Embedding research to improve program implementation in Latin America and the Caribbean.

PubMed

Tran, Nhan; Langlois, Etienne V; Reveiz, Ludovic; Varallyay, Ilona; Elias, Vanessa; Mancuso, Arielle; Becerra-Posada, Francisco; Ghaffar, Abdul

2017-06-08

In the last 10 years, implementation research has come to play a critical role in improving the implementation of already-proven health interventions by promoting the systematic uptake of research findings and other evidence-based strategies into routine practice. The Alliance for Health Policy and Systems Research and the Pan American Health Organization implemented a program of embedded implementation research to support health programs in Latin America and the Caribbean (LAC) in 2014-2015. A total of 234 applications were received from 28 countries in the Americas. The Improving Program Implementation through Embedded Research (iPIER) scheme supported 12 implementation research projects led by health program implementers from nine LAC countries: Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, Panama, Peru, and Saint Lucia. Through this experience, we learned that the "insider" perspective, which implementers bring to the research proposal, is particularly important in identifying research questions that focus on the systems failures that often manifest in barriers to implementation. This paper documents the experience of and highlights key conclusions about the conduct of embedded implementation research. The iPIER experience has shown great promise for embedded research models that place implementers at the helm of implementation research initiatives.

Implementation strategies: recommendations for specifying and reporting

PubMed Central

2013-01-01

Implementation strategies have unparalleled importance in implementation science, as they constitute the ‘how to’ component of changing healthcare practice. Yet, implementation researchers and other stakeholders are not able to fully utilize the findings of studies focusing on implementation strategies because they are often inconsistently labelled and poorly described, are rarely justified theoretically, lack operational definitions or manuals to guide their use, and are part of ‘packaged’ approaches whose specific elements are poorly understood. We address the challenges of specifying and reporting implementation strategies encountered by researchers who design, conduct, and report research on implementation strategies. Specifically, we propose guidelines for naming, defining, and operationalizing implementation strategies in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes addressed, and theoretical justification. Ultimately, implementation strategies cannot be used in practice or tested in research without a full description of their components and how they should be used. As with all intervention research, their descriptions must be precise enough to enable measurement and ‘reproducibility.’ We propose these recommendations to improve the reporting of implementation strategies in research studies and to stimulate further identification of elements pertinent to implementation strategies that should be included in reporting guidelines for implementation strategies. PMID:24289295

Implementation strategies: recommendations for specifying and reporting.

PubMed

Proctor, Enola K; Powell, Byron J; McMillen, J Curtis

2013-12-01

Implementation strategies have unparalleled importance in implementation science, as they constitute the 'how to' component of changing healthcare practice. Yet, implementation researchers and other stakeholders are not able to fully utilize the findings of studies focusing on implementation strategies because they are often inconsistently labelled and poorly described, are rarely justified theoretically, lack operational definitions or manuals to guide their use, and are part of 'packaged' approaches whose specific elements are poorly understood. We address the challenges of specifying and reporting implementation strategies encountered by researchers who design, conduct, and report research on implementation strategies. Specifically, we propose guidelines for naming, defining, and operationalizing implementation strategies in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes addressed, and theoretical justification. Ultimately, implementation strategies cannot be used in practice or tested in research without a full description of their components and how they should be used. As with all intervention research, their descriptions must be precise enough to enable measurement and 'reproducibility.' We propose these recommendations to improve the reporting of implementation strategies in research studies and to stimulate further identification of elements pertinent to implementation strategies that should be included in reporting guidelines for implementation strategies.

Implementing Dementia Care Mapping to develop person-centred care: results of a process evaluation within the Leben-QD II trial.

PubMed

Quasdorf, Tina; Riesner, Christine; Dichter, Martin Nikolaus; Dortmann, Olga; Bartholomeyczik, Sabine; Halek, Margareta

2017-03-01

To evaluate Dementia Care Mapping implementation in nursing homes. Dementia Care Mapping, an internationally applied method for supporting and enhancing person-centred care for people with dementia, must be successfully implemented into care practice for its effective use. Various factors influence the implementation of complex interventions such as Dementia Care Mapping; few studies have examined the specific factors influencing Dementia Care Mapping implementation. A convergent parallel mixed-methods design embedded in a quasi-experimental trial was used to assess Dementia Care Mapping implementation success and influential factors. From 2011-2013, nine nursing units in nine different nursing homes implemented either Dementia Care Mapping (n = 6) or a periodic quality of life measurement using the dementia-specific instrument QUALIDEM (n = 3). Diverse data (interviews, n = 27; questionnaires, n = 112; resident records, n = 81; and process documents) were collected. Each data set was separately analysed and then merged to comprehensively portray the implementation process. Four nursing units implemented the particular intervention without deviating from the preplanned intervention. Translating Dementia Care Mapping results into practice was challenging. Necessary organisational preconditions for Dementia Care Mapping implementation included well-functioning networks, a dementia-friendly culture and flexible organisational structures. Involved individuals' positive attitudes towards Dementia Care Mapping also facilitated implementation. Precisely planning the intervention and its implementation, recruiting champions who supported Dementia Care Mapping implementation and having well-qualified, experienced project coordinators were essential to the implementation process. For successful Dementia Care Mapping implementation, it must be embedded in a systematic implementation strategy considering the specific setting. Organisational preconditions may need to be developed before Dementia Care Mapping implementation. Necessary steps may include team building, developing and realising a person-centred care-based mission statement or educating staff regarding general dementia care. The implementation strategy may include attracting and involving individuals on different hierarchical levels in Dementia Care Mapping implementation and supporting staff to translate Dementia Care Mapping results into practice. The identified facilitating factors can guide Dementia Care Mapping implementation strategy development. © 2016 John Wiley & Sons Ltd.

A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework.

PubMed

Moullin, Joanna C; Sabater-Hernández, Daniel; Fernandez-Llimos, Fernando; Benrimoj, Shalom I

2015-03-14

Implementation science and knowledge translation have developed across multiple disciplines with the common aim of bringing innovations to practice. Numerous implementation frameworks, models, and theories have been developed to target a diverse array of innovations. As such, it is plausible that not all frameworks include the full range of concepts now thought to be involved in implementation. Users face the decision of selecting a single or combining multiple implementation frameworks. To aid this decision, the aim of this review was to assess the comprehensiveness of existing frameworks. A systematic search was undertaken in PubMed to identify implementation frameworks of innovations in healthcare published from 2004 to May 2013. Additionally, titles and abstracts from Implementation Science journal and references from identified papers were reviewed. The orientation, type, and presence of stages and domains, along with the degree of inclusion and depth of analysis of factors, strategies, and evaluations of implementation of included frameworks were analysed. Frameworks were assessed individually and grouped according to their targeted innovation. Frameworks for particular innovations had similar settings, end-users, and 'type' (descriptive, prescriptive, explanatory, or predictive). On the whole, frameworks were descriptive and explanatory more often than prescriptive and predictive. A small number of the reviewed frameworks covered an implementation concept(s) in detail, however, overall, there was limited degree and depth of analysis of implementation concepts. The core implementation concepts across the frameworks were collated to form a Generic Implementation Framework, which includes the process of implementation (often portrayed as a series of stages and/or steps), the innovation to be implemented, the context in which the implementation is to occur (divided into a range of domains), and influencing factors, strategies, and evaluations. The selection of implementation framework(s) should be based not solely on the healthcare innovation to be implemented, but include other aspects of the framework's orientation, e.g., the setting and end-user, as well as the degree of inclusion and depth of analysis of the implementation concepts. The resulting generic structure provides researchers, policy-makers, health administrators, and practitioners a base that can be used as guidance for their implementation efforts.

Improving the effectiveness of health care innovation implementation: middle managers as change agents.

PubMed

Birken, Sarah A; Lee, Shoou-Yih Daniel; Weiner, Bryan J; Chin, Marshall H; Schaefer, Cynthia T

2013-02-01

The rate of successful health care innovation implementation is dismal. Middle managers have a potentially important yet poorly understood role in health care innovation implementation. This study used self-administered surveys and interviews of middle managers in health centers that implemented an innovation to reduce health disparities to address the questions: Does middle managers' commitment to health care innovation implementation influence implementation effectiveness? If so, in what ways does their commitment influence implementation effectiveness? Although quantitative survey data analysis results suggest a weak relationship, qualitative interview data analysis results indicate that middle managers' commitment influences implementation effectiveness when middle managers are proactive. Scholars should account for middle managers' influence in implementation research, and health care executives may promote implementation effectiveness by hiring proactive middle managers and creating climates in which proactivity is rewarded, supported, and expected.

Improving the Effectiveness of Health Care Innovation Implementation: Middle Managers as Change Agents

PubMed Central

Birken, Sarah A.; Lee, Shoou-Yih Daniel; Weiner, Bryan J.; Chin, Marshall H.; Schaefer, Cynthia T.

2013-01-01

The rate of successful health care innovation implementation is dismal. Middle managers have a potentially important yet poorly understood role in health care innovation implementation. This study used self-administered surveys and interviews of middle managers in health centers that implemented an innovation to reduce health disparities to address the questions: Does middle managers’ commitment to health care innovation implementation influence implementation effectiveness? If so, in what ways does their commitment influence implementation effectiveness? Although quantitative survey data analysis results suggest a weak relationship, qualitative interview data analysis results indicate that middle managers’ commitment influences implementation effectiveness when middle managers are proactive. Scholars should account for middle managers’ influence in implementation research, and health care executives may promote implementation effectiveness by hiring proactive middle managers and creating climates in which proactivity is rewarded, supported, and expected. PMID:22930312

Analysis of Transportation Options for Commercial Spent Fuel in the U.S.

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

Kalinina, Elena; Busch, Ingrid Karin

The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S.more » Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. Department of Energy (DOE) is laying the groundwork for implementing interim storage The U.S. 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nuclear fuel (SNF)...« less

[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.

Process Evaluation of Making HEPA Policy Practice: A Group Randomized Trial.

PubMed

Weaver, Robert G; Moore, Justin B; Huberty, Jennifer; Freedman, Darcy; Turner-McGrievy, Brie; Beighle, Aaron; Ward, Diane; Pate, Russell; Saunders, Ruth; Brazendale, Keith; Chandler, Jessica; Ajja, Rahma; Kyryliuk, Becky; Beets, Michael W

2016-09-01

This study examines the link between implementation of Strategies to Enhance Practice (STEPs) and outcomes. Twenty after-school programs (ASPs) participated in an intervention to increase children's accumulation of 30 minutes/day of moderate to vigorous physical activity (MVPA) and quality of snacks served during program time. Outcomes were measured via accelerometer (MVPA) and direct observation (snacks). STEPs implementation data were collected via document review and direct observation. Based on implementation data, ASPs were divided into high/low implementers. Differences between high/low implementers' change in percentage of boys accumulating 30 minutes/day of MVPA were observed. There was no difference between high/low implementers for girls. Days fruits and/or vegetables and water were served increased in the high/low implementation groups, while desserts and sugar-sweetened beverages decreased. Effect sizes (ES) for the difference in changes between the high and low group ranged from low (ES = 0.16) to high (ES = 0.97). Higher levels of implementation led to increased MVPA for boys, whereas girls MVPA benefited from the intervention regardless of high/low implementation. ESs of the difference between high/low implementers indicate that increased implementation of STEPs increases days healthier snacks are served. Programs in the high-implementation group implemented a variety of STEPs strategies, suggesting local adoption/adaptation is key to implementation. © 2016 Society for Public Health Education.

Agency responses to a system-driven implementation of multiple evidence-based practices in children's mental health services.

PubMed

Regan, Jennifer; Lau, Anna S; Barnett, Miya; Stadnick, Nicole; Hamilton, Alison; Pesanti, Keri; Bando, Lillian; Brookman-Frazee, Lauren

2017-09-19

Large mental health systems are increasingly using fiscal policies to encourage the implementation of multiple evidence-based practices (EBPs). Although many implementation strategies have been identified, little is known about the types and impacts of strategies that are used by organizations within implementation as usual. This study examined organizational-level responses to a fiscally-driven, rapid, and large scale EBP implementation in children's mental health within the Los Angeles County Department of Mental Health. Qualitative methods using the principles of grounded theory were used to characterize the responses of 83 community-based agencies to the implementation effort using documentation from site visits conducted 2 years post reform. Findings indicated that agencies perceived the rapid system-driven implementation to have both positive and negative organizational impacts. Identified challenges were primarily related to system implementation requirements rather than to characteristics of specific EBPs. Agencies employed a variety of implementation strategies in response to the system-driven implementation, with agency size associated with implementation strategies used. Moderate- and large-sized agencies were more likely than small agencies to have employed systematic strategies at multiple levels (i.e., organization, therapist, client) to support implementation. These findings are among the first to characterize organizational variability in response to system-driven implementation and suggest ways that implementation interventions might be tailored by organizational characteristics.

A mixed methods multiple case study of implementation as usual in children’s social service organizations: study protocol

PubMed Central

2013-01-01

Background Improving quality in children’s mental health and social service settings will require implementation strategies capable of moving effective treatments and other innovations (e.g., assessment tools) into routine care. It is likely that efforts to identify, develop, and refine implementation strategies will be more successful if they are informed by relevant stakeholders and are responsive to the strengths and limitations of the contexts and implementation processes identified in usual care settings. This study will describe: the types of implementation strategies used; how organizational leaders make decisions about what to implement and how to approach the implementation process; organizational stakeholders’ perceptions of different implementation strategies; and the potential influence of organizational culture and climate on implementation strategy selection, implementation decision-making, and stakeholders’ perceptions of implementation strategies. Methods/design This study is a mixed methods multiple case study of seven children’s social service organizations in one Midwestern city in the United States that compose the control group of a larger randomized controlled trial. Qualitative data will include semi-structured interviews with organizational leaders (e.g., CEOs/directors, clinical directors, program managers) and a review of documents (e.g., implementation and quality improvement plans, program manuals, etc.) that will shed light on implementation decision-making and specific implementation strategies that are used to implement new programs and practices. Additionally, focus groups with clinicians will explore their perceptions of a range of implementation strategies. This qualitative work will inform the development of a Web-based survey that will assess the perceived effectiveness, relative importance, acceptability, feasibility, and appropriateness of implementation strategies from the perspective of both clinicians and organizational leaders. Finally, the Organizational Social Context measure will be used to assess organizational culture and climate. Qualitative, quantitative, and mixed methods data will be analyzed and interpreted at the case level as well as across cases in order to highlight meaningful similarities, differences, and site-specific experiences. Discussion This study is designed to inform efforts to develop more effective implementation strategies by fully describing the implementation experiences of a sample of community-based organizations that provide mental health services to youth in one Midwestern city. PMID:23961701

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-based facilitated expert recommendation process will be employed to establish expert recommendations about which implementations strategies are essential for each phase of implementation in each scenario. Discussion Using a novel method of selecting implementation strategies for use within specific contexts, this study contributes to our understanding of implementation science and practice by sharpening conceptual distinctions among a comprehensive collection of implementation strategies. PMID:24669765

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 discrete implementation strategies used over time, estimating dose, describing temporal ordering of implementation strategies, and pinpointing the major implementation actors. This detail could facilitate clear reporting of a full range of implementation strategies, including those that may be less observable. This approach could lead to a more nuanced understanding of what it takes to implement different innovations, the types of strategies that are most useful during specific phases of implementation, and how implementation strategies need to be adaptively applied throughout the course of a given initiative.

A stitch in time saves nine? A repeated cross-sectional case study on the implementation of the intersectoral community approach Youth At a Healthy Weight.

PubMed

van der Kleij, Rianne M J J; Crone, Mathilde R; Paulussen, Theo G W M; van de Gaar, Vivan M; Reis, Ria

2015-10-08

The implementation of programs complex in design, such as the intersectoral community approach Youth At a Healthy Weight (JOGG), often deviates from their application as intended. There is limited knowledge of their implementation processes, making it difficult to formulate sound implementation strategies. For two years, we performed a repeated cross-sectional case study on the implementation of a JOGG fruit and water campaign targeting children age 0-12. Semi-structured observations, interviews, field notes and professionals' logs entries were used to evaluate implementation process. Data was analyzed via a framework approach; within-case and cross-case displays were formulated and key determinants identified. Principles from Qualitative Comparative Analysis (QCA) were used to identify causal configurations of determinants per sector and implementation phase. Implementation completeness differed, but was highest in the educational and health care sector, and higher for key than additional activities. Determinants and causal configurations of determinants were mostly sector- and implementation phase specific. High campaign ownership and possibilities for campaign adaptation were most frequently mentioned as facilitators. A lack of reinforcement strategies, low priority for campaign use and incompatibility of own goals with campaign goals were most often indicated as barriers. We advise multiple 'stitches in time'; tailoring implementation strategies to specific implementation phases and sectors using both the results from this study and a mutual adaptation strategy in which professionals are involved in the development of implementation strategies. The results of this study show that the implementation process of IACOs is complex and sustainable implementation is difficult to achieve. Moreover, this study reveals that the implementation process is influenced by predominantly sector and implementation phase specific (causal configurations of) determinants.

Integrating: A managerial practice that enables implementation in fragmented health care environments.

PubMed

Kerrissey, Michaela; Satterstrom, Patricia; Leydon, Nicholas; Schiff, Gordon; Singer, Sara

How some organizations improve while others remain stagnant is a key question in health care research. Studies identifying how organizations can implement improvement despite barriers are needed, particularly in primary care. This inductive qualitative study examines primary care clinics implementing improvement efforts in order to identify mechanisms that enable implementation despite common barriers, such as lack of time and fragmentation across stakeholder groups. Using an embedded multiple case study design, we leverage a longitudinal data set of field notes, meeting minutes, and interviews from 16 primary care clinics implementing improvement over 15 months. We segment clinics into those that implemented more versus those that implemented less, comparing similarities and differences. We identify interpersonal mechanisms promoting implementation, develop a conceptual model of our key findings, and test the relationship with performance using patient surveys conducted pre-/post-implementation. Nine clinics implemented more successfully over the study period, whereas seven implemented less. Successfully implementing clinics exhibited the managerial practice of integrating, which we define as achieving unity of effort among stakeholder groups in the pursuit of a shared and mutually developed goal. We theorize that integrating is critical in improvement implementation because of the fragmentation observed in health care settings, and we extend theory about clinic managers' role in implementation. We identify four integrating mechanisms that clinic managers enacted: engaging groups, bridging communication, sensemaking, and negotiating. The mean patient survey results for integrating clinics improved by 0.07 units over time, whereas the other clinics' survey scores declined by 0.08 units on a scale of 5 (p = .02). Our research explores an understudied element of how clinics can implement improvement despite barriers: integrating stakeholders within and outside the clinic into the process. It provides clinic managers with an actionable path for implementing improvement.

We have the programme, what next? Planning the implementation of an injury prevention programme

PubMed Central

Donaldson, Alex; Lloyd, David G; Gabbe, Belinda J; Cook, Jill

2017-01-01

Background and aim The impact of any injury prevention programme is a function of the programme and its implementation. However, real world implementation of injury prevention programmes is challenging. Lower limb injuries (LLIs) are common in community Australian football (community-AF) and it is likely that many could be prevented by implementing exercise-based warm-up programmes for players. This paper describes a systematic, evidence-informed approach used to develop the implementation plan for a LLI prevention programme in community-AF in Victoria, Australia. Methods An ecological approach, using Step 5 of the Intervention Mapping health promotion programme planning protocol, was taken. Results An implementation advisory group was established to ensure the implementation plan and associated strategies were relevant to the local context. Coaches were identified as the primary programme adopters and implementers within an ecological system including players, other coaches, first-aid providers, and club and league administrators. Social Cognitive Theory was used to identify likely determinants of programme reach, adoption and implementation among coaches (eg, knowledge, beliefs, skills and environment). Diffusion of Innovations theory, the Implementation Drivers framework and available research evidence were used to identify potential implementation strategies including the use of multiple communication channels, programme resources, coach education and mentoring. Conclusions A strategic evidence-informed approach to implementing interventions will help maximise their population impact. The approach to implementation planning described in this study relied on an effective researcher-practitioner partnership and active engagement of stakeholders. The identified implementation strategies were informed by theory, evidence and an in-depth understanding of the implementation context. PMID:26787739

Initial Implementation Indicators From a Statewide Rollout of SafeCare Within a Child Welfare System

PubMed Central

Whitaker, Daniel J.; Ryan, Kerry A.; Wild, Robert C.; Self-Brown, Shannon; Lutzker, John R.; Shanley, Jenelle R.; Edwards, Anna M.; McFry, Erin A.; Moseley, Colby N.; Hodges, Amanda E.

