Marshall Cleveland; Murphey, Craig; Rowell, John Bryan; Wilkinson, Brad

    1988-01-01

    SKITTER (Spacial Kinematic Inertial Translatory Tripod Extremity Robot) is a three-legged transport vehicle designed to perform under the unique environment of the moon. The objective of this project was to design a mechanical interface for SKITTER. This mechanical latching interface will allow SKITTER to use a series of implements such as drills, cranes, etc., and perform different tasks on the moon. The design emphasized versatility and detachability; that is, the interface design is the same for all implements, and connection and detachment is simple. After consideration of many alternatives, a system of three identical latches at each of the three interface points was chosen. The latching mechanism satisfies the design constraints because it facilitates connection and detachment. Also, the moving parts are protected from the dusty environment by housing plates.

  9. Preparing palliative home care nurses to act as facilitators for physicians' learning: Evaluation of a training programme.

    PubMed

    Pype, Peter; Mertens, Fien; Wens, Johan; Stes, Ann; Van den Eynden, Bart; Deveugele, Myriam

    2015-05-01

    Palliative care requires a multidisciplinary care team. General practitioners often ask specialised palliative home care teams for support. Working with specialised nurses offers learning opportunities, also called workplace learning. This can be enhanced by the presence of a learning facilitator. To describe the development and evaluation of a training programme for nurses in primary care. The programme aimed to prepare palliative home care team nurses to act as facilitators for general practitioners' workplace learning. A one-group post-test only design (quantitative) and semi-structured interviews (qualitative) were used. A multifaceted train-the-trainer programme was designed. Evaluation was done through assignments with individual feedback, summative assessment through videotaped encounters with simulation-physicians and individual interviews after a period of practice implementation. A total of 35 nurses followed the programme. The overall satisfaction was high. Homework assignments interfered with the practice workload but showed to be fundamental in translating theory into practice. Median score on the summative assessment was 7 out of 14 with range 1-13. Interviews revealed some aspects of the training (e.g. incident analysis) to be too difficult for implementation or to be in conflict with personal preferences (focus on patient care instead of facilitating general practitioners' learning). Training palliative home care team nurses as facilitator of general practitioners' workplace learning is a feasible but complex intervention. Personal characteristics, interpersonal relationships and contextual variables have to be taken into account. Training expert palliative care nurses to facilitate general practitioners' workplace learning requires careful and individualised mentoring. © The Author(s) 2014.

  10. Implementation lessons: the importance of assessing organizational "fit" and external factors when implementing evidence-based teen pregnancy prevention programs.

    PubMed

    Demby, Hilary; Gregory, Alethia; Broussard, Marsha; Dickherber, Jennifer; Atkins, Shantice; Jenner, Lynne W

    2014-03-01

    In recent years, the demand for evidence-based teen pregnancy prevention programs has increased, but practitioners often struggle to replicate and implement them as designed in real-world community settings. The purpose of this article is to describe the barriers and facilitators encountered during pilot year attempts to implement an evidence-based teen pregnancy prevention program within three types of organizations: (1) small community-based organizations; (2) a school-based organization; and (3) a large decentralized city-sponsored summer youth program. We frame our discussion of these experiences within the context of a systemic, multilevel framework for implementation consisting of (1) core implementation components; (2) organizational components; and (3) external factors. This article explores the organizational and external implementation factors we experienced during the implementation process, describes our lessons learned throughout this process, and offers strategies for other practitioners to proactively address these factors from the start of program planning. These findings may provide useful insight for other organizations looking to implement multi-session, group-level interventions with fidelity. Copyright © 2014 Society for Adolescent Health and Medicine. All rights reserved.

  11. Using Gemba Boards to Facilitate Evidence-Based Practice in Critical Care.

    PubMed

    Bourgault, Annette M; Upvall, Michele J; Graham, Alison

    2018-06-01

    Tradition-based practices lack supporting research evidence and may be harmful or ineffective. Engagement of key stakeholders is a critical step toward facilitating evidence-based practice change. Gemba , derived from Japanese, refers to the real place where work is done. Gemba boards (visual management tools) appear to be an innovative method to engage stakeholders and facilitate evidence-based practice. To explore the use of gemba boards and gemba huddles to facilitate practice change. Twenty-two critical care nurses participated in interviews in this qualitative, descriptive study. Thematic analysis was used to code and categorize interview data. Two researchers reached consensus on coding and derived themes. Data were managed with qualitative analysis software. The code gemba occurred most frequently; a secondary analysis was performed to explore its impact on practice change. Four themes were derived from the gemba code: (1) facilitation of staff, leadership, and interdisciplinary communication, (2) transparency of outcome data, (3) solicitation of staff ideas and feedback, and (4) dissemination of practice changes. Gemba boards and gemba huddles became part of the organizational culture for promoting and disseminating evidence-based practices. Unit-based, publicly located gemba boards and huddles have become key components of evidence-based practice culture. Gemba is both a tool and a process to engage team members and the public to generate clinical questions and to plan, implement, and evaluate practice changes. Future research on the effectiveness of gemba boards to facilitate evidence-based practice is warranted. ©2018 American Association of Critical-Care Nurses.

  12. Implementing living room theatre activities for people with dementia on nursing home wards: a process evaluation study.

    PubMed

    van Haeften-van Dijk, A Marijke; van Weert, Julia C M; Dröes, Rose-Marie

    2015-01-01

    A new communication method, the 'Veder Method', was implemented in the Netherlands. This method uses theatrical stimuli in combination with proven person-centred communication methods. Care staff was trained to apply the Veder Method in a 'living room theatre activity' for people with dementia. This study evaluates the implementation of the Veder Method on psychogeriatric nursing home wards. Facilitators and barriers to train staff and implement the Veder Method in psychogeriatric nursing homes were identified by conducting semi-structured interviews with 12 stakeholders who were involved in the implementation, and five focus groups with 35 trained care staff. The interviews and focus groups were transcribed verbatim, and two independent researchers analysed the content of the transcripts. The Implementation Process Evaluation (IPE) Framework was used to categorize the data and the 7s-model to contextualize the qualitative findings. A structured overview of facilitators and barriers in different stages of the implementation process is presented. Positive reactions in residents and more reciprocity in caregiver-resident contact motivated trained care staff to work with the Veder Method. An action plan, executive support, the visibility of the method in the organization and a pioneer group that initiated implementation were essential for successful implementation. High work pressure for the care staff was a hindering factor. Respondents experienced the added value of the Veder Method. The facilitators and barriers to implementation we identified in this study can help to implement and disseminate the successful Veder Method and other person-centred communication methods in psychogeriatric nursing homes effectively.

  13. The effect of motor imagery with specific implement in expert badminton player.

    PubMed

    Wang, Z; Wang, S; Shi, F-Y; Guan, Y; Wu, Y; Zhang, L-L; Shen, C; Zeng, Y-W; Wang, D-H; Zhang, J

    2014-09-05

    Motor skill can be improved with mental simulation. Implements are widely used in daily life and in various sports. However, it is unclear whether the utilization of implements enhances the effect of mental simulation. The present study was designed to investigate the different effects of motor imagery in athletes and novices when they handled a specific implement. We hypothesize that athletes have better motor imagery ability than novices when they hold a specific implement for the sport. This is manifested as higher motor cortical excitability in athletes than novices during motor imagery with the specific implement. Sixteen expert badminton players and 16 novices were compared when they held a specific implement such as a badminton racket and a non-specific implement such as a a plastic bar. Motor imagery ability was measured with a self-evaluation questionnaire. Transcranial magnetic stimulation was used to test the motor cortical excitability during motor imagery. Motor-evoked potentials (MEPs) in the first dorsal interosseous (FDI) and extensor carpi radialis muscles were recorded. Athletes reported better motor imagery than novices when they held a specific implement. Athletes exhibited more MEP facilitation than novices in the FDI muscle with the specific implement applied during motor imagery. The MEP facilitation is correlated with motor imagery ability in athletes. We conclude that the effects of motor imagery with a specific implement are enhanced in athletes compared to novices and the difference between two groups is caused by long-term physical training of athletes with the specific implement. Copyright © 2014 IBRO. Published by Elsevier Ltd. All rights reserved.

  14. Information technology from novice to expert: implementation implications.

    PubMed

    Courtney, Karen L; Alexander, Gregory L; Demiris, George

    2008-09-01

    This paper explores how the Novice-to-Expert Nursing Practice framework can illuminate the challenges of and opportunities in implementing information technology (IT), such as clinical decision support systems (CDSS), in nursing practice. IT implementation in health care is increasing; however, substantial costs and risks remain associated with these projects. The theoretical framework of Novice-to-Expert Nursing Practice was applied to current design and implementation literature for CDSS. Organizational policies and CDSS design affect implementation and user adoption. Nursing CDSS can improve the overall quality of care when designed for the appropriate end-user group and based on a knowledge base reflecting nursing expertise. Nurse administrators can positively influence CDSS function and end-user acceptance by participating in and facilitating staff nurse involvement in IT design, planning and implementation. Specific steps for nurse administrators and managers are included in this paper.

  15. A central support system can facilitate implementation and sustainability of a Classroom-based Undergraduate Research Experience (CURE) in Genomics.

    PubMed

    Lopatto, David; Hauser, Charles; Jones, Christopher J; Paetkau, Don; Chandrasekaran, Vidya; Dunbar, David; MacKinnon, Christy; Stamm, Joyce; Alvarez, Consuelo; Barnard, Daron; Bedard, James E J; Bednarski, April E; Bhalla, Satish; Braverman, John M; Burg, Martin; Chung, Hui-Min; DeJong, Randall J; DiAngelo, Justin R; Du, Chunguang; Eckdahl, Todd T; Emerson, Julia; Frary, Amy; Frohlich, Donald; Goodman, Anya L; Gosser, Yuying; Govind, Shubha; Haberman, Adam; Hark, Amy T; Hoogewerf, Arlene; Johnson, Diana; Kadlec, Lisa; Kaehler, Marian; Key, S Catherine Silver; Kokan, Nighat P; Kopp, Olga R; Kuleck, Gary A; Lopilato, Jane; Martinez-Cruzado, Juan C; McNeil, Gerard; Mel, Stephanie; Nagengast, Alexis; Overvoorde, Paul J; Parrish, Susan; Preuss, Mary L; Reed, Laura D; Regisford, E Gloria; Revie, Dennis; Robic, Srebrenka; Roecklien-Canfield, Jennifer A; Rosenwald, Anne G; Rubin, Michael R; Saville, Kenneth; Schroeder, Stephanie; Sharif, Karim A; Shaw, Mary; Skuse, Gary; Smith, Christopher D; Smith, Mary; Smith, Sheryl T; Spana, Eric P; Spratt, Mary; Sreenivasan, Aparna; Thompson, Jeffrey S; Wawersik, Matthew; Wolyniak, Michael J; Youngblom, James; Zhou, Leming; Buhler, Jeremy; Mardis, Elaine; Leung, Wilson; Shaffer, Christopher D; Threlfall, Jennifer; Elgin, Sarah C R

    2014-01-01

    In their 2012 report, the President's Council of Advisors on Science and Technology advocated "replacing standard science laboratory courses with discovery-based research courses"-a challenging proposition that presents practical and pedagogical difficulties. In this paper, we describe our collective experiences working with the Genomics Education Partnership, a nationwide faculty consortium that aims to provide undergraduates with a research experience in genomics through a scheduled course (a classroom-based undergraduate research experience, or CURE). We examine the common barriers encountered in implementing a CURE, program elements of most value to faculty, ways in which a shared core support system can help, and the incentives for and rewards of establishing a CURE on our diverse campuses. While some of the barriers and rewards are specific to a research project utilizing a genomics approach, other lessons learned should be broadly applicable. We find that a central system that supports a shared investigation can mitigate some shortfalls in campus infrastructure (such as time for new curriculum development, availability of IT services) and provides collegial support for change. Our findings should be useful for designing similar supportive programs to facilitate change in the way we teach science for undergraduates. © 2014 D. Lopatto et al. CBE—Life Sciences Education © 2014 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

  16. Changing shape: workforce and the implementation of Aboriginal health policy.

    PubMed

    Lloyd, Jane E; Wise, Marilyn J; Weeramanthri, Tarun

    2008-02-01

    Thirty-five interviews were conducted in a case study on the implementation of the Northern Territory Preventable Chronic Disease Strategy (PCDS) to explore the role of the health workforce in the implementation of Aboriginal health policy. There was a tendency for the workforce to implement those aspects of the policy that drew on existing skills in treatment and management and to avoid or delay implementation that required the acquisition of new skills in primary prevention. Factors that facilitated the implementation of the PCDS included the addition of new resources, employment of additional staff, training, increased commitment from managers, and the creation of dedicated chronic disease positions. Factors impeding implementation included insufficient numbers of service providers, too little support for current Aboriginal Health Workers, and high staff turnover.

  17. Improving the organization of palliative care: identification of barriers and facilitators in five European countries.

    PubMed

    van Riet Paap, Jasper; Vernooij-Dassen, Myrra; Brouwer, Frederike; Meiland, Franka; Iliffe, Steve; Davies, Nathan; Leppert, Wojciech; Jaspers, Birgit; Mariani, Elena; Sommerbakk, Ragni; Vissers, Kris; Engels, Yvonne

    2014-10-16

    Interventions to improve palliative care encounter challenges beyond the usual implementation problems because of palliative care's complex and changing character. In this study, we explored barriers and facilitators faced by health-care professionals in five European countries (England, Germany, Italy, Norway and the Netherlands) with regard to improving the organization of their palliative care service. Semi-structured individual and focus group interviews were conducted with purposefully selected health-care professionals. The constant comparative method was used to analyse the data. Professionals working in hospitals, hospices, nursing homes and primary care facilities who provide palliative care to adult patients were interviewed (n =40) or participated in ten focus group interviews (n =59). Barriers and facilitators were inductively grouped into 16 categories and arranged into five themes: innovation, individual professional level, group dynamics, organizational context and local political-economic context. Although the barriers and facilitators identified differed in scope, context, strength and provenance, they were shared by professionals from different European countries. This study identified barriers and facilitators to organizational change in palliative care. Some of these barriers and facilitators were experienced by professionals in almost all countries and are therefore prerequisites to change. Understanding the barriers to and facilitators of change will help tailor organizational improvements to the needs of individuals and organizations.

  18. Using the Consolidated Framework for Implementation Research (CFIR) to produce actionable findings: a rapid-cycle evaluation approach to improving implementation.

    PubMed

    Keith, Rosalind E; Crosson, Jesse C; O'Malley, Ann S; Cromp, DeAnn; Taylor, Erin Fries

    2017-02-10

    Much research does not address the practical needs of stakeholders responsible for introducing health care delivery interventions into organizations working to achieve better outcomes. In this article, we present an approach to using the Consolidated Framework for Implementation Research (CFIR) to guide systematic research that supports rapid-cycle evaluation of the implementation of health care delivery interventions and produces actionable evaluation findings intended to improve implementation in a timely manner. To present our approach, we describe a formative cross-case qualitative investigation of 21 primary care practices participating in the Comprehensive Primary Care (CPC) initiative, a multi-payer supported primary care practice transformation intervention led by the Centers for Medicare and Medicaid Services. Qualitative data include observational field notes and semi-structured interviews with primary care practice leadership, clinicians, and administrative and medical support staff. We use intervention-specific codes, and CFIR constructs to reduce and organize the data to support cross-case analysis of patterns of barriers and facilitators relating to different CPC components. Using the CFIR to guide data collection, coding, analysis, and reporting of findings supported a systematic, comprehensive, and timely understanding of barriers and facilitators to practice transformation. Our approach to using the CFIR produced actionable findings for improving implementation effectiveness during this initiative and for identifying improvements to implementation strategies for future practice transformation efforts. The CFIR is a useful tool for guiding rapid-cycle evaluation of the implementation of practice transformation initiatives. Using the approach described here, we systematically identified where adjustments and refinements to the intervention could be made in the second year of the 4-year intervention. We think the approach we describe has broad

  19. Implementation of transportation asset management in Grandview, Missouri : final report.

    DOT National Transportation Integrated Search

    2017-02-01

    The successful implementation of transportation asset management (TAM) by local governments facilitates the optimization of limited resources. The use of a data-driven TAM program helps to identify and prioritize needs, identify and dedicate resource...

  20. Barriers and Facilitators of Utilizing Research Among Nurses in Nepal.

    PubMed

    Kc, Srijana; Subramaniam, Prithwi Raj; Paudel, Sarita

    2016-04-01

    This study determined the perceived barriers to and facilitators of Nepalese nurses in utilizing research in the workplace. Evidence-based nursing practice provides the synergy for high-quality patient care, but it does not seem to be the case in underdeveloped countries, such as Nepal. A descriptive, cross-sectional study involving 97 nurses from Nepal was conducted. Data were collected using the BARRIERS Scale and a facilitator questionnaire. The top three barriers to research utilization in Nepalese nurses are (a) research reports and articles are not readily available (80.5%), (b) inadequate facilities for implementation (75.3%), and (c) research reports and articles are not published fast enough (71.6%). The top three facilitators perceived to encourage Nepalese nurses to utilize or participate in research are (a) initiation of nursing research projects (27.4%), (b) educational update on research methods (16.7%), and (c) provision of funding for research (15.5%). Findings from this study mirror the barriers to research utilization experienced by nurses in other countries. Macro- and micro-level support are needed to foster a culture of evidence-based practice among Nepalese nurses to empower them in making informed decisions based on research in providing quality patient care. Copyright 2016, SLACK Incorporated.

  1. Using Appreciative Inquiry to Facilitate Implementation of the Recovery Model in Mental Health Agencies

    ERIC Educational Resources Information Center

    Clossey, Laurene; Mehnert, Kevin; Silva, Sara

    2011-01-01

    This article describes an organizational development tool called appreciative inquiry (AI) and its use in mental health to aid agencies implementing recovery model services. AI is a discursive tool with the power to shift dominant organizational cultures. Its philosophical underpinnings emphasize values consistent with recovery: community,…

  2. Effectiveness of metaphoric facilitation techniques in a challenge course program on the empowerment of women participants

    Treesearch

    Penny A. James; Lynn Anderson; Anderson Young

    2007-01-01

    Research has shown support for the efficacy of differing processing techniques, particularly isomorphic framing. Feminist practitioners contend this methodology disempowers participants. Proponents argue this could result only from improper implementation. This experiment employed a facilitation technique (control, derived, isomorphic) between subjects design with time...

  3. Exploring the Use of a Social Network to Facilitate and Integrate Long-Term Interprofessional Educational Experiences

    ERIC Educational Resources Information Center

    Pittenger, Amy L.

    2011-01-01

    The purpose of this study was to evaluate the feasibility and effectiveness of implementing interprofessional education to students from six health professional programs through use of an online social networking platform. Specifically, three pedagogical models (Minimally Structured, Facilitated, Highly Structured) were evaluated for impact on…

  4. A Pilot Study: Facilitating Cross-Cultural Understanding with Project-Based Collaborative Learning in an Online Environment

    ERIC Educational Resources Information Center

    Shadiev, Rustam; Hwang, Wu-Yuin; Huang, Yueh-Min

    2015-01-01

    This study investigated three aspects: how project-based collaborative learning facilitates cross-cultural understanding; how students perceive project-based collaborative learning implementation in a collaborative cyber community (3C) online environment; and what types of communication among students are used. A qualitative case study approach…

  5. Implementation of science process skills using ICT-based approach to facilitate student life skills

    NASA Astrophysics Data System (ADS)

    Rahayu, Y. S.; Yuliani; Wijaya, B. R.