2013-01-01

There is a strong movement toward implementation of evidence-based practices (EBP) in child welfare systems. The SafeCare parenting model is one of few parent-training models that addresses child neglect, the most common form of maltreatment. Here, the authors describe initial findings from a statewide effort to implement the EBP, SafeCare®, into a state child welfare system. A total of 50 agencies participated in training, with 295 individuals entering training to implement SafeCare. Analyses were conducted to describe the trainee sample, describe initial training and implementation indicators, and to examine correlates of initial training performance and implementation indicators. The quality of SafeCare uptake during training and implementation was high with trainees performing very well on training quizzes and role-plays, and demonstrating high fidelity when implementing SafeCare in the field (performing over 90% of expected behaviors). However, the quantity of implementation was generally low, with relatively few providers (only about 25%) implementing the model following workshop training. There were no significant predictors of training or implementation performance, once corrections for multiple comparisons were applied. The Discussion focuses on challenges to large-scale system-wide implementation of EBP. PMID:22146860

Uncovering middle managers' role in healthcare innovation implementation

PubMed Central

2012-01-01

Background Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers' role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers' role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in healthcare organizations. Discussion Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. Summary Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers' role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers' influence to improve the effectiveness of healthcare innovation implementation. PMID:22472001

Uncovering middle managers' role in healthcare innovation implementation.

PubMed

Birken, Sarah A; Lee, Shoou-Yih Daniel; Weiner, Bryan J

2012-04-03

Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers' role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers' role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in healthcare organizations. Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers' role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers' influence to improve the effectiveness of healthcare innovation implementation.

A complex adaptive systems perspective of health information technology implementation.

PubMed

Keshavjee, Karim; Kuziemsky, Craig; Vassanji, Karim; Ghany, Ahmad

2013-01-01

Implementing health information technology (HIT) is a challenge because of the complexity and multiple interactions that define HIT implementation. Much of the research on HIT implementation is descriptive in nature and has focused on distinct processes such as order entry or decision support. These studies fail to take into account the underlying complexity of the processes, people and settings that are typical of HIT implementations. Complex adaptive systems (CAS) is a promising field that could elucidate the complexity and non-linear interacting issues that are typical in HIT implementation. Initially we sought new models that would enable us to better understand the complex nature of HIT implementation, to proactively identify problem issues that could be a precursor to unintended consequences and to develop new models and new approaches to successful HIT implementations. Our investigation demonstrates that CAS does not provide prediction, but forces us to rethink our HIT implementation paradigms and question what we think we know. CAS provides new ways to conceptualize HIT implementation and suggests new approaches to increasing HIT implementation successes.

Factors associated with early childhood education and care service implementation of healthy eating and physical activity policies and practices in Australia: a cross-sectional study.

PubMed

Wolfenden, Luke; Finch, Meghan; Nathan, Nicole; Weaver, Natasha; Wiggers, John; Yoong, Sze Lin; Jones, Jannah; Dodds, Pennie; Wyse, Rebecca; Sutherland, Rachel; Gillham, Karen

2015-09-01

Many early childhood education and care (ECEC) services fail to implement recommended policies and practices supportive of healthy eating and physical activity. The purpose of this study was to assess whether certain theoretically-based factors are associated with implementation of healthy eating and physical activity policies and practices in a sample of ECEC services. A cross-sectional survey was conducted with Service Managers of ECEC services. The survey assessed the operational characteristics, policy, and practice implementation, and 13 factors were suggested by Damschroder's Consolidated Framework for Implementation Research to impede or promote implementation. Logistic regression analyses found a significant association between implementation factor score and full implementation (OR 1.38; 95% CI 1.18-1.61; p = <0.01), indicating that for every one point increase in implementation score, ECEC services were 38 % more likely to be fully implementing the policies and practices. The findings highlight the opportunities for improving implementation of obesity prevention interventions in this setting by developing interventions that address such factors.

Design and Implementation of the PMS Module for ’Argos’

DTIC Science & Technology

1989-12-01

designing , and implementing a fully workable Planned Maintenance System (PMS). This implementation demonstrates both the capabilities and benefits such a...analyzing, designing , and implementing a fully workable Planned Maintenance System (PMS). This implementation demonstrates both the capabilities and... design and implementation. PMS is the system developed by the navy to provide each ship, department, and supervisor with the tools needed to plan

Determining the predictors of innovation implementation in healthcare: a quantitative analysis of implementation effectiveness.

PubMed

Jacobs, Sara R; Weiner, Bryan J; Reeve, Bryce B; Hofmann, David A; Christian, Michael; Weinberger, Morris

2015-01-22

The failure rates for implementing complex innovations in healthcare organizations are high. Estimates range from 30% to 90% depending on the scope of the organizational change involved, the definition of failure, and the criteria to judge it. The innovation implementation framework offers a promising approach to examine the organizational factors that determine effective implementation. To date, the utility of this framework in a healthcare setting has been limited to qualitative studies and/or group level analyses. Therefore, the goal of this study was to quantitatively examine this framework among individual participants in the National Cancer Institute's Community Clinical Oncology Program using structural equation modeling. We examined the innovation implementation framework using structural equation modeling (SEM) among 481 physician participants in the National Cancer Institute's Community Clinical Oncology Program (CCOP). The data sources included the CCOP Annual Progress Reports, surveys of CCOP physician participants and administrators, and the American Medical Association Physician Masterfile. Overall the final model fit well. Our results demonstrated that not only did perceptions of implementation climate have a statistically significant direct effect on implementation effectiveness, but physicians' perceptions of implementation climate also mediated the relationship between organizational implementation policies and practices (IPP) and enrollment (p <0.05). In addition, physician factors such as CCOP PI status, age, radiological oncologists, and non-oncologist specialists significantly influenced enrollment as well as CCOP organizational size and structure, which had indirect effects on implementation effectiveness through IPP and implementation climate. Overall, our results quantitatively confirmed the main relationship postulated in the innovation implementation framework between IPP, implementation climate, and implementation effectiveness among individual physicians. This finding is important, as although the model has been discussed within healthcare organizations before, the studies have been predominately qualitative in nature and/or at the organizational level. In addition, our findings have practical applications. Managers looking to increase implementation effectiveness of an innovation should focus on creating an environment that physicians perceive as encouraging implementation. In addition, managers should consider instituting specific organizational IPP aimed at increasing positive perceptions of implementation climate. For example, IPP should include specific expectations, support, and rewards for innovation use.

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 autonomy and dependence on funding agencies and SafeCare developers. In addition to the retrospective application of organizational theories demonstrated above, we advocate for the proactive use of organizational theories to design implementation research. For example, implementation strategies should be selected to minimize transaction costs, promote and maintain congruence between organizations' dynamic internal and external contexts over time, and simultaneously attend to organizations' financial needs while preserving their autonomy. We describe implications of applying organizational theory in implementation research for implementation strategies, the evaluation of implementation efforts, measurement, research design, theory, and practice. We also offer guidance to implementation researchers for applying organizational theory.

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.

Critical challenges in ERP implementation: A qualitative case study in the Canadian oil and gas industry

NASA Astrophysics Data System (ADS)

Menon, Sreekumar A.

This exploratory qualitative single-case study examines critical challenges encountered during ERP implementation based on individual perspectives in four project roles: senior leaders, project managers, project team members, and business users, all specifically in Canadian oil and gas industry. Data was collected by interviewing participants belonging to these categories, and by analyzing project documentation about ERP implementation. The organization for the case study was a leading multinational oil and gas company having a substantial presence in the energy sector in Canada. The study results were aligned with the six management questions regarding critical challenges in ERP: (a) circumstances to implement ERP, (b) benefits and process improvements achieved, (c) best practices implemented, (d) critical challenges encountered, (e) strategies and mitigating actions used, and (f) recommendations to improve future ERP implementations. The study results highlight six key findings. First, the study provided valid circumstances for implementing ERP systems. Second, the study underscored the importance of benefits and process improvements in ERP implementation. Third, the study highlighted that adoption of best practices is crucial for ERP Implementation. Fourth, the study found that critical challenges are encountered in ERP Implementation and are significant during ERP implementation. Fifth, the study found that strategies and mitigating actions can overcome challenges in ERP implementation. Finally, the study provided ten major recommendations on how to improve future ERP implementations.

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.

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.

Some Methods for Evaluating Program Implementation.

ERIC Educational Resources Information Center

Hardy, Roy A.

An approach to evaluating program implementation is described. This approach includes the development of a project description which includes a structure matrix, sampling from the structure matrix, and preparing an implementation evaluation plan. The implementation evaluation plan should include: (1) verification of implementation of planned…

A systematic review of the implementation of recommended psychological interventions for schizophrenia: Rates, barriers, and improvement strategies.

PubMed

Ince, Paul; Haddock, Gillian; Tai, Sara

2016-09-01

A systematic review of the literature exploring if the UK recommendations for psychological interventions for schizophrenia were being met was carried out. Rates of implementation for cognitive behavioural therapy (CBT) and family intervention (FI) were compared. The barriers against implementation and described strategies aimed at improving implementation were reviewed. A literature search of electronic bibliography databases (Psychinfo, Medline, Pubmed, AMED, CINHAL, and EMBASE), reference and citation lists, the Evaluation and Review of NICE Implementation (ERNIE) database, a manual search of Clinical Psychology Forum, governmental reports, charity, and service user group reports was conducted. Twenty-six articles met the inclusion criteria, 11 provided data on implementation rates, 13 explored the barriers to implementation, and 10 gave information about improvement strategies. Rates of implementation varied from 4% to 100% for CBT and 0% to 53% for FI, and studies varied in the methodology used and quality of the articles. Previously reported barriers to implementation were found, with organisational barriers being most commonly followed by barriers met by staff members and service users. Implementation strategies discovered included training packages for CBT, FI, and psychosocial interventions as well as empirical evidence suggesting methods for engagement with service users. Rates of implementation for CBT and FI are still below recommended levels with wide variation of rates found. This suggests inequalities in the provision of psychological interventions for schizophrenia are still present. Previously identified barriers to implementation were confirmed. Attempted implementation strategies have been met with modest success. Inequalities in the provision of psychological therapies for schizophrenia persist. Good quality cognitive behavioural therapy and FI training do not ensure implementation. Collaboration at all levels of healthcare is needed for effective implementation. © 2015 The British Psychological Society.

Implementation plans included in World Health Organisation guidelines.

PubMed

Wang, Zhicheng; Norris, Susan L; Bero, Lisa

2016-05-20

The implementation of high-quality guidelines is essential to improve clinical practice and public health. The World Health Organisation (WHO) develops evidence-based public health and other guidelines that are used or adapted by countries around the world. Detailed implementation plans are often necessary for local policymakers to properly use the guidelines developed by WHO. This paper describes the plans for guideline implementation reported in WHO guidelines and indicates which of these plans are evidence-based. We conducted a content analysis of the implementation sections of WHO guidelines approved by the WHO guideline review committee between December 2007 and May 2015. The implementation techniques reported in each guideline were coded according to the Cochrane Collaboration's Effective Practice and Organisation of Care (EPOC) taxonomy and classified as passive, active or policy strategies. The frequencies of implementation techniques are reported. The WHO guidelines (n = 123) analysed mentioned implementation techniques 800 times, although most mentioned implementation techniques very briefly, if at all. Passive strategies (21 %, 167/800) and general policy strategies (62 %, 496/800) occurred most often. Evidence-based active implementation methods were generally neglected with no guideline mentioning reminders (computerised or paper) and only one mentioning a multifaceted approach. Many guidelines contained implementation sections that were identical to those used in older guidelines produced by the same WHO technical unit. The prevalence of passive and policy-based implementation techniques as opposed to evidence-based active techniques suggests that WHO guidelines should contain stronger guidance for implementation. This could include structured and increased detail on implementation considerations, accompanying or linked documents that provide information on what is needed to contextualise or adapt a guideline and specific options from among evidence-based implementation strategies.

Implementing Immediate Postpartum Long-Acting Reversible Contraception Programs.

PubMed

Hofler, Lisa G; Cordes, Sarah; Cwiak, Carrie A; Goedken, Peggy; Jamieson, Denise J; Kottke, Melissa

2017-01-01

To understand the most important steps required to implement immediate postpartum long-acting reversible contraception (LARC) programs in different Georgia hospitals and the barriers to implementing such a program. This was a qualitative study. We interviewed 32 key personnel from 10 Georgia hospitals working to establish immediate postpartum LARC programs. Data were analyzed using directed qualitative content analysis principles. We used the Stages of Implementation to organize participant-identified key steps for immediate postpartum LARC into an implementation guide. We compared this guide to hospitals' implementation experiences. At the completion of the study, LARC was available for immediate postpartum placement at 7 of 10 study hospitals. Participants identified common themes for the implementation experience: team member identification and ongoing communication, payer preparedness challenges, interdependent department-specific tasks, and piloting with continuing improvements. Participants expressed a need for anticipatory guidance throughout the process. Key first steps to immediate postpartum LARC program implementation were identifying project champions, creating an implementation team that included all relevant departments, obtaining financial reassurance, and ensuring hospital administration awareness of the project. Potential barriers included lack of knowledge about immediate postpartum LARC, financial concerns, and competing clinical and administrative priorities. Hospitals that were successful at implementing immediate postpartum LARC programs did so by prioritizing clear communication and multidisciplinary teamwork. Although the implementation guide reflects a comprehensive assessment of the steps to implementing immediate postpartum LARC programs, not all hospitals required every step to succeed. Hospital teams report that implementing immediate postpartum LARC programs involves multiple departments and a number of important steps to consider. A stage-based approach to implementation, and a standardized guide detailing these steps, may provide the necessary structure for the complex process of implementing immediate postpartum LARC programs in the hospital setting.

Predictors of Success for Electronic Health Record Implementation in Small Physician Practices

PubMed Central

Ancker, J.S.; Singh, M.P.; Thomas, R.; Edwards, A.; Snyder, A.; Kashyap, A.; Kaushal, R.

2013-01-01

Background The federal government is promoting adoption of electronic health records (EHRs) through financial incentives for EHR use and implementation support provided by regional extension centers. Small practices have been slow to adopt EHRs. Objectives Our objective was to measure time to EHR implementation and identify factors associated with successful implementation in small practices receiving financial incentives and implementation support. This study is unique in exploiting quantitative implementation time data collected prospectively as part of routine project management. Methods This mixed-methods study includes interviews of key informants and a cohort study of 544 practices that had worked with the Primary Care Information Project (PCIP), a publicly funded organization that since 2007 has subsidized EHRs and provided implementation support similar to that supplied by the new regional extension centers. Data from a project management database were used for a cohort study to assess time to implementation and predictors of implementation success. Results Four hundred and thirty practices (79%) implemented EHRs within the analysis period, with a median project time of 24.7 weeks (95% CI: 23.3 – 26.4). Factors associated with implementation success were: fewer providers, practice sites, and patients; fewer Medicaid and uninsured patients; having previous experience with scheduling software; enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice management product rather than two products. Interviews identified positive attitude toward EHRs, resources, and centralized leadership as additional practice-level predictors of success. Conclusions A local initiative similar to current federal programs successfully implemented EHRs in primary care practices by offsetting software costs and providing implementation assistance. Nevertheless, implementation success was affected by practice size and other characteristics, suggesting that the federal programs can reduce barriers to EHR implementation but may not eliminate them. PMID:23650484

Core Implementation Components

ERIC Educational Resources Information Center

Fixsen, Dean L.; Blase, Karen A.; Naoom, Sandra F.; Wallace, Frances

2009-01-01

The failure of better science to readily produce better services has led to increasing interest in the science and practice of implementation. The results of recent reviews of implementation literature and best practices are summarized in this article. Two frameworks related to implementation stages and core implementation components are described…

A Model for Implementing a Career Education System.

ERIC Educational Resources Information Center

Ryan, T. Antoinette

The model for career education implementation defines three major functions which constitute the essential elements in the implementation process: planning, implementation, and evaluation. Emphasis is placed on the interrelatedness of implementation to both planning and evaluation of career education. The 11 subsystems involved in implementing…

Positive youth development programs for adolescents with greater psychosocial needs: evaluation based on program implementers.

PubMed

Shek, Daniel T L; Ng, Catalina S M; Law, Moon Y M

2017-02-01

As program implementers' views are seldom included in program evaluation and there are few related studies in different Chinese communities, this study examined the perceptions of the program implementers who implemented the Tier 2 Program of the P.A.T.H.S. Program in Hong Kong. The Tier 2 Program was designed to promote the development of adolescents with greater psychosocial needs. In the community-based P.A.T.H.S. Project, 400 program implementers completed a subjective outcome evaluation form (Form D) for program implementers. Consistent with the previous findings, program implementers generally held positive views towards the program, implementers, and program effectiveness and their views towards these three domains did not differ across grades. In line with the hypotheses, perceived program quality and perceived implementer quality predicted program effectiveness. The present findings provided an alternative perspective showing that the Tier 2 Program was well received by the program implementers and they regarded the program to be beneficial to the program participants.

Experiences of Agency for Healthcare Research and Quality-funded projects that implemented practices for safer patient care.

PubMed

Taylor, Stephanie L; Ridgely, M Susan; Greenberg, Michael D; Sorbero, Melony E S; Teleki, Stephanie S; Damberg, Cheryl L; Farley, Donna O

2009-04-01

To synthesize lessons learned from the experiences of Agency for Healthcare Research and Quality-funded patient safety projects in implementing safe practices. Self-reported data from individual and group interviews with Original, Challenge, and Partnerships in Implementing Patient Safety (PIPS) grantees, from 2003 to 2006. Interviews with three grantee groups (n=60 total) implementing safe practice projects, with comparisons on factors influencing project implementation and sustainability. Semi-structured protocols contained open-ended questions on lessons learned and more structured questions on factors associated with project implementation and sustainability. The grantees shared common experiences, frequently identifying lessons learned regarding structural components needing to be in place before implementation, components of the implementation process, components of interventions' results needed for sustainability, changes in timelines or activities, unanticipated issues, and staff acceptance/adoption. Also, fewer Original grants had many of the factors related project to implementation/sustainability than the PIPS or Challenge grantees had. Although much of what was reported seemed like common sense, surprisingly few projects actually planned for or expected many of the barriers or facilitators they experienced during their project implementation. Others implementing practice improvements likely will share the experiences and issues identified by these implementation projects and can learn from their lessons.

[Implementing evidence and implementation research: two different and prime realities].

PubMed

Rumbo Prieto, José María; Martínez Ques, Ángel Alfredo; Sobrido Prieto, María; Raña Lama, Camilo Daniel; Vázquez Campo, Miriam; Braña Marcos, Beatriz

Scientific research can contribute to more efficient health care, enhance care quality and safety of persons. In order for this to happen, the knowledge gained must be put into practice. Implementation is known as the introduction of a change or innovation to daily practice, which requires effective communication and the elimination of barriers that hinder this process. Best practice implementation experiences are being used increasingly in the field of nursing. The difficulty in identifying the factors that indicate the success or failure of implementation has led to increased studies to build a body of differentiated knowledge, recognized as implementation science or implementation research. Implementation research is the scientific study whose objective is the adoption and systematic incorporation of research findings into clinical practice to improve the quality and efficiency of health services. The purpose of implementation research is to improve the health of the population through equitable and effective implementation of rigorously evaluated scientific knowledge, which involves gathering the evidence that has a positive impact on the health of the community. In this text, we set out the characteristics of nursing implementation research, providing a synthesis of different methods, theories, key frameworks and implementation strategies, along with the terminology proposed for greater conceptual clarity. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

How change management can prevent the failure of information systems implementation among Malaysian government hospitals?

NASA Astrophysics Data System (ADS)

ChePa, Noraziah; Jasin, Noorhayati Md; Bakar, Nur Azzah Abu

2017-10-01

Fail to prevent or control challenges of Information System (IS) implementation have led to the failure of its implementation. Successful implementation of IS has been a challenging task to any organization including government hospitals. Government has invested a big amount of money on information system (IS) projects to improve service delivery in healthcare. However, several of them failed to be implemented successfully due to several factors. This article proposes a prevention model which incorporated Change Management (CM) concepts to avoid the failure of IS implementation, hence ensuring the success of it. Challenges of IS implementation in government hospitals have been discovered. Extensive literature review and deep interview approaches were employed to discover these challenges. A prevention model has been designed to cater the challenges. The model caters three main phases of implementation; pre-implementation, during implementation, and post-implementation by adopting CM practices of Lewin's, Kotter's and Prosci's CM model. Six elements of CM comprising thirteen sub-elements adopted from the three CM models have been used to handle CFFs of Human and Support issues; guiding team, resistance avoidance, IS adoption, enforcement, monitoring, and IS sustainability. Successful practice of the proposed mapping is expected to prevent CFFs to occur, hence ensuring a successful implementation of IS in the hospitals. The proposed model has been presented and successfully evaluated by the domain experts from the selected hospitals. The proposed model is believed to be beneficial for top management, IT practitioners and medical practitioners in preventing IS implementation failure among government hospitals towards ensuring the success implementation.

Factors associated with implementation of a multicomponent responsible beverage service program – results from two surveys in 290 Swedish municipalities

PubMed Central

2013-01-01

Background The purpose of this study was to investigate which factors affected the implementation of a multicomponent Responsible Beverage Service (RBS) program in 290 Swedish municipalities and whether the amount of such factors influenced the level of implementation of the program. Methods This study used variation in the presence of implementation-promoting factors to predict the level of implementation of the RBS program in municipalities throughout Sweden. The presence of such factors and the level of implementation of the program were studied by means of two surveys in all Swedish municipalities (N=290). Logistic regression and Spearman’s correlation analyses were used to analyze the relationship between implementation-promoting factors and the level of implementation of the RBS program. Results The response rates of the two surveys were 96% and 98%, respectively. One main finding was that program fidelity was low. Only 13% of the municipalities surveyed had implemented the RBS program as a whole, as stated in the specification of requirements. In municipalities reporting a higher amount of implementation-promoting factors, a significantly higher level of implementation of the program was shown. Evaluation and feedback was the only factor that correlated significantly with the level of implementation of the RBS program as a whole. Conclusion Evaluation and feedback constitutes an important implementation-promoting factor also in complex programs like the RBS program. Program fidelity is significant for the outcome of an intervention and must be a major focus of the implementation processes. PMID:23497692

Implementing a Capital Plan.

ERIC Educational Resources Information Center

Daigneau, William A.

2003-01-01

Addresses four questions regarding implementation of a long-term capital plan to manage a college's facilities portfolio: When should the projects be implemented? How should the capital improvements be implemented? What will it actually cost in terms of project costs as well as operating costs? Who will implement the plan? (EV)

76 FR 32209 - Agency Information Collection Activities; Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-03

...) Provider Pre-Implementation and Post-Implementation Questionnaires. These questionnaires will be completed... implementation. NH and ED questions differ somewhat, as do pre- and post-implementation surveys. In addition to... assess change in the providers' use and opinion of antibiograms. (3) Nurse Pre/Post-Implementation...

78 FR 34964 - Implementation of the 2008 National Ambient Air Quality Standards for Ozone: State Implementation...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-11

...] Implementation of the 2008 National Ambient Air Quality Standards for Ozone: State Implementation Plan... Ambient Air Quality Standards for Ozone: State Implementation Plan Requirements'' which published in the... the 2008 ozone national ambient air quality standards (NAAQS) (the ``2008 ozone NAAQS'') that were...

77 FR 43205 - Notice of Data Availability for Approval, Disapproval and Promulgation of Implementation Plans...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-24

... Haze State Implementation Plan; Federal Implementation Plan for Regional Haze AGENCY: Environmental... (SIP) revision submitted by the State of Wyoming on January 12, 2011, that addresses regional haze...; Regional Haze State Implementation Plan; Federal Implementation Plan for Regional Haze; Proposed Rule (77...

Implementation: Measuring and Explaining the Fidelity of CSR Implementation

ERIC Educational Resources Information Center

Kurki, Anja; Boyle, Andrea; Aladjem, Daniel K.

2006-01-01

Comprehensive school reform (CSR) is only as effective as its implementation. By using data collected for the National Longitudinal Evaluation of Comprehensive School Reform (NLECSR), this article explores the factors that predict CSR model implementation and the ways that CSR model implementation varies. We found little difference in the fidelity…

The National Evaluation of NASA's Science, Engineering, Mathematics and Aerospace Academy (SEMAA) Program

ERIC Educational Resources Information Center

Martinez, Alina; Cosentino de Cohen, Clemencia

2010-01-01

This report presents findings from a NASA requested evaluation in 2008, which contains both implementation and impact modules. The implementation study investigated how sites implement Science, Engineering, Mathematics, and Aerospace Academy (SEMAA) and the contextual factors important in this implementation. The implementation study used data…

37 CFR 5.18 - Arms, ammunition, and implements of war.

Code of Federal Regulations, 2010 CFR

2010-07-01

... implements of war. 5.18 Section 5.18 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK... implements of war. (a) The exportation of technical data relating to arms, ammunition, and implements of war... parts 120 through 130); the articles designated as arms, ammunitions, and implements of war are...

78 FR 28775 - Approval and Promulgation of Implementation Plans; North Carolina; State Implementation Plan...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-16

... Promulgation of Implementation Plans; North Carolina; State Implementation Plan Miscellaneous Revisions AGENCY... a revision to the North Carolina State Implementation Plan submitted on February 3, 2010, through... particulate matter found in the Code of Federal Regulations. In the Final Rules Section of this Federal...

10 CFR 712.12 - HRP implementation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false HRP implementation. 712.12 Section 712.12 Energy... Program Procedures § 712.12 HRP implementation. (a) The implementation of the HRP is the responsibility of... by April 22, 2004. (b) The HRP Management Official must: (1) Prepare an initial HRP implementation...

10 CFR 712.12 - HRP implementation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false HRP implementation. 712.12 Section 712.12 Energy... Program Procedures § 712.12 HRP implementation. (a) The implementation of the HRP is the responsibility of... by April 22, 2004. (b) The HRP Management Official must: (1) Prepare an initial HRP implementation...

Implementation Fidelity in Community-Based Interventions

PubMed Central

Breitenstein, Susan M.; Gross, Deborah; Garvey, Christine; Hill, Carri; Fogg, Louis; Resnick, Barbara

2012-01-01

Implementation fidelity is the degree to which an intervention is delivered as intended and is critical to successful translation of evidence-based interventions into practice. Diminished fidelity may be why interventions that work well in highly controlled trials may fail to yield the same outcomes when applied in real life contexts. The purpose of this paper is to define implementation fidelity and describe its importance for the larger science of implementation, discuss data collection methods and current efforts in measuring implementation fidelity in community-based prevention interventions, and present future research directions for measuring implementation fidelity that will advance implementation science. PMID:20198637

Adaptive runtime for a multiprocessing API

DOEpatents

Antao, Samuel F.; Bertolli, Carlo; Eichenberger, Alexandre E.; O'Brien, John K.

2016-11-15

A computer-implemented method includes selecting a runtime for executing a program. The runtime includes a first combination of feature implementations, where each feature implementation implements a feature of an application programming interface (API). Execution of the program is monitored, and the execution uses the runtime. Monitor data is generated based on the monitoring. A second combination of feature implementations are selected, by a computer processor, where the selection is based at least in part on the monitor data. The runtime is modified by activating the second combination of feature implementations to replace the first combination of feature implementations.

Adaptive runtime for a multiprocessing API

DOEpatents

Antao, Samuel F.; Bertolli, Carlo; Eichenberger, Alexandre E.; O'Brien, John K.

2016-10-11

A computer-implemented method includes selecting a runtime for executing a program. The runtime includes a first combination of feature implementations, where each feature implementation implements a feature of an application programming interface (API). Execution of the program is monitored, and the execution uses the runtime. Monitor data is generated based on the monitoring. A second combination of feature implementations are selected, by a computer processor, where the selection is based at least in part on the monitor data. The runtime is modified by activating the second combination of feature implementations to replace the first combination of feature implementations.

Methodology issues in implementation science.

PubMed

Newhouse, Robin; Bobay, Kathleen; Dykes, Patricia C; Stevens, Kathleen R; Titler, Marita

2013-04-01

Putting evidence into practice at the point of care delivery requires an understanding of implementation strategies that work, in what context and how. To identify methodological issues in implementation science using 4 studies as cases and make recommendations for further methods development. Four cases are presented and methodological issues identified. For each issue raised, evidence on the state of the science is described. Issues in implementation science identified include diverse conceptual frameworks, potential weaknesses in pragmatic study designs, and the paucity of standard concepts and measurement. Recommendations to advance methods in implementation include developing a core set of implementation concepts and metrics, generating standards for implementation methods including pragmatic trials, mixed methods designs, complex interventions and measurement, and endorsing reporting standards for implementation studies.

Bridging informatics and implementation science: evaluating a framework to assess electronic health record implementations in community settings.

PubMed

Richardson, Joshua E; Abramson, Erika L; Pfoh, Elizabeth R; Kaushal, Rainu

2012-01-01

Effective electronic health record (EHR) implementations in community settings are critical to promoting safe and reliable EHR use as well as mitigating provider dissatisfaction that often results. The implementation challenge is compounded given the scale and scope of EHR installations that are occurring and will continue to occur over the next five years. However, when compared to EHR evaluations relatively few biomedical informatics researchers have published on evaluating EHR implementations. Fewer still have evaluated EHR implementations in community settings. We report on the methods we used to achieve a novel application of an implementation science framework in informatics to qualitatively evaluate community-based EHR implementations. We briefly provide an overview of the implementation science framework, our methods for adapting it to informatics, the effects the framework had on our qualitative methods of inquiry and analysis, and discuss its potential value for informatics research.

The Application of an Implementation Science Framework to Comprehensive School Physical Activity Programs: Be a Champion!

PubMed Central

Moore, Justin B.; Carson, Russell L.; Webster, Collin A.; Singletary, Camelia R.; Castelli, Darla M.; Pate, Russell R.; Beets, Michael W.; Beighle, Aaron

2018-01-01

Comprehensive school physical activity programs (CSPAPs) have been endorsed as a promising strategy to increase youth physical activity (PA) in school settings. A CSPAP is a five-component approach, which includes opportunities before, during, and after school for PA. Extensive resources are available to public health practitioners and school officials regarding what should be implemented, but little guidance and few resources are available regarding how to effectively implement a CSPAP. Implementation science provides a number of conceptual frameworks that can guide implementation of a CSPAP, but few published studies have employed an implementation science framework to a CSPAP. Therefore, we developed Be a Champion! (BAC), which represents a synthesis of implementation science strategies, modified for application to CSPAPs implementation in schools while allowing for local tailoring of the approach. This article describes BAC while providing examples from the implementation of a CSPAP in three rural elementary schools. PMID:29354631

Social network analysis for program implementation.

PubMed

Valente, Thomas W; Palinkas, Lawrence A; Czaja, Sara; Chu, Kar-Hai; Brown, C Hendricks

2015-01-01

This paper introduces the use of social network analysis theory and tools for implementation research. The social network perspective is useful for understanding, monitoring, influencing, or evaluating the implementation process when programs, policies, practices, or principles are designed and scaled up or adapted to different settings. We briefly describe common barriers to implementation success and relate them to the social networks of implementation stakeholders. We introduce a few simple measures commonly used in social network analysis and discuss how these measures can be used in program implementation. Using the four stage model of program implementation (exploration, adoption, implementation, and sustainment) proposed by Aarons and colleagues [1] and our experience in developing multi-sector partnerships involving community leaders, organizations, practitioners, and researchers, we show how network measures can be used at each stage to monitor, intervene, and improve the implementation process. Examples are provided to illustrate these concepts. We conclude with expected benefits and challenges associated with this approach.

Social Network Analysis for Program Implementation

PubMed Central

Valente, Thomas W.; Palinkas, Lawrence A.; Czaja, Sara; Chu, Kar-Hai; Brown, C. Hendricks

2015-01-01

This paper introduces the use of social network analysis theory and tools for implementation research. The social network perspective is useful for understanding, monitoring, influencing, or evaluating the implementation process when programs, policies, practices, or principles are designed and scaled up or adapted to different settings. We briefly describe common barriers to implementation success and relate them to the social networks of implementation stakeholders. We introduce a few simple measures commonly used in social network analysis and discuss how these measures can be used in program implementation. Using the four stage model of program implementation (exploration, adoption, implementation, and sustainment) proposed by Aarons and colleagues [1] and our experience in developing multi-sector partnerships involving community leaders, organizations, practitioners, and researchers, we show how network measures can be used at each stage to monitor, intervene, and improve the implementation process. Examples are provided to illustrate these concepts. We conclude with expected benefits and challenges associated with this approach. PMID:26110842

Implementation Measurement for Evidence-Based Violence Prevention Programs in Communities.

PubMed

Massetti, Greta M; Holland, Kristin M; Gorman-Smith, Deborah

2016-08-01

Increasing attention to the evaluation, dissemination, and implementation of evidence-based programs (EBPs) has led to significant advancements in the science of community-based violence prevention. One of the prevailing challenges in moving from science to community involves implementing EBPs and strategies with quality. The CDC-funded National Centers of Excellence in Youth Violence Prevention (YVPCs) partner with communities to implement a comprehensive community-based strategy to prevent violence and to evaluate that strategy for impact on community-wide rates of violence. As part of their implementation approach, YVPCs document implementation of and fidelity to the components of the comprehensive youth violence prevention strategy. We describe the strategies and methods used by the six YVPCs to assess implementation and to use implementation data to inform program improvement efforts. The information presented describes the approach and measurement strategies employed by each center and for each program implemented in the partner communities. YVPCs employ both established and innovative strategies for measurement and tracking of implementation across a broad range of programs, practices, and strategies. The work of the YVPCs highlights the need to use data to understand the relationship between implementation of EBPs and youth violence outcomes.

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.

Contextual factors related to implementation of classroom physical activity breaks.

PubMed

Carlson, Jordan A; Engelberg, Jessa K; Cain, Kelli L; Conway, Terry L; Geremia, Carrie; Bonilla, Edith; Kerner, Jon; Sallis, James F

2017-09-01

Brief structured physical activity in the classroom is effective for increasing student physical activity. The present study investigated the association between implementation-related contextual factors and intervention implementation after adoption of a structured classroom physical activity intervention. Six elementary-school districts adopted structured classroom physical activity programs in 2013-2014. Implementation contextual factors and intervention implementation (structured physical activity provided in past week or month, yes/no) were assessed using surveys of 337 classroom teachers from 24 schools. Mixed-effects models accounted for the nested design. Availability of resources (yes/no, ORs = 1.91-2.93) and implementation climate z-scores (ORs = 1.36-1.47) were consistently associated with implementation. Teacher-perceived classroom behavior benefits (OR = 1.29) but not student enjoyment or health benefits, and time (OR = 2.32) and academic (OR = 1.63) barriers but not student cooperation barriers were associated with implementation (all z-scores). Four implementation contextual factor composites had an additive association with implementation (OR = 1.64 for each additional favorable composite). Training and technical assistance alone may not support a large proportion of teachers to implement structured classroom physical activity. In addition to lack of time and interference with academic lessons, school climate related to whether administrators and other teachers were supportive of the intervention were key factors explaining whether teachers implemented the intervention. Evidence-based implementation strategies are needed for effectively communicating the benefits of classroom physical activity on student behavior and improving teacher and administrator climate/attitudes around classroom physical activity.

Stages of change: A qualitative study on the implementation of a perinatal audit programme in South Africa.

PubMed

Belizán, María; Bergh, Anne-Marie; Cilliers, Carolé; Pattinson, Robert C; Voce, Anna

2011-09-30

Audit and feedback is an established strategy for improving maternal, neonatal and child health. The Perinatal Problem Identification Programme (PPIP), implemented in South African public hospitals in the late 1990s, measures perinatal mortality rates and identifies avoidable factors associated with each death. The aim of this study was to elucidate the processes involved in the implementation and sustainability of this programme. Clinicians' experiences of the implementation and maintenance of PPIP were explored qualitatively in two workshop sessions. An analytical framework comprising six stages of change, divided into three phases, was used: pre-implementation (create awareness, commit to implementation); implementation (prepare to implement, implement) and institutionalisation (integrate into routine practice, sustain new practices). Four essential factors emerged as important for the successful implementation and sustainability of an audit system throughout the different stages of change: 1) drivers (agents of change) and team work, 2) clinical outreach visits and supervisory activities, 3) institutional perinatal review and feedback meetings, and 4) communication and networking between health system levels, health care facilities and different role-players.During the pre-implementation phase high perinatal mortality rates highlighted the problem and indicated the need to implement an audit programme (stage 1). Commitment to implementing the programme was achieved by obtaining buy-in from management, administration and health care practitioners (stage 2).Preparations in the implementation phase included the procurement and installation of software and training in its use (stage 3). Implementation began with the collection of data, followed by feedback at perinatal review meetings (stage 4).The institutionalisation phase was reached when the results of the audit were integrated into routine practice (stage 5) and when data collection had been sustained for a longer period (stage 6). Insights into the factors necessary for the successful implementation and maintenance of an audit programme and the process of change involved may also be transferable to similar low- and middle-income public health settings where the reduction of the neonatal mortality rate is a key objective in reaching Millennium Development Goal 4. A tool for reflecting on the implementation and maintenance of an audit programme is also proposed.

Stages of change: A qualitative study on the implementation of a perinatal audit programme in South Africa

PubMed Central

2011-01-01

Background Audit and feedback is an established strategy for improving maternal, neonatal and child health. The Perinatal Problem Identification Programme (PPIP), implemented in South African public hospitals in the late 1990s, measures perinatal mortality rates and identifies avoidable factors associated with each death. The aim of this study was to elucidate the processes involved in the implementation and sustainability of this programme. Methods Clinicians' experiences of the implementation and maintenance of PPIP were explored qualitatively in two workshop sessions. An analytical framework comprising six stages of change, divided into three phases, was used: pre-implementation (create awareness, commit to implementation); implementation (prepare to implement, implement) and institutionalisation (integrate into routine practice, sustain new practices). Results Four essential factors emerged as important for the successful implementation and sustainability of an audit system throughout the different stages of change: 1) drivers (agents of change) and team work, 2) clinical outreach visits and supervisory activities, 3) institutional perinatal review and feedback meetings, and 4) communication and networking between health system levels, health care facilities and different role-players. During the pre-implementation phase high perinatal mortality rates highlighted the problem and indicated the need to implement an audit programme (stage 1). Commitment to implementing the programme was achieved by obtaining buy-in from management, administration and health care practitioners (stage 2). Preparations in the implementation phase included the procurement and installation of software and training in its use (stage 3). Implementation began with the collection of data, followed by feedback at perinatal review meetings (stage 4). The institutionalisation phase was reached when the results of the audit were integrated into routine practice (stage 5) and when data collection had been sustained for a longer period (stage 6). Conclusion Insights into the factors necessary for the successful implementation and maintenance of an audit programme and the process of change involved may also be transferable to similar low- and middle-income public health settings where the reduction of the neonatal mortality rate is a key objective in reaching Millennium Development Goal 4. A tool for reflecting on the implementation and maintenance of an audit programme is also proposed. PMID:21958353

The impact of inter-organizational alignment (IOA) on implementation outcomes: evaluating unique and shared organizational influences in education sector mental health.

PubMed

Lyon, Aaron R; Whitaker, Kelly; Locke, Jill; Cook, Clayton R; King, Kevin M; Duong, Mylien; Davis, Chayna; Weist, Mark D; Ehrhart, Mark G; Aarons, Gregory A

2018-02-07

Integrated healthcare delivered by work groups in nontraditional service settings is increasingly common, yet contemporary implementation frameworks typically assume a single organization-or organizational unit-within which system-level processes influence service quality and implementation success. Recent implementation frameworks predict that inter-organizational alignment (i.e., similarity in values, characteristics, activities related to implementation across organizations) may facilitate the implementation of evidence-based practices (EBP), but few studies have evaluated this premise. This study's aims examine the impact of overlapping organizational contexts by evaluating the implementation contexts of externally employed mental health clinicians working in schools-the most common integrated service delivery setting for children and adolescents. Aim 1 is to estimate the effects of unique intra-organizational implementation contexts and combined inter-organizational alignment on implementation outcomes. Aim 2 is to examine the underlying mechanisms through which inter-organizational alignment facilitates or hinders EBP implementation. This study will conduct sequential, exploratory mixed-methods research to evaluate the intra- and inter-organizational implementation contexts of schools and the external community-based organizations that most often employ school-based mental health clinicians, as they relate to mental health EBP implementation. Aim 1 will involve quantitative surveys with school-based, externally-employed mental health clinicians, their supervisors, and proximal school-employed staff (total n = 120 participants) to estimate the effects of each organization's general and implementation-specific organizational factors (e.g., climate, leadership) on implementation outcomes (fidelity, acceptability, appropriateness) and assess the moderating role of the degree of clinician embeddedness in the school setting. Aim 2 will explore the mechanisms through which inter-organizational alignment influences implementation outcomes by presenting the results of Aim 1 surveys to school-based clinicians (n = 30) and conducting semi-structured qualitative interviews. Qualitative data will be evaluated using an integrative inductive and deductive approach. The study aims are expected to identify intra- and inter-organizational constructs that are most instrumental to EBP implementation success in school-based integrated care settings and illuminate mechanisms that may account for the influence of inter-organizational alignment. In addition to improving school-based mental health, these findings will spur future implementation science that considers the relationships across organizations and optimize the capacity of implementation science to guide practice in increasingly complex systems of care.