    2018-01-01

    The purpose of this study is to describe the results of the implementation of a teaching-learning package in Plant Physiology courses to improve the student’s life skills using the science process skills-based approach ICT. This research used 15 students of Biology Education of Undergraduate International Class who are in the Plant Physiology course. This study consists of two phases items, namely the development phase and implementation phase by using a one-shot case study design. Research parameters were the feasibility of lesson plans, student achievement, Including academic skills, thinking skills, and social skills. Data were descriptively Analyzed According to the characteristics of the existing data. The result shows that the feasibility of a lesson plan is very satisfied and can be improvements in student’s life skills, especially with regards to student’s thinking skills and scientific thinking skills. The results indicate that the science process skills using ICT-based approach can be effective methods to improve student’s life skills.

  6. School Characteristics Influencing the Implementation of a Data-Based Decision Making Intervention

    ERIC Educational Resources Information Center

    van Geel, Marieke; Visscher, Adrie J.; Teunis, Bernard

    2017-01-01

    There is an increasing global emphasis on using data for decision making, with a growing body of research on interventions aimed at implementing and sustaining data-based decision making (DBDM) in schools. Yet, little is known about the school features that facilitate or hinder the implementation of DBDM. Based on a literature review, the authors…

  7. A multi-disciplinary approach to implementation science: the NIH-PEPFAR PMTCT implementation science alliance.

    PubMed

    Sturke, Rachel; Harmston, Christine; Simonds, R J; Mofenson, Lynne M; Siberry, George K; Watts, D Heather; McIntyre, James; Anand, Nalini; Guay, Laura; Castor, Delivette; Brouwers, Pim; Nagel, Joan D

    2014-11-01

    In resource-limited countries, interventions to prevent mother-to-child HIV transmission (PMTCT) have not yet realized their full potential health impact, illustrating the common gap between the scientific proof of an intervention's efficacy and effectiveness and its successful implementation at scale into routine health services. For PMTCT, this gap results, in part, from inadequate adaptation of PMTCT interventions to the realities of the implementation environment, including client and health care worker behaviors and preferences, health care policies and systems, and infrastructure and resource constraints. Elimination of mother-to-child HIV transmission can only be achieved through understanding of key implementation barriers and successful adaptation of scientifically proven interventions to the local environment. Central to such efforts is implementation science (IS), which aims to investigate and address major bottlenecks that impede effective implementation and to test new approaches to identifying, understanding, and overcoming barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based interventions. Advancing IS will require deliberate and strategic efforts to facilitate collaboration, communication, and relationship-building among researchers, implementers, and policy-makers. To speed the translation of effective PMTCT interventions into practice and advance IS more broadly, the US National Institutes of Health, in collaboration with the President's Emergency Plan for AIDS Relief launched the National Institutes of Health/President's Emergency Plan for AIDS Relief PMTCT IS Alliance, comprised of IS researchers, PMTCT program implementers, and policy-makers as an innovative platform for interaction and coordination.

  8. Using Win-Win Strategies to Implement Health in All Policies: A Cross-Case Analysis

    PubMed Central

    Molnar, Agnes; Renahy, Emilie; O’Campo, Patricia; Muntaner, Carles; Freiler, Alix; Shankardass, Ketan

    2016-01-01

    Background In spite of increasing research into intersections of public policy and health, little evidence shows how policy processes impact the implementation of Health in All Policies (HiAP) initiatives. Our research sought to understand how and why strategies for engaging partners from diverse policy sectors in the implementation of HiAP succeed or fail in order to uncover the underlying social mechanisms contributing to sustainable implementation of HiAP. Methods In this explanatory multiple case study, we analyzed grey and peer-review literature and key informant interviews to identify mechanisms leading to implementation successes and failures in relation to different strategies for engagement across three case studies (Sweden, Quebec and South Australia), after accounting for the role of different contextual conditions. Findings Our results yielded no support for the use of awareness-raising or directive strategies as standalone approaches for engaging partners to implement HiAP. However, we found strong evidence that mechanisms related to “win-win” strategies facilitated implementation by increasing perceived acceptability (or buy-in) and feasibility of HiAP implementation across sectors. Win-win strategies were facilitated by mechanisms related to several activities, including: the development of a shared language to facilitate communication between actors from different sectors; integrating health into other policy agendas (eg., sustainability) and use of dual outcomes to appeal to the interests of diverse policy sectors; use of scientific evidence to demonstrate the effectiveness of HiAP; and using health impact assessment to make policy coordination for public health outcomes more feasible and to give credibility to policies being developed by diverse policy sectors. Conclusion Our findings enrich theoretical understanding in an under-unexplored area of intersectoral action. They also provide policy makers with examples of HiAP across wealthy

  9. Implementation of a workplace smoking ban in bars: the limits of local discretion.

    PubMed

    Montini, Theresa; Bero, Lisa A

    2008-12-08

    In January 1998, the California state legislature extended a workplace smoking ban to bars. The purpose of this study was to explore the conditions that facilitate or hinder compliance with a smoking ban in bars. We studied the implementation of the smoking ban in bars by interviewing three sets of policy participants: bar employers responsible for complying with the law; local government officials responsible for enforcing the law; and tobacco control activists who facilitated implementation. We transcribed the interviews and did a qualitative analysis of the text. The conditions that facilitated bar owners' compliance with a smoking ban in bars included: if the cost to comply was minimal; if the bars with which they were in competition were in compliance with the smoking ban; and if there was authoritative, consistent, coordinated, and uniform enforcement. Conversely, the conditions that hindered compliance included: if the law had minimal sanctions; if competing bars in the area allowed smoking; and if enforcement was delayed or inadequate. Many local enforcers wished to forfeit their local discretion and believed the workplace smoking ban in bars would be best implemented by a state agency. The potential implication of this study is that, given the complex nature of local politics, smoking bans in bars are best implemented at a broader provincial or national level.

  10. Implementation of a workplace smoking ban in bars: The limits of local discretion

    PubMed Central

    Montini, Theresa; Bero, Lisa A

    2008-01-01

    Background In January 1998, the California state legislature extended a workplace smoking ban to bars. The purpose of this study was to explore the conditions that facilitate or hinder compliance with a smoking ban in bars. Methods We studied the implementation of the smoking ban in bars by interviewing three sets of policy participants: bar employers responsible for complying with the law; local government officials responsible for enforcing the law; and tobacco control activists who facilitated implementation. We transcribed the interviews and did a qualitative analysis of the text. Results The conditions that facilitated bar owners' compliance with a smoking ban in bars included: if the cost to comply was minimal; if the bars with which they were in competition were in compliance with the smoking ban; and if there was authoritative, consistent, coordinated, and uniform enforcement. Conversely, the conditions that hindered compliance included: if the law had minimal sanctions; if competing bars in the area allowed smoking; and if enforcement was delayed or inadequate. Conclusion Many local enforcers wished to forfeit their local discretion and believed the workplace smoking ban in bars would be best implemented by a state agency. The potential implication of this study is that, given the complex nature of local politics, smoking bans in bars are best implemented at a broader provincial or national level. PMID:19063716

  11. Mobilizing and Managing Social Capital: On Roles and Responsibilities of Local Facilitators in Territorial Development

    ERIC Educational Resources Information Center

    Schermer, Markus; Kirchengast, Christoph; Petit, Sandrine; Magnani, Natalia; Mieville-Ott, Valerie

    2010-01-01

    The paper explores the difficulties and challenges in mobilizing and managing social capital in concrete local and territorial directed rural development project activities. The main focus is put on the roles of local facilitators working with farmers and other local stakeholders during project implementation. The EU 5th framework project IMALP…

  12. Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO) protocol: testing the effectiveness of a facilitation intervention in a pragmatic, cluster-randomised trial with an embedded process evaluation and cost analysis.

    PubMed

    Bucknall, Tracey K; Harvey, Gill; Considine, Julie; Mitchell, Imogen; Rycroft-Malone, Jo; Graham, Ian D; Mohebbi, Mohammadreza; Watts, Jennifer; Hutchinson, Alison M

    2017-07-11

    Vital signs are the primary indicator of physiological status and for determining the need for urgent clinical treatment. Yet, if physiological signs of deterioration are missed, misinterpreted or mismanaged, then critical illness, unplanned intensive care admissions, cardiac arrest and death may ensue. Although evidence demonstrates the benefit of early recognition and management of deteriorating patients, failure to escalate care and manage deteriorating patients remains a relatively frequent occurrence in hospitals. A pragmatic cluster-randomised controlled trial design will be used to measure clinical effectiveness and cost of a facilitation intervention to improve nurses' vital sign measurement, interpretation, treatment and escalation of care for patients with abnormal vital signs. A cost consequence analysis will evaluate the intervention cost and effectiveness, and a process evaluation will determine how the implementation of the intervention contributes to outcomes. We will compare clinical outcomes and costs from standard implementation of clinical practice guidelines (CPGs) to facilitated implementation of CPGs. The primary outcome will be adherence to the CPGs by nurses, as measured by escalation of care as per organisational policy. The study will be conducted in four Australian major metropolitan teaching hospitals. In each hospital, eight to ten wards will be randomly allocated to intervention and control groups. Control wards will receive standard implementation of CPGs, while intervention wards will receive standard CPG implementation plus facilitation, using facilitation methods and processes tailored to the ward context. The intervention will be administered to all nursing staff at the ward level for 6 months. At each hospital, two types of facilitators will be provided: a hospital-level facilitator as the lead; and two ward-level facilitators for each ward. This study uses an innovative, networked approach to facilitation to enable uptake of

  13. STAR Algorithm Integration Team - Facilitating operational algorithm development

    NASA Astrophysics Data System (ADS)

    Mikles, V. J.

    2015-12-01

    The NOAA/NESDIS Center for Satellite Research and Applications (STAR) provides technical support of the Joint Polar Satellite System (JPSS) algorithm development and integration tasks. Utilizing data from the S-NPP satellite, JPSS generates over thirty Environmental Data Records (EDRs) and Intermediate Products (IPs) spanning atmospheric, ocean, cryosphere, and land weather disciplines. The Algorithm Integration Team (AIT) brings technical expertise and support to product algorithms, specifically in testing and validating science algorithms in a pre-operational environment. The AIT verifies that new and updated algorithms function in the development environment, enforces established software development standards, and ensures that delivered packages are functional and complete. AIT facilitates the development of new JPSS-1 algorithms by implementing a review approach based on the Enterprise Product Lifecycle (EPL) process. Building on relationships established during the S-NPP algorithm development process and coordinating directly with science algorithm developers, the AIT has implemented structured reviews with self-contained document suites. The process has supported algorithm improvements for products such as ozone, active fire, vegetation index, and temperature and moisture profiles.

  14. Facilitating preemptive hardware system design using partial reconfiguration techniques.

    PubMed

    Dondo Gazzano, Julio; Rincon, Fernando; Vaderrama, Carlos; Villanueva, Felix; Caba, Julian; Lopez, Juan Carlos

    2014-01-01

    In FPGA-based control system design, partial reconfiguration is especially well suited to implement preemptive systems. In real-time systems, the deadline for critical task can compel the preemption of noncritical one. Besides, an asynchronous event can demand immediate attention and, then, force launching a reconfiguration process for high-priority task implementation. If the asynchronous event is previously scheduled, an explicit activation of the reconfiguration process is performed. If the event cannot be previously programmed, such as in dynamically scheduled systems, an implicit activation to the reconfiguration process is demanded. This paper provides a hardware-based approach to explicit and implicit activation of the partial reconfiguration process in dynamically reconfigurable SoCs and includes all the necessary tasks to cope with this issue. Furthermore, the reconfiguration service introduced in this work allows remote invocation of the reconfiguration process and then the remote integration of off-chip components. A model that offers component location transparency is also presented to enhance and facilitate system integration.

  15. Facilitating Preemptive Hardware System Design Using Partial Reconfiguration Techniques

    PubMed Central

    Rincon, Fernando; Vaderrama, Carlos; Villanueva, Felix; Caba, Julian; Lopez, Juan Carlos

    2014-01-01

    In FPGA-based control system design, partial reconfiguration is especially well suited to implement preemptive systems. In real-time systems, the deadline for critical task can compel the preemption of noncritical one. Besides, an asynchronous event can demand immediate attention and, then, force launching a reconfiguration process for high-priority task implementation. If the asynchronous event is previously scheduled, an explicit activation of the reconfiguration process is performed. If the event cannot be previously programmed, such as in dynamically scheduled systems, an implicit activation to the reconfiguration process is demanded. This paper provides a hardware-based approach to explicit and implicit activation of the partial reconfiguration process in dynamically reconfigurable SoCs and includes all the necessary tasks to cope with this issue. Furthermore, the reconfiguration service introduced in this work allows remote invocation of the reconfiguration process and then the remote integration of off-chip components. A model that offers component location transparency is also presented to enhance and facilitate system integration. PMID:24672292

  16. Implementing and evaluating shared decision making in oncology practice.

    PubMed

    Kane, Heather L; Halpern, Michael T; Squiers, Linda B; Treiman, Katherine A; McCormack, Lauren A

    2014-01-01

    Engaging individuals with cancer in decision making about their treatments has received increased attention; shared decision making (SDM) has become a hallmark of patient-centered care. Although physicians indicate substantial interest in SDM, implementing SDM in cancer care is often complex; high levels of uncertainty may exist, and health care providers must help patients understand the potential risks versus benefits of different treatment options. However, patients who are more engaged in their health care decision making are more likely to experience confidence in and satisfaction with treatment decisions and increased trust in their providers. To implement SDM in oncology practice, physicians and other health care providers need to understand the components of SDM and the approaches to supporting and facilitating this process as part of cancer care. This review summarizes recent information regarding patient and physician factors that influence SDM for cancer care, outcomes resulting from successful SDM, and strategies for implementing SDM in oncology practice. We present a conceptual model illustrating the components of SDM in cancer care and provide recommendations for facilitating SDM in oncology practice. © 2014 American Cancer Society, Inc.

  17. Research funders' roles and perceived responsibilities in relation to the implementation of clinical research results: a multiple case study of Swedish research funders.

    PubMed

    Brantnell, Anders; Baraldi, Enrico; van Achterberg, Theo; Winblad, Ulrika

    2015-07-17

    Implementation of clinical research results is challenging, yet the responsibility for implementation is seldom addressed. The process from research to the use of clinical research results in health care can be facilitated by research funders. In this paper, we report the roles of ten Swedish research funders in relation to implementation and their views on responsibilities in implementation. Ten cases were studied and compared using semi-structured interviews. In addition, websites and key documents were reviewed. Eight facilitative roles for research funders in relation to the implementation of clinical research results were identified. Three of them were common for several funders: "Advocacy work," "Monitoring implementation outcomes," and "Dissemination of knowledge." Moreover, the research funders identified six different actors responsible for implementation, five of which belonged to the healthcare setting. Collective and organizational responsibilities were the most common forms of responsibilities among the identified actors responsible for implementation. The roles commonly identified by the Swedish funders, "Advocacy work," "Monitoring implementation outcomes," and "Dissemination of knowledge," seem feasible facilitative roles in relation to the implementation of clinical research results. However, many actors identified as responsible for implementation together with the fact that collective and organizational responsibilities were the most common forms of responsibilities entail a risk of implementation becoming no one's responsibility.

  18. Barriers to Advance Care Planning at the End of Life: An Explanatory Systematic Review of Implementation Studies

    PubMed Central

    Lund, Susi; Richardson, Alison; May, Carl

    2015-01-01

    Context Advance Care Plans (ACPs) enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges. Objective To investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice. Design An explanatory systematic review of qualitative implementation studies. Data sources Empirical studies that reported interventions designed to support ACP in healthcare. Web of Knowledge, Ovid MEDLINE, CINAHL, PsycINFO, British Nursing Index and PubMed databases were searched. Methods Direct content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes. Results 13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations. Conclusions This review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows. PMID:25679395

  19. How to implement Illness Management and Recovery (IMR) in mental health service settings: evaluation of the implementation strategy.

    PubMed

    Egeland, Karina Myhren; Ruud, Torleif; Ogden, Terje; Färdig, Rickard; Lindstrøm, Jonas Christoffer; Heiervang, Kristin Sverdvik

    2017-01-01

    The purpose of this study was to evaluate the implementation strategy used in the first-phase of implementation of the Illness Management and Recovery (IMR) programme, an intervention for adults with severe mental illnesses, in nine mental health service settings in Norway. A total of 9 clinical leaders, 31 clinicians, and 44 consumers at 9 service settings participated in the implementation of IMR. Implementation was conducted by an external team of researchers and an experienced trainer. Data were gathered on fidelity to the intervention and implementation strategy, feasibility, and consumer outcomes. Although the majority of clinicians scored within the acceptable range of high intervention fidelity, their participation in the implementation strategy appeared to moderate anticipated future use of IMR. No service settings reached high intervention fidelity scores for organizational quality improvement after 12 months of implementation. IMR implementation seemed feasible, albeit with some challenges. Consumer outcomes indicated significant improvements in illness self-management, severity of problems, functioning, and hope. There were nonsignificant positive changes in symptoms and quality of life. The implementation strategy appeared adequate to build clinician competence over time, enabling clinicians to provide treatment that increased functioning and hope for consumers. Additional efficient strategies should be incorporated to facilitate organizational change and thus secure the sustainability of the implemented practice. Trial registration ClinicalTrials.gov NCT02077829. Registered 25 February 2014.

  20. Facilitating central line-associated bloodstream infection prevention: a qualitative study comparing perspectives of infection control professionals and frontline staff.

    PubMed

    McAlearney, Ann Scheck; Hefner, Jennifer L

    2014-10-01

    Infection control professionals (ICPs) play a critical role in implementing and managing healthcare-associated infection reduction interventions, whereas frontline staff are responsible for delivering direct and ongoing patient care. The objective of our study was to determine if ICPs and frontline staff have different perspectives about the facilitators and challenges of central line-associated bloodstream infection (CLABSI) prevention program success. We conducted key informant interviews at 8 hospitals that participated in the Agency for Healthcare Research and Quality CLABSI prevention initiative called "On the CUSP: Stop BSI." We analyzed interview data from 50 frontline nurses and 26 ICPs to identify common themes related to program facilitators and challenges. We identified 4 facilitators of CLABSI program success: education, leadership, data, and consistency. We also identified 3 common challenges: lack of resources, competing priorities, and physician resistance. However, the perspective of ICPs and frontline nurses differed. Whereas ICPs tended to focus on general descriptions, frontline staff noted program specifics and often discussed concrete examples. Our results suggest that ICPs need to take into account the perspectives of staff nurses when implementing infection control and broader quality improvement initiatives. Further, the deliberate inclusion of frontline staff in the implementation of these programs may be critical to program success. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  1. Virtual reality exergaming as adjunctive therapy in a sub-acute stroke rehabilitation setting: facilitators and barriers.