TMDL Implementation: Lessons Learned

EPA Pesticide Factsheets

Virginia Tech Center for TMDL and Watershed Studies provided state TMDL implementation information and reviewed ongoing TMDL implementation efforts across the country to identify factors that contribute to successful implementation.

Hospital staff views of prescribing and discharge communication before and after electronic prescribing system implementation.

PubMed

Mills, Pamela Ruth; Weidmann, Anita Elaine; Stewart, Derek

2017-12-01

Background Electronic prescribing system implementation is recommended to improve patient safety and general practitioner's discharge information communication. There is a paucity of information about hospital staff perspectives before and after system implementation. Objective To explore hospital staff views regarding prescribing and discharge communication systems before and after hospital electronic prescribing and medicines administration (HEPMA) system implementation. Setting A 560 bed United Kingdom district general hospital. Methods Semi-structured face-to-face qualitative interviews with a purposive sample of hospital staff involved in the prescribing and discharge communication process. Interviews transcribed verbatim and coded using the Framework Approach. Behavioural aspects mapped to Theoretical Domains Framework (TDF) to highlight associated behavioural change determinants. Main outcome measure Staff perceptions before and after implementation. Results Nineteen hospital staff (consultant doctors, junior doctors, pharmacists and advanced nurse practitioners) participated before and after implementation. Pre-implementation main themes were inpatient chart and discharge letter design and discharge communication process with issues of illegible and inaccurate information. Improved safety was anticipated after implementation. Post-implementation themes were improved inpatient chart clarity and discharge letter quality. TDF domains relevant to staff behavioural determinants preimplementation were knowledge (task or environment); skills (competence); social/professional roles and identity; beliefs about capabilities; environmental context and resources (including incidents). An additional two were relevant post-implementation: social influences and behavioural regulation (including self-monitoring). Participants described challenges and patient safety concerns pre-implementation which were mostly resolved post-implementation. Conclusion HEPMA implementation produced perceptions of patient safety improvement. TDF use enabled behaviour change analysis due to implementation, for example, staff adoption of behaviours to ensure general practitioners receive good quality discharge information.

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 John Wiley & Sons Ltd.

Adjusting Estimates of the Expected Value of Information for Implementation: Theoretical Framework and Practical Application.

PubMed

Andronis, Lazaros; Barton, Pelham M

2016-04-01

Value of information (VoI) calculations give the expected benefits of decision making under perfect information (EVPI) or sample information (EVSI), typically on the premise that any treatment recommendations made in light of this information will be implemented instantly and fully. This assumption is unlikely to hold in health care; evidence shows that obtaining further information typically leads to "improved" rather than "perfect" implementation. To present a method of calculating the expected value of further research that accounts for the reality of improved implementation. This work extends an existing conceptual framework by introducing additional states of the world regarding information (sample information, in addition to current and perfect information) and implementation (improved implementation, in addition to current and optimal implementation). The extension allows calculating the "implementation-adjusted" EVSI (IA-EVSI), a measure that accounts for different degrees of implementation. Calculations of implementation-adjusted estimates are illustrated under different scenarios through a stylized case study in non-small cell lung cancer. In the particular case study, the population values for EVSI and IA-EVSI were £ 25 million and £ 8 million, respectively; thus, a decision assuming perfect implementation would have overestimated the expected value of research by about £ 17 million. IA-EVSI was driven by the assumed time horizon and, importantly, the specified rate of change in implementation: the higher the rate, the greater the IA-EVSI and the lower the difference between IA-EVSI and EVSI. Traditionally calculated measures of population VoI rely on unrealistic assumptions about implementation. This article provides a simple framework that accounts for improved, rather than perfect, implementation and offers more realistic estimates of the expected value of research. © The Author(s) 2015.

From strategy to action: how top managers' support increases middle managers' commitment to innovation implementation in health care organizations.

PubMed

Birken, Sarah A; Lee, Shoou-Yih Daniel; Weiner, Bryan J; Chin, Marshall H; Chiu, Michael; Schaefer, Cynthia T

2015-01-01

Evidence suggests that top managers' support influences middle managers' commitment to innovation implementation. What remains unclear is how top managers' support influences middle managers' commitment. Results may be used to improve dismal rates of innovation implementation. We used a mixed-method sequential design. We surveyed (n = 120) and interviewed (n = 16) middle managers implementing an innovation intended to reduce health disparities in 120 U.S. health centers to assess whether top managers' support directly influences middle managers' commitment; by allocating implementation policies and practices; or by moderating the influence of implementation policies and practices on middle managers' commitment. For quantitative analyses, multivariable regression assessed direct and moderated effects; a mediation model assessed mediating effects. We used template analysis to assess qualitative data. We found support for each hypothesized relationship: Results suggest that top managers increase middle managers' commitment by directly conveying to middle managers that innovation implementation is an organizational priority (β = 0.37, p = .09); allocating implementation policies and practices including performance reviews, human resources, training, and funding (bootstrapped estimate for performance reviews = 0.09; 95% confidence interval [0.03, 0.17]); and encouraging middle managers to leverage performance reviews and human resources to achieve innovation implementation. Top managers can demonstrate their support directly by conveying to middle managers that an initiative is an organizational priority, allocating implementation policies and practices such as human resources and funding to facilitate innovation implementation, and convincing middle managers that innovation implementation is possible using available implementation policies and practices. Middle managers may maximize the influence of top managers' support on their commitment by communicating with top managers about what kind of support would be most effective in increasing their commitment to innovation implementation.

From Strategy to Action: How Top Managers’ Support Increases Middle Managers’ Commitment to Innovation Implementation in Healthcare Organizations

PubMed Central

Lee, Shoou-Yih Daniel; Weiner, Bryan J.; Chin, Marshall H.; Chiu, Michael; Schaefer, Cynthia T.

2014-01-01

Background Evidence suggests that top managers’ support influences middle managers’ commitment to innovation implementation. What remains unclear is how top managers’ support influences middle managers’ commitment. Results may be used to improve dismal rates of innovation implementation. Methods We used a mixed-method sequential design. We surveyed (n = 120) and interviewed (n = 16) middle managers implementing an innovation intended to reduce health disparities in 120 US health centers to assess whether top managers’ support influences middle managers’ commitment directly, by allocating implementation policies and practices, or by moderating the influence of implementation policies and practices on middle managers’ commitment. For quantitative analyses, multivariable regression assessed direct and moderated effects; a mediation model assessed mediating effects. We used template analysis to assess qualitative data. Findings We found support for each hypothesized relationship: Results suggest that top managers increase middle managers’ commitment by directly conveying to middle managers that innovation implementation is an organizational priority (β = 0.37, p = 0.09); allocating implementation policies and practices including performance reviews, human resources, training, and funding (bootstrapped estimate for performance reviews = 0.09; 95 percent CI: 0.03, 0.17); and encouraging middle managers to leverage performance reviews and human resources to achieve innovation implementation. Practice Implications Top managers can demonstrate their support by directly conveying to middle managers that an initiative is an organizational priority, allocating implementation policies and practices such as human resources and funding to facilitate innovation implementation, and convincing middle managers that innovation implementation is possible using available implementation policies and practices. Middle managers may maximize the influence of top managers’ support on their commitment by communicating with top managers about what kind of support would be most effective in increasing their commitment to innovation implementation. PMID:24566252

Reviewing evidence on complex social interventions: appraising implementation in systematic reviews of the health effects of organisational-level workplace interventions

PubMed Central

Egan, M; Bambra, C; Petticrew, M; Whitehead, M

2009-01-01

Background: The reporting of intervention implementation in studies included in systematic reviews of organisational-level workplace interventions was appraised. Implementation is taken to include such factors as intervention setting, resources, planning, collaborations, delivery and macro-level socioeconomic contexts. Understanding how implementation affects intervention outcomes may help prevent erroneous conclusions and misleading assumptions about generalisability, but implementation must be adequately reported if it is to be taken into account. Methods: Data on implementation were obtained from four systematic reviews of complex interventions in workplace settings. Implementation was appraised using a specially developed checklist and by means of an unstructured reading of the text. Results: 103 studies were identified and appraised, evaluating four types of organisational-level workplace intervention (employee participation, changing job tasks, shift changes and compressed working weeks). Many studies referred to implementation, but reporting was generally poor and anecdotal in form. This poor quality of reporting did not vary greatly by type or date of publication. A minority of studies described how implementation may have influenced outcomes. These descriptions were more usefully explored through an unstructured reading of the text, rather than by means of the checklist. Conclusions: Evaluations of complex interventions should include more detailed reporting of implementation and consider how to measure quality of implementation. The checklist helped us explore the poor reporting of implementation in a more systematic fashion. In terms of interpreting study findings and their transferability, however, the more qualitative appraisals appeared to offer greater potential for exploring how implementation may influence the findings of specific evaluations. Implementation appraisal techniques for systematic reviews of complex interventions require further development and testing. PMID:18718981

Reviewing evidence on complex social interventions: appraising implementation in systematic reviews of the health effects of organisational-level workplace interventions.

PubMed

Egan, M; Bambra, C; Petticrew, M; Whitehead, M

2009-01-01

The reporting of intervention implementation in studies included in systematic reviews of organisational-level workplace interventions was appraised. Implementation is taken to include such factors as intervention setting, resources, planning, collaborations, delivery and macro-level socioeconomic contexts. Understanding how implementation affects intervention outcomes may help prevent erroneous conclusions and misleading assumptions about generalisability, but implementation must be adequately reported if it is to be taken into account. Data on implementation were obtained from four systematic reviews of complex interventions in workplace settings. Implementation was appraised using a specially developed checklist and by means of an unstructured reading of the text. 103 studies were identified and appraised, evaluating four types of organisational-level workplace intervention (employee participation, changing job tasks, shift changes and compressed working weeks). Many studies referred to implementation, but reporting was generally poor and anecdotal in form. This poor quality of reporting did not vary greatly by type or date of publication. A minority of studies described how implementation may have influenced outcomes. These descriptions were more usefully explored through an unstructured reading of the text, rather than by means of the checklist. Evaluations of complex interventions should include more detailed reporting of implementation and consider how to measure quality of implementation. The checklist helped us explore the poor reporting of implementation in a more systematic fashion. In terms of interpreting study findings and their transferability, however, the more qualitative appraisals appeared to offer greater potential for exploring how implementation may influence the findings of specific evaluations. Implementation appraisal techniques for systematic reviews of complex interventions require further development and testing.

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.

Approved Air Quality Implementation Plans in Region 10

EPA Pesticide Factsheets

Landing page for information about EPA-approved air quality State Implementation Plans (SIPs), Tribal Implementation Plans (TIPs), and Federal Implementation Plans (FIPs) in Alaska, Idaho, Oregon, Washington.

78 FR 69625 - Approval and Promulgation of Implementation Plans; New York State Ozone Implementation Plan Revision

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-20

...] Approval and Promulgation of Implementation Plans; New York State Ozone Implementation Plan Revision AGENCY...) is proposing to approve a revision to the New York State Implementation Plan (SIP) for ozone... air quality standards for ozone. DATES: Comments must be received on or before December 20, 2013...

78 FR 44485 - Implementation of the 2008 National Ambient Air Quality Standards for Ozone: State Implementation...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-24

...] Implementation of the 2008 National Ambient Air Quality Standards for Ozone: State Implementation Plan... Rule Regarding ``Implementation of the 2008 National Ambient Air Quality Standards for Ozone: State... ground-level ozone formation. B. What should I consider as I prepare my comments for the EPA? 1...

77 FR 13974 - Approval and Promulgation of Implementation Plans; New York State Ozone Implementation Plan Revision

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-08

... Promulgation of Implementation Plans; New York State Ozone Implementation Plan Revision AGENCY: Environmental... a proposed revision to the New York State Implementation Plan (SIP) for ozone concerning the control... national ambient air quality standards for ozone. DATES: Effective Date: This rule will be effective April...

Higher Education Institutional Agents as Policy Implementers: The Case of Policies That Affect Undocumented and DACAmented Students

ERIC Educational Resources Information Center

Nienhusser, H. Kenny

2018-01-01

This study examines 45 community college institutional agents across four states in their role as implementer of policies that affected undocumented and DACAmented students. The findings delve into the role of changing implementation landscape, policy vagueness, implementation burden, and institutional support in this implementation environment.…

Increasing In-Service Teacher Implementation of Classroom Management Practices through Consultation, Implementation Planning, and Participant Modeling

ERIC Educational Resources Information Center

Hagermoser Sanetti, Lisa M.; Williamson, Kathleen M.; Long, Anna C. J.; Kratochwill, Thomas R.

2018-01-01

Numerous evidence-based classroom management strategies to prevent and respond to problem behavior have been identified, but research consistently indicates teachers rarely implement them with sufficient implementation fidelity. The purpose of this study was to evaluate the effectiveness of implementation planning, a strategy involving logistical…

27 CFR 70.444 - Importation of arms, ammunition, and implements of war.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., ammunition, and implements of war. 70.444 Section 70.444 Alcohol, Tobacco Products and Firearms ALCOHOL AND... implements of war. Part 47 of title 27 CFR implements Executive Order 11958 and supplements the import... implements of war, (b) Import permit requirements, (c) Import certification and verification, (d) Import...

33 CFR 385.13 - Projects implemented under additional program authority.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Implementation Report is prepared and approved in accordance with § 385.26; and (3) Not exceed a total cost of... RESTORATION PLAN CERP Implementation Processes § 385.13 Projects implemented under additional program authority. (a) To expedite implementation of the Plan, the Corps of Engineers and non-Federal sponsors may...

Review of implementation strategies to change healthcare provider behaviour in the emergency department.

PubMed

de Wit, Kerstin; Curran, Janet; Thoma, Brent; Dowling, Shawn; Lang, Eddy; Kuljic, Nebojsa; Perry, Jeffrey J; Morrison, Laurie

2018-05-01

Advances in emergency medicine research can be slow to make their way into clinical care, and implementing a new evidence-based intervention can be challenging in the emergency department. The Canadian Association of Emergency Physicians (CAEP) Knowledge Translation Symposium working group set out to produce recommendations for best practice in the implementation of a new science in Canadian emergency departments. A systematic review of implementation strategies to change health care provider behaviour in the emergency department was conducted simultaneously with a national survey of emergency physician experience. We summarized our findings into a list of draft recommendations that were presented at the national CAEP Conference 2017 and further refined based on feedback through social media strategies. We produced 10 recommendations for implementing new evidence-based interventions in the emergency department, which cover identifying a practice gap, evaluating the evidence, planning the intervention strategy, monitoring, providing feedback during implementation, and desired qualities of future implementation research. We present recommendations to guide future emergency department implementation initiatives. There is a need for robust and well-designed implementation research to guide future emergency department implementation initiatives.

Implementation science in healthcare: Introduction and perspective.

PubMed

Wensing, Michel

2015-01-01

Implementation science is the scientific study of the methods to promote the uptake of research findings into routine healthcare in clinical, organisational, or policy contexts. The presence of gaps between knowledge and practice is well documented and a range of strategies is available to overcome these gaps. To optimize their impact, it is recommended that implementation strategies are tailored to the target population, setting and goals for improvement. Themes for future research in the field are: implementation of personalized medicine, the economics of implementation, knowledge implementation in various health professions, patient involvement in implementation, and a better understanding of the determinants of implementation. Addressing these challenges requires dedicated training programs, research funding, and networks for effective collaboration with stakeholders in healthcare. Copyright © 2015. Published by Elsevier GmbH.

JTRS/SCA and Custom/SDR Waveform Comparison

NASA Technical Reports Server (NTRS)

Oldham, Daniel R.; Scardelletti, Maximilian C.

2007-01-01

This paper compares two waveform implementations generating the same RF signal using the same SDR development system. Both waveforms implement a satellite modem using QPSK modulation at 1M BPS data rates with one half rate convolutional encoding. Both waveforms are partitioned the same across the general purpose processor (GPP) and the field programmable gate array (FPGA). Both waveforms implement the same equivalent set of radio functions on the GPP and FPGA. The GPP implements the majority of the radio functions and the FPGA implements the final digital RF modulator stage. One waveform is implemented directly on the SDR development system and the second waveform is implemented using the JTRS/SCA model. This paper contrasts the amount of resources to implement both waveforms and demonstrates the importance of waveform partitioning across the SDR development system.

Medical team training and coaching in the Veterans Health Administration; assessment and impact on the first 32 facilities in the programme.

PubMed

Neily, Julia; Mills, Peter D; Lee, Pamela; Carney, Brian; West, Priscilla; Percarpio, Katherine; Mazzia, Lisa; Paull, Douglas E; Bagian, James P

2010-08-01

Communication is problematic in healthcare. The Veterans Health Administration is implementing Medical Team Training. The authors describe results of the first 32 of 130 sites to undergo the programme. This report is unique; it provides aggregate results of a crew resource-management programme for numerous facilities. Facilities were taught medical team training and implemented briefings, debriefings and other projects. The authors coached teams through consultative phone interviews over a year. Implementation teams self-reported implementation and rated programme impact: 1='no impact' and 5='significant impact.' We used logistic regression to examine implementation of briefing/debriefing. Ninety-seven per cent of facilities implemented briefings and debriefings, and all implemented an additional project. As of the final interview, 73% of OR and 67% of ICU implementation teams self-reported and rated staff impact 4-5. Eighty-six per cent of OR and 82% of ICU implementation teams self-reported and rated patient impact 4-5. Improved teamwork was reported by 84% of OR and 75% of ICU implementation teams. Efficiency improvements were reported by 94% of OR implementation teams. Almost all facilities (97%) reported a success story or avoiding an undesirable event. Sites with lower volume were more likely to conduct briefings/debriefings in all cases for all surgical services (p=0.03). Sites are implementing the programme with a positive impact on patients and staff, and improving teamwork, efficiency and safety. A unique feature of the programme is that implementation was facilitated through follow-up support. This may have contributed to the early success of the programme.

From the abstract to the concrete - Implementation of an innovative tool in home care.

PubMed

Kajamaa, Anu; Schulz, Klaus-Peter

2018-02-01

Background The implementation of innovations in practice is a critical factor for change and development processes in health and home care. We therefore analyze how an innovative tool - a mobility agreement to maintain physical mobility of home care clients - was implemented in Finnish home care. Methods Our study involves ethnographic research of 13 home care visits, two years after the mobility agreement was implemented. We analyze the emergence of contradictions, the motives of the actors and the use of artifacts supporting or inhibiting the implementation. Two in-depth cases illustrate the implementation of the mobility agreement in home care visits. Findings Our findings show that, first, to achieve practice change and development, the innovation implementation requires the overcoming of contradictions in the implementation process. Second, it calls for the emergence of a shared motive between the actors to transform the abstract concept of an innovation into a concrete practice. Third, artifacts, customary to the clients are important in supporting the implementation process. Fourth, the implementation brings about a modification of the innovation and the adopting social system. Conclusions Innovation implementation should be seen as a transformation process of an abstract concept into a concrete practice, enabled by the actors involved. Concept design and implementation should be closely linked. In health/home care innovation management, the implementation of innovations needs to be understood as a complex collective learning process. Results can be far reaching - in our case leading to change of home care workers' professional understanding and elderly clients' mobility habits.

"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.

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.

Implementing health promotion tools in Australian Indigenous primary health care.

PubMed

Percival, Nikki A; McCalman, Janya; Armit, Christine; O'Donoghue, Lynette; Bainbridge, Roxanne; Rowley, Kevin; Doyle, Joyce; Tsey, Komla

2018-02-01

In Australia, significant resources have been invested in producing health promotion best practice guidelines, frameworks and tools (herein referred to as health promotion tools) as a strategy to improve Indigenous health promotion programmes. Yet, there has been very little rigorous implementation research about whether or how health promotion tools are implemented. This paper theorizes the complex processes of health promotion tool implementation in Indigenous comprehensive primary healthcare services. Data were derived from published and grey literature about the development and the implementation of four Indigenous health promotion tools. Tools were theoretically sampled to account for the key implementation types described in the literature. Data were analysed using the grounded-theory methods of coding and constant comparison with construct a theoretical implementation model. An Indigenous Health Promotion Tool Implementation Model was developed. Implementation is a social process, whereby researchers, practitioners and community members collectively interacted in creating culturally responsive health promotion to the common purpose of facilitating empowerment. The implementation of health promotion tools was influenced by the presence of change agents; a commitment to reciprocity and organizational governance and resourcing. The Indigenous Health Promotion Tool Implementation Model assists in explaining how health promotion tools are implemented and the conditions that influence these actions. Rather than simply developing more health promotion tools, our study suggests that continuous investment in developing conditions that support empowering implementation processes are required to maximize the beneficial impacts and effectiveness of health promotion tools. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Pre-implementation guidelines for infectious disease point-of-care testing in medical institutions.

PubMed

van der Eijk, Annemiek A; Tintu, Andrei N; Hays, John P

2017-01-01

Infectious disease point-of-care test (ID-POCT) devices are becoming widely available, and in this respect, international quality standards and guidelines are available for consultation once ID-POCT has been implemented into medical institutions. However, specific guidelines for consultation during the initial pre-implementation decision-making process are currently lacking. Further, there exist pre-implementation issues specific to ID-POCT. Here we present pre-implementation guidelines for consultation when considering the implementation of ID-POCT in medical institutions.

Empowering nurses to handle the guideline implementation process: identification of implementation competencies.

PubMed

Holleman, Gerda; van Tol, Marjo; Schoonhoven, Lisette; Mintjes-de Groot, Joke; van Achterberg, Theo

2014-01-01

Employing nurses as opinion leaders to implement guidelines may be a promising implementation activity. Until now, insight into necessary competencies of nurse opinion leaders is lacking. We studied and supported aspiring nurse opinion leaders, using a training program based on social influence and implementation theory. Twenty-one competencies were identified, of which the most important were cooperating, communicating, delegating, giving feedback, networking, and information processing. Understanding and addressing these competencies may support the implementation of evidence-based guidelines.

Implementation of emergency department transfer communication measures in Minnesota critical access hospitals.

PubMed

Klingner, Jill; Moscovice, Ira; Casey, Michelle; McEllistrem Evenson, Alex

2015-01-01

Previously published findings based on field tests indicated that emergency department patient transfer communication measures are feasible and worthwhile to implement in rural hospitals. This study aims to expand those findings by focusing on the wide-scale implementation of these measures in the 79 Critical Access Hospitals (CAHs) in Minnesota from 2011 to 2013. Information was obtained from interviews with key informants involved in implementing the emergency department patient transfer communication measures in Minnesota as part of required statewide quality reporting. The first set of interviews targeted state-level organizations regarding their experiences working with providers. A second set of interviews targeted quality and administrative staff from CAHs regarding their experiences implementing measures. Implementing the measures in Minnesota CAHs proved to be successful in a number of respects, but informants also faced new challenges. Our recommendations, addressed to those seeking to successfully implement these measures in other states, take these challenges into account. Field-testing new quality measure implementations with volunteers may not be indicative of a full-scale implementation that requires facilities to participate. The implementation team's composition, communication efforts, prior relationships with facilities and providers, and experience with data collection and abstraction tools are critical factors in successfully implementing required reporting of quality measures on a wide scale. © 2014 National Rural Health Association.

The role of staff turnover in the implementation of evidence-based practices in mental health care.

PubMed

Woltmann, Emily M; Whitley, Rob; McHugo, Gregory J; Brunette, Mary; Torrey, William C; Coots, Laura; Lynde, David; Drake, Robert E

2008-07-01

This study examined turnover rates of teams implementing psychosocial evidence-based practices in public-sector mental health settings. It also explored the relationship between turnover and implementation outcomes in an effort to understand whether practitioner perspectives on turnover are related to implementation outcomes. Team turnover was measured for 42 implementing teams participating in a national demonstration project examining implementation of five evidence-based practices between 2002 and 2005. Regression techniques were used to analyze the effects of team turnover on penetration and fidelity. Qualitative data collected throughout the project were blended with the quantitative data to examine the significance of team turnover to those attempting to implement the practices. High team turnover was common (M+/-SD=81%+/-46%) and did not vary by practice. The 24-month turnover rate was inversely related to fidelity scores at 24 months (N=40, beta=-.005, p=.01). A negative trend was observed for penetration. Further analysis indicated that 71% of teams noted that turnover was a relevant factor in implementation. The behavioral health workforce remains in flux. High turnover most often had a negative impact on implementation, although some teams were able to use strategies to improve implementation through turnover. Implementation models must consider turbulent behavioral health workforce conditions.

Implementation of The World Starts With Me, a comprehensive rights-based sex education programme in Uganda.

PubMed

Rijsdijk, Liesbeth E; Bos, Arjan E R; Lie, Rico; Leerlooijer, Joanne N; Eiling, Ellen; Atema, Vera; Gebhardt, Winifred A; Ruiter, Robert A C

2014-04-01

This article presents a process evaluation of the implementation of the sex education programme the World Starts With Me (WSWM) for secondary school students in Uganda. The purpose of this mixed-methods study was to examine factors associated with dose delivered (number of lessons implemented) and fidelity of implementation (implementation according to the manual), as well as to identify the main barriers and facilitators of implementation. Teachers' confidence in teaching WSWM was negatively associated with dose delivered. Confidence in educating and discussing sexuality issues in class was positively associated with fidelity of implementation, whereas the importance teachers attached to open sex education showed a negative association with fidelity. Main barriers for implementing WSWM were lack of time, unavailability of computers, lack of student manuals and lack of financial support and rewards. Other barriers for successful implementation were related to high turnover of staff and insufficient training and guidance of teachers. Teachers' beliefs/attitudes towards sexuality of adolescents, condom use and sex education were found to be important socio-cognitive factors intervening with full fidelity of implementation. These findings can be used to improve the intervention implementation and to better plan for large-scale dissemination of school-based sex education programmes in sub-Saharan Africa.

Use of health information technology to advance evidence-based care: lessons from the VA QUERI program.

PubMed

Hynes, Denise M; Weddle, Timothy; Smith, Nina; Whittier, Erika; Atkins, David; Francis, Joseph

2010-01-01

As the Department of Veterans Affairs (VA) Health Services Research and Development Service's Quality Enhancement Research Initiative (QUERI) has progressed, health information technology (HIT) has occupied a crucial role in implementation research projects. We evaluated the role of HIT in VA QUERI implementation research, including HIT use and development, the contributions implementation research has made to HIT development, and HIT-related barriers and facilitators to implementation research. Key informants from nine disease-specific QUERI Centers. Documentation analysis of 86 implementation project abstracts followed up by semi-structured interviews with key informants from each of the nine QUERI centers. We used qualitative and descriptive analyses. We found: (1) HIT provided data and information to facilitate implementation research, (2) implementation research helped to further HIT development in a variety of uses including the development of clinical decision support systems (23 of 86 implementation research projects), and (3) common HIT barriers to implementation research existed but could be overcome by collaborations with clinical and administrative leadership. Our review of the implementation research progress in the VA revealed interdependency on an HIT infrastructure and research-based development. Collaboration with multiple stakeholders is a key factor in successful use and development of HIT in implementation research efforts and in advancing evidence-based practice.

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.

Evaluating the implementation of "managing the risk of suicide: a suicide prevention strategy for the ACT 2009-2014".

PubMed

Sheehan, Johann; Griffiths, Kathleen; Rickwood, Debra; Carron-Arthur, Bradley

2015-01-01

Over the past two decades, governments have invested significantly in policies and strategies to prevent the tragic loss of life to suicide. However, there has been little focus on evaluating the implementation of such policies. This paper reports on the evaluation of the implementation of "Managing the Risk of Suicide: A Suicide Prevention Strategy for the ACT 2009-2014," the Australian Capital Territory's (ACT) suicide prevention strategy. We sought to answer two questions: (1) Could agencies provide data reporting on their progress in implementing the activities for which they were responsible?; and (2) Could a judgment about implementation progress be made and, if so, to what extent was the activity implemented? Individually tailored electronic surveys were sent to 18 ACT agencies annually over 4 years to measure their progress in implementing activities for which they had responsibility. By year four, full data were provided for 64% of activities, maximal partial data for 9%, and minimal partial data for 27%. Forty-two per cent of activities were fully implemented, 20% were partially implemented, and 38% were not implemented or could not be measured. It is possible to measure implementation of suicide prevention strategies, but appropriate processes and dedicated resources must be in place at the outset.

The implementation research institute: training mental health implementation researchers in the United States

PubMed Central

2013-01-01

Background The Implementation Research Institute (IRI) provides two years of training in mental health implementation science for 10 new fellows each year. The IRI is supported by a National Institute of Mental Health (NIMH) R25 grant and the Department of Veterans Affairs (VA). Fellows attend two annual week-long trainings at Washington University in St. Louis. Training is provided through a rigorous curriculum, local and national mentoring, a ‘learning site visit’ to a federally funded implementation research project, pilot research, and grant writing. Methods This paper describes the rationale, components, outcomes to date, and participant experiences with IRI. Results IRI outcomes include 31 newly trained implementation researchers, their new grant proposals, contributions to other national dissemination and implementation research training, and publications in implementation science authored by the Core Faculty and fellows. Former fellows have obtained independent research funding in implementation science and are beginning to serve as mentors for more junior investigators. Conclusions Based on the number of implementation research grant proposals and papers produced by fellows to date, the IRI is proving successful in preparing new researchers who can inform the process of making evidence-based mental healthcare more available through real-world settings of care and who are advancing the field of implementation science. PMID:24007290

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.

Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.

PubMed

Curran, Geoffrey M; Bauer, Mark; Mittman, Brian; Pyne, Jeffrey M; Stetler, Cheryl

2012-03-01

This study proposes methods for blending design components of clinical effectiveness and implementation research. Such blending can provide benefits over pursuing these lines of research independently; for example, more rapid translational gains, more effective implementation strategies, and more useful information for decision makers. This study proposes a "hybrid effectiveness-implementation" typology, describes a rationale for their use, outlines the design decisions that must be faced, and provides several real-world examples. An effectiveness-implementation hybrid design is one that takes a dual focus a priori in assessing clinical effectiveness and implementation. We propose 3 hybrid types: (1) testing effects of a clinical intervention on relevant outcomes while observing and gathering information on implementation; (2) dual testing of clinical and implementation interventions/strategies; and (3) testing of an implementation strategy while observing and gathering information on the clinical intervention's impact on relevant outcomes. The hybrid typology proposed herein must be considered a construct still in evolution. Although traditional clinical effectiveness and implementation trials are likely to remain the most common approach to moving a clinical intervention through from efficacy research to public health impact, judicious use of the proposed hybrid designs could speed the translation of research findings into routine practice.

HIV policy implementation in two health and demographic surveillance sites in Uganda: findings from a national policy review, health facility surveys and key informant interviews.

PubMed

McRobie, Ellen; Wringe, Alison; Nakiyingi-Miiro, Jessica; Kiweewa, Francis; Lutalo, Tom; Nakigozi, Gertrude; Todd, Jim; Eaton, Jeffrey William; Zaba, Basia; Church, Kathryn

2017-04-05

Successful HIV testing, care and treatment policy implementation is essential for realising the reductions in morbidity and mortality those policies are designed to target. While adoption of new HIV policies is rapid, less is known about the facility-level implementation of new policies and the factors influencing this. We assessed implementation of national policies about HIV testing, treatment and retention at health facilities serving two health and demographic surveillance sites (HDSS) (10 in Kyamulibwa, 14 in Rakai). Ugandan Ministry of Health HIV policy documents were reviewed in 2013, and pre-determined indicators were extracted relating to the content and nature of guidance on HIV service provision. Facility-level policy implementation was assessed via a structured questionnaire administered to in-charge staff from each health facility. Implementation of policies was classified as wide (≥75% facilities), partial (26-74% facilities) or minimal (≤25% facilities). Semi-structured interviews were conducted with key informants (policy-makers, implementers, researchers) to identify factors influencing implementation; data were analysed using the Framework Method of thematic analysis. Most policies were widely implemented in both HDSS (free testing, free antiretroviral treatment (ART), WHO first-line regimen as standard, Option B+). Both had notable implementation gaps for policies relating to retention on treatment (availability of nutritional supplements, support groups or isoniazid preventive therapy). Rakai implemented more policies relating to provision of antiretroviral treatment than Kyamulibwa and performed better on quality of care indicators, such as frequency of stock-outs. Factors facilitating implementation were donor investment and support, strong scientific evidence, low policy complexity, phased implementation and effective planning. Limited human resources, infrastructure and health management information systems were perceived as major barriers to effective implementation. Most HIV policies were widely implemented in the two settings; however, gaps in implementation coverage prevail and the value of ensuring complete coverage of existing policies should be considered against the adoption of new policies in regard to resource needs and health benefits.

Going above and beyond for implementation: the development and validity testing of the Implementation Citizenship Behavior Scale (ICBS).

PubMed

Ehrhart, Mark G; Aarons, Gregory A; Farahnak, Lauren R

2015-05-07

In line with recent research on the role of the inner context of organizations in implementation effectiveness, this study extends research on organizational citizenship behavior (OCB) to the domain of evidence-based practice (EBP) implementation. OCB encompasses those behaviors that go beyond what is required for a given job that contribute to greater organizational effectiveness. The goal of this study was to develop and test a measure of implementation citizenship behavior (ICB) or those behaviors that employees perform that go above and beyond what is required in order to support EBP implementation. The primary participants were 68 supervisors from ten mental health agencies throughout California. Items measuring ICB were developed based on past research on OCB and in consultation with experts on EBP implementation in mental health settings. Supervisors rated 357 of their subordinates on ICB and implementation success. In addition, 292 of the subordinates provided data on self-rated performance, attitudes towards EBPs, work experience, and full-time status. The supervisor sample was randomly split, with half used for exploratory factor analyses and the other half for confirmatory factor analyses. The entire sample of supervisors and subordinates was utilized for analyses assessing the reliability and construct validity of the measure. Exploratory factor analyses supported the proposed two-factor structure of the Implementation Citizenship Behavior Scale (ICBS): (1) Helping Others and (2) Keeping Informed. Confirmatory factor analyses with the other half of the sample supported the factor structure. Additional analyses supported the reliability and construct validity for the ICBS. The ICBS is a pragmatic brief measure (six items) that captures critical behaviors employees perform to go above and beyond the call of duty to support EBP implementation, including helping their fellow employees on implementation-related activities and keeping informed about issues related to EBP and implementation efforts. The ICBS can be used by researchers to better understand the outcomes of improved organizational support for implementation (i.e., implementation climate) and the proximal predictors of implementation effectiveness. The ICBS can also provide insight for organizations, practitioners, and managers by focusing on key employee behaviors that should increase the probability of implementation success.

Criteria for selecting implementation science theories and frameworks: results from an international survey.

PubMed

Birken, Sarah A; Powell, Byron J; Shea, Christopher M; Haines, Emily R; Alexis Kirk, M; Leeman, Jennifer; Rohweder, Catherine; Damschroder, Laura; Presseau, Justin

2017-10-30

Theories provide a synthesizing architecture for implementation science. The underuse, superficial use, and misuse of theories pose a substantial scientific challenge for implementation science and may relate to challenges in selecting from the many theories in the field. Implementation scientists may benefit from guidance for selecting a theory for a specific study or project. Understanding how implementation scientists select theories will help inform efforts to develop such guidance. Our objective was to identify which theories implementation scientists use, how they use theories, and the criteria used to select theories. We identified initial lists of uses and criteria for selecting implementation theories based on seminal articles and an iterative consensus process. We incorporated these lists into a self-administered survey for completion by self-identified implementation scientists. We recruited potential respondents at the 8th Annual Conference on the Science of Dissemination and Implementation in Health and via several international email lists. We used frequencies and percentages to report results. Two hundred twenty-three implementation scientists from 12 countries responded to the survey. They reported using more than 100 different theories spanning several disciplines. Respondents reported using theories primarily to identify implementation determinants, inform data collection, enhance conceptual clarity, and guide implementation planning. Of the 19 criteria presented in the survey, the criteria used by the most respondents to select theory included analytic level (58%), logical consistency/plausibility (56%), empirical support (53%), and description of a change process (54%). The criteria used by the fewest respondents included fecundity (10%), uniqueness (12%), and falsifiability (15%). Implementation scientists use a large number of criteria to select theories, but there is little consensus on which are most important. Our results suggest that the selection of implementation theories is often haphazard or driven by convenience or prior exposure. Variation in approaches to selecting theory warn against prescriptive guidance for theory selection. Instead, implementation scientists may benefit from considering the criteria that we propose in this paper and using them to justify their theory selection. Future research should seek to refine the criteria for theory selection to promote more consistent and appropriate use of theory in implementation science.

Developing an active implementation model for a chronic disease management program.

PubMed

Smidth, Margrethe; Christensen, Morten Bondo; Olesen, Frede; Vedsted, Peter

2013-04-01

Introduction and diffusion of new disease management programs in healthcare is usually slow, but active theory-driven implementation seems to outperform other implementation strategies. However, we have only scarce evidence on the feasibility and real effect of such strategies in complex primary care settings where municipalities, general practitioners and hospitals should work together. The Central Denmark Region recently implemented a disease management program for chronic obstructive pulmonary disease (COPD) which presented an opportunity to test an active implementation model against the usual implementation model. The aim of the present paper is to describe the development of an active implementation model using the Medical Research Council's model for complex interventions and the Chronic Care Model. We used the Medical Research Council's five-stage model for developing complex interventions to design an implementation model for a disease management program for COPD. First, literature on implementing change in general practice was scrutinised and empirical knowledge was assessed for suitability. In phase I, the intervention was developed; and in phases II and III, it was tested in a block- and cluster-randomised study. In phase IV, we evaluated the feasibility for others to use our active implementation model. The Chronic Care Model was identified as a model for designing efficient implementation elements. These elements were combined into a multifaceted intervention, and a timeline for the trial in a randomised study was decided upon in accordance with the five stages in the Medical Research Council's model; this was captured in a PaTPlot, which allowed us to focus on the structure and the timing of the intervention. The implementation strategies identified as efficient were use of the Breakthrough Series, academic detailing, provision of patient material and meetings between providers. The active implementation model was tested in a randomised trial (results reported elsewhere). The combination of the theoretical model for complex interventions and the Chronic Care Model and the chosen specific implementation strategies proved feasible for a practice-based active implementation model for a chronic-disease-management-program for COPD. Using the Medical Research Council's model added transparency to the design phase which further facilitated the process of implementing the program. http://www.clinicaltrials.gov/(NCT01228708).

Implementation of Metal Casting Best Practices

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

Eppich, Robert; Naranjo, Robert D.

2007-01-01

The project examined cases where metal casters had implemented ITP research results and the benefits they received due to that implementation. In cases where casters had not implemented those results, the project examined the factors responsible for that lack of implementation. The project also informed metal casters of the free tools and service offered by the ITP Technology Delivery subprogram.

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.

Implementation of Evidence-Based HIV Interventions for Gay, Bisexual, and Other Men Who Have Sex with Men.

PubMed

Jeffries, William L; Garrett, Sherese; Phields, Miriam; Olubajo, Babatunde; Lemon, Emily; Valdés-Salgado, Raydel; Collins, Charles B

2017-10-01

The Centers for Disease Control and Prevention provides trainings to support implementation of five evidence-based HIV prevention interventions (EBIs) for men who have sex with men (MSM): d-up: Defend Yourself!; Many Men, Many Voices; Mpowerment; Personalized Cognitive Counseling; and Popular Opinion Leader. We evaluated trainees' implementation of these EBIs and, using multivariable logistic regression, examined factors associated with implementation. Approximately 43% of trainees had implemented the EBIs for which they received training. Implementation was associated with working in community-based organizations (vs. health departments or other settings); acquiring training for Mpowerment or Popular Opinion Leader (vs. Personalized Cognitive Counseling); having ≥3 funding sources (vs. one); and having (vs. not having) sufficient time and necessary EBI resources. Findings suggest that implementation may vary by trainee characteristics, especially those related to employment setting, EBI training, funding, and perceived implementation barriers. Efforts that address these factors may help to improve EBI implementation among trainees.

Guideline implementation strategies for specialist mental healthcare.

PubMed

Girlanda, Francesca; Fiedler, Ines; Ay, Esra; Barbui, Corrado; Koesters, Markus

2013-07-01

Clinical practice guidelines in mental healthcare are viewed as an essential asset if appropriately developed and implemented. The purpose of this article was to review the existing literature on how guidelines should be implemented to optimize their impact on provider performance and patient outcomes in specialist mental healthcare settings. Findings from recent studies suggest a trend toward an improvement in process and patient outcomes following guideline implementation. However, studies are heterogeneous in terms of design, implementation strategies and outcome measures, making it very difficult to draw firm conclusions about which implementation strategy is effective in different healthcare contexts. Current knowledge about how guidelines should be implemented is still sparse and inconclusive in mental healthcare. Future studies should attempt to employ more rigorous designs, including random allocation of patients or clusters of patients, to shed further light on this compelling issue. Research on guideline implementation strategies should additionally take into account potential barriers to knowledge translation, which can heavily influence the implementability of treatment recommendations.