    PubMed

    Nguyen, Ai-Vi; Ong, Yau-Lok Austin; Luo, Cindy Xin; Thuraisingam, Thiviya; Rubino, Michael; Levin, Mindy F; Kaizer, Franceen; Archambault, Philippe S

    2018-03-12

    To identify the facilitators and barriers perceived by clinicians to using an Exergaming Room as adjunct to conventional therapy. Phenomenological qualitative study using an interpretive description methodology. Ten clinicians (four physical therapists, six occupational therapists) from the Stroke Program at the Jewish Rehabilitation Hospital (nine female, one male, age range 25-50 years old) who referred clients to the Exergaming Room. Ten to twenty minute semi-structured interviews were conducted with each clinician. Convenience sampling was used. A thematic analysis was performed on the data collected by grouping all the open codes into facilitators and barriers, and then categorized into levels, themes and subthemes. Facilitators and barriers were divided into three levels: organizational, individual and technological. Major facilitators at the organizational level were: institutional support; at the individual level: personal experience of referring clinician, presence of an expert clinician, and relevance of the Exergaming Room for stroke clients; and at the technological level: perceived ease of use of the exergames and possibility of providing additional therapy. Key barriers to successful implementation of the Exergaming Room at the organizational level were: scheduling difficulties and lack of staffing; at the individual level: client functional limitations; at the technological level: low precision in motion capture of the exergame systems. Multiple factors affect the implementation of new technology in rehabilitation settings. In order to successfully integrate exergame systems into practice, institutions are encouraged to take the identified factors (facilitators and barriers) into account. Implications for Rehabilitation Clinicians who have referred individuals with stroke to an "exergames" room over a 1-year period at a rehabilitation hospital have found the service to be highly relevant to their clients. The presence of an expert clinician, who

  2. Protocol: Adaptive Implementation of Effective Programs Trial (ADEPT): cluster randomized SMART trial comparing a standard versus enhanced implementation strategy to improve outcomes of a mood disorders program.

    PubMed

    Kilbourne, Amy M; Almirall, Daniel; Eisenberg, Daniel; Waxmonsky, Jeanette; Goodrich, David E; Fortney, John C; Kirchner, JoAnn E; Solberg, Leif I; Main, Deborah; Bauer, Mark S; Kyle, Julia; Murphy, Susan A; Nord, Kristina M; Thomas, Marshall R

    2014-09-30

    Despite the availability of psychosocial evidence-based practices (EBPs), treatment and outcomes for persons with mental disorders remain suboptimal. Replicating Effective Programs (REP), an effective implementation strategy, still resulted in less than half of sites using an EBP. The primary aim of this cluster randomized trial is to determine, among sites not initially responding to REP, the effect of adaptive implementation strategies that begin with an External Facilitator (EF) or with an External Facilitator plus an Internal Facilitator (IF) on improved EBP use and patient outcomes in 12 months. This study employs a sequential multiple assignment randomized trial (SMART) design to build an adaptive implementation strategy. The EBP to be implemented is life goals (LG) for patients with mood disorders across 80 community-based outpatient clinics (N = 1,600 patients) from different U.S. regions. Sites not initially responding to REP (defined as < 50% patients receiving ≥ 3 EBP sessions) will be randomized to receive additional support from an EF or both EF/IF. Additionally, sites randomized to EF and still not responsive will be randomized to continue with EF alone or to receive EF/IF. The EF provides technical expertise in adapting LG in routine practice, whereas the on-site IF has direct reporting relationships to site leadership to support LG use in routine practice. The primary outcome is mental health-related quality of life; secondary outcomes include receipt of LG sessions, mood symptoms, implementation costs, and organizational change. This study design will determine whether an off-site EF alone versus the addition of an on-site IF improves EBP uptake and patient outcomes among sites that do not respond initially to REP. It will also examine the value of delaying the provision of EF/IF for sites that continue to not respond despite EF. ClinicalTrials.gov identifier: NCT02151331.

  3. Building a Collaborative Network for Education and Training in International Trade Facilitation Clusters

    NASA Astrophysics Data System (ADS)

    Clendenin, John A.; Petrova, Nadya N.; Gill, Joshua K.

    The authors present the benefits of collaboration rather than competition in developing educational and training resources for international trade within a geographic region and explore the challenges for business partners, governments and educational institutions. The paper indicates that flexibility in the 21st Century is critical, particularly when striving for virtual implementations of the solution services. It is essential, say the authors, for educators, governments and business executives to focus on performance and the careful orchestration and integration of business, policy and information technology for “Networking” that successfully stimulates inter-governmental cooperation and innovative policies that foster Regional trade facilitation. An innovative way to enhance 21st Century Trade Facilitation is offered with Supply Chain Centers of Regional Excellence (SCcORE).

  4. From workshop to work practice: An exploration of context and facilitation in the development of evidence-based practice.

    PubMed

    Ellis, Isabelle; Howard, Peter; Larson, Ann; Robertson, Jeanette

    2005-01-01

    This article examines the process of translating evidence into practice using a facilitation model developed by the Western Australian Centre for Evidence Based Nursing and Midwifery. Using the conceptual framework Promoting Action on Research Implementation in Health Services (PARIHS), the aims of the study were (1) to explore the relative and combined importance of context and facilitation in the successful implementation of a new evidence-based clinical practice protocol and (2) to examine the establishment of more lasting change to individuals and organizations that resulted in greater incorporation of the principles of evidence-based practice (EBP). A pre-workshop, semi-structured telephone survey with 16 nurse managers in six rural hospitals; a summative evaluation immediately post-workshop with 54 participants; and follow-up, semi-structured interviews with 23 workshop participants. The contexts in each of the participating hospitals were very different; of the six hospitals, only one had not implemented the new protocol. Five had reviewed their practices and brought them in line with the protocol developed at the workshop. The rate of adoption varied considerably from 2 weeks to months. The participants reported being better informed about EBP in general and were positive about their ability to improve their practice and search more efficiently for best practice information. Underlying motivations for protocol development should be included in the PARIHS framework. IMPLICATIONS FOR EDUCATION: Good facilitation appears to be more influential than context in overcoming the barriers to the uptake of EBP.

  5. Bridge over Troubled Water: Using Implementation Science to Facilitate Effective Services in Child Welfare

    ERIC Educational Resources Information Center

    Mildon, Robyn; Shlonsky, Aron

    2011-01-01

    To maximize benefits to children and their families, effective practices need to be used competently in child welfare settings. Since the 1990s, researchers and policy makers have focused attention on empirically supported interventions (ESIs). Much less attention has been paid to what is needed to implement these in a range of real-world…

  6. Tank waste remediation system immobilized high-level waste storage project configuration management implementation plan

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Burgard, K.G.

    This Configuration Management Implementation Plan was developed to assist in the management of systems, structures, and components, to facilitate the effective control and statusing of changes to systems, structures, and components; and to ensure technical consistency between design, performance, and operational requirements. Its purpose is to describe the approach Project W-464 will take in implementing a configuration management control, to determine the rigor of control, and to identify the mechanisms for imposing that control.This Configuration Management Implementation Plan was developed to assist in the management of systems, structures, and components, to facilitate the effective control and statusing of changes tomore » systems, structures, and components; and to ensure technical consistency between design, performance, and operational requirements. Its purpose is to describe the approach Project W-464 will take in implementing a configuration management control, to determine the rigor of control, and to identify the mechanisms for imposing that control.« less

  7. Methods to Improve the Selection and Tailoring of Implementation Strategies

    PubMed Central

    Powell, Byron J.; Beidas, Rinad S.; Lewis, Cara C.; Aarons, Gregory A.; McMillen, J. Curtis; Proctor, Enola K.; Khinduka, Shanti K.; Mandell, David S.

    2015-01-01

    Implementing behavioral health interventions is a complicated process. It has been suggested that implementation strategies should be selected and tailored to address the contextual needs of a given change effort; however, there is limited guidance as to how to do this. This article proposes four methods (concept mapping, group model building, conjoint analysis, and intervention mapping) that could be used to match implementation strategies to identified barriers and facilitators for a particular evidence-based practice or process change being implemented in a given setting. Each method is reviewed, examples of their use are provided, and their strengths and weaknesses are discussed. The discussion includes suggestions for future research pertaining to implementation strategies and highlights these methods' relevance to behavioral health services and research. PMID:26289563

  8. Barriers and facilitators to the implementation of antenatal syphilis screening and treatment for the prevention of congenital syphilis in the Democratic Republic of Congo and Zambia: results of qualitative formative research.

    PubMed

    Nkamba, Dalau; Mwenechanya, Musaku; Kilonga, Arlette Mavila; Cafferata, Maria Luisa; Berrueta, Amanda Mabel; Mazzoni, Agustina; Althabe, Fernando; Garcia-Elorrio, Ezequiel; Tshefu, Antoniette K; Chomba, Elwyn; Buekens, Pierre M; Belizan, Maria

    2017-08-14

    The impact of untreated syphilis during pregnancy on neonatal health remains a major public health threat worldwide. Given the high prevalence of syphilis during pregnancy in Zambia and Democratic Republic of Congo (DRC), the Preventive Congenital Syphilis Trial (PCS Trial), a cluster randomized trial, was proposed to increase same-day screening and treatment of syphilis during antenatal care visits. To design an accepted and feasible intervention, we conducted a qualitative  formative research. Our objective was to identify context-specific  barriers and facilitators to the implementation of antenatal screening and treatment during pregnancy. Qualitative research included in-depth semi-structured interviews with clinic administrators, group interviews with health care providers, and focus groups with pregnant women in primary care clinics (PCCs) in Kinshasa (DRC) and Lusaka (Zambia). A total of 112 individuals participated in the interviews and focus groups. Barriers for the implementation of syphilis testing and treatment were identified at the a) system level: fragmentation of the health system, existence of ANC guidelines in conflict with proposed intervention, poor accessibility of clinics (geographical and functional), staff and product shortages at the PCCs; b) healthcare providers' level: lack of knowledge and training about evolving best practices, reservations regarding same-day screening and treatment; c) Pregnant women level: late enrollment in ANC, lack of knowledge about consequences and treatment of syphilis, and stigma. Based on these results, we developed recommendations for the design of the PCS Trial intervention. This research allowed us to identify barriers and facilitators to improve the feasibility and acceptability of a behavioral intervention. Formative research is a critical step in designing appropriate and effective interventions by closing the "know-do gap".

  9. Leading and Supporting the Implementation of the Norwegian Network of Health Promoting Schools

    ERIC Educational Resources Information Center

    Viig, Nina Grieg; Fosse, Elisabeth; Samdal, Oddrun; Wold, Bente

    2012-01-01

    The aim of this study was to examine how program leaders in the Norwegian Network of Health Promoting Schools managed, facilitated, and supported the development and implementation of the health promotion initiatives at their school. Two focus group interviews were conducted with 10 program leaders. The findings suggest that the implementation of…

  10. Implementation of targeted medication adherence interventions within a community chain pharmacy practice: The Pennsylvania Project.

    PubMed

    Bacci, Jennifer L; McGrath, Stephanie Harriman; Pringle, Janice L; Maguire, Michelle A; McGivney, Melissa Somma

    2014-01-01

    To identify facilitators and barriers to implementing targeted medication adherence interventions in community chain pharmacies, and describe adaptations of the targeted intervention and organizational structure within each individual pharmacy practice. Qualitative study. Central and western Pennsylvania from February to April 2012. Rite Aid pharmacists staffed at the 118 Pennsylvania Project intervention sites. Qualitative analysis of pharmacists' perceptions of facilitators and barriers experienced, targeted intervention and organizational structure adaptations implemented, and training and preparation prior to implementation. A total of 15 key informant interviews were conducted from February to April 2012. Ten pharmacists from "early adopter" practices and five pharmacists from "traditionalist" practices were interviewed. Five themes emerged regarding the implementation of targeted interventions, including all pharmacists' need to understand the relationship of patient care programs to their corporation's vision; providing individualized, continual support and mentoring to pharmacists; anticipating barriers before implementation of patient care programs; encouraging active patient engagement; and establishing best practices regarding implementation of patient care services. This qualitative analysis revealed that there are a series of key steps that can be taken before the execution of targeted interventions that may promote successful implementation of medication therapy management in community chain pharmacies.

  11. Facilitating Facilitators to Facilitate, in Problem or Enquiry Based Learning Sessions

    ERIC Educational Resources Information Center

    Coelho, Catherine

    2014-01-01

    Problem based learning (PBL) has been used in dental education over the past 20 years and uses a patient case scenario to stimulate learning in a small group setting, where a trained facilitator does not teach but guides the group to bring about deep contextualized learning, to be empathetic to each other and to encourage fair and equitable…

  12. Mentor mother support for mothers experiencing intimate partner violence in family practice: A qualitative study of three different perspectives on the facilitators and barriers of implementation.

    PubMed

    Loeffen, Maartje J W; Daemen, Jasper; Wester, Fred P J F; Laurant, Miranda G H; Lo Fo Wong, Sylvie H; Lagro-Janssen, Antoine L M

    2017-12-01

    Intimate partner violence (IPV) is highly prevalent and associated with physical and mental health problems. Mentor mother support is a low threshold intervention in family practice consisting of support by non-professionals trained to support mothers experiencing IPV. A mentor mother support study showed reduced exposure to IPV and decreased symptoms of depression. Identify factors determining implementation success of mentor mother support in family practice. Individual interviews were conducted with 12 family physicians, 16 abused mothers and three mentor mothers. Four mentor mothers participated in a focus group. Qualitative content analysis was used to analyse the data. The identification and discussion of abuse is hindered by family physicians' attitudes because they considered mothers experiencing IPV as a difficult target group with a responsibility of their own to break out of their violent situation. Some family physicians doubted the partner's violence because he was known as a patient as well. Acceptance of mentor mother support is related to the readiness for change of mothers experiencing IPV. Mentor mothers facilitate acceptance and completion of their support by connecting as a friend who is equal and less threatening than professionals. To improve successful implementation of mentor mother support in primary care, we should focus on family physicians' attitudes towards IPV. To change these attitudes, we recommend continuous training of family physicians. By being paraprofessional friends, mentor mothers offer low threshold support that is complementary to professional support and should be embedded more widely in primary care. [Box: see text].

  13. Implementation of Mindfulness Training for Mental Health Staff: Organizational Context and Stakeholder Perspectives.

    PubMed

    Byron, Gerard; Ziedonis, Douglas M; McGrath, Caroline; Frazier, Jean A; deTorrijos, Fernando; Fulwiler, Carl

    2015-08-01

    Occupational stress and burnout adversely impacts mental health care staff well-being and patient outcomes. Mindfulness training reduces staff stress and may improve patient care. However, few studies explore mental health setting implementation. This qualitative study used focus groups to evaluate stakeholders' perceptions of organizational factors affecting implementation of an adapted version of Mindfulness-Based Stress Reduction (MBSR) for staff on adolescent mental health units. Common facilitators included leadership securing buy-in with staff, allocating staff time to participate, and quiet space for training and practice. Other facilitators were past staff knowledge of mindfulness, local champions, and acculturating staff with mindfulness through a non-mandatory training attendance policy. Common barriers were limited staff time to attend training sessions and insufficient training coverage for some staff. Staff also reported improved focus when interacting with adolescents and improved social cohesion on the units. We conclude that a mindfulness-based program for reducing occupational stress can be successfully implemented on adolescent mental health units. Implementation appeared to change the social context of the units, including staff and patient interactions. More broadly, our findings highlight the importance of environmental factors in shaping attitudes, diffusion of innovation, and acculturation of wellness program implementations.

  14. Management considerations to implementing pharmaceutical care.

    PubMed

    Wichman, K; Hales, B; O'Brodovich, M; Paton, T; Wielenga, J

    1993-12-01

    Progressing towards the goal of PC requires a fundamental change to pharmacy practice. Strong leadership and management skills will be needed to facilitate this change. Even with enthusiastic and capable staff, implementation of the PC model will require considerable effort. Changes to the department's mission statement and organizational structure will be required. From this beginning, an action plan for the department can be developed. This plan includes the training of individuals and/or recruiting the necessary personnel. An ongoing education program, as well as determining the value of your service, is required. With successful implementation the PC model will lead to the acceptance of the pharmacist's role as the person responsible for identifying, preventing, and resolving drug-related problems.

  15. A Toolkit to Implement Graduate Attributes in Geography Curricula

    ERIC Educational Resources Information Center

    Spronken-Smith, Rachel; McLean, Angela; Smith, Nell; Bond, Carol; Jenkins, Martin; Marshall, Stephen; Frielick, Stanley

    2016-01-01

    This article uses findings from a project on engagement with graduate outcomes across higher education institutions in New Zealand to produce a toolkit for implementing graduate attributes in geography curricula. Key facets include strong leadership; academic developers to facilitate conversations about graduate attributes and teaching towards…

  16. Education Needs for Intelligent Transportation System Implementation in the United States

    DOT National Transportation Integrated Search

    1996-01-01

    Intelligent transportation systems (ITS) are being promoted as potential solutions to a wide variety of today's transportation problems. To facilitate their successful implementation, it may be useful to define an integrated program for educating the...

  17. Use of agents to implement an integrated computing environment

    NASA Technical Reports Server (NTRS)

    Hale, Mark A.; Craig, James I.

    1995-01-01

    Integrated Product and Process Development (IPPD) embodies the simultaneous application to both system and quality engineering methods throughout an iterative design process. The use of IPPD results in the time-conscious, cost-saving development of engineering systems. To implement IPPD, a Decision-Based Design perspective is encapsulated in an approach that focuses on the role of the human designer in product development. The approach has two parts and is outlined in this paper. First, an architecture, called DREAMS, is being developed that facilitates design from a decision-based perspective. Second, a supporting computing infrastructure, called IMAGE, is being designed. Agents are used to implement the overall infrastructure on the computer. Successful agent utilization requires that they be made of three components: the resource, the model, and the wrap. Current work is focused on the development of generalized agent schemes and associated demonstration projects. When in place, the technology independent computing infrastructure will aid the designer in systematically generating knowledge used to facilitate decision-making.

  18. Facilitators and Barriers to Learning in Occupational Therapy Fieldwork Education: Student Perspectives.

    PubMed

    Grenier, Marie-Lyne

    2015-01-01

    The purpose of this study was to gain a comprehensive understanding of the facilitators of and barriers to learning within occupational therapy fieldwork education from the perspective of both Canadian and American students. A qualitative study using an online open survey format was conducted to gather data from 29 occupational therapy students regarding their fieldwork experiences. An inductive grounded theory approach to content analysis was used. Individual, environmental, educational, and institutional facilitators of and barriers to learning within occupational therapy fieldwork education were identified. This study's findings suggest that learning within fieldwork education is a highly individual and dynamic process that is influenced by numerous factors. The new information generated by this study has the potential to positively affect the future design and implementation of fieldwork education. Copyright © 2015 by the American Occupational Therapy Association, Inc.

  19. Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial.

    PubMed

    Meropol, Sharon B; Schiltz, Nicholas K; Sattar, Abdus; Stange, Kurt C; Nevar, Ann H; Davey, Christina; Ferretti, Gerald A; Howell, Diana E; Strosaker, Robyn; Vavrek, Pamela; Bader, Samantha; Ruhe, Mary C; Cuttler, Leona

    2014-06-01

    Evolving primary care models require methods to help practices achieve quality standards. This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of 3 pediatric preventive services. In this cluster-randomized trial, a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty practices were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods. Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late practices, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: <0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for improvement compared with Late practices' control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P < .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need. Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care. Copyright © 2014 by the American Academy of Pediatrics.