Teachers’ patterns of implementation of an evidence-based intervention and student outcomes: results from a nationwide dissemination over 24-months follow-up

PubMed Central

Stanton, Bonita; Wang, Bo; Deveaux, Lynette; Lunn, Sonja; Rolle, Glenda; Mortimer, Arvis; Li, Xiaoming; Marshall, Sharon; Poitier, Maxwell; Adderley, Richard

2015-01-01

More information is needed about factors influencing real-life implementation and program impact of interventions effective in controlled study conditions. Ongoing national implementation of an evidence-based HIV prevention program targeting grade 6 students in The Bahamas offers the opportunity to examine patterns of implementation and relate them to student outcomes. Data were collected from 208 grade 6 teachers, 75 grade 7 teachers and 4,411 grade 6 students followed over two years. Mixed-effects modeling analysis examined the association of teachers’ patterns of implementation with student outcomes. High quality program implementation in grade 6 (high implementation dosage and fidelity) was significantly related to student outcomes six and 18 months post-intervention. Quality of implementation of the booster session in grade 7 was also significantly related to student outcomes in grade 7. Quality of delivery of the brief booster session a year after initial implementation is important in maintaining or resetting the student outcome trajectory. PMID:26093781

Mixed methods for implementation research: application to evidence-based practice implementation and staff turnover in community-based organizations providing child welfare services.

PubMed

Aarons, Gregory A; Fettes, Danielle L; Sommerfeld, David H; Palinkas, Lawrence A

2012-02-01

Many public sector service systems and provider organizations are in some phase of learning about or implementing evidence-based interventions. Child welfare service systems represent a context where implementation spans system, management, and organizational concerns. Research utilizing mixed methods that combine qualitative and quantitative design, data collection, and analytic approaches are particularly well suited to understanding both the process and outcomes of dissemination and implementation efforts in child welfare systems. This article describes the process of using mixed methods in implementation research and provides an applied example of an examination of factors impacting staff retention during an evidence-based intervention implementation in a statewide child welfare system. The authors integrate qualitative data with previously published quantitative analyses of job autonomy and staff turnover during this statewide implementation project in order to illustrate the utility of mixed method approaches in providing a more comprehensive understanding of opportunities and challenges in implementation research.

Why and How Do Nursing Homes Implement Culture Change Practices? Insights from Qualitative Interviews in a Mixed Methods Study

PubMed Central

Shield, Renée R.; Looze, Jessica; Tyler, Denise; Lepore, Michael; Miller, Susan C.

2015-01-01

Objective To understand the process of instituting culture change (CC) practices in nursing homes (NHs). Methods NH Directors of Nursing (DONs) and Administrators (NHAs) at 4,149 United States NHs were surveyed about CC practices. Follow-up interviews with 64 NHAs were conducted and analyzed by a multidisciplinary team which reconciled interpretations recorded in an audit trail. Results The themes include: 1) Reasons for implementing CC practices vary; 2) NH approaches to implementing CC practices are diverse; 3) NHs consider resident mix in deciding to implement practices; 4) NHAs note benefits and few implementation costs of implementing CC practices; 5) Implementation of changes is challenging and strategies for change are tailored to the challenges encountered; 6) Education and communication efforts are vital ways to institute change; and 7) NHA and other staff leadership is key to implementing changes. Discussion Diverse strategies and leadership skills appear to help NHs implement reform practices, including CC innovations. PMID:24652888

The Pharmacogenomics Research Network Translational Pharmacogenetics Program: Outcomes and Metrics of Pharmacogenetic Implementations Across Diverse Healthcare Systems.

PubMed

Luzum, J A; Pakyz, R E; Elsey, A R; Haidar, C E; Peterson, J F; Whirl-Carrillo, M; Handelman, S K; Palmer, K; Pulley, J M; Beller, M; Schildcrout, J S; Field, J R; Weitzel, K W; Cooper-DeHoff, R M; Cavallari, L H; O'Donnell, P H; Altman, R B; Pereira, N; Ratain, M J; Roden, D M; Embi, P J; Sadee, W; Klein, T E; Johnson, J A; Relling, M V; Wang, L; Weinshilboum, R M; Shuldiner, A R; Freimuth, R R

2017-09-01

Numerous pharmacogenetic clinical guidelines and recommendations have been published, but barriers have hindered the clinical implementation of pharmacogenetics. The Translational Pharmacogenetics Program (TPP) of the National Institutes of Health (NIH) Pharmacogenomics Research Network was established in 2011 to catalog and contribute to the development of pharmacogenetic implementations at eight US healthcare systems, with the goal to disseminate real-world solutions for the barriers to clinical pharmacogenetic implementation. The TPP collected and normalized pharmacogenetic implementation metrics through June 2015, including gene-drug pairs implemented, interpretations of alleles and diplotypes, numbers of tests performed and actionable results, and workflow diagrams. TPP participant institutions developed diverse solutions to overcome many barriers, but the use of Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines provided some consistency among the institutions. The TPP also collected some pharmacogenetic implementation outcomes (scientific, educational, financial, and informatics), which may inform healthcare systems seeking to implement their own pharmacogenetic testing programs. © 2017, The American Society for Clinical Pharmacology and Therapeutics.

Mixed Methods for Implementation Research: Application to Evidence-Based Practice Implementation and Staff Turnover in Community Based Organizations Providing Child Welfare Services

PubMed Central

Aarons, Gregory A.; Fettes, Danielle L.; Sommerfeld, David H.; Palinkas, Lawrence

2013-01-01

Many public sector services systems and provider organizations are in some phase of learning about or implementing evidence-based interventions. Child welfare service systems represent a context where implementation spans system, management, and organizational concerns. Research utilizing mixed methods that combine qualitative and quantitative design, data collection, and analytic approaches are particularly well-suited to understanding both the process and outcomes of dissemination and implementation efforts in child welfare systems. This paper describes the process of using mixed methods in implementation research and provides an applied example of an examination of factors impacting staff retention during an evidence-based intervention implementation in a statewide child welfare system. We integrate qualitative data with previously published quantitative analyses of job autonomy and staff turnover during this statewide implementation project in order to illustrate the utility of mixed method approaches in providing a more comprehensive understanding of opportunities and challenges in implementation research. PMID:22146861

Adopting best practices: "Agility" moves from software development to healthcare project management.

PubMed

Kitzmiller, Rebecca; Hunt, Eleanor; Sproat, Sara Breckenridge

2006-01-01

It is time for a change in mindset in how nurses operationalize system implementations and manage projects. Computers and systems have evolved over time from unwieldy mysterious machines of the past to ubiquitous computer use in every aspect of daily lives and work sites. Yet, disconcertingly, the process used to implement these systems has not evolved. Technology implementation does not need to be a struggle. It is time to adapt traditional plan-driven implementation methods to incorporate agile techniques. Agility is a concept borrowed from software development and is presented here because it encourages flexibility, adaptation, and continuous learning as part of the implementation process. Agility values communication and harnesses change to an advantage, which facilitates the natural evolution of an adaptable implementation process. Specific examples of agility in an implementation are described, and plan-driven implementation stages are adapted to incorporate relevant agile techniques. This comparison demonstrates how an agile approach enhances traditional implementation techniques to meet the demands of today's complex healthcare environments.

Implementation notes on bdes(1). [data encryption implementation

NASA Technical Reports Server (NTRS)

Bishop, Matt

1991-01-01

This note describes the implementation of bdes, the file encryption program being distributed in the 4.4 release of the Berkeley Software Distribution. It implements all modes of the Data Encryption Standard program.

Approved Air Quality Implementation Plans in The Virgin Islands

EPA Pesticide Factsheets

This site contains information about air quality regulations called State Implementation Plans (SIPs), Federal Implementation Plans (FIPs), and Tribal Implementation Plans (TIPs) approved by EPA within the U.S. Virgin Islands.

The role of economics in the QUERI program: QUERI Series

PubMed Central

Smith, Mark W; Barnett, Paul G

2008-01-01

Background The United States (U.S.) Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) has implemented economic analyses in single-site and multi-site clinical trials. To date, no one has reviewed whether the QUERI Centers are taking an optimal approach to doing so. Consistent with the continuous learning culture of the QUERI Program, this paper provides such a reflection. Methods We present a case study of QUERI as an example of how economic considerations can and should be integrated into implementation research within both single and multi-site studies. We review theoretical and applied cost research in implementation studies outside and within VA. We also present a critique of the use of economic research within the QUERI program. Results Economic evaluation is a key element of implementation research. QUERI has contributed many developments in the field of implementation but has only recently begun multi-site implementation trials across multiple regions within the national VA healthcare system. These trials are unusual in their emphasis on developing detailed costs of implementation, as well as in the use of business case analyses (budget impact analyses). Conclusion Economics appears to play an important role in QUERI implementation studies, only after implementation has reached the stage of multi-site trials. Economic analysis could better inform the choice of which clinical best practices to implement and the choice of implementation interventions to employ. QUERI economics also would benefit from research on costing methods and development of widely accepted international standards for implementation economics. PMID:18430199

Implementation challenges of free maternity services policy in Kenya: the health workers' perspective.

PubMed

Wamalwa, Emmanuel Wekesa

2015-01-01

Kenya implemented the policy of free maternity services to reduce maternal mortality and morbidity. For successful implementation of this policy, there is need to monitor the implementation progress, identify the challenges and mitigate them and determine better strategies for implementation based on emerging implementation issues. This study was carried out to determine the challenges facing policy implementation and strategies for better implementation. This was a cross-sectional descriptive study carried at the Rift Valley Provincial General Hospital (RVPGH) and Bondeni maternity. All the staff who work at Bondeni Maternity (including nursing officer in-charge) were included in the study. All the staff who work at the Maternity Unit of the RVPGH were included in the study, as well as the Medical Superintendent of the facility. A total of 110 respondents were sampled. A questionnaire and interview guide were used to collect data. Data was analyzed using SPSS software. A response rate of 91% (n=100) was achieved. Major implementation challenges include inadequate supplies (86%), inadequate funding (38%), staff shortage (92%), lack of motivation among health workers (62%), overwhelming workload (89%) and abuse of services by clients (32%). Strategies for better implementation include employment of more staff, motivation of health workers, improvement in policy financing, training of health workers and provision of adequate supplies. Implementation of free maternity services policy in Kenya is facing challenges but there exists strategies, which, if implemented, will help address these challenges.

The role of economics in the QUERI program: QUERI Series.

PubMed

Smith, Mark W; Barnett, Paul G

2008-04-22

The United States (U.S.) Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) has implemented economic analyses in single-site and multi-site clinical trials. To date, no one has reviewed whether the QUERI Centers are taking an optimal approach to doing so. Consistent with the continuous learning culture of the QUERI Program, this paper provides such a reflection. We present a case study of QUERI as an example of how economic considerations can and should be integrated into implementation research within both single and multi-site studies. We review theoretical and applied cost research in implementation studies outside and within VA. We also present a critique of the use of economic research within the QUERI program. Economic evaluation is a key element of implementation research. QUERI has contributed many developments in the field of implementation but has only recently begun multi-site implementation trials across multiple regions within the national VA healthcare system. These trials are unusual in their emphasis on developing detailed costs of implementation, as well as in the use of business case analyses (budget impact analyses). Economics appears to play an important role in QUERI implementation studies, only after implementation has reached the stage of multi-site trials. Economic analysis could better inform the choice of which clinical best practices to implement and the choice of implementation interventions to employ. QUERI economics also would benefit from research on costing methods and development of widely accepted international standards for implementation economics.

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 of being broad and comprehensive also limits its usefulness as an implementation framework because it does not discriminate between the relative importance of its many constructs for implementation success. This is the first study to identify which CFIR constructs are the most promising to distinguish between high and low implementation success across settings and interventions. Findings from this study can contribute to the refinement of CFIR toward a more succinct and parsimonious framework for planning and evaluation of the implementation of clinical interventions. ClinicalTrial Clinicaltrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6cWeqN1uY) PMID:26582138

Edit distance for marked point processes revisited: An implementation by binary integer programming

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

Hirata, Yoshito; Aihara, Kazuyuki

2015-12-15

We implement the edit distance for marked point processes [Suzuki et al., Int. J. Bifurcation Chaos 20, 3699–3708 (2010)] as a binary integer program. Compared with the previous implementation using minimum cost perfect matching, the proposed implementation has two advantages: first, by using the proposed implementation, we can apply a wide variety of software and hardware, even spin glasses and coherent ising machines, to calculate the edit distance for marked point processes; second, the proposed implementation runs faster than the previous implementation when the difference between the numbers of events in two time windows for a marked point process ismore » large.« less

Approaches to Mixed Methods Dissemination and Implementation Research: Methods, Strengths, Caveats, and Opportunities.

PubMed

Green, Carla A; Duan, Naihua; Gibbons, Robert D; Hoagwood, Kimberly E; Palinkas, Lawrence A; Wisdom, Jennifer P

2015-09-01

Limited translation of research into practice has prompted study of diffusion and implementation, and development of effective methods of encouraging adoption, dissemination and implementation. Mixed methods techniques offer approaches for assessing and addressing processes affecting implementation of evidence-based interventions. We describe common mixed methods approaches used in dissemination and implementation research, discuss strengths and limitations of mixed methods approaches to data collection, and suggest promising methods not yet widely used in implementation research. We review qualitative, quantitative, and hybrid approaches to mixed methods dissemination and implementation studies, and describe methods for integrating multiple methods to increase depth of understanding while improving reliability and validity of findings.

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.

Approaches to Mixed Methods Dissemination and Implementation Research: Methods, Strengths, Caveats, and Opportunities

PubMed Central

Green, Carla A.; Duan, Naihua; Gibbons, Robert D.; Hoagwood, Kimberly E.; Palinkas, Lawrence A.; Wisdom, Jennifer P.

2015-01-01

Limited translation of research into practice has prompted study of diffusion and implementation, and development of effective methods of encouraging adoption, dissemination and implementation. Mixed methods techniques offer approaches for assessing and addressing processes affecting implementation of evidence-based interventions. We describe common mixed methods approaches used in dissemination and implementation research, discuss strengths and limitations of mixed methods approaches to data collection, and suggest promising methods not yet widely used in implementation research. We review qualitative, quantitative, and hybrid approaches to mixed methods dissemination and implementation studies, and describe methods for integrating multiple methods to increase depth of understanding while improving reliability and validity of findings. PMID:24722814

Hope for successful implementation of psychosocial/psychiatric rehabilitation in the forensic mental health setting.

PubMed

Brown, Stephanie A; Lewis, Kent

2015-12-01

To explore staff perceptions of the successes and barriers to implementation of the psychosocial/psychiatric rehabilitation (PSR) model in the forensic mental health setting and identify staff supports needed for greater implementation. A qualitative descriptive design was used and staff focus group data was analyzed using the constant comparative method. All aspects of PSR are being implemented in the forensic setting. Barriers limiting comprehensive implementation include hospital processes and functions, legal components, client clinical presentation, staff attributes and interactions, and lack of resources. To foster greater implementation, employees require support to improve interprofessional interactions and acquire additional resources and education. Strengthening existing successes and addressing barriers identified will foster greater PSR implementation in the forensic setting. Adjusting the physical environment, streamlining documentation, shifting focus from security to rehabilitation goals, and adapting PSR principles to various levels of illness acuity and stages of treatment would enhance PSR implementation. A management focus on improving staff morale, self-care, peer support, team cohesion, and communication would limit burnout and increase successful implementation of PSR. Additional educational opportunities and ongoing training are suggested to support a unified understanding and sustained approach to PSR implementation in the forensic setting. (c) 2015 APA, all rights reserved).

Identifying Strategies Programs Adopt to Meet Healthy Eating and Physical Activity Standards in Afterschool Programs.

PubMed

Weaver, Robert G; Moore, Justin B; Turner-McGrievy, Brie; Saunders, Ruth; Beighle, Aaron; Khan, M Mahmud; Chandler, Jessica; Brazendale, Keith; Randell, Allison; Webster, Collin; Beets, Michael W

2017-08-01

The YMCA of USA has adopted Healthy Eating and Physical Activity (HEPA) Standards for its afterschool programs (ASPs). Little is known about strategies YMCA ASPs are implementing to achieve Standards and these strategies' effectiveness. (1) Identify strategies implemented in YMCA ASPs and (2) evaluate the relationship between strategy implementation and meeting Standards. HEPA was measured via accelerometer (moderate-to-vigorous-physical-activity [MVPA]) and direct observation (snacks served) in 20 ASPs. Strategies were identified and mapped onto a capacity building framework ( Strategies To Enhance Practice [STEPs]). Mixed-effects regression estimated increases in HEPA outcomes as implementation increased. Model-implied estimates were calculated for high (i.e., highest implementation score achieved), moderate (median implementation score across programs), and low (lowest implementation score achieved) implementation for both HEPA separately. Programs implemented a variety of strategies identified in STEPs. For every 1-point increase in implementation score 1.45% (95% confidence interval = 0.33% to 2.55%, p ≤ .001) more girls accumulated 30 min/day of MVPA and fruits and/or vegetables were served on 0.11 more days (95% confidence interval = 0.11-0.45, p ≤ .01). Relationships between implementation and other HEPA outcomes did not reach statistical significance. Still regression estimates indicated that desserts are served on 1.94 fewer days (i.e., 0.40 vs. 2.34) in the highest implementing program than the lowest implementing program and water is served 0.73 more days (i.e., 2.37 vs. 1.64). Adopting HEPA Standards at the national level does not lead to changes in routine practice in all programs. Practical strategies that programs could adopt to more fully comply with the HEPA Standards are identified.

Assessing organizational implementation context in the education sector: confirmatory factor analysis of measures of implementation leadership, climate, and citizenship.

PubMed

Lyon, Aaron R; Cook, Clayton R; Brown, Eric C; Locke, Jill; Davis, Chayna; Ehrhart, Mark; Aarons, Gregory A

2018-01-08

A substantial literature has established the role of the inner organizational setting on the implementation of evidence-based practices in community contexts, but very little of this research has been extended to the education sector, one of the most common settings for the delivery of mental and behavioral health services to children and adolescents. The current study examined the factor structure, psychometric properties, and interrelations of an adapted set of pragmatic organizational instruments measuring key aspects of the organizational implementation context in schools: (1) strategic implementation leadership, (2) strategic implementation climate, and (3) implementation citizenship behavior. The Implementation Leadership Scale (ILS), Implementation Climate Scale (ICS), and Implementation Citizenship Behavior Scale (ICBS) were adapted by a research team that included the original scale authors and experts in the implementation of evidence-based practices in schools. These instruments were then administered to a geographically representative sample (n = 196) of school-based mental/behavioral health consultants to assess the reliability and structural validity via a series of confirmatory factor analyses. Overall, the original factor structures for the ILS, ICS, and ICBS were confirmed in the current sample. The one exception was poor functioning of the Rewards subscale of the ICS, which was removed in the final ICS model. Correlations among the revised measures, evaluated as part of an overarching model of the organizational implementation context, indicated both unique and shared variance. The current analyses suggest strong applicability of the revised instruments to implementation of evidence-based mental and behavioral practices in the education sector. The one poorly functioning subscale (Rewards on the ICS) was attributed to typical educational policies that do not allow for individual financial incentives to personnel. Potential directions for future expansion, revision, and application of the instruments in schools are discussed.

The Implementation Leadership Scale (ILS): development of a brief measure of unit level implementation leadership.

PubMed

Aarons, Gregory A; Ehrhart, Mark G; Farahnak, Lauren R

2014-04-14

In healthcare and allied healthcare settings, leadership that supports effective implementation of evidenced-based practices (EBPs) is a critical concern. However, there are no empirically validated measures to assess implementation leadership. This paper describes the development, factor structure, and initial reliability and convergent and discriminant validity of a very brief measure of implementation leadership: the Implementation Leadership Scale (ILS). Participants were 459 mental health clinicians working in 93 different outpatient mental health programs in Southern California, USA. Initial item development was supported as part of a two United States National Institutes of Health (NIH) studies focused on developing implementation leadership training and implementation measure development. Clinician work group/team-level data were randomly assigned to be utilized for an exploratory factor analysis (n = 229; k = 46 teams) or for a confirmatory factor analysis (n = 230; k = 47 teams). The confirmatory factor analysis controlled for the multilevel, nested data structure. Reliability and validity analyses were then conducted with the full sample. The exploratory factor analysis resulted in a 12-item scale with four subscales representing proactive leadership, knowledgeable leadership, supportive leadership, and perseverant leadership. Confirmatory factor analysis supported an a priori higher order factor structure with subscales contributing to a single higher order implementation leadership factor. The scale demonstrated excellent internal consistency reliability as well as convergent and discriminant validity. The ILS is a brief and efficient measure of unit level leadership for EBP implementation. The availability of the ILS will allow researchers to assess strategic leadership for implementation in order to advance understanding of leadership as a predictor of organizational context for implementation. The ILS also holds promise as a tool for leader and organizational development to improve EBP implementation.

Integrated versus fragmented implementation of complex innovations in acute health care.