  20. Practice-Tailored Facilitation to Improve Pediatric Preventive Care Delivery: A Randomized Trial

    PubMed Central

    Schiltz, Nicholas K.; Sattar, Abdus; Stange, Kurt C.; Nevar, Ann H.; Davey, Christina; Ferretti, Gerald A.; Howell, Diana E.; Strosaker, Robyn; Vavrek, Pamela; Bader, Samantha; Ruhe, Mary C.; Cuttler, Leona

    2014-01-01

    OBJECTIVE: Evolving primary care models require methods to help practices achieve quality standards. This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of 3 pediatric preventive services. METHODS: In this cluster-randomized trial, a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty practices were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods. RESULTS: Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late practices, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: <0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for improvement compared with Late practices’ control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P < .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need. CONCLUSIONS: Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care. PMID:24799539

  1. The Process of Facilitating Knowledge Acquisition and Retention: An Inquiry into Magnetic Poles with Challenging Questions

    ERIC Educational Resources Information Center

    Okulu, Hasan Zühtü; Ünver, Ayse Oguz

    2018-01-01

    The current research is to give an example to the inquiry-based science teaching implementations for facilitating knowledge acquisition and retention in a short period of time. Thus, the aim of the research is to transfer of acquired knowledge into different situations using sequential inquiry activities, which have challenging questions for…

  2. Lay Patient Navigators' Perspectives of Barriers, Facilitators and Training Needs in Initiating Advance Care Planning Conversations With Older Patients With Cancer.

    PubMed

    Niranjan, Soumya J; Huang, Chao-Hui S; Dionne-Odom, J Nicholas; Halilova, Karina I; Pisu, Maria; Drentea, Patricia; Kvale, Elizabeth A; Bevis, Kerri S; Butler, Thomas W; Partridge, Edward E; Rocque, Gabrielle B

    2018-04-01

    Respecting Choices is an evidence-based model of facilitating advance care planning (ACP) conversations between health-care professionals and patients. However, the effectiveness of whether lay patient navigators can successfully initiate Respecting Choices ACP conversations is unknown. As part of a large demonstration project (Patient Care Connect [PCC]), a cohort of lay patient navigators underwent Respecting Choices training and were tasked to initiate ACP conversations with Medicare beneficiaries diagnosed with cancer. This article explores PCC lay navigators' perceived barriers and facilitators in initiating Respecting Choices ACP conversations with older patients with cancer in order to inform implementation enhancements to lay navigator-facilitated ACP. Twenty-six lay navigators from 11 PCC cancer centers in 4 states (Alabama, George, Tennessee, and Florida) completed in-depth, one-on-one semistructured interviews between June 2015 and August 2015. Data were analyzed using a thematic analysis approach. This evaluation identifies 3 levels-patient, lay navigator, and organizational factors in addition to training needs that influence ACP implementation. Key facilitators included physician buy-in, patient readiness, and navigators' prior experience with end-of-life decision-making. Lay navigators' perceived challenges to initiating ACP conversations included timing of the conversation and social and personal taboos about discussing dying. Our results suggest that further training and health system support are needed for lay navigators playing a vital role in improving the implementation of ACP among older patients with cancer. The lived expertise of lay navigators along with flexible longitudinal relationships with patients and caregivers may uniquely position this workforce to promote ACP.

  3. Implementing Accountable Care Organizations: Lessons From a Qualitative Analysis of Four Private Sector Organizations.

    PubMed

    Walker, Daniel M; Hefner, Jennifer L; Sova, Lindsey N; Hilligoss, Brian; Song, Paula H; McAlearney, Ann Scheck

    Accountable care organizations (ACOs) are emerging across the healthcare marketplace and now include Medicare, Medicaid, and private sector payers covering more than 24 million lives. However, little is known about the process of organizational change required to achieve cost savings and quality improvements from the ACO model. This study applies the complex innovation implementation framework to understand the challenges and facilitators associated with the ACO implementation process. We conducted four case studies of private sector ACOs, selected to achieve variation in terms of geography and organizational maturity. Across sites, we used semistructured interviews with 68 key informants to elicit information regarding ACO implementation. Our analysis found challenges and facilitators across all domains in the conceptual framework. Notably, our findings deviated from the framework in two ways. First, findings from the financial resource availability domain revealed both financial and nonfinancial (i.e., labor) resources that contributed to implementation effectiveness. Second, a new domain, patient engagement, emerged as an important factor in implementation effectiveness. We present these deviations in an adapted framework. As the ACO model proliferates, these findings can support implementation efforts, and they highlight the importance of focusing on patients throughout the process. Importantly, this study extends the complex innovation implementation framework to incorporate consumers into the implementation framework, making it more patient centered and aiding future efforts.

  4. Implementation of the power to prevent diabetes prevention educational curriculum into rural African American communities: a feasibility study.

    PubMed

    Cené, Crystal W; Haymore, Laura Beth; Ellis, Danny; Whitaker, Shaketa; Henderson, Stacey; Lin, Feng-Chang; Corbie-Smith, Giselle

    2013-01-01

    The purpose of this study was to describe the feasibility of using a community-based participatory research (CBPR) approach to implement the Power to Prevent (P2P) diabetes prevention education curriculum in rural African American (AA) settings. Trained community health workers facilitated the 12-session P2P curriculum across 3 community settings. Quantitative (based on the pre- and post-curriculum questionnaires and changes in blood glucose, blood pressure [BP], and weight at baseline and 6 months) and qualitative data (based on semi-structured interviews with facilitators) were collected. Indicators of feasibility included: demand, acceptability, implementation fidelity, and limited efficacy testing. Across 3 counties, 104 AA participants were recruited; 43% completed ≥ 75% of the sessions. There was great demand for the program. Fifteen community health ambassadors (CHAs) were trained, and 4 served as curriculum facilitators. Content and structure of the intervention was acceptable to facilitators but there were challenges to implementing the program as designed. Improvements were seen in diabetes knowledge and the impact of healthy eating and physical activity on diabetes prevention, but there were no significant changes in blood glucose, BP, or weight. While it is feasible to use a CBPR approach to recruit participants and implement the P2P curriculum in AA community settings, there are significant challenges that must be overcome.

  5. ERP System Implementation: An Oil and Gas Exploration Sector Perspective

    NASA Astrophysics Data System (ADS)

    Mishra, Alok; Mishra, Deepti

    Enterprise Resource Planning (ERP) systems provide integration and optimization of various business processes which leads to improved planning and decision quality, smoother coordination between business units resulting in higher efficiency, and quicker response time to customer demands and inquiries. This paper reports challenges, opportunities and outcome of ERP implementation in Oil & Gas exploration sector. This study will facilitate in understanding transition, constraints and implementation of ERP in this sector and also provide guidelines from lessons learned in this regard.

  6. Improved Delivery of Cardiovascular Care (IDOCC): Findings from Narrative Reports by Practice Facilitators.

    PubMed

    Liddy, Clare; Rowan, Margo; Valiquette-Tessier, Sophie-Claire; Drosinis, Paul; Crowe, Lois; Hogg, William

    2017-03-01

    Practice facilitation can help family physicians adopt evidence-based guidelines. However, many practices struggle to effectively implement practice changes that result in meaningful improvement. Building on our previous research, we examined the barriers to and enablers of implementation perceived by practice facilitators (PF) in helping practices to adopt the Improved Delivery of Cardiovascular Care (IDOCC) program, which took place at 84 primary care practices in Ottawa, Canada between April 2008 and March 2012. We conducted a qualitative analysis of PFs' narrative reports using a multiple case study design. We used a combined purposeful sampling approach to identify cases that 1) reflected experiences typical of the broader sample and 2) presented sufficient breadth of experience from each project step and family practice model. Sampling continued until data saturation was reached. Team members conducted a qualitative analysis of reports using an open and axial coding style and a constant comparative approach. Barriers and enablers were divided into five constructs: structural, organizational, provider, patient, and innovation. Narratives from 13 practice sites were reviewed. A total of 8 barriers and 11 enablers were consistently identified across practices. Barriers were most commonly reported at the organizational (n = 3) and structural level, (n = 2) while enablers were most common at the innovation level (n = 6). While physicians responded positively to PFs' presence and largely supported their recommendations for practice change, organizational and structural aspects such as lack of time, minimal staff engagement, and provider reimbursement remained too great for practices to successfully implement practice-level changes. Trial Registration: ClinicalTrials.gov, NCT00574808.

  7. From parent to 'peer facilitator': a qualitative study of a peer-led parenting programme.

    PubMed

    Thomson, S; Michelson, D; Day, C

    2015-01-01

    Peer-led interventions are increasingly common in community health settings. Although peer-led approaches have proven benefits for service users, relatively little is known about the process and outcomes of participation for peer leaders. This study investigated experiences of parents who had participated as 'peer facilitators' in Empowering Parents, Empowering Communities (EPEC), a peer-led programme designed to improve access to evidence-based parenting support in socially disadvantaged communities. A qualitative cross-sectional design was used. Semi-structured interviews were conducted with 14 peer facilitators and scrutinized using thematic analysis. Peer facilitators developed their knowledge and skills through personal experience of receiving parenting support, participation in formal training and supervised practice, access to an intervention manual, and peer modelling. Peer facilitators described positive changes in their own families, confidence and social status. Transformative personal gains reinforced peer facilitators' role commitment and contributed to a cohesive 'family' identity among EPEC staff and service users. Peer facilitators' enthusiasm, openness and mutual identification with families were seen as critical to EPEC's effectiveness and sustainability. Peer facilitators also found the training emotionally and intellectually demanding. There were particular difficulties around logistical issues (e.g. finding convenient supervision times), managing psychosocial complexity and child safeguarding. The successful delivery and sustained implementation of peer-led interventions requires careful attention to the personal qualities and support of peer leaders. Based on the findings of this study, support should include training, access to intervention manuals, regular and responsive supervision, and logistical/administrative assistance. Further research is required to elaborate and extend these findings to other peer-led programmes. © 2014 John Wiley

  8. Simple Tools to Facilitate Project Management of a Nursing Research Project.

    PubMed

    Aycock, Dawn M; Clark, Patricia C; Thomas-Seaton, LaTeshia; Lee, Shih-Yu; Moloney, Margaret

    2016-07-01

    Highly organized project management facilitates rigorous study implementation. Research involves gathering large amounts of information that can be overwhelming when organizational strategies are not used. We describe a variety of project management and organizational tools used in different studies that may be particularly useful for novice researchers. The studies were a multisite study of caregivers of stroke survivors, an Internet-based diary study of women with migraines, and a pilot study testing a sleep intervention in mothers of low-birth-weight infants. Project management tools were used to facilitate enrollment, data collection, and access to results. The tools included protocol and eligibility checklists, event calendars, screening and enrollment logs, instrument scoring tables, and data summary sheets. These tools created efficiency, promoted a positive image, minimized errors, and provided researchers with a sense of control. For the studies described, there were no protocol violations, there were minimal missing data, and the integrity of data collection was maintained. © The Author(s) 2016.

  9. Evaluation and implementation of highly challenging balance training in clinical practice for people with Parkinson's disease: protocol for the HiBalance effectiveness-implementation trial.

    PubMed

    Leavy, Breiffni; Kwak, Lydia; Hagströmer, Maria; Franzén, Erika

    2017-02-07

    If people with progressive neurological diseases are to avail of evidence-based rehabilitation, programs found effective in randomized controlled trials (RCT's) must firstly be adapted and tested in clinical effectiveness studies as a means of strengthening their evidence base. This paper describes the protocol for an effectiveness-implementation trial that will assess the clinical effectiveness of a highly challenging balance training program (the HiBalance program) for people with mild-moderate Parkinson's disease (PD) while simultaneously collecting data concerning the way in which the program is implemented. The HiBalance program is systemically designed to target balance impairments in PD and has been shown effective at improving balance control and gait in a previous RCT. Study aims are to i) determine the effectiveness of the adapted HiBalance program on performance and self-rated outcomes such as balance control, gait and physical activity level ii) conduct a process evaluation of program implementation at the various clinics iii) determine barriers and facilitators to program implementation in these settings. This effectiveness-implementation type 1 hybrid study will use a non-randomized controlled design with consecutive inclusion of people with PD at multiple clinical sites. A mixed method approach will be used to collect clinical effectiveness data and process evaluation data which is both quantitative and qualitative in nature. The consolidated framework for implementation research (CFIR) will be used to guide the planning and collection of data concerning implementation barriers and facilitators. The HiBalance program will be provided by physical therapists as a part of standard rehabilitation care at the clinical sites, while the evaluation of the implementation process will be performed by the research group and funded by research grants. An effectiveness-implementation study design benefits patients by speeding up the process of translating

  10. Facilitating professional liaison in collaborative care for depression in UK primary care; a qualitative study utilising normalisation process theory.

    PubMed

    Coupe, Nia; Anderson, Emma; Gask, Linda; Sykes, Paul; Richards, David A; Chew-Graham, Carolyn

    2014-05-01

    Collaborative care (CC) is an organisational framework which facilitates the delivery of a mental health intervention to patients by case managers in collaboration with more senior health professionals (supervisors and GPs), and is effective for the management of depression in primary care. However, there remains limited evidence on how to successfully implement this collaborative approach in UK primary care. This study aimed to explore to what extent CC impacts on professional working relationships, and if CC for depression could be implemented as routine in the primary care setting. This qualitative study explored perspectives of the 6 case managers (CMs), 5 supervisors (trial research team members) and 15 general practitioners (GPs) from practices participating in a randomised controlled trial of CC for depression. Interviews were transcribed verbatim and data was analysed using a two-step approach using an initial thematic analysis, and a secondary analysis using the Normalisation Process Theory concepts of coherence, cognitive participation, collective action and reflexive monitoring with respect to the implementation of CC in primary care. Supervisors and CMs demonstrated coherence in their understanding of CC, and consequently reported good levels of cognitive participation and collective action regarding delivering and supervising the intervention. GPs interviewed showed limited understanding of the CC framework, and reported limited collaboration with CMs: barriers to collaboration were identified. All participants identified the potential or experienced benefits of a collaborative approach to depression management and were able to discuss ways in which collaboration can be facilitated. Primary care professionals in this study valued the potential for collaboration, but GPs' understanding of CC and organisational barriers hindered opportunities for communication. Further work is needed to address these organisational barriers in order to facilitate

  11. Clinicians’ Perspectives on Cognitive Therapy in Community Mental Health Settings: Implications for Training and Implementation

    PubMed Central

    Gutiérrez-Colina, Ana; Toder, Katherine; Esposito, Gregory; Barg, Frances; Castro, Frank; Beck, Aaron T.; Crits-Christoph, Paul

    2012-01-01

    Policymakers are investing significant resources in large-scale training and implementation programs for evidence-based psychological treatments (EBPTs) in public mental health systems. However, relatively little research has been conducted to understand factors that may influence the success of efforts to implement EBPTs for adult consumers of mental health services. In a formative investigation during the development of a program to implement cognitive therapy (CT) in a community mental health system, we surveyed and interviewed clinicians and clinical administrators to identify potential influences on CT implementation within their agencies. Four primary themes were identified. Two related to attitudes towards CT: (1) ability to address client needs and issues that are perceived as most central to their presenting problems, and (2) reluctance to fully implement CT. Two themes were relevant to context: (1) agency-level barriers, specifically workload and productivity concerns and reactions to change, and (2) agency-level facilitators, specifically, treatment planning requirements and openness to training. These findings provide information that can be used to develop strategies to facilitate the implementation of CT interventions for clients being treated in public-sector settings. PMID:22426739

  12. Developing facilitation skills--a narrative.

    PubMed

    Newton, Jennifer M

    2003-07-01

    Effective facilitation has been identified in the literature as one of three elements, along with context and evidence, that have a dynamic and coexisting relationship to enable the successful uptake of evidence into practice. This paper presents an overview of the concept of facilitation within the context of practice development, ahead of a personal and professional reflective account of a 'developing facilitator'. In the summer of 2001, the author was instrumental in organising the first Practice Development School in Melbourne. Thrown in at the deep end, she found herself co-facilitating with an experienced practice developer from the United Kingdom. Having never facilitated in the arena of an action learning group, nor worked in the field of practice development, there was initially a sense of impending overload and drowning in the new knowledge and skills that needed to be acquired. Drawing upon the work of narrative inquiry the author shares her experiences in the anticipation that in telling her story it will assist others in their journey of becoming a facilitator.

  13. Facilitation of Psychiatric Advance Directives by Peers and Clinicians on Assertive Community Treatment Teams.

    PubMed

    Easter, Michele M; Swanson, Jeffrey W; Robertson, Allison G; Moser, Lorna L; Swartz, Marvin S

    2017-07-01

    Psychiatric advance directives (PADs) provide a legal mechanism for competent adults to document care preferences and authorize a surrogate to make treatment decisions. In a controlled research setting, an evidence-based intervention, the facilitated psychiatric advance directive (FPAD), was previously shown to overcome most barriers to PAD completion. This study examined implementation of the FPAD intervention in usual care settings as delivered by peer support specialists and nonpeer clinicians on assertive community treatment (ACT) teams. A total of 145 ACT consumers were randomly assigned, within teams, to FPAD with facilitation by either a peer (N=71) or a clinician (N=74). Completion rates and PAD quality were compared with the previous study's standard and across facilitator type. Logistic regression was used to estimate effects on the likelihood of PAD completion. The completion rate of 50% in the intent-to-treat sample (N=145) was somewhat inferior to the prior standard (61%), but the rate of 58% for the retained sample (those who completed a follow-up interview, N=116) was not significantly different from the standard. Rates for peers and clinicians did not differ significantly from each other for either sample. PAD quality was similar to that achieved in the prior study. Four consumer variables predicted completion: independent living status, problematic substance use, length of time served by the ACT team, and no perceived unmet need for hospitalization in crisis. Peers and clinicians can play a crucial role in increasing the number of consumers with PADs, an important step toward improving implementation of PADs in mental health care.

  14. Domestic Implementation of a Chemical Weapons Treaty

    DTIC Science & Technology

    1989-10-01

    regulations can be used for treaty comliance; identify producers of certain treaty chemicals and present case studies on two such chemicals; review and...discuss the protocol limitations of using existing statutes for the reporting requirements through case studies of two chemicals for which reporting...requirements or requ.lations can be used to facilitate domestic implementation, studies the domestic implmentation procedures and experience gained fron the

  15. Graphic facilitation as a novel approach to practice development.

    PubMed

    Leonard, Angela; Bonaconsa, Candice; Ssenyonga, Lydia; Coetzee, Minette

    2017-10-10

    The active participation of staff from the outset of any health service or practice improvement process ensures they are more likely to become engaged in the implementation phases that follow initial service analyses. Graphic facilitation is a way of getting participants to develop an understanding of complex systems and articulate solutions from within them. This article describes how a graphic facilitation process enabled the members of a multidisciplinary team at a specialist paediatric neurosurgery hospital in Uganda to understand how their system worked. The large graphic representation the team created helped each team member to visualise their day-to-day practice, understand each person's contribution, celebrate their triumphs and highlight opportunities for service improvement. The process highlighted three features of their practice: an authentic interdisciplinary team approach to care, admission of the primary carer with the child, and previously unrecognised delays in patient flow through the outpatients department. The team's active participation and ownership of the process resulted in sustainable improvements to clinical practice. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  16. Physician perspectives on a tailored multifaceted primary care practice facilitation intervention for improvement of cardiovascular care.

    PubMed

    Liddy, Clare; Singh, Jatinderpreet; Guo, Merry; Hogg, William

    2016-02-01

    Practice facilitation is an effective way to help physicians implement change in their clinics, but little is known about physicians' perspectives on this service. To examine physicians' responses to a practice facilitation program, focussing on their overall satisfaction, perceived most significant clinical changes, and interactions with the facilitator. The Improved Delivery of Cardiovascular Care program investigated the impact of practice facilitation on improving the quality of cardiovascular primary care in Eastern Ontario, Canada, from 2007 to 2011. We conducted a qualitative content analysis of post-intervention surveys completed by participating physicians, using a constant comparison approach framed around the Chronic Care Model. Ninety-five physicians completed the survey. Physicians overwhelmingly viewed the program positively, though descriptions of its benefits and impact varied widely. Facilitators filled three key roles for physicians, acting as a resource centre, motivator and outside perspective. Physicians adopted a number of changes in their practices. These changes include adoption of clinical information systems (diabetes registries), decision support tools (chart audits, guideline documents, flow sheets) and delivery system design (community resources). Most physicians appreciated having access to a practice facilitator and viewed the intervention positively. Insight into physicians' perspectives on practice facilitation provides a valuable counterpoint to outcomes-based evaluations of such services. Further research should investigate potential obstacles in the group of physicians who make fewer practice changes, as well as the sustainability of this type of facilitation intervention. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. Implementation fidelity of a self-management course for epilepsy: method and assessment.

    PubMed

    Wojewodka, G; Hurley, S; Taylor, S J C; Noble, A J; Ridsdale, L; Goldstein, L H

    2017-07-11

    Complex interventions such as self-management courses are difficult to evaluate due to the many interacting components. The way complex interventions are delivered can influence the effect they have for patients, and can impact the interpretation of outcomes of clinical trials. Implementation fidelity evaluates whether complex interventions are delivered according to protocol. Such assessments have been used for one-to-one psychological interventions; however, the science is still developing for group interventions. We developed and tested an instrument to measure implementation fidelity of a two-day self-management course for people with epilepsy, SMILE(UK). Using audio recordings, we looked at adherence and competence of course facilitators. Adherence was assessed by checklists. Competence was measured by scoring group interaction, an overall impression score and facilitator "didacticism". To measure "didacticism", we developed a novel way to calculate facilitator speech using computer software. Using this new instrument, implementation fidelity of SMILE(UK) was assessed on three modules of the course, for 28% of all courses delivered. Using the instrument for adherence, scores from two independent raters showed substantial agreement with weighted Kappa of 0.67 and high percent agreement of 81.2%. For didacticism, the results from both raters were highly correlated with an intraclass coefficient of 0.97 (p < 0.0001). We found that the courses were delivered with a good level of adherence (> 50% of scored items received the maximum of 2 points) and high competence. Groups were interactive (mean score: 1.9-2.0 out of 2) and the overall impression was on average assessed as "good". Didacticism varied from 42% to 93% of total module time and was not associated with the other competence scores. The instrument devised to measure implementation fidelity was reproducible and easy to use. The courses for the SMILE(UK) study were delivered with a good level of adherence

  18. The Biosurveillance Analytics Resource Directory (BARD): Facilitating the use of epidemiological models for infectious disease surveillance

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Margevicius, Kristen J.; Generous, Nicholas; Abeyta, Esteban

    Epidemiological modeling for infectious disease is important for disease management and its routine implementation needs to be facilitated through better description of models in an operational context. A standardized model characterization process that allows selection or making manual comparisons of available models and their results is currently lacking. A key need is a universal framework to facilitate model description and understanding of its features. Los Alamos National Laboratory (LANL) has developed a comprehensive framework that can be used to characterize an infectious disease model in an operational context. The framework was developed through a consensus among a panel of subjectmore » matter experts. In this paper, we describe the framework, its application to model characterization, and the development of the Biosurveillance Analytics Resource Directory (BARD; http://brd.bsvgateway.org/brd/), to facilitate the rapid selection of operational models for specific infectious/communicable diseases. We offer this framework and associated database to stakeholders of the infectious disease modeling field as a tool for standardizing model description and facilitating the use of epidemiological models.« less

  19. The Biosurveillance Analytics Resource Directory (BARD): Facilitating the Use of Epidemiological Models for Infectious Disease Surveillance

    PubMed Central

    Margevicius, Kristen J; Generous, Nicholas; Abeyta, Esteban; Althouse, Ben; Burkom, Howard; Castro, Lauren; Daughton, Ashlynn; Del Valle, Sara Y.; Fairchild, Geoffrey; Hyman, James M.; Kiang, Richard; Morse, Andrew P.; Pancerella, Carmen M.; Pullum, Laura; Ramanathan, Arvind; Schlegelmilch, Jeffrey; Scott, Aaron; Taylor-McCabe, Kirsten J; Vespignani, Alessandro; Deshpande, Alina

    2016-01-01

    Epidemiological modeling for infectious disease is important for disease management and its routine implementation needs to be facilitated through better description of models in an operational context. A standardized model characterization process that allows selection or making manual comparisons of available models and their results is currently lacking. A key need is a universal framework to facilitate model description and understanding of its features. Los Alamos National Laboratory (LANL) has developed a comprehensive framework that can be used to characterize an infectious disease model in an operational context. The framework was developed through a consensus among a panel of subject matter experts. In this paper, we describe the framework, its application to model characterization, and the development of the Biosurveillance Analytics Resource Directory (BARD; http://brd.bsvgateway.org/brd/), to facilitate the rapid selection of operational models for specific infectious/communicable diseases. We offer this framework and associated database to stakeholders of the infectious disease modeling field as a tool for standardizing model description and facilitating the use of epidemiological models. PMID:26820405

  20. The Biosurveillance Analytics Resource Directory (BARD): Facilitating the Use of Epidemiological Models for Infectious Disease Surveillance.

    PubMed

    Margevicius, Kristen J; Generous, Nicholas; Abeyta, Esteban; Althouse, Ben; Burkom, Howard; Castro, Lauren; Daughton, Ashlynn; Del Valle, Sara Y; Fairchild, Geoffrey; Hyman, James M; Kiang, Richard; Morse, Andrew P; Pancerella, Carmen M; Pullum, Laura; Ramanathan, Arvind; Schlegelmilch, Jeffrey; Scott, Aaron; Taylor-McCabe, Kirsten J; Vespignani, Alessandro; Deshpande, Alina

    2016-01-01

    Epidemiological modeling for infectious disease is important for disease management and its routine implementation needs to be facilitated through better description of models in an operational context. A standardized model characterization process that allows selection or making manual comparisons of available models and their results is currently lacking. A key need is a universal framework to facilitate model description and understanding of its features. Los Alamos National Laboratory (LANL) has developed a comprehensive framework that can be used to characterize an infectious disease model in an operational context. The framework was developed through a consensus among a panel of subject matter experts. In this paper, we describe the framework, its application to model characterization, and the development of the Biosurveillance Analytics Resource Directory (BARD; http://brd.bsvgateway.org/brd/), to facilitate the rapid selection of operational models for specific infectious/communicable diseases. We offer this framework and associated database to stakeholders of the infectious disease modeling field as a tool for standardizing model description and facilitating the use of epidemiological models.

  1. The Biosurveillance Analytics Resource Directory (BARD): Facilitating the use of epidemiological models for infectious disease surveillance

    DOE PAGES

    Margevicius, Kristen J.; Generous, Nicholas; Abeyta, Esteban; ...

    2016-01-28

    Epidemiological modeling for infectious disease is important for disease management and its routine implementation needs to be facilitated through better description of models in an operational context. A standardized model characterization process that allows selection or making manual comparisons of available models and their results is currently lacking. A key need is a universal framework to facilitate model description and understanding of its features. Los Alamos National Laboratory (LANL) has developed a comprehensive framework that can be used to characterize an infectious disease model in an operational context. The framework was developed through a consensus among a panel of subjectmore » matter experts. In this paper, we describe the framework, its application to model characterization, and the development of the Biosurveillance Analytics Resource Directory (BARD; http://brd.bsvgateway.org/brd/), to facilitate the rapid selection of operational models for specific infectious/communicable diseases. We offer this framework and associated database to stakeholders of the infectious disease modeling field as a tool for standardizing model description and facilitating the use of epidemiological models.« less

  2. Medical students' and facilitators' experiences of an Early Professional Contact course: active and motivated students, strained facilitators.

    PubMed

    von Below, Bernhard; Hellquist, Gunilla; Rödjer, Stig; Gunnarsson, Ronny; Björkelund, Cecilia; Wahlqvist, Mats

    2008-12-02

    Today, medical students are introduced to patient contact, communication skills, and clinical examination in the preclinical years of the curriculum with the purpose of gaining clinical experience. These courses are often evaluated from the student perspective. Reports with an additional emphasis on the facilitator perspective are scarce. According to constructive alignment, an influential concept from research in higher education, the learning climate between students and teachers is also of great importance. In this paper, we approach the learning climate by studying both students' and facilitators' course experiences.In 2001, a new "Early Professional Contact" longitudinal strand through term 1-4, was introduced at the Sahlgrenska Academy, University of Gothenburg, Sweden. General practitioners and hospital specialists were facilitators.The aim of this study was to assess and analyse students' and clinical facilitators' experiences of the Early Professional Contact course and to illuminate facilitators' working conditions. Inspired by a Swedish adaptation of the Course Experience Questionnaire, an Early Professional Contact Questionnaire was constructed. In 2003, on the completion of the first longitudinal strand, a student and facilitator version was distributed to 86 students and 21 facilitators. In the analysis, both Chi-square and the Mann-Whitney tests were used. Sixty students (70%) and 15 facilitators (71%) completed the questionnaire. Both students and facilitators were satisfied with the course. Students reported gaining iiration for their future work as doctors along with increased confidence in meeting patients. They also reported increased motivation for biomedical studies. Differences in attitudes between facilitators and students were found. Facilitators experienced a greater workload, less reasonable demands and less support, than students. In this project, a new Early Professional Contact course was analysed from both student and facilitator

  3. Implementing and Sustaining Team-Based Telecare for Bipolar Disorder: Lessons Learned from a Model-Guided, Mixed Methods Analysis.

    PubMed

    Bauer, Mark S; Krawczyk, Lois; Tuozzo, Kathy; Frigand, Cara; Holmes, Sally; Miller, Christopher J; Abel, Erica; Osser, David N; Franz, Aleda; Brandt, Cynthia; Rooney, Meghan; Fleming, Jerry; Smith, Eric; Godleski, Linda

    2018-01-01

    Telemental health interventions have empirical support from clinical trials and structured demonstration projects. However, their implementation and sustainability under less structured clinical conditions are not well demonstrated. We conducted a follow-up analysis of the implementation and sustainability of a clinical video teleconference-based collaborative care model for individuals with bipolar disorder treated in the Department of Veterans Affairs to (a) characterize the extent of implementation and sustainability of the program after its establishment and (b) identify barriers and facilitators to implementation and sustainability. We conducted a mixed methods program evaluation, assessing quantitative aspects of implementation according to the Reach, Efficacy, Adoption, Implementation, and Maintenance implementation framework. We conducted qualitative analysis of semistructured interviews with 16 of the providers who submitted consults, utilizing the Integrated Promoting Action on Research Implementation in the Health Services implementation framework. The program demonstrated linear growth in sites (n = 35) and consults (n = 915) from late 2011 through mid-2016. Site-based analysis indicated statistically significant sustainability beyond the first year of operation. Qualitative analysis identified key facilitators, including consult content, ease of use via electronic health record, and national infrastructure. Barriers included availability of telehealth space, equipment, and staff at the sites, as well as the labor-intensive nature of scheduling. The program achieved continuous growth over almost 5 years due to (1) successfully filling a need perceived by providers, (2) developing in a supportive context, and (3) receiving effective facilitation by national and local infrastructure. Clinical video teleconference-based interventions, even multicomponent collaborative care interventions for individuals with complex mental health conditions, can

  4. A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa.

    PubMed

    Silumbwe, Adam; Zulu, Joseph Mumba; Halwindi, Hikabasa; Jacobs, Choolwe; Zgambo, Jessy; Dambe, Rosalia; Chola, Mumbi; Chongwe, Gershom; Michelo, Charles

    2017-05-22

    Understanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa. A systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation. The main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs) through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution. Mass drug administration for lymphatic filariasis elimination programmes should design their implementation strategies differently based on specific contextual factors to

  5. Implementation of an ergonomics intervention in a Swedish flight baggage handling company—A process evaluation

    PubMed Central

    Mathiassen, Svend Erik; Larsson, Johan; Kwak, Lydia

    2018-01-01

    Objective To conduct a process evaluation of the implementation of an ergonomics training program aimed at increasing the use of loading assist devices in flight baggage handling. Methods Feasibility related to the process items recruitment, reach, context, dose delivered (training time and content); dose received (participants’ engagement); satisfaction with training; intermediate outcomes (skills, confidence and behaviors); and barriers and facilitators of the training intervention were assessed by qualitative and quantitative methods. Results Implementation proved successful regarding dose delivered, dose received and satisfaction. Confidence among participants in the training program in using and talking about devices, observed use of devices among colleagues, and internal feedback on work behavior increased significantly (p<0.01). Main facilitators were self-efficacy, motivation, and perceived utility of training among the trainees. Barriers included lack of peer support, opportunities to observe and practice behaviors, and follow-up activities; as well as staff reduction and job insecurity. Conclusions In identifying important barriers and facilitators for a successful outcome, this study can help supporting the effectiveness of future interventions. Our results suggest that barriers caused by organizational changes may likely be alleviated by recruiting motivated trainees and securing strong organizational support for the implementation. PMID:29513671

  6. BioC implementations in Go, Perl, Python and Ruby

    PubMed Central

    Liu, Wanli; Islamaj Doğan, Rezarta; Kwon, Dongseop; Marques, Hernani; Rinaldi, Fabio; Wilbur, W. John; Comeau, Donald C.

    2014-01-01

    As part of a communitywide effort for evaluating text mining and information extraction systems applied to the biomedical domain, BioC is focused on the goal of interoperability, currently a major barrier to wide-scale adoption of text mining tools. BioC is a simple XML format, specified by DTD, for exchanging data for biomedical natural language processing. With initial implementations in C++ and Java, BioC provides libraries of code for reading and writing BioC text documents and annotations. We extend BioC to Perl, Python, Go and Ruby. We used SWIG to extend the C++ implementation for Perl and one Python implementation. A second Python implementation and the Ruby implementation use native data structures and libraries. BioC is also implemented in the Google language Go. BioC modules are functional in all of these languages, which can facilitate text mining tasks. BioC implementations are freely available through the BioC site: http://bioc.sourceforge.net. Database URL: http://bioc.sourceforge.net/ PMID:24961236

  7. A qualitative analysis of the concepts of fidelity and adaptation in the implementation of an evidence-based HIV prevention intervention

    PubMed Central

    Owczarzak, Jill; Broaddus, Michelle; Pinkerton, Steven

    2016-01-01

    Continued debate about the relative value of fidelity versus adaptation, and lack of clarity about the meaning of fidelity, raise concerns about how frontline service providers resolve similar issues in their daily practice. We use SISTA (‘Sisters Informing Sisters on Topics about acquired immune deficiency syndrome’), an evidence-based human immunodeficiency virus (HIV) prevention intervention for African American women, to understand how facilitators and program directors interpret and enact implementation fidelity with the need for adaptation in real-world program delivery. We conducted 22 in-depth, semi-structured interviews with service providers from four agencies implementing SISTA. Facilitators valued their skills as group leaders and ability to emotionally engage participants as more critical to program effectiveness than delivering the intervention with strict fidelity. Consequently, they saw program manuals as guides rather than static texts that should never be changed and, moreover, viewed the prescriptive nature of manuals as undermining their efforts to fully engage with participants. Our findings suggest that greater consideration should be given to understanding the role of facilitators in program effectiveness over and above the question of whether they implement the program with fidelity. Moreover, training curricula should provide facilitators with transferable skills through general facilitator training rather than only program-specific or manual-specific training. PMID:26944867

  8. Implementation of proteomic biomarkers: making it work

    PubMed Central

    Mischak, Harald; Ioannidis, John PA; Argiles, Angel; Attwood, Teresa K; Bongcam-Rudloff, Erik; Broenstrup, Mark; Charonis, Aristidis; Chrousos, George P; Delles, Christian; Dominiczak, Anna; Dylag, Tomasz; Ehrich, Jochen; Egido, Jesus; Findeisen, Peter; Jankowski, Joachim; Johnson, Robert W; Julien, Bruce A; Lankisch, Tim; Leung, Hing Y; Maahs, David; Magni, Fulvio; Manns, Michael P; Manolis, Efthymios; Mayer, Gert; Navis, Gerjan; Novak, Jan; Ortiz, Alberto; Persson, Frederik; Peter, Karlheinz; Riese, Hans H; Rossing, Peter; Sattar, Naveed; Spasovski, Goce; Thongboonkerd, Visith; Vanholder, Raymond; Schanstra, Joost P; Vlahou, Antonia

    2012-01-01

    While large numbers of proteomic biomarkers have been described, they are generally not implemented in medical practice. We have investigated the reasons for this shortcoming, focusing on hurdles downstream of biomarker verification, and describe major obstacles and possible solutions to ease valid biomarker implementation. Some of the problems lie in suboptimal biomarker discovery and validation, especially lack of validated platforms with well-described performance characteristics to support biomarker qualification. These issues have been acknowledged and are being addressed, raising the hope that valid biomarkers may start accumulating in the foreseeable future. However, successful biomarker discovery and qualification alone does not suffice for successful implementation. Additional challenges include, among others, limited access to appropriate specimens and insufficient funding, the need to validate new biomarker utility in interventional trials, and large communication gaps between the parties involved in implementation. To address this problem, we propose an implementation roadmap. The implementation effort needs to involve a wide variety of stakeholders (clinicians, statisticians, health economists, and representatives of patient groups, health insurance, pharmaceutical companies, biobanks, and regulatory agencies). Knowledgeable panels with adequate representation of all these stakeholders may facilitate biomarker evaluation and guide implementation for the specific context of use. This approach may avoid unwarranted delays or failure to implement potentially useful biomarkers, and may expedite meaningful contributions of the biomarker community to healthcare. PMID:22519700

  9. Implementation of Mindfulness Training for Mental Health Staff: Organizational Context and Stakeholder Perspectives

    PubMed Central

    Byron, Gerard; Ziedonis, Douglas M.; McGrath, Caroline; Frazier, Jean A.; deTorrijos, Fernando

    2014-01-01

    Occupational stress and burnout adversely impacts mental health care staff well-being and patient outcomes. Mindfulness training reduces staff stress and may improve patient care. However, few studies explore mental health setting implementation. This qualitative study used focus groups to evaluate stakeholders’ perceptions of organizational factors affecting implementation of an adapted version of Mindfulness-Based Stress Reduction (MBSR) for staff on adolescent mental health units. Common facilitators included leadership securing buy-in with staff, allocating staff time to participate, and quiet space for training and practice. Other facilitators were past staff knowledge of mindfulness, local champions, and acculturating staff with mindfulness through a non-mandatory training attendance policy. Common barriers were limited staff time to attend training sessions and insufficient training coverage for some staff. Staff also reported improved focus when interacting with adolescents and improved social cohesion on the units. We conclude that a mindfulness-based program for reducing occupational stress can be successfully implemented on adolescent mental health units. Implementation appeared to change the social context of the units, including staff and patient interactions. More broadly, our findings highlight the importance of environmental factors in shaping attitudes, diffusion of innovation, and acculturation of wellness program implementations. PMID:26500708

  10. Barriers and facilitators to health information exchange in low- and middle-income country settings: a systematic review.