PubMed

Woiceshyn, Jaana; Blades, Kenneth; Pendharkar, Sachin R

Increased demand and escalating costs necessitate innovation in health care. The challenge is to implement complex innovations-those that require coordinated use across the adopting organization to have the intended benefits. We wanted to understand why and how two of five similar hospitals associated with the same health care authority made more progress with implementing a complex inpatient discharge innovation whereas the other three experienced more difficulties in doing so. We conducted a qualitative comparative case study of the implementation process at five comparable urban hospitals adopting the same inpatient discharge innovation mandated by their health care authority. We analyzed documents and conducted 39 interviews of the health care authority and hospital executives and frontline managers across the five sites over a 1-year period while the implementation was ongoing. In two and a half years, two of the participating hospitals had made significant progress with implementing the innovation and had begun to realize benefits; they exemplified an integrated implementation mode. Three sites had made minimal progress, following a fragmented implementation mode. In the former mode, a semiautonomous health care organization developed a clear overall purpose and chose one umbrella initiative to implement it. The integrative initiative subsumed the rest and guided resource allocation and the practices of hospital executives, frontline managers, and staff who had bought into it. In contrast, in the fragmented implementation mode, the health care authority had several overlapping, competing innovations that overwhelmed the sites and impeded their implementation. Implementing a complex innovation across hospital sites required (a) early prioritization of one initiative as integrative, (b) the commitment of additional (traded off or new) human resources, (c) deliberate upfront planning and continual support for and evaluation of implementation, and (d) allowance for local customization within the general principles of standardization.

The implementation leadership scale (ILS): development of a brief measure of unit level implementation leadership

PubMed Central

2014-01-01

Background In healthcare and allied healthcare settings, leadership that supports effective implementation of evidenced-based practices (EBPs) is a critical concern. However, there are no empirically validated measures to assess implementation leadership. This paper describes the development, factor structure, and initial reliability and convergent and discriminant validity of a very brief measure of implementation leadership: the Implementation Leadership Scale (ILS). Methods Participants were 459 mental health clinicians working in 93 different outpatient mental health programs in Southern California, USA. Initial item development was supported as part of a two United States National Institutes of Health (NIH) studies focused on developing implementation leadership training and implementation measure development. Clinician work group/team-level data were randomly assigned to be utilized for an exploratory factor analysis (n = 229; k = 46 teams) or for a confirmatory factor analysis (n = 230; k = 47 teams). The confirmatory factor analysis controlled for the multilevel, nested data structure. Reliability and validity analyses were then conducted with the full sample. Results The exploratory factor analysis resulted in a 12-item scale with four subscales representing proactive leadership, knowledgeable leadership, supportive leadership, and perseverant leadership. Confirmatory factor analysis supported an a priori higher order factor structure with subscales contributing to a single higher order implementation leadership factor. The scale demonstrated excellent internal consistency reliability as well as convergent and discriminant validity. Conclusions The ILS is a brief and efficient measure of unit level leadership for EBP implementation. The availability of the ILS will allow researchers to assess strategic leadership for implementation in order to advance understanding of leadership as a predictor of organizational context for implementation. The ILS also holds promise as a tool for leader and organizational development to improve EBP implementation. PMID:24731295

Cross-border healthcare in Spain and the implementation of the Directive 2011/24/EU on the Application of Patient's Rights in Cross-border Healthcare.

PubMed

Requejo, M Teresa

2014-03-01

This work describes and assesses the implementation of the Cross-border Healthcare Directive in Spain. Although implementation has not yet taken place, the Government has already adopted a draft implementing regulation, on which this article is based. In addition, this article deals with a number of other rules that have been adopted in Spain, which are not strictly aimed at the implementation of the Directive but which are expected to facilitate its implementation and to help cement its effectiveness.

Evidence-based management of ambulatory electronic health record system implementation: an assessment of conceptual support and qualitative evidence.

PubMed

McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia; Rizer, Milisa; Huerta, Timothy R

2014-07-01

While electronic health record (EHR) systems have potential to drive improvements in healthcare, a majority of EHR implementations fall short of expectations. Shortcomings in implementations are often due to organizational issues around the implementation process rather than technological problems. Evidence from both the information technology and healthcare management literature can be applied to improve the likelihood of implementation success, but the translation of this evidence into practice has not been widespread. Our objective was to comprehensively study and synthesize best practices for managing ambulatory EHR system implementation in healthcare organizations, highlighting applicable management theories and successful strategies. We held 45 interviews with key informants in six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR implementation. We also conducted six focus groups comprised of 37 physicians. Interview and focus group transcripts were analyzed using both deductive and inductive methods to answer research questions and explore emergent themes. We suggest that successful management of ambulatory EHR implementation can be guided by the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. While participants did not acknowledge nor emphasize use of this model, we found evidence that successful implementation practices could be framed using the PDSA model. Additionally, successful sites had three strategies in common: 1) use of evidence from published health information technology (HIT) literature emphasizing implementation facilitators; 2) focusing on workflow; and 3) incorporating critical management factors that facilitate implementation. Organizations seeking to improve ambulatory EHR implementation processes can use frameworks such as the PDSA QI model to guide efforts and provide a means to formally accommodate new evidence over time. Implementing formal management strategies and incorporating new evidence through the PDSA model is a key element of evidence-based management and a crucial way for organizations to position themselves to proactively address implementation and use challenges before they are exacerbated. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The influence of formal and informal policies and practices on health care innovation implementation: A mixed-methods analysis.

PubMed

DiMartino, Lisa D; Birken, Sarah A; Hanson, Laura C; Trogdon, Justin G; Clary, Alecia S; Weinberger, Morris; Reeder-Hayes, Katherine; Weiner, Bryan J

The implementation science literature has contributed important insights regarding the influence of formal policies and practices on health care innovation implementation, whereas informal implementation policies and practices have garnered little attention. The broader literature suggests that informal implementation policies and practices could also influence innovation use. We used the Organizational Theory of Innovation Implementation to further understand the role of formal and informal implementation policies and practices as determinants of implementation effectiveness. We examined their role within the context of initiatives to increase palliative care consultation in inpatient oncology. We used a case study design in two organizational settings within one academic medical center: medical and gynecologic oncology. We completed semistructured interviews with medical (n = 12) and gynecologic (n = 10) oncology clinicians using questions based on organizational theory. Quantitative data assessed implementation effectiveness, defined as aggregated palliative care consult rates within oncology services from 2010 to 2016. Four palliative care clinicians were interviewed to gain additional implementation context insights. Medical oncology employed multiple formal policies and practices including training and clinician prompting to support palliative care consultation and a top-down approach, yet most clinicians were unaware of the policies and practices, contributing to a weak implementation climate. In contrast, gynecologic oncology employed one formal policy (written guideline of criteria for initiating a consult) but also relied on informal policies and practices, such as spontaneous feedback and communication; they adopted a bottom-up approach, contributing to broader clinician awareness and strong implementation climate. Both services exhibited variable, increasing consult rates over time. Informal policies and practices may compensate or substitute for formal policies and practices under certain conditions (e.g., smaller health care organizations). Further research is needed to investigate the role of formal and informal policies and practices in shaping a strong and sustainable implementation climate and subsequent effective innovation implementation.

Understanding HMIS Implementation in a Developing Country Ministry of Health Context - an Institutional Logics Perspective

PubMed Central

Asangansi, Ime

2012-01-01

Globally, health management information systems (HMIS) have been hailed as important tools for health reform (1). However, their implementation has become a major challenge for researchers and practitioners because of the significant proportion of failure of implementation efforts (2; 3). Researchers have attributed this significant failure of HMIS implementation, in part, to the complexity of meeting with and satisfying multiple (poorly understood) logics in the implementation process. This paper focuses on exploring the multiple logics, including how they may conflict and affect the HMIS implementation process. Particularly, I draw on an institutional logics perspective to analyze empirical findings from an action research project, which involved HMIS implementation in a state government Ministry of Health in (Northern) Nigeria. The analysis highlights the important HMIS institutional logics, where they conflict and how they are resolved. I argue for an expanded understanding of HMIS implementation that recognizes various institutional logics that participants bring to the implementation process, and how these are inscribed in the decision making process in ways that may be conflicting, and increasing the risk of failure. Furthermore, I propose that the resolution of conflicting logics can be conceptualized as involving deinstitutionalization, changeover resolution or dialectical resolution mechanisms. I conclude by suggesting that HMIS implementation can be improved by implementation strategies that are made based on an understanding of these conflicting logics. PMID:23569646

Implementation of intravenous to oral antibiotic switch therapy guidelines in the general medical wards of a tertiary-level hospital in South Africa.

PubMed

van Niekerk, Anida C; Venter, Daniel J L; Boschmans, Shirley-Anne

2012-03-01

The design and implementation of an antibiotic intravenous (iv) to oral switch therapy (IVOST) guideline in a Third World health setting. The guideline was developed and integrated into daily practice by a ward pharmacist over a period of 7 weeks. Patients were switched once they were deemed clinically stable according to IVOST criteria. The final decision to switch was left to the attending physician. One pre- and two post-implementation audits (150 patient medical records per audit) were compared. Implementation of the IVOST guideline was successful in increasing (P<0.0005) the number of patients switched from 16% (19/119) pre-implementation to 43.9% (47/107) immediately after implementation; however, the change was not sustained 3 months after implementation (20.8%; 25/120). The intervention was also successful in decreasing the overall duration of iv therapy (P<0.0005) from 7.2 ± 3.5 days pre-implementation to 5.2 ± 3.0 days immediately post-implementation. The change was not sustained 3 months after implementation (6.5 ± 3.5 days). Despite the challenges encountered in a Third World environment, an antibiotic IVOST guideline can be successfully implemented. Continual, active integration of the guideline into daily practice by a ward pharmacist is essential if positive IVOST outcomes are to be maintained.

Population-Level Cost-Effectiveness of Implementing Evidence-Based Practices into Routine Care

PubMed Central

Fortney, John C; Pyne, Jeffrey M; Burgess, James F

2014-01-01

Objective The objective of this research was to apply a new methodology (population-level cost-effectiveness analysis) to determine the value of implementing an evidence-based practice in routine care. Data Sources/Study Setting Data are from sequentially conducted studies: a randomized controlled trial and an implementation trial of collaborative care for depression. Both trials were conducted in the same practice setting and population (primary care patients prescribed antidepressants). Study Design The study combined results from a randomized controlled trial and a pre-post-quasi-experimental implementation trial. Data Collection/Extraction Methods The randomized controlled trial collected quality-adjusted life years (QALYs) from survey and medication possession ratios (MPRs) from administrative data. The implementation trial collected MPRs and intervention costs from administrative data and implementation costs from survey. Principal Findings In the randomized controlled trial, MPRs were significantly correlated with QALYs (p = .03). In the implementation trial, patients at implementation sites had significantly higher MPRs (p = .01) than patients at control sites, and by extrapolation higher QALYs (0.00188). Total costs (implementation, intervention) were nonsignificantly higher ($63.76) at implementation sites. The incremental population-level cost-effectiveness ratio was $33,905.92/QALY (bootstrap interquartile range −$45,343.10/QALY to $99,260.90/QALY). Conclusions The methodology was feasible to operationalize and gave reasonable estimates of implementation value. PMID:25328029

Evaluating Lean in healthcare.

PubMed

Burgess, Nicola; Radnor, Zoe

2013-01-01

The purpose of this paper is to present findings relating to how Lean is implemented in English hospitals. Lean implementation snapshots in English hospitals were conducted by content analysing all annual reports and web sites over two time periods, giving a thorough analysis of Lean's status in English healthcare. The article identifies divergent approaches to Lean implementation in English hospitals. These approaches are classified into a typology to facilitate an evaluation of how Lean is implemented. The findings suggest that implementation tends to be isolated rather than system-wide. A second dataset conveys Lean implementation trajectory across the time period. These data signal Lean's increasing use by English hospitals and shows progression towards an increasingly systemic approach. Data were collected using content analysis methods, which relies on how "Lean" methods were articulated within the annual report and/or on the organisation's web site, which indicates approaches taken by hospital staff implementing Lean. This research is the first to examine more closely "how" Lean is implemented in English hospitals. The emergent typology could prove relevant to other public sector organizations and service organisations more generally. The research also presents a first step to understanding Lean thinking in the English NHS. This article empirically analyses Lean implementation in English hospitals. It identifies divergent approaches that allow inferences about how far Lean is implemented in an organisation. Data represent a baseline for further analysis so that Lean implementation can be tracked.

Understanding HMIS Implementation in a Developing Country Ministry of Health Context - an Institutional Logics Perspective.

PubMed

Asangansi, Ime

2012-01-01

Globally, health management information systems (HMIS) have been hailed as important tools for health reform (1). However, their implementation has become a major challenge for researchers and practitioners because of the significant proportion of failure of implementation efforts (2; 3). Researchers have attributed this significant failure of HMIS implementation, in part, to the complexity of meeting with and satisfying multiple (poorly understood) logics in the implementation process. This paper focuses on exploring the multiple logics, including how they may conflict and affect the HMIS implementation process. Particularly, I draw on an institutional logics perspective to analyze empirical findings from an action research project, which involved HMIS implementation in a state government Ministry of Health in (Northern) Nigeria. The analysis highlights the important HMIS institutional logics, where they conflict and how they are resolved. I argue for an expanded understanding of HMIS implementation that recognizes various institutional logics that participants bring to the implementation process, and how these are inscribed in the decision making process in ways that may be conflicting, and increasing the risk of failure. Furthermore, I propose that the resolution of conflicting logics can be conceptualized as involving deinstitutionalization, changeover resolution or dialectical resolution mechanisms. I conclude by suggesting that HMIS implementation can be improved by implementation strategies that are made based on an understanding of these conflicting logics.

Implementation Science for the Environment.

PubMed

Hering, Janet G

2018-05-15

The establishment of the field of implementation science was motivated by the understanding that medical and health research alone is insufficient to generate better health outcomes. With strong support from funding agencies for medical research, implementation science promotes the application of a structured framework or model in the implementation of research-based results, specifically evidence-based practices (EBPs). Furthermore, explicit consideration is given to the context of EBP implementation (i.e., socio-economic, political, cultural, and institutional factors that could affect the implementation process). Finally, implementation is monitored in a robust and rigorous way. Today, the field of implementation science supports conferences and professional societies as well as one dedicated journal and numerous others with related content. The goal of these various activities is to reduce the estimated, average "bench to bedside" time lag of 17 years for uptake of EBPs from health research into routine practice. Despite similar time lags and impediments to uptake in the environmental domain, a parallel field of implementation science for the environment has not (yet) emerged. Although some parallels in needs and opportunities can easily be drawn between the health and environmental domains, a detailed mapping exercise is needed to understand which aspects of implementation science could be applied in the environmental domain either directly or in a modified form. This would allow an accelerated development of implementation science for the environment.

76 FR 9706 - Finding of Substantial Inadequacy of Implementation Plan; Call for Iowa State Implementation Plan...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-22

... advance and available for prompt implementation once triggered. Section 110(k)(5) of the CAA provides that... Environmental protection, Air pollution control, Iowa, Particulate matter, State Implementation Plan. Dated...

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

Implementation evaluation of the Telephone Lifestyle Coaching (TLC) program: organizational factors associated with successful implementation.

PubMed

Damschroder, Laura J; Reardon, Caitlin M; Sperber, Nina; Robinson, Claire H; Fickel, Jacqueline J; Oddone, Eugene Z

2017-06-01

The Telephone Lifestyle Coaching (TLC) program provided telephone-based coaching for six lifestyle behaviors to 5321 Veterans at 24 Veterans Health Administration (VHA) medical facilities. The purpose of the study was to conduct an evaluation of the TLC program to identify factors associated with successful implementation. A mixed-methods study design was used. Quantitative measures of organizational readiness for implementation and facility complexity were used to purposively select a subset of facilities for in-depth evaluation. Context assessments were conducted using interview transcripts. The Consolidated Framework for Implementation Research (CFIR) was used to guide qualitative data collection and analysis. Factors most strongly correlated with referral rates included having a skilled implementation leader who used effective multi-component strategies to engage primary care clinicians as well as general clinic structures that supported implementation. Evaluation findings pointed to recommendations for local and national leaders to help anticipate and mitigate potential barriers to successful implementation.

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.

The evidence-practice gap in specialist mental healthcare: systematic review and meta-analysis of guideline implementation studies.

PubMed

Girlanda, Francesca; Fiedler, Ines; Becker, Thomas; Barbui, Corrado; Koesters, Markus

2017-01-01

Clinical practice guidelines are not easily implemented, leading to a gap between research synthesis and their use in routine care. To summarise the evidence relating to the impact of guideline implementation on provider performance and patient outcomes in mental healthcare settings, and to explore the performance of different strategies for guideline implementation. A systematic review of randomised controlled trials, controlled clinical trials and before-and-after studies comparing guideline implementation strategies v. usual care, and different guideline implementation strategies, in patients with severe mental illness. In total, 19 studies met our inclusion criteria. The studies did not show a consistent positive effect of guideline implementation on provider performance, but a more consistent small to modest positive effect on patient outcomes. Guideline implementation does not seem to have an impact on provider performance, nonetheless it may influence patient outcomes positively. © The Royal College of Psychiatrists 2017.

Implementation of clinical decision rules in the emergency department.

PubMed

Stiell, Ian G; Bennett, Carol

2007-11-01

Clinical decision rules (CDRs) are tools designed to help clinicians make bedside diagnostic and therapeutic decisions. The development of a CDR involves three stages: derivation, validation, and implementation. Several criteria need to be considered when designing and evaluating the results of an implementation trial. In this article, the authors review the results of implementation studies evaluating the effect of four CDRs: the Ottawa Ankle Rules, the Ottawa Knee Rule, the Canadian C-Spine Rule, and the Canadian CT Head Rule. Four implementation studies demonstrated that the implementation of CDRs in the emergency department (ED) safely reduced the use of radiography for ankle, knee, and cervical spine injuries. However, a recent trial failed to demonstrate an impact on computed tomography imaging rates. Well-developed and validated CDRs can be successfully implemented into practice, efficiently standardizing ED care. However, further research is needed to identify barriers to implementation in order to achieve improved uptake in the ED.

Sustainability of teacher implementation of school-based mental health programs.

PubMed

Han, Susan S; Weiss, Bahr

2005-12-01

Evidence-based prevention and intervention programs are increasingly being implemented in schools and it therefore is becoming increasingly important to understand the complexities of program implementation under real-world conditions. Much research has focused on the contextual factors that influence program implementation but less work has attempted to provide an integrated understanding of mechanisms (e.g., teacher-training processes) that affect teachers' program implementation. In this paper, we review literature on factors related to teachers' implementation of school-based prevention and intervention programs, then from this review abstract what we believe are four basic ingredients that characterize potentially sustainable teacher-implemented classroom programs. Finally, we present a sequential model, based on these ingredients, of the naturalistic processes underlying sustainability of teachers' program implementation and describe how this sustainability can be enhanced through provision of teacher training and performance feedback from a classroom consultant.

Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: a systematic integrative review.

PubMed

Li, Shelly-Anne; Jeffs, Lianne; Barwick, Melanie; Stevens, Bonnie

2018-05-05

Organizational contextual features have been recognized as important determinants for implementing evidence-based practices across healthcare settings for over a decade. However, implementation scientists have not reached consensus on which features are most important for implementing evidence-based practices. The aims of this review were to identify the most commonly reported organizational contextual features that influence the implementation of evidence-based practices across healthcare settings, and to describe how these features affect implementation. An integrative review was undertaken following literature searches in CINAHL, MEDLINE, PsycINFO, EMBASE, Web of Science, and Cochrane databases from January 2005 to June 2017. English language, peer-reviewed empirical studies exploring organizational context in at least one implementation initiative within a healthcare setting were included. Quality appraisal of the included studies was performed using the Mixed Methods Appraisal Tool. Inductive content analysis informed data extraction and reduction. The search generated 5152 citations. After removing duplicates and applying eligibility criteria, 36 journal articles were included. The majority (n = 20) of the study designs were qualitative, 11 were quantitative, and 5 used a mixed methods approach. Six main organizational contextual features (organizational culture; leadership; networks and communication; resources; evaluation, monitoring and feedback; and champions) were most commonly reported to influence implementation outcomes in the selected studies across a wide range of healthcare settings. We identified six organizational contextual features that appear to be interrelated and work synergistically to influence the implementation of evidence-based practices within an organization. Organizational contextual features did not influence implementation efforts independently from other features. Rather, features were interrelated and often influenced each other in complex, dynamic ways to effect change. These features corresponded to the constructs in the Consolidated Framework for Implementation Research (CFIR), which supports the use of CFIR as a guiding framework for studies that explore the relationship between organizational context and implementation. Organizational culture was most commonly reported to affect implementation. Leadership exerted influence on the five other features, indicating it may be a moderator or mediator that enhances or impedes the implementation of evidence-based practices. Future research should focus on how organizational features interact to influence implementation effectiveness.