    PubMed

    Akhlaq, Ather; McKinstry, Brian; Muhammad, Khalid Bin; Sheikh, Aziz

    2016-11-01

    The exchange and use of health information can help healthcare professionals and policymakers make informed decisions on ways of improving patient and population health. Many low- and middle-income countries (LMICs) have however failed to embrace the approaches and technologies to facilitate health information exchange (HIE). We sought to understand the barriers and facilitators to the implementation and adoption of HIE in LMICs. Two reviewers independently searched 11 academic databases for published and on-going qualitative, quantitative and mixed-method studies and searched for unpublished work through the Google search engine. The searches covered the period from January 1990 to July 2014 and were not restricted by language. Eligible studies were independently, critically appraised and then thematically analysed. The searches yielded 5461 citations after de-duplication of results. Of these, 56 articles, three conference abstracts and four technical reports met the inclusion criteria. The lack of importance given to data in decision making, corruption and insecurity, lack of training and poor infrastructure were considered to be major challenges to implementing HIE, but strong leadership and clear policy direction coupled with the financial support to acquire essential technology, improve the communication network, and provide training for staff all helped to promote implementation. The body of work also highlighted how implementers of HIE needed to take into account local needs to ensure that stakeholders saw HIE as relevant and advantageous. HIE interventions implemented through leapfrog technologies such as telehealth/telemedicine and mHealth in Brazil, Kenya, and South Africa, provided successful examples of exchanging health information in LMICs despite limited resources and capability. It is important that implementation of HIE is aligned with national priorities and local needs. © The Author 2016. Published by Oxford University Press in association with

  11. Nurse-Led Programs to Facilitate Enrollment to Children's Oncology Group Cancer Control Trials.

    PubMed

    Haugen, Maureen; Kelly, Katherine Patterson; Leonard, Marcia; Mills, Denise; Sung, Lillian; Mowbray, Catriona; Landier, Wendy

    2016-09-01

    The progress made over the past 50 years in disease-directed clinical trials has significantly increased cure rates for children and adolescents with cancer. The Children's Oncology Group (COG) is now conducting more studies that emphasize improving quality of life for young people with cancer. These types of clinical trials are classified as cancer control (CCL) studies by the National Cancer Institute and require different resources and approaches to facilitate adequate accrual and implementation at COG institutions. Several COG institutions that had previously experienced problems with low accruals to CCL trials have successfully implemented local nursing leadership for these types of studies. Successful models of nurses as institutional leaders and "champions" of CCL trials are described. © 2015 by Association of Pediatric Hematology/Oncology Nurses.

  12. Analysing Teachers' Curriculum Implementation from Integrity and Actor-Oriented Perspectives

    ERIC Educational Resources Information Center

    Penuel, William R.; Phillips, Rachel S.; Harris, Christopher J.

    2014-01-01

    Curriculum materials and knowledge about curricular purposes and structures are valuable tools that teachers often draw upon to organize instruction and facilitate student learning. Careful analysis of teachers' curriculum implementation and the decision-making that undergirds their curriculum use is critical for fully understanding enactment.…

  13. Informatics tools to improve clinical research study implementation.

    PubMed

    Brandt, Cynthia A; Argraves, Stephanie; Money, Roy; Ananth, Gowri; Trocky, Nina M; Nadkarni, Prakash M

    2006-04-01

    There are numerous potential sources of problems when performing complex clinical research trials. These issues are compounded when studies are multi-site and multiple personnel from different sites are responsible for varying actions from case report form design to primary data collection and data entry. We describe an approach that emphasizes the use of a variety of informatics tools that can facilitate study coordination, training, data checks and early identification and correction of faulty procedures and data problems. The paper focuses on informatics tools that can help in case report form design, procedures and training and data management. Informatics tools can be used to facilitate study coordination and implementation of clinical research trials.

  14. Implementation strategies in pediatric neurocritical care.

    PubMed

    Markham, Christopher; Proctor, Enola K; Pineda, Jose A

    2017-06-01

    Brain-directed critical care for children is a relatively new area of subspecialization in pediatric critical care. Pediatric neurocritical care teams combine the expertise of neurology, neurosurgery, and critical care medicine. The positive impact of delivering specialized care to pediatric patients with acute neurological illness is becoming more apparent, but the optimum way to implement and sustain the delivery of this is complicated and poorly understood. We aim to provide emerging evidence supporting that effective implementation of pediatric neurocritical care pathways can improve patient survival and outcomes. We also provide an overview of the most effective strategies across the field of implementation science that can facilitate deployment of neurocritical care pathways in the pediatric ICU. Implementation strategies can broadly be grouped according to six categories: planning, educating, restructuring, financing, managing quality, and attending to the policy context. Using a combination of these strategies in the last decade, several institutions have improved patient morbidity and mortality. Although much work remains to be done, emerging evidence supports that implementation of evidence-based care pathways for critically ill children with two common neurological diagnoses - status epilepticus and traumatic brain injury - improves outcomes. Pediatric and neonatal neurocritical care programs that support evidence-based care can be effectively structured using appropriately sequenced implementation strategies to improve outcomes across a variety of patient populations and in a variety of healthcare settings.

  15. Relationship between Systems Coaching and Problem-Solving Implementation Fidelity in a Response-to-Intervention Model

    ERIC Educational Resources Information Center

    March, Amanda L.; Castillo, Jose M.; Batsche, George M.; Kincaid, Donald

    2016-01-01

    The literature on RTI has indicated that professional development and coaching are critical to facilitating problem-solving implementation with fidelity. This study examined the extent to which systems coaching related to the fidelity of problem-solving implementation in 31 schools from six districts. Schools participated in three years of a…

  16. Barriers to and Facilitators of Research Utilization: A Survey of Registered Nurses in China

    PubMed Central

    Wang, Li-Ping; Jiang, Xiao-Lian; Wang, Lei; Wang, Guo-Rong; Bai, Yang-Jing

    2013-01-01

    Aims This survey aims to describe the perception of barriers to and facilitators of research utilization by registered nurses in Sichuan province, China, and to explore the factors influencing the perceptions of the barriers to and facilitators of research utilization. Methods A cross sectional survey design and a double cluster sampling method were adopted. A total of 590 registered nurses from 3 tertiary level hospitals in Sichuan province, China, were recruited in a period from September 2006 to January 2007. A modified BARRUERS Scale and a Facilitators Scale were used. Data were analyzed with descriptive statistics, rank transformation test, and multiple linear regression. Results Barriers related to the setting subscale were more influential than barriers related to other subscales. The lack of authority was ranked as the top greatest barrier (15.7%), followed by the lack of time (13.4%) and language barrier (15.0%). Additional barriers identified were the reluctance of patients to research utilization, the lack of funding, and the lack of legal protection. The top three greatest facilitators were enhancing managerial support (36.9%), advancing education to increase knowledge base (21.1%), and increasing time for reviewing and implementing (17.5%), while cooperation of patients to research utilization, establishing a panel to evaluate researches, and funding were listed as additional facilitators. Hospital, educational background, research experience, and knowledge on evidence-based nursing were the factors influencing perceptions of the barriers and facilitators. Conclusions Nurses in China are facing a number of significant barriers in research utilization. Enhancing managerial support might be the most promising facilitator, given Chinese traditional culture and existing health care system. Hospital, educational background, research experience and knowledge on evidence-based nursing should be taken into account to promote research utilization. The BARRIERS

  17. Expert recommendations for implementing change (ERIC): protocol for a mixed methods study

    PubMed Central

    2014-01-01

    Background Identifying feasible and effective implementation strategies that are contextually appropriate is a challenge for researchers and implementers, exacerbated by the lack of conceptual clarity surrounding terms and definitions for implementation strategies, as well as a literature that provides imperfect guidance regarding how one might select strategies for a given healthcare quality improvement effort. In this study, we will engage an Expert Panel comprising implementation scientists and mental health clinical managers to: establish consensus on a common nomenclature for implementation strategy terms, definitions and categories; and develop recommendations to enhance the match between implementation strategies selected to facilitate the use of evidence-based programs and the context of certain service settings, in this case the U.S. Department of Veterans Affairs (VA) mental health services. Methods/Design This study will use purposive sampling to recruit an Expert Panel comprising implementation science experts and VA mental health clinical managers. A novel, four-stage sequential mixed methods design will be employed. During Stage 1, the Expert Panel will participate in a modified Delphi process in which a published taxonomy of implementation strategies will be used to establish consensus on terms and definitions for implementation strategies. In Stage 2, the panelists will complete a concept mapping task, which will yield conceptually distinct categories of implementation strategies as well as ratings of the feasibility and effectiveness of each strategy. Utilizing the common nomenclature developed in Stages 1 and 2, panelists will complete an innovative menu-based choice task in Stage 3 that involves matching implementation strategies to hypothetical implementation scenarios with varying contexts. This allows for quantitative characterizations of the relative necessity of each implementation strategy for a given scenario. In Stage 4, a live web

  18. Tracking implementation strategies: a description of a practical approach and early findings.

    PubMed

    Bunger, Alicia C; Powell, Byron J; Robertson, Hillary A; MacDowell, Hannah; Birken, Sarah A; Shea, Christopher

    2017-02-23

    Published descriptions of implementation strategies often lack precision and consistency, limiting replicability and slowing accumulation of knowledge. Recent publication guidelines for implementation strategies call for improved description of the activities, dose, rationale and expected outcome(s) of strategies. However, capturing implementation strategies with this level of detail can be challenging, as responsibility for implementation is often diffuse and strategies may be flexibly applied as barriers and challenges emerge. We describe and demonstrate the development and application of a practical approach to identifying implementation strategies used in research and practice that could be used to guide their description and specification. An approach to tracking implementation strategies using activity logs completed by project personnel was developed to facilitate identification of discrete strategies. This approach was piloted in the context of a multi-component project to improve children's access to behavioural health services in a county-based child welfare agency. Key project personnel completed monthly activity logs that gathered data on strategies used over 17 months. Logs collected information about implementation activities, intent, duration and individuals involved. Using a consensus approach, two sets of coders categorised each activity based upon Powell et al.'s (Med Care Res Rev 69:123-57, 2012) taxonomy of implementation strategies. Participants reported on 473 activities, which represent 45 unique strategies. Initial implementation was characterised by planning strategies followed by educational strategies. After project launch, quality management strategies predominated, suggesting a progression of implementation over time. Together, these strategies accounted for 1594 person-hours, many of which were reported by the leadership team that was responsible for project design, implementation and oversight. This approach allows for identifying

  19. Factors that influence the implementation of dietary guidelines regarding food provision in centre based childcare services: A systematic review.

    PubMed

    Seward, Kirsty; Finch, Meghan; Yoong, Sze Lin; Wyse, Rebecca; Jones, Jannah; Grady, Alice; Wiggers, John; Nathan, Nicole; Conte, Kathleen; Wolfenden, Luke

    2017-12-01

    Children attending centre based childcare services consume as much as two thirds of their daily dietary requirements while in care. However, such services often fail to provide foods that are consistent with guideline recommendations. Developing strategies to improve childcare service adherence to menu dietary guidelines requires a comprehensive understanding of factors that may impede or promote implementation. The primary aim of this systematic review is to describe factors (barriers and facilitators) that may influence the implementation of menu dietary guidelines regarding food provision in centre-based childcare services and to map these factors to a theoretical framework. Over 7000 citations were identified from all sources. Duplicate abstracts were removed and selection criteria applied. Twelve studies (1994-2015) were included in the review. Dual data extraction was conducted and the reported factors were synthesised using the theoretical domains framework (TDF). Barriers and facilitators identified in qualitative studies were classified into 8 and 10 of the 14 TDF domains. Barriers and facilitators reported in quantitative studies covered 6 and 3 TDF domains respectively. The most common domain of which both barriers and facilitators to the implementation of menu dietary guidelines were identified was 'environmental context and resources'. This is the first study that comprehensively assesses literature to identify factors that influence the implementation of menu dietary guidelines in childcare services utilising a theoretical framework. Findings provide guidance to support researchers and policy makers design strategies to improve menu dietary guideline implementation and, as such have the potential to improve food provision in care. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  20. Online interprofessional education facilitation: A scoping review.

    PubMed

    Evans, Sherryn Maree; Ward, Catherine; Reeves, Scott

    2018-04-22

    The use of online media to deliver interprofessional education (IPE) is becoming more prevalent across health professions education settings. Facilitation of IPE activities is known to be critical to the effective delivery of IPE, however, specifics about the nature of online IPE facilitation remains unclear. To explore the health professions education literature to understand the extent, range and nature of research on online IPE facilitation. Scoping review methodology was used to guide a search of four electronic databases for relevant papers. Of the 2095 abstracts initially identified, after screening of both abstracts and full-text papers, 10 studies were selected for inclusion in this review. Following abstraction of key information from each study, a thematic analysis was undertaken. Three key themes emerged to describe the nature of the IPE facilitation literature: (1) types of online IPE facilitation contributions, (2) the experience of online IPE facilitation and (3) personal outcomes of online IPE facilitation. These IPE facilitation themes were particularly focused on facilitation of interprofessional student teams on an asynchronous basis. While the included studies provide some insight into the nature of online IPE facilitation, future research is needed to better understand facilitator contributions, and the facilitation experience and associated outcomes, both relating to synchronous and asynchronous online environments.

  1. Implementing a social network intervention designed to enhance and diversify support for people with long-term conditions. A qualitative study.

    PubMed

    Kennedy, Anne; Vassilev, Ivaylo; James, Elizabeth; Rogers, Anne

    2016-02-29

    For people with long-term conditions, social networks provide a potentially central means of mobilising, mediating and accessing support for health and well-being. Few interventions address the implementation of improving engagement with and through social networks. This paper describes the development and implementation of a web-based tool which comprises: network mapping, user-centred preference elicitation and need assessment and facilitated engagement with resources. The study aimed to determine whether the intervention was acceptable, implementable and acted to enhance support and to add to theory concerning social networks and engagement with resources and activities. A longitudinal design with 15 case studies used ethnographic methods comprising video, non-participant observation of intervention delivery and qualitative interviews (baseline, 6 and 12 months). Participants were people with type 2 diabetes living in a marginalised island community. Facilitators were local health trainers and care navigators. Analysis applied concepts concerning implementation of technology for self-management support to explain how new practices of work were operationalised and how the technology impacted on relationships fit with everyday life and allowed for visual feedback. Most participants reported identifying and taking up new activities as a result of using the tool. Thematic analysis suggested that workability of the tool was predicated on disruption and reconstruction of networks, challenging/supportive facilitation and change and reflection over time concerning network support. Visualisation of the network enabled people to mobilise support and engage in new activities. The tool aligned synergistically with the facilitators' role of linking people to local resources. The social network tool works through a process of initiating positive disruption of established self-management practice through mapping and reflection on personal network membership and support. This

  2. Policies and Programs to Facilitate Access to Targeted Cancer Therapies in Thailand

    PubMed Central

    Sruamsiri, Rosarin; Ross-Degnan, Dennis; Lu, Christine Y.; Chaiyakunapruk, Nathorn; Wagner, Anita K.

    2015-01-01

    Background Increasing access to clinically beneficial targeted cancer medicines is a challenge in every country due to their high cost. We describe the interplay of innovative policies and programs involving multiple stakeholders to facilitate access to these medicines in Thailand, as well as the utilization of selected targeted therapies over time. Methods We selected two medicines on the 2013 Thai national list of essential medicines (NLEM) [letrozole and imatinib] and three unlisted medicines for the same indications [trastuzumab, nilotinib and dasatinib]. We created timelines of access policies and programs for these products based on scientific and grey literature. Using IMS Health sales data, we described the trajectories of sales volumes of the study medicines between January 2001 and December 2012. We compared estimated average numbers of patients treated before and after the implementation of policies and programs for each product. Results Different stakeholders implemented multiple interventions to increase access to the study medicines for different patient populations. During 2007–2009, the Thai Government created a special NLEM category with different coverage requirements for payers and issued compulsory licenses; payers negotiated prices with manufacturers and engaged in pooled procurement; pharmaceutical companies expanded patient assistance programs and lowered prices in different ways. Compared to before the interventions, estimated numbers of patients treated with each medicine increased significantly afterwards: for letrozole from 645 (95% CI 366–923) to 3683 (95% CI 2,748–4,618); for imatinib from 103 (95% CI 72–174) to 350 (95% CI 307–398); and for trastuzumab from 68 (95% CI 45–118) to 412 (95% CI 344–563). Conclusions Government, payers, and manufacturers implemented multi-pronged approaches to facilitate access to targeted cancer therapies for the Thai population, which differed by medicine. Routine monitoring is needed to

  3. Barriers and facilitators to recruitment of South Asians to health research: a scoping review

    PubMed Central

    Frimer, Leora; Janssen, Patricia A; Lamers, Yvonne

    2017-01-01

    Objectives People of South Asian ethnicity are under-represented in health research studies. The objectives of this scoping review were to examine the barriers and facilitators to recruitment of South Asians to health research studies and to describe strategies for improving recruitment. Design Scoping review Methods Using the Arksey and O’Malley framework for scoping reviews, we comprehensively searched electronic databases (MEDLINE via PubMed, Cochrane Library, CINAHL and PsycINFO). Studies that identified barriers and facilitators to recruitment, or recruitment strategies for South Asian populations were included. Recruitment barriers, facilitators and strategies were grouped thematically and summarised narratively. Synthesis Of 1846 potentially relevant articles, 15 met the inclusion criteria and were included in the thematic synthesis. Multiple facilitators and barriers to enrolment of South Asians in health research studies were identified; these most commonly related to logistical challenges, language and cultural barriers, concerns about adverse consequences of participating and mistrust of research. Several actionable strategies were discussed, the most common being engagement of South Asian communities, demonstration of cultural competency, provision of incentives and benefits, language sensitivity through the use of translators and translated materials and the development of trust and personal relationships. Conclusion There is a growing awareness of the barriers and facilitators to recruitment of South Asian participants to health research studies. Knowledge of effective recruitment strategies and implementation during the grant funding stages may reduce the risk of poor recruitment and representation of South Asians. PMID:28576896

  4. Factors affecting implementation of an evidence-based practice in the Veterans Health Administration: Illness management and recovery.

    PubMed

    McGuire, Alan B; Salyers, Michelle P; White, Dominique A; Gilbride, Daniel J; White, Laura M; Kean, Jacob; Kukla, Marina

    2015-12-01

    Illness management and recovery (IMR) is an evidence-based practice that assists consumers in managing their illnesses and pursuing personal recovery goals. Although research has examined factors affecting IMR implementation facilitated by multifaceted, active roll-outs, the current study attempted to elucidate factors affecting IMR implementation outside the context of a research-driven implementation. Semi-structured interviews with 20 local recovery coordinators and 18 local IMR experts were conducted at 23 VA medical centers. Interviews examined perceived and experienced barriers and facilitators to IMR implementation. Data were analyzed via thematic inductive/deductive analysis in the form of crystallization/immersion. Six factors differed between sites implementing IMR from those not providing IMR: awareness of IMR, importer-champions, autonomy-supporting leadership, veteran-centered care, presence of a sensitive period, and presence of a psychosocial rehabilitation and recovery center. Four factors were common in both groups: recovery orientation, evidence-based practices orientation, perceived IMR fit within program structure, and availability of staff time. IMR can be adopted in lieu of active implementation support; however, knowledge dissemination appears to be key. Future research should examine factors affecting the quality of implementation. (c) 2015 APA, all rights reserved).

  5. Facilitating Factors and Barriers to the Use of Emerging Technologies for Suicide Prevention in Europe: Multicountry Exploratory Study

    PubMed Central

    Delgado, Carmen; Sánchez-Prada, Andrés; Parra-Vidales, Esther; de Leo, Diego; Franco-Martín, Manuel

    2018-01-01

    Background This study provides an analysis on the use of emerging technologies for the prevention of suicide in 8 different European countries. Objective The objective of this study was to analyze the potentiality of using emerging technologies in the area of suicide prevention based on the opinion of different professionals involved in suicide prevention. Methods Opinions of 3 groups of stakeholders (ie, relevant professionals in suicide field) were gathered using a specifically designed questionnaire to explore dimensions underlying perceptions of facilitating factors and barriers in relation to the use of emerging technologies for suicide prevention. Results Goal 1 involved facilitating factors for the use of emerging technologies in suicide prevention. Northern European countries, except for Belgium, attach greater relevance to those that optimize implementation and benefits. On the other hand, Southern European countries attach greater importance to professionally oriented and user-centered facilitating factors. According to different stakeholders, the analysis of these facilitating factors suggest that professionals in the field of social work attach greater relevance to those that optimize implementation and benefits. However, professionals involved in the area of mental health, policy makers, and political decision makers give greater importance to professionally oriented and user-centered facilitating factors. Goal 2 was related to barriers to the usability of emerging technologies for suicide prevention. Both countries and stakeholders attach greater importance to barriers associated with resource constraints than to those centered on personal limitations. There are no differences between countries or between stakeholders. Nevertheless, there is a certain stakeholders-countries interaction that indicates that the opinions on resource constraints expressed by different stakeholders do not follow a uniform pattern in different countries, but they differ

  6. Facilitating Factors and Barriers to the Use of Emerging Technologies for Suicide Prevention in Europe: Multicountry Exploratory Study.

    PubMed

    Muñoz-Sánchez, Juan-Luis; Delgado, Carmen; Parra-Vidales, Esther; Franco-Martín, Manuel

    2018-01-24

    This study provides an analysis on the use of emerging technologies for the prevention of suicide in 8 different European countries. The objective of this study was to analyze the potentiality of using emerging technologies in the area of suicide prevention based on the opinion of different professionals involved in suicide prevention. Opinions of 3 groups of stakeholders (ie, relevant professionals in suicide field) were gathered using a specifically designed questionnaire to explore dimensions underlying perceptions of facilitating factors and barriers in relation to the use of emerging technologies for suicide prevention. Goal 1 involved facilitating factors for the use of emerging technologies in suicide prevention. Northern European countries, except for Belgium, attach greater relevance to those that optimize implementation and benefits. On the other hand, Southern European countries attach greater importance to professionally oriented and user-centered facilitating factors. According to different stakeholders, the analysis of these facilitating factors suggest that professionals in the field of social work attach greater relevance to those that optimize implementation and benefits. However, professionals involved in the area of mental health, policy makers, and political decision makers give greater importance to professionally oriented and user-centered facilitating factors. Goal 2 was related to barriers to the usability of emerging technologies for suicide prevention. Both countries and stakeholders attach greater importance to barriers associated with resource constraints than to those centered on personal limitations. There are no differences between countries or between stakeholders. Nevertheless, there is a certain stakeholders-countries interaction that indicates that the opinions on resource constraints expressed by different stakeholders do not follow a uniform pattern in different countries, but they differ depending on the country. Although all

  7. Middle Managers' Experiences and Role in Implementing an Interactive Tailored Patient Assessment eHealth Intervention in Clinical Practice.

    PubMed

    Varsi, Cecilie; Ekstedt, Mirjam; Gammon, Deede; Børøsund, Elin; Ruland, Cornelia M

    2015-06-01

    The role of nurse and physician managers is considered crucial for implementing eHealth interventions in clinical practice, but few studies have explored this. The aim of the current study was to examine the perceptions of nurse and physician managers regarding facilitators, barriers, management role, responsibility, and action taken in the implementation of an eHealth intervention called Choice into clinical practice. Individual qualitative interviews were conducted with six nurses and three physicians in management positions at five hospital units. The findings revealed that nurse managers reported conscientiously supporting the implementation, but workloads prevented them from participating in the process as closely as they wanted. Physician managers reported less contribution. The implementation process was influenced by facilitating factors such as perceptions of benefits from Choice and use of implementation strategies, along with barriers such as physician resistance, contextual factors and difficulties for front-line providers in learning a new way of communicating with the patients. The findings suggest that role descriptions for both nurse and physician managers should include implementation knowledge and implementation skills. Managers could benefit from an implementation toolkit. Implementation management should be included in management education for healthcare managers to prepare them for the constant need for implementation and improvement in clinical practice.

  8. Reporting guidelines for implementation and operational research.

    PubMed

    Hales, Simon; Lesher-Trevino, Ana; Ford, Nathan; Maher, Dermot; Ramsay, Andrew; Tran, Nhan

    2016-01-01

    In public health, implementation research is done to improve access to interventions that have been shown to work but have not reached many of the people who could benefit from them. Researchers identify practical problems facing public health programmes and aim to find solutions that improve health outcomes. In operational research, routinely-collected programme data are used to uncover ways of delivering more effective, efficient and equitable health care. As implementation research can address many types of questions, many research designs may be appropriate. Existing reporting guidelines partially cover the methods used in implementation and operational research, so we ran a consultation through the World Health Organization (WHO), the Alliance for Health Policy & Systems Research (AHPSR) and the Special Programme for Research and Training in Tropical Diseases (TDR) and developed guidelines to facilitate the funding, conduct, review and publishing of such studies. Our intention is to provide a practical reference for funders, researchers, policymakers, implementers, reviewers and editors working with implementation and operational research. This is an evolving field, so we plan to monitor the use of these guidelines and develop future versions as required.

  9. Implementation of building information modeling in Malaysian construction industry

    NASA Astrophysics Data System (ADS)

    Memon, Aftab Hameed; Rahman, Ismail Abdul; Harman, Nur Melly Edora

    2014-10-01

    This study has assessed the implementation level of Building Information Modeling (BIM) in the construction industry of Malaysia. It also investigated several computer software packages facilitating BIM and challenges affecting its implementation. Data collection for this study was carried out using questionnaire survey among the construction practitioners. 95 completed forms of questionnaire received against 150 distributed questionnaire sets from consultant, contractor and client organizations were analyzed statistically. Analysis findings indicated that the level of implementation of BIM in the construction industry of Malaysia is very low. Average index method employed to assess the effectiveness of various software packages of BIM highlighted that Bentley construction, AutoCAD and ArchiCAD are three most popular and effective software packages. Major challenges to BIM implementation are it requires enhanced collaboration, add work to a designer, interoperability and needs enhanced collaboration. For improving the level of implementing BIM in Malaysian industry, it is recommended that a flexible training program of BIM for all practitioners must be created.

  10. Mexico’s National Cancer Control Plan: From Development to Implementation

    Cancer.gov

    The National Cancer Institute and the Center for Global Health have had a long-standing and successful partnership with INCan, and at their request are identifying new or enhanced ways to provide technical support by way of resources, training, and collaborative programs to facilitate the implementation of the NCCP.

  11. Capacity Building and Districts' Decision to Implement Coaching Initiatives

    ERIC Educational Resources Information Center

    Mangin, Melinda M.

    2014-01-01

    The United States has experienced tremendous growth in the development of coaching initiatives including professional training programs, state endorsements and resources for coaches. These developments bring attention to the potential for coaching to improve education. They also raise the question of how best to facilitate implementation in local…

  12. The Role of School Context in Implementing a Statewide Anti-Bullying Policy and Protecting Students

    ERIC Educational Resources Information Center

    Hall, William J.; Chapman, Mimi V.

    2018-01-01

    Bullying is a significant problem in U.S. schools. Policies have been developed to reduce bullying, yet policy implementation by educators is an essential yet difficult and complex process. Few studies have investigated factors that act as barriers to or facilitators of bullying policy implementation and teacher protection of students. This study…

  13. The Resourceful Facilitator: Teacher Leaders Constructing Identities as Facilitators of Teacher Peer Groups

    ERIC Educational Resources Information Center

    Allen, David

    2016-01-01

    The use of teacher peer groups is a prevalent strategy for school-based professional development and instructional improvement. Facilitation of such groups is an increasingly vital dimension of teacher leadership as a component of school improvement efforts. Drawing on a qualitative study of facilitation of teacher peer groups, the article…

  14. A Qualitative Exploration of Implementation Factors in a School-Based Mindfulness and Yoga Program: Lessons Learned from Students and Teachers

    PubMed Central

    Dariotis, Jacinda K.; Mirabal-Beltran, Roxanne; Cluxton-Keller, Fallon; Gould, Laura Feagans; Greenberg, Mark T.; Mendelson, Tamar

    2016-01-01

    Identifying factors relevant for successful implementation of school-based interventions is essential to ensure that programs are provided in an effective and engaging manner. The perspectives of two key stakeholders critical for identifying implementation barriers and facilitators – students and their classroom teachers – merit attention in this context and have rarely been explored using qualitative methods. This study reports qualitative perspectives of fifth and sixth grade participants and their teachers of a 16-week school-based mindfulness and yoga program in three public schools serving low-income urban communities. Four themes related to program implementation barriers and facilitators emerged: program delivery factors, program buy-in, implementer communication with teachers, and instructor qualities. Feedback from students and teachers is discussed in the context of informing implementation, adaptation, and future development of school-based mindfulness and yoga programming in urban settings. PMID:28670007

  15. A Qualitative Exploration of Implementation Factors in a School-Based Mindfulness and Yoga Program: Lessons Learned from Students and Teachers.

    PubMed

    Dariotis, Jacinda K; Mirabal-Beltran, Roxanne; Cluxton-Keller, Fallon; Gould, Laura Feagans; Greenberg, Mark T; Mendelson, Tamar

    2017-01-01

    Identifying factors relevant for successful implementation of school-based interventions is essential to ensure that programs are provided in an effective and engaging manner. The perspectives of two key stakeholders critical for identifying implementation barriers and facilitators - students and their classroom teachers - merit attention in this context and have rarely been explored using qualitative methods. This study reports qualitative perspectives of fifth and sixth grade participants and their teachers of a 16-week school-based mindfulness and yoga program in three public schools serving low-income urban communities. Four themes related to program implementation barriers and facilitators emerged: program delivery factors, program buy-in, implementer communication with teachers, and instructor qualities. Feedback from students and teachers is discussed in the context of informing implementation, adaptation, and future development of school-based mindfulness and yoga programming in urban settings.

  16. The Role of the Principal in the Implementation of a Gifted Education Program in a School.

    ERIC Educational Resources Information Center

    Taylor, C. A.

    1987-01-01

    The degree to which a principal provides appropriate and sufficient support for implementation of a gifted education program will determine the success of the program. Actions that can facilitate implementation, teacher use, and institutionalization and the effects of various managerial styles are discussed. Components of a gifted program are…

  17. Implementation of evidence-based HIV interventions for young adult African American women in church settings.

    PubMed

    Stewart, Jennifer M

    2014-01-01

    To assess the barriers and facilitators to using African American churches as sites for implementation of evidence-based HIV interventions among young African American women. Mixed methods cross-sectional design. African American churches in Philadelphia, PA. 142 African American pastors, church leaders, and young adult women ages 18 to 25. Mixed methods convergent parallel design. The majority of young adult women reported engaging in high-risk HIV-related behaviors. Although church leaders reported willingness to implement HIV risk-reduction interventions, they were unsure of how to initiate this process. Key facilitators to the implementation of evidence-based interventions included the perception of the leadership and church members that HIV interventions were needed and that the church was a promising venue for them. A primary barrier to implementation in this setting is the perception that discussions of sexuality should be private. Implementation of evidence-based HIV interventions for young adult African American women in church settings is feasible and needed. Building a level of comfort in discussing matters of sexuality and adapting existing evidence-based interventions to meet the needs of young women in church settings is a viable approach for successful implementation. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  18. Concept Mapping of PMTCT Implementation Challenges and Solutions Across 6 sub-Saharan African Countries in the NIH-PEPFAR PMTCT Implementation Science Alliance.

    PubMed

    Aarons, Gregory A; Sommerfeld, David H; Chi, Benjamin H; Ezeanolue, Echezona E; Sturke, Rachel; Guay, Laura; Siberry, George K

    2016-08-01

    Although tremendous gains have been made to reduce mother-to-child HIV transmission (MTCT) globally, evidence-based practice implementation remains inconsistent in sub-Saharan Africa. We sought to identify the key domains for effective prevention of MTCT (PMTCT) implementation, using a participatory mixed-methods approach. Participants were members of the NIH-PEPFAR PMTCT Implementation Science Alliance (ISA), a platform of researchers, public-health practitioners, policymakers, and donors supported through NIH/PEPFAR. We used concept mapping to identify priority areas for PMTCT implementation science. Participants responded to the focus question: "In your experience, what factors have facilitated or hindered implementation of PMTCT interventions?" Responses were consolidated into discrete statements, grouped together based on similarity, and rated for importance, changeability, and extent to which ISA participation enhanced the capacity to influence/change the factor. Using multidimensional scaling and cluster analysis, we identified 12 key domains of PMTCT implementation. Two domains (Governmental Commitment and Data Measurement & Collection) were consistently ranked at or near the top for overall importance, perceived changeability, and enhanced ability to address through ISA participation. Through a stakeholder-based, participatory approach, we identified key domains for that should be considered for future PMTCT implementation research in sub-Saharan Africa.

  19. Barriers and facilitators among health professionals in primary care to prevention of cardiometabolic diseases: A systematic review.

    PubMed

    Wändell, Per E; de Waard, Anne-Karien M; Holzmann, Martin J; Gornitzki, Carl; Lionis, Christos; de Wit, Niek; Søndergaard, Jens; Sønderlund, Anders L; Kral, Norbert; Seifert, Bohumil; Korevaar, Joke C; Schellevis, François G; Carlsson, Axel C

    2018-01-29

    The aim of this study is to identify potential facilitators and barriers for health care professionals to undertake selective prevention of cardiometabolic diseases (CMD) in primary health care. We developed a search string for Medline, Embase, Cinahl and PubMed. We also screened reference lists of relevant articles to retain barriers and facilitators for prevention of CMD. We found 19 qualitative studies, 7 quantitative studies and 2 mixed qualitative and quantitative studies. In terms of five overarching categories, the most frequently reported barriers and facilitators were as follows: Structural (barriers: time restraints, ineffective counselling and interventions, insufficient reimbursement and problems with guidelines; facilitators: feasible and effective counselling and interventions, sufficient assistance and support, adequate referral, and identification of obstacles), Organizational (barriers: general organizational problems, role of practice, insufficient IT support, communication problems within health teams and lack of support services, role of staff, lack of suitable appointment times; facilitators: structured practice, IT support, flexibility of counselling, sufficient logistic/practical support and cooperation with allied health staff/community resources, responsibility to offer and importance of prevention), Professional (barriers: insufficient counselling skills, lack of knowledge and of experience; facilitators: sufficient training, effective in motivating patients), Patient-related factors (barriers: low adherence, causes problems for patients; facilitators: strong GP-patient relationship, appreciation from patients), and Attitudinal (barriers: negative attitudes to prevention; facilitators: positive attitudes of importance of prevention). We identified several frequently reported barriers and facilitators for prevention of CMD, which may be used in designing future implementation and intervention studies. © The Author(s) 2018. Published by

  20. Determinants of quality management systems implementation in hospitals.

    PubMed

    Wardhani, Viera; Utarini, Adi; van Dijk, Jitse Pieter; Post, Doeke; Groothoff, Johan Willem

    2009-03-01

    To identify the problems and facilitating factors in the implementation of quality management system (QMS) in hospitals through a systematic review. A search strategy was performed on the Medline database for articles written in English published between 1992 and early 2006. Using the thesaurus terms 'Total Quality Management' and 'Quality Assurance Health Care', combined with the term 'hospital' and 'implement*', we identified 533 publications. The screening process was based on empirical articles describing organization-wide QMS implementation. Fourteen empirical articles fulfilled the inclusion criteria and were reviewed in this paper. An organization culture emphasizing standards and values associated with affiliation, teamwork and innovation, assumption of change and risk taking, play as the key success factor in QMS implementation. This culture needs to be supported by sufficient technical competence to apply a scientific problem-solving approach. A clear distribution of QMS function within the organizational structure is more important than establishing a formal quality structure. In addition to management leadership, physician involvement also plays an important role in implementing QMS. Six supporting and limiting factors determining QMS implementation are identified in this review. These are the organization culture, design, leadership for quality, physician involvement, quality structure and technical competence.

  1. Routines for change: how managers can use absorptive capacity to adopt and implement evidence-based practice.

    PubMed

    Innis, Jennifer; Berta, Whitney

    2016-09-01

    This paper uses the construct of absorptive capacity to understand how nurse managers can facilitate the adoption and use of evidence-based practice within health-care organisations. How health-care organisations adopt and implement innovations such as new evidence-based practices will depend on their absorptive, or learning, capacity. Absorptive capacity manifests as routines, which are the practices, procedures and customs that organisational members use to carry out work and to make work-related decisions. Using the construct of absorptive capacity as well as a recent literature review of how health-care organisations take on best practices, we illustrate how the uptake and use of new knowledge, such as evidence-based practices, can be facilitated through the use of routines. This paper highlights routines that nurse managers can use to foster environments where evidence-based practices can be readily identified, and strategies for facilitating their adoption and implementation. The construct of absorptive capacity and the use of routines can be used to examine the ways in which nurse managers can adopt, implement and evaluate the use of evidence-based practices. © 2016 John Wiley & Sons Ltd.

  2. Lynch syndrome: barriers to and facilitators of screening and disease management.

    PubMed

    Watkins, Kathy E; Way, Christine Y; Fiander, Jacqueline J; Meadus, Robert J; Esplen, Mary Jane; Green, Jane S; Ludlow, Valerie C; Etchegary, Holly A; Parfrey, Patrick S

    2011-09-07

    Lynch syndrome is a hereditary cancer with confirmed carriers at high risk for colorectal (CRC) and extracolonic cancers. The purpose of the current study was to develop a greater understanding of the factors influencing decisions about disease management post-genetic testing. The study used a grounded theory approach to data collection and analysis as part of a multiphase project examining the psychosocial and behavioral impact of predictive DNA testing for Lynch syndrome. Individual and small group interviews were conducted with individuals from 10 families with the MSH2 intron 5 splice site mutation or exon 8 deletion. The data from confirmed carriers (n = 23) were subjected to re-analysis to identify key barriers to and/or facilitators of screening and disease management. Thematic analysis identified personal, health care provider and health care system factors as dominant barriers to and/or facilitators of managing Lynch syndrome. Person-centered factors reflect risk perceptions and decision-making, and enduring screening/disease management. The perceived knowledge and clinical management skills of health care providers also influenced participation in recommended protocols. The health care system barriers/facilitators are defined in terms of continuity of care and coordination of services among providers. Individuals with Lynch syndrome often encounter multiple barriers to and facilitators of disease management that go beyond the individual to the provider and health care system levels. The current organization and implementation of health care services are inadequate. A coordinated system of local services capable of providing integrated, efficient health care and follow-up, populated by providers with knowledge of hereditary cancer, is necessary to maintain optimal health.

  3. Implementation and evaluation of a community-based interprofessional learning activity.

    PubMed

    Luebbers, Ellen L; Dolansky, Mary A; Vehovec, Anton; Petty, Gayle

    2017-01-01

    Implementation of large-scale, meaningful interprofessional learning activities for pre-licensure students has significant barriers and requires novel approaches to ensure success. To accomplish this goal, faculty at Case Western Reserve University, Ohio, USA, used the Ottawa Model of Research Use (OMRU) framework to create, improve, and sustain a community-based interprofessional learning activity for large numbers of medical students (N = 177) and nursing students (N = 154). The model guided the process and included identification of context-specific barriers and facilitators, continual monitoring and improvement using data, and evaluation of student learning outcomes as well as programme outcomes. First year Case Western Reserve University medical students and undergraduate nursing students participated in team-structured prevention screening clinics in the Cleveland Metropolitan Public School District. Identification of barriers and facilitators assisted with overcoming logistic and scheduling issues, large class size, differing ages and skill levels of students and creating sustainability. Continual monitoring led to three distinct phases of improvement and resulted in the creation of an authentic team structure, role clarification, and relevance for students. Evaluation of student learning included both qualitative and quantitative methods, resulting in statistically significant findings and qualitative themes of learner outcomes. The OMRU implementation model provided a useful framework for successful implementation resulting in a sustainable interprofessional learning activity.

  4. Florida First Start Program: Program Planning and Implementation Guide.

    ERIC Educational Resources Information Center

    Florida State Dept. of Education, Tallahassee. Office of Early Intervention and School Readiness.

    This guide is designed to facilitate the implementation of the Florida First Start (FFS) program, created to help at-risk children from birth to 3 years of age have the best possible start in life and to support parents in their roles as their children's first teachers. Emphasis is on providing early, high-quality education and support services.…

  5. Implementation of the new AASHTO pavement design procedure in Louisiana : final report.

    DOT National Transportation Integrated Search

    1990-06-01

    This study was undertaken to provide the LA DOTD with an implementation package to facilitate adoption of the new AASHTO Guide for Design of Pavement Structures. The study included evaluation of design parameters for rigid and flexible pavements, inc...

  6. Using a multi-state Learning Community as an implementation strategy for immediate postpartum long-acting reversible contraception.

    PubMed

    DeSisto, Carla L; Estrich, Cameron; Kroelinger, Charlan D; Goodman, David A; Pliska, Ellen; Mackie, Christine N; Waddell, Lisa F; Rankin, Kristin M

    2017-11-21

    Implementation strategies are imperative for the successful adoption and sustainability of complex evidence-based public health practices. Creating a learning collaborative is one strategy that was part of a recently published compilation of implementation strategy terms and definitions. In partnership with the Centers for Disease Control and Prevention and other partner agencies, the Association of State and Territorial Health Officials recently convened a multi-state Learning Community to support cross-state collaboration and provide technical assistance for improving state capacity to increase access to long-acting reversible contraception (LARC) in the immediate postpartum period, an evidence-based practice with the potential for reducing unintended pregnancy and improving maternal and child health outcomes. During 2015-2016, the Learning Community included multi-disciplinary, multi-agency teams of state health officials, payers, clinicians, and health department staff from 13 states. This qualitative study was conducted to better understand the successes, challenges, and strategies that the 13 US states in the Learning Community used for increasing access to immediate postpartum LARC. We conducted telephone interviews with each team in the Learning Community. Interviews were semi-structured and organized by the eight domains of the Learning Community. We coded transcribed interviews for facilitators, barriers, and implementation strategies, using a recent compilation of expert-defined implementation strategies as a foundation for coding the latter. Data analysis showed three ways that the activities of the Learning Community helped in policy implementation work: structure and accountability, validity, and preparing for potential challenges and opportunities. Further, the qualitative data demonstrated that the Learning Community integrated six other implementation strategies from the literature: organize clinician implementation team meetings, conduct

  7. Implementing Ethics Policies in Developing Countries: Ploughing on Parched Ground?

    ERIC Educational Resources Information Center

    Mazonde, Isaac N.; Jackson-Malete, Jose; Sugarman, Jeremy

    2007-01-01

    It is globally expected that universities will ensure that policies guiding researchers' conduct are in place and adhered to. This expectation is not waived in developing countries. Successful implementation of an ethics policy is facilitated by an appropriate national regulatory framework on which to base the argument for compliance. However, it…

  8. Implementing a Coach-Delivered Dating Violence Prevention Program with High School Athletes.

    PubMed

    Jaime, Maria Catrina D; McCauley, Heather L; Tancredi, Daniel J; Decker, Michele R; Silverman, Jay G; O'Connor, Brian; Miller, Elizabeth

    2018-05-10

    Teen dating violence and sexual violence are severe public health problems. Abusive behaviors within the context of dating or romantic relationships are associated with adverse health outcomes. Promoting positive bystander intervention and increasing knowledge of abusive behaviors are promising strategies for preventing dating and sexual violence. Coaching Boys Into Men (CBIM) is an evidence-based, athletic coach-delivered dating violence prevention program that has been shown to increase positive bystander behaviors and reduce abuse perpetration among high school male athletes. Identifying specific barriers and facilitators based on the coaches' experiences with program delivery combined with the coaches' and athletes' program perceptions may help optimize future CBIM implementation and sustainability. Semi-structured interviews with coaches (n = 36) explored the implementers' perspectives on strategies that worked well and potential barriers to program implementation. Ten focus groups with male athletes (n = 39) assessed their experiences with CBIM and the suitability of having their coaches deliver this program. Coaches described using the CBIM training cards and integrating program delivery during practice. Athletes reported coaches routinely delivering the CBIM program and adding their own personal stories or examples to the discussions. Key facilitators to program implementation include support from the violence prevention advocate, the ease of integrating CBIM into the sports season, and using the program materials. Barriers to implementation included finding sufficient time for the program, dynamics of delivering sensitive program content, and participant constraints. Coaches and athletes alike found the program feasible and acceptable to implement within the sports setting. Both coaches and athletes offered insights on the implementation and the feasibility and acceptability of CBIM within school-based athletic programs. These experiences by

  9. Implementing an Enterprise Information System to Reengineer and Streamline Administrative Processes in a Distance Learning Unit

    ERIC Educational Resources Information Center

    Abdous, M'hammed; He, Wu

    2009-01-01

    During the past three years, we have developed and implemented an enterprise information system (EIS) to reengineer and facilitate the administrative process for preparing and teaching distance learning courses in a midsized-to-large university (with 23,000 students). The outcome of the implementation has been a streamlined and efficient process…

  10. Tank waste remediation system privatization infrastructure program, configuration management implementation plan

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Schaus, P.S.

    This Configuration Management Implementation Plan (CMIP) was developed to assist in managing systems, structures, and components (SSCS), to facilitate the effective control and statusing of changes to SSCS, and to ensure technical consistency between design, performance, and operational requirements. Its purpose is to describe the approach Privatization Infrastructure will take in implementing a configuration management program, to identify the Program`s products that need configuration management control, to determine the rigor of control, and to identify the mechanisms for that control.

  11. A qualitative analysis of the concepts of fidelity and adaptation in the implementation of an evidence-based HIV prevention intervention.

    PubMed

    Owczarzak, Jill; Broaddus, Michelle; Pinkerton, Steven

    2016-04-01

    Continued debate about the relative value of fidelity versus adaptation, and lack of clarity about the meaning of fidelity, raise concerns about how frontline service providers resolve similar issues in their daily practice. We use SISTA ('Sisters Informing Sisters on Topics about acquired immune deficiency syndrome'), an evidence-based human immunodeficiency virus (HIV) prevention intervention for African American women, to understand how facilitators and program directors interpret and enact implementation fidelity with the need for adaptation in real-world program delivery. We conducted 22 in-depth, semi-structured interviews with service providers from four agencies implementing SISTA. Facilitators valued their skills as group leaders and ability to emotionally engage participants as more critical to program effectiveness than delivering the intervention with strict fidelity. Consequently, they saw program manuals as guides rather than static texts that should never be changed and, moreover, viewed the prescriptive nature of manuals as undermining their efforts to fully engage with participants. Our findings suggest that greater consideration should be given to understanding the role of facilitators in program effectiveness over and above the question of whether they implement the program with fidelity. Moreover, training curricula should provide facilitators with transferable skills through general facilitator training rather than only program-specific or manual-specific training. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  12. Physical Activity among Somali Men in Minnesota: Barriers, Facilitators and Recommendations

    PubMed Central

    Mohamed, Ahmed A.; Hassan, Abdullahi M.; Weis, Jennifer A.; Sia, Irene G.; Wieland, Mark L.

    2014-01-01

    Immigrants and refugees arrive to the US healthier than the general population, but this advantage declines with increasing duration of residence. One factor contributing to this decline is sub-optimal physical activity, but reasons for this are poorly understood. Persons from Somalia represent the largest African refugee population to the United States, yet little is known about perceptions of physical activity among Somali men. Somali members of a community-based participatory research partnership implemented three age-stratified focus groups and three semi-structured interviews among 20 Somali men in Rochester, MN. Team-based inductive analysis generated themes for barriers and facilitators to physical activity. Barriers to physical activity included less walking opportunities in the US, embarrassment about exercise clothing and lack of familiarity with exercise equipment/modalities, fear of harassment, competing priorities, facility costs, transportation, and winter weather. Facilitators to physical activity included high knowledge about how to be active, success stories from others in their community as inspiration, and community cohesion. Findings may be used to derive interventions aimed to promote physical activity among Somali men in the US. PMID:23697961

  13. Exploring barriers and facilitators to the clinical use of virtual reality for post-stroke unilateral spatial neglect assessment.

    PubMed

    Ogourtsova, Tatiana; Archambault, Philippe S; Lamontagne, Anouk

    2017-11-07

    Hemineglect, defined as a failure to attend to the contralesional side of space, is a prevalent and disabling post-stroke deficit. Conventional hemineglect assessments lack sensitivity as they contain mainly non-functional tasks performed in near-extrapersonal space, using static, two-dimensional methods. This is of concern given that hemineglect is a strong predictor for functional deterioration, limited post-stroke recovery, and difficulty in community reintegration. With the emerging field of virtual reality, several virtual tools have been proposed and have reported better sensitivity in neglect-related deficits detection than conventional methods. However, these and future virtual reality-based tools are yet to be implemented in clinical practice. The present study aimed to explore the barriers/facilitators perceived by clinicians in the use of virtual reality for hemineglect assessment; and to identify features of an optimal virtual assessment. A qualitative descriptive process, in the form of focus groups, self-administered questionnaire and individual interviews was used. Two focus groups (n = 11 clinicians) were conducted and experts in the field (n = 3) were individually interviewed. Several barriers and facilitators, including personal, institutional, client suitability, and equipment factors, were identified. Clinicians and experts in the field reported numerous features for the virtual tool optimization. Factors identified through this study lay the foundation for the development of a knowledge translation initiative towards an implementation of a virtual assessment for hemineglect. Addressing the identified barriers/facilitators during implementation and incorporating the optimal features in the design of the virtual assessment could assist and promote its eventual adoption in clinical settings. Implications for rehabilitation A multimodal and active knowledge translation intervention built on the presently identified modifiable factors is

  14. Evaluation of the Facilitated Communication Pilot

    ERIC Educational Resources Information Center

    Cooper-Martin, Elizabeth

    2014-01-01

    The Office of Special Education and Student Services asked the Office of Shared Accountability to evaluate the "Facilitated Communication Pilot." In facilitated communication (FC), people with communication impairments express themselves by typing with the aid of a communication partner, called a facilitator, who provides physical (and…

  15. [Implementation of functional autonomy measurement system: barriers and facilitators in PISE-Dordogne project].

    PubMed

    Gervais, Pauline; Hébert, Réjean; Lamontagne, Julie; Tousignant, Michel

    2011-12-01

    The objectives of the study were to identify the adjustments made during the implantation and the conditions favouring or limiting the SMAF utilisation. A multiqualitative quote was developed. The Functional autonomy measurement system (SMAF) was implanted in 11 French medico-social establishments. Analyses were made with the mixed type thematic method from Miles and Huberman. Principal adjustments that have been made during implantation concern the informatics assistance and clinical support. Strategic, organizational and individual factors explained adhesion level of actors and the subsequent flow of implantation. Establishment of SMAF and of the software eSMAF® in the medico-social establishments rests on a certain number of conditions which could be identified during the study. These conditions made it possible to work out structured recommendations for future implementations.

  16. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study

    PubMed Central

    2013-01-01

    Background Hypertension is prevalent and often sub-optimally controlled; however, interventions to improve blood pressure control have had limited success. Objectives Through implementation of an evidence-based nurse-delivered self-management phone intervention to facilitate hypertension management within large complex health systems, we sought to answer the following questions: What is the level of organizational readiness to implement the intervention? What are the specific facilitators, barriers, and contextual factors that may affect organizational readiness to change? Study design Each intervention site from three separate Veterans Integrated Service Networks (VISNs), which represent 21 geographic regions across the US, agreed to enroll 500 participants over a year with at least 0.5 full time equivalent employees of nursing time. Our mixed methods approach used a priori semi-structured interviews conducted with stakeholders (n = 27) including nurses, physicians, administrators, and information technology (IT) professionals between 2010 and 2011. Researchers iteratively identified facilitators and barriers of organizational readiness to change (ORC) and implementation. Additionally, an ORC survey was conducted with the stakeholders who were (n = 102) preparing for program implementation. Results Key ORC facilitators included stakeholder buy-in and improving hypertension. Positive organizational characteristics likely to impact ORC included: other similar programs that support buy-in, adequate staff, and alignment with the existing site environment; improved patient outcomes; is positive for the professional nurse role, and is evidence-based; understanding of the intervention; IT infrastructure and support, and utilization of existing equipment and space. The primary ORC barrier was unclear long-term commitment of nursing. Negative organizational characteristics likely to impact ORC included: added workload, competition with existing programs

  17. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study.

    PubMed

    Shaw, Ryan J; Kaufman, Miriam A; Bosworth, Hayden B; Weiner, Bryan J; Zullig, Leah L; Lee, Shoou-Yih Daniel; Kravetz, Jeffrey D; Rakley, Susan M; Roumie, Christianne L; Bowen, Michael E; Del Monte, Pamela S; Oddone, Eugene Z; Jackson, George L

    2013-09-08

    Hypertension is prevalent and often sub-optimally controlled; however, interventions to improve blood pressure control have had limited success. Through implementation of an evidence-based nurse-delivered self-management phone intervention to facilitate hypertension management within large complex health systems, we sought to answer the following questions: What is the level of organizational readiness to implement the intervention? What are the specific facilitators, barriers, and contextual factors that may affect organizational readiness to change? Each intervention site from three separate Veterans Integrated Service Networks (VISNs), which represent 21 geographic regions across the US, agreed to enroll 500 participants over a year with at least 0.5 full time equivalent employees of nursing time. Our mixed methods approach used a priori semi-structured interviews conducted with stakeholders (n = 27) including nurses, physicians, administrators, and information technology (IT) professionals between 2010 and 2011. Researchers iteratively identified facilitators and barriers of organizational readiness to change (ORC) and implementation. Additionally, an ORC survey was conducted with the stakeholders who were (n = 102) preparing for program implementation. Key ORC facilitators included stakeholder buy-in and improving hypertension. Positive organizational characteristics likely to impact ORC included: other similar programs that support buy-in, adequate staff, and alignment with the existing site environment; improved patient outcomes; is positive for the professional nurse role, and is evidence-based; understanding of the intervention; IT infrastructure and support, and utilization of existing equipment and space.The primary ORC barrier was unclear long-term commitment of nursing. Negative organizational characteristics likely to impact ORC included: added workload, competition with existing programs, implementation length, and limited available nurse staff time

  18. Environmental Scanning for Occupational Education. A Facilitator's Guide. A Model for Environmental Scanning to Systematically Assess Future Occupational Education and Training Needs of a Michigan Community College Service Area.

    ERIC Educational Resources Information Center

    Kellogg Foundation, Battle Creek, MI.

    This manual is designed to facilitate the planning and implementation of an environmental scanning project in Michigan's community colleges. (Environmental scanning is a systematic process for gathering and analyzing information about the external environment and relating it to an organization's internal environment.) This facilitator's guide is…

  19. BioC implementations in Go, Perl, Python and Ruby.

    PubMed

    Liu, Wanli; Islamaj Doğan, Rezarta; Kwon, Dongseop; Marques, Hernani; Rinaldi, Fabio; Wilbur, W John; Comeau, Donald C

    2014-01-01

    As part of a communitywide effort for evaluating text mining and information extraction systems applied to the biomedical domain, BioC is focused on the goal of interoperability, currently a major barrier to wide-scale adoption of text mining tools. BioC is a simple XML format, specified by DTD, for exchanging data for biomedical natural language processing. With initial implementations in C++ and Java, BioC provides libraries of code for reading and writing BioC text documents and annotations. We extend BioC to Perl, Python, Go and Ruby. We used SWIG to extend the C++ implementation for Perl and one Python implementation. A second Python implementation and the Ruby implementation use native data structures and libraries. BioC is also implemented in the Google language Go. BioC modules are functional in all of these languages, which can facilitate text mining tasks. BioC implementations are freely available through the BioC site: http://bioc.sourceforge.net. Database URL: http://bioc.sourceforge.net/ Published by Oxford University Press 2014. This work is written by US Government employees and is in the public domain in the US.

  20. Predictors of Parent Involvement and Their Impact on Access of Postsecondary Education Facilitators among White and American Indian Parents

    ERIC Educational Resources Information Center

    Bardhoshi, Gerta; Duncan, Kelly; Schweinle, Amy

    2016-01-01

    This study examined demographic factors as predictors of parent involvement (engagement with school, support of learning, support of child) among parents of children that attended a school implementing a college access program. The authors also examined whether involvement predicted access of postsecondary education facilitators in parents, when…