Linking molar organizational climate and strategic implementation climate to clinicians' use of evidence-based psychotherapy techniques: cross-sectional and lagged analyses from a 2-year observational study.

PubMed

Williams, Nathaniel J; Ehrhart, Mark G; Aarons, Gregory A; Marcus, Steven C; Beidas, Rinad S

2018-06-25

Behavioral health organizations are characterized by multiple organizational climates, including molar climate, which encompasses clinicians' shared perceptions of how the work environment impacts their personal well-being, and strategic implementation climate, which includes clinicians' shared perceptions of the extent to which evidence-based practice implementation is expected, supported, and rewarded by the organization. Theory suggests these climates have joint, cross-level effects on clinicians' implementation of evidence-based practice and that these effects may be long term (i.e., up to 2 years); however, no empirical studies have tested these relationships. We hypothesize that molar climate moderates implementation climate's concurrent and long-term relationships with clinicians' use of evidence-based practice such that strategic implementation climate will have its most positive effects when it is accompanied by a positive molar climate. Hypotheses were tested using data collected from 235 clinicians in 20 behavioral health organizations. At baseline, clinicians reported on molar climate and implementation climate. At baseline and at a 2-year follow-up, all clinicians who were present in the organizations reported on their use of cognitive-behavioral psychotherapy techniques, an evidence-based practice for youth psychiatric disorders. Two-level mixed-effects regression models tested whether baseline molar climate and implementation climate interacted in predicting clinicians' evidence-based practice use at baseline and at 2-year follow-up. In organizations with more positive molar climates at baseline, higher levels of implementation climate predicted increased evidence-based practice use among clinicians who were present at baseline and among clinicians who were present in the organizations at 2-year follow-up; however, in organizations with less positive molar climates, implementation climate was not related to clinicians' use of evidence-based practice at either time point. Optimizing clinicians' implementation of evidence-based practice in behavioral health requires attention to both molar climate and strategic implementation climate. Strategies that focus exclusively on implementation climate may not be effective levers for behavior change if the organization does not also engender a positive molar climate. These findings have implications for the development of implementation theory and effective implementation strategies.

Assessing the organizational context for EBP implementation: the development and validity testing of the Implementation Climate Scale (ICS).

PubMed

Ehrhart, Mark G; Aarons, Gregory A; Farahnak, Lauren R

2014-10-23

Although the importance of the organizational environment for implementing evidence-based practices (EBP) has been widely recognized, there are limited options for measuring implementation climate in public sector health settings. The goal of this research was to develop and test a measure of EBP implementation climate that would both capture a broad range of issues important for effective EBP implementation and be of practical use to researchers and managers seeking to understand and improve the implementation of EBPs. Participants were 630 clinicians working in 128 work groups in 32 US-based mental health agencies. Items to measure climate for EBP implementation were developed based on past literature on implementation climate and other strategic climates and in consultation with experts on the implementation of EBPs in mental health settings. The sample was randomly split at the work group level of analysis; half of the sample was used for exploratory factor analysis (EFA), and the other half was used for confirmatory factor analysis (CFA). The entire sample was utilized for additional analyses assessing the reliability, support for level of aggregation, and construct-based evidence of validity. The EFA resulted in a final factor structure of six dimensions for the Implementation Climate Scale (ICS): 1) focus on EBP, 2) educational support for EBP, 3) recognition for EBP, 4) rewards for EBP, 5) selection for EBP, and 6) selection for openness. This structure was supported in the other half of the sample using CFA. Additional analyses supported the reliability and construct-based evidence of validity for the ICS, as well as the aggregation of the measure to the work group level. The ICS is a very brief (18 item) and pragmatic measure of a strategic climate for EBP implementation. It captures six dimensions of the organizational context that indicate to employees the extent to which their organization prioritizes and values the successful implementation of EBPs. The ICS can be used by researchers to better understand the role of the organizational context on implementation outcomes and by organizations to evaluate their current climate as they consider how to improve the likelihood of implementation success.

Analyzing implementation dynamics using theory-driven evaluation principles: lessons learnt from a South African centralized chronic dispensing model.

PubMed

Magadzire, Bvudzai Priscilla; Marchal, Bruno; Mathys, Tania; Laing, Richard O; Ward, Kim

2017-12-04

Centralized dispensing of essential medicines is one of South Africa's strategies to address the shortage of pharmacists, reduce patients' waiting times and reduce over-crowding at public sector healthcare facilities. This article reports findings of an evaluation of the Chronic Dispensing Unit (CDU) in one province. The objectives of this process evaluation were to: (1) compare what was planned versus the actual implementation and (2) establish the causal elements and contextual factors influencing implementation. This qualitative study employed key informant interviews with the intervention's implementers (clinicians, managers and the service provider) [N = 40], and a review of policy and program documents. Data were thematically analyzed by identifying the main influences shaping the implementation process. Theory-driven evaluation principles were applied as a theoretical framework to explain implementation dynamics. The overall participants' response about the CDU was positive and the majority of informants concurred that the establishment of the CDU to dispense large volumes of medicines is a beneficial strategy to address healthcare barriers because mechanical functions are automated and distribution of medicines much quicker. However, implementation was influenced by the context and discrepancies between planned activities and actual implementation were noted. Procurement inefficiencies at central level caused medicine stock-outs and affected CDU activities. At the frontline, actors were aware of the CDU's implementation guidelines regarding patient selection, prescription validity and management of non-collected medicines but these were adapted to accommodate practical realities and to meet performance targets attached to the intervention. Implementation success was a result of a combination of 'hardware' (e.g. training, policies, implementation support and appropriate infrastructure) and 'software' (e.g. ownership, cooperation between healthcare practitioners and trust) factors. This study shows that health system interventions have unpredictable paths of implementation. Discrepancies between planned and actual implementation reinforce findings in existing literature suggesting that while tools and defined operating procedures are necessary for any intervention, their successful application depends crucially on the context and environment in which implementation occurs. We anticipate that this evaluation will stimulate wider thinking about the implementation of similar models in low- and middle-income countries.

Study protocol for "Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET)": a pragmatic trial comparing implementation strategies.

PubMed

Gold, Rachel; Hollombe, Celine; Bunce, Arwen; Nelson, Christine; Davis, James V; Cowburn, Stuart; Perrin, Nancy; DeVoe, Jennifer; Mossman, Ned; Boles, Bruce; Horberg, Michael; Dearing, James W; Jaworski, Victoria; Cohen, Deborah; Smith, David

2015-10-16

Little research has directly compared the effectiveness of implementation strategies in any setting, and we know of no prior trials directly comparing how effectively different combinations of strategies support implementation in community health centers. This paper outlines the protocol of the Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET), a trial designed to compare the effectiveness of several common strategies for supporting implementation of an intervention and explore contextual factors that impact the strategies' effectiveness in the community health center setting. This cluster-randomized trial compares how three increasingly hands-on implementation strategies support adoption of an evidence-based diabetes quality improvement intervention in 29 community health centers, managed by 12 healthcare organizations. The strategies are as follows: (arm 1) a toolkit, presented in paper and electronic form, which includes a training webinar; (arm 2) toolkit plus in-person training with a focus on practice change and change management strategies; and (arm 3) toolkit, in-person training, plus practice facilitation with on-site visits. We use a mixed methods approach to data collection and analysis: (i) baseline surveys on study clinic characteristics, to explore how these characteristics impact the clinics' ability to implement the tools and the effectiveness of each implementation strategy; (ii) quantitative data on change in rates of guideline-concordant prescribing; and (iii) qualitative data on the "how" and "why" underlying the quantitative results. The outcomes of interest are clinic-level results, categorized using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, within an interrupted time-series design with segmented regression models. This pragmatic trial will compare how well each implementation strategy works in "real-world" practices. Having a better understanding of how different strategies support implementation efforts could positively impact the field of implementation science, by comparing practical, generalizable methods for implementing clinical innovations in community health centers. Bridging this gap in the literature is a critical step towards the national long-term goal of effectively disseminating and implementing effective interventions into community health centers. ClinicalTrials.gov, NCT02325531.

Assessing the link between implementation fidelity and health outcomes for a trial of intensive case management by community health workers: a mixed methods study protocol.

PubMed

Schmidt, Barbara; Watt, Kerrianne; McDermott, Robyn; Mills, Jane

2017-07-17

Better systems of care are required to address chronic disease in Indigenous people to ensure they can access all their care needs. Health research has produced evidence about effective models of care and chronic disease strategies to address Indigenous health, however the transfer of research findings into routine clinical practice has proven challenging. Complex interventions, such as those related to chronic disease, have many components that are often poorly implemented and hence rarely achieve implementation fidelity. Implementation fidelity is "the degree to which programs are implemented as intended by the program developer". Knowing if an intervention was implemented as planned is fundamental to knowing what has contributed to the success of an intervention. The aim of this study is to adapt the implementation fidelity framework developed by Keith et al. and apply it to the intervention implemented in phase 1 of the Getting Better at Chronic Care in North Queensland study. The objectives are to quantify the level of implementation fidelity achieved during phase 1 of the study, measure the association between implementation fidelity and health outcomes and to explore the features of the primary health care system that contributed to improved health outcomes. A convergent parallel mixed methods study design will be used to develop a process for assessing implementation fidelity. Information collected via a questionnaire and routine data generated during phase 1 of the study will be used to explain the context for the intervention in each site and develop an implementation fidelity score for each component of the intervention. A weighting will be applied to each component of the intervention to calculate the overall implementation score for each participating community. Statistical analysis will assess the level of association between implementation fidelity scores and health outcomes. Health services research seeks to find solutions to social and technical problems to improve health outcomes. The development of a tool and methodology for assessing implementation fidelity in the Indigenous primary health care context will help address some of the barriers to the translation of research into practice. ACTRN12610000812099 : 29.9.2010.

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 facilitation via an external agency can help to structure the implementation process and address contextual barriers. Passive facilitation using web-based implementation resources appears less effective. Moving from initial implementation to wider scale-up presents challenges and is an issue that warrants further attention.

Community-based implementation and effectiveness in a randomized trial of a risk reduction intervention for HIV-serodiscordant couples: study protocol

PubMed Central

2014-01-01

Background The HIV/AIDS epidemic continues to disproportionately affect African American communities in the US, particularly those located in urban areas. Despite the fact that HIV is often transmitted from one sexual partner to another, most HIV prevention interventions have focused only on individuals, rather than couples. This five-year study investigates community-based implementation, effectiveness, and sustainability of ‘Eban II,’ an evidence-based risk reduction intervention for African-American heterosexual, serodiscordant couples. Methods/design This hybrid implementation/effectiveness implementation study is guided by organizational change theory as conceptualized in the Texas Christian University Program Change Model (PCM), a model of phased organizational change from exposure to adoption, implementation, and sustainability. The primary implementation aims are to assist 10 community-based organizations (CBOs) to implement and sustain Eban II; specifically, to partner with CBOs to expose providers to the intervention; facilitate its adoption, implementation and sustainment; and to evaluate processes and determinants of implementation, effectiveness, fidelity, and sustainment. The primary effectiveness aim is to evaluate the effect of Eban II on participant (n = 200 couples) outcomes, specifically incidents of protected sex and proportion of condom use. We will also determine the cost-effectiveness of implementation, as measured by implementation costs and potential cost savings. A mixed methods evaluation will examine implementation at the agency level; staff members from the CBOs will complete baseline measures of organizational context and climate, while key stakeholders will be interviewed periodically throughout implementation. Effectiveness of Eban II will be assessed using a randomized delayed enrollment (waitlist) control design to evaluate the impact of treatment on outcomes at posttest and three-month follow-up. Multi-level hierarchical modeling with a multi-level nested structure will be used to evaluate the effects of agency- and couples-level characteristics on couples-level outcomes (e.g., condom use). Discussion This study will produce important information regarding the value of the Eban II program and a theory-guided implementation process and tools designed for use in implementing Eban II and other evidence-based programs in demographically diverse, resource-constrained treatment settings. Trial registration NCT00644163 PMID:24950708

The NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester: combining empirical, theoretical and experiential evidence to design and evaluate a large-scale implementation strategy.

PubMed

Harvey, Gill; Fitzgerald, Louise; Fielden, Sandra; McBride, Anne; Waterman, Heather; Bamford, David; Kislov, Roman; Boaden, Ruth

2011-08-23

In response to policy recommendations, nine National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) were established in England in 2008, aiming to create closer working between the health service and higher education and narrow the gap between research and its implementation in practice. The Greater Manchester (GM) CLAHRC is a partnership between the University of Manchester and twenty National Health Service (NHS) trusts, with a five-year mission to improve healthcare and reduce health inequalities for people with cardiovascular conditions. This paper outlines the GM CLAHRC approach to designing and evaluating a large-scale, evidence- and theory-informed, context-sensitive implementation programme. The paper makes a case for embedding evaluation within the design of the implementation strategy. Empirical, theoretical, and experiential evidence relating to implementation science and methods has been synthesised to formulate eight core principles of the GM CLAHRC implementation strategy, recognising the multi-faceted nature of evidence, the complexity of the implementation process, and the corresponding need to apply approaches that are situationally relevant, responsive, flexible, and collaborative. In turn, these core principles inform the selection of four interrelated building blocks upon which the GM CLAHRC approach to implementation is founded. These determine the organizational processes, structures, and roles utilised by specific GM CLAHRC implementation projects, as well as the approach to researching implementation, and comprise: the Promoting Action on Research Implementation in Health Services (PARIHS) framework; a modified version of the Model for Improvement; multiprofessional teams with designated roles to lead, facilitate, and support the implementation process; and embedded evaluation and learning. Designing and evaluating a large-scale implementation strategy that can cope with and respond to the local complexities of implementing research evidence into practice is itself complex and challenging. We present an argument for adopting an integrative, co-production approach to planning and evaluating the implementation of research into practice, drawing on an eclectic range of evidence sources.

Community-based implementation and effectiveness in a randomized trial of a risk reduction intervention for HIV-serodiscordant couples: study protocol.

PubMed

Hamilton, Alison B; Mittman, Brian S; Williams, John K; Liu, Honghu H; Eccles, Alicia M; Hutchinson, Craig S; Wyatt, Gail E

2014-06-20

The HIV/AIDS epidemic continues to disproportionately affect African American communities in the US, particularly those located in urban areas. Despite the fact that HIV is often transmitted from one sexual partner to another, most HIV prevention interventions have focused only on individuals, rather than couples. This five-year study investigates community-based implementation, effectiveness, and sustainability of 'Eban II,' an evidence-based risk reduction intervention for African-American heterosexual, serodiscordant couples. This hybrid implementation/effectiveness implementation study is guided by organizational change theory as conceptualized in the Texas Christian University Program Change Model (PCM), a model of phased organizational change from exposure to adoption, implementation, and sustainability. The primary implementation aims are to assist 10 community-based organizations (CBOs) to implement and sustain Eban II; specifically, to partner with CBOs to expose providers to the intervention; facilitate its adoption, implementation and sustainment; and to evaluate processes and determinants of implementation, effectiveness, fidelity, and sustainment. The primary effectiveness aim is to evaluate the effect of Eban II on participant (n = 200 couples) outcomes, specifically incidents of protected sex and proportion of condom use. We will also determine the cost-effectiveness of implementation, as measured by implementation costs and potential cost savings. A mixed methods evaluation will examine implementation at the agency level; staff members from the CBOs will complete baseline measures of organizational context and climate, while key stakeholders will be interviewed periodically throughout implementation. Effectiveness of Eban II will be assessed using a randomized delayed enrollment (waitlist) control design to evaluate the impact of treatment on outcomes at posttest and three-month follow-up. Multi-level hierarchical modeling with a multi-level nested structure will be used to evaluate the effects of agency- and couples-level characteristics on couples-level outcomes (e.g., condom use). This study will produce important information regarding the value of the Eban II program and a theory-guided implementation process and tools designed for use in implementing Eban II and other evidence-based programs in demographically diverse, resource-constrained treatment settings. NCT00644163.

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.

Providers' perceptions of the implementation of a performance measurement system for substance abuse treatment: A process evaluation of the Service Quality Measures initiative.

PubMed

Myers, Bronwyn; Williams, Petal Petersen; Johnson, Kim; Govender, Rajen; Manderscheid, Ron; Koch, J Randy

2016-02-22

In South Africa, concerns exist about the quality of substance abuse treatment. We developed a performance measurement system, known as the Service Quality Measures (SQM) initiative, to monitor the quality of treatment and assess efforts to improve quality of care. In 2014, the SQM system was implemented at six treatment sites to evaluate how implementation protocols could be improved in preparation for wider roll-out. To describe providers' perceptions of the feasibility and acceptability of implementing the SQM system, including barriers to and facilitators of implementation. We conducted 15 in-depth interviews (IDIs) with treatment providers from six treatment sites (two sites in KwaZulu-Natal and four in the Western Cape). Providers were asked about their experiences in implementing the system, the perceived feasibility of the system, and barriers to implementation. All IDIs were audio-recorded and transcribed verbatim. A framework approach was used to analyse the data. Providers reported that the SQM system was feasible to implement and acceptable to patients and providers. Issues identified through the IDIs included a perceived lack of clarity about sequencing of key elements in the implementation of the SQM system, questions on integration of the system into clinical care pathways, difficulties in tracking patients through the system, and concerns about maximising patient participation in the process. Findings suggest that the SQM system is feasible to implement and acceptable to providers, but that some refinements to the implementation protocols are needed to maximise patient participation and the likelihood of sustained implementation.

Building Sustainable Professional Development Programs: Applying Strategies From Implementation Science to Translate Evidence Into Practice.

PubMed

Baldwin, Constance D; Chandran, Latha; Gusic, Maryellen E

2017-01-01

Multisite and national professional development (PD) programs for educators are challenging to establish. Use of implementation science (IS) frameworks designed to convert evidence-based intervention methods into effective health care practice may help PD developers translate proven educational methods and models into successful, well-run programs. Implementation of the national Educational Scholars Program (ESP) is used to illustrate the value of the IS model. Four adaptable elements of IS are described: (1) replication of an evidence-based model, (2) systematic stages of implementation, (3) management of implementation using three implementation drivers, and (4) demonstration of program success through measures of fidelity to proven models and sustainability. Implementation of the ESP was grounded on five established principles and methods for successful PD. The process was conducted in four IS stages over 10 years: Exploration, Installation, Initial Implementation, and Full Implementation. To ensure effective and efficient processes, attention to IS implementation drivers helped to manage organizational relationships, build competence in faculty and scholars, and address leadership challenges. We describe the ESP's fidelity to evidence-based structures and methods, and offer three examples of sustainability efforts that enabled achievement of targeted program outcomes, including academic productivity, strong networking, and career advancement of scholars. Application of IS frameworks to program implementation may help other PD programs to translate evidence-based methods into interventions with enhanced impact. A PD program can follow systematic developmental stages and be operationalized by practical implementation drivers, thereby creating successful and sustainable interventions that promote the academic vitality of health professions educators.

Towards local implementation of Dutch health policy guidelines: a concept-mapping approach.

PubMed

Kuunders, Theo J M; van Bon-Martens, Marja J H; van de Goor, Ien A M; Paulussen, Theo G W M; van Oers, Hans A M

2017-02-22

To develop a targeted implementation strategy for a municipal health policy guideline, implementation targets of two guideline users [Regional Health Services (RHSs)] and guideline developers of leading national health institutes were made explicit. Therefore, characteristics of successful implementation of the guideline were identified. Differences and similarities in perceptions of these characteristics between RHSs and developers were explored. Separate concept mapping procedures were executed in two RHSs, one with representatives from partner local health organizations and municipalities, the second with RHS members only. A third map was conducted with the developers of the guideline. All mapping procedures followed the same design of generating statements up to interpretation of results with participants. Concept mapping, as a practical implementation tool, will be discussed in the context of international research literature on guideline implementation in public health. Guideline developers consider implementation successful when substantive components (health issues) of the guidelines, content are visible in local policy practice. RHSs, local organizations and municipalities view the implementation process itself within and between organizations as more relevant, and state that usability of the guideline for municipal policy and commitment by officials and municipal managers are critical targets for successful implementation. Between the RHSs, differences in implementation targets were smaller than between RHSs and guideline developers. For successful implementation, RHSs tend to focus on process targets while developers focus more on the thematic contents of the guideline. Implications of these different orientations for implementation strategies are dealt with in the discussion. © The Author 2017. Published by Oxford University Press.

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.

Implementation of Best Practices in Obesity Prevention in Child Care Facilities: The Arizona Empower Program, 2013–2015

PubMed Central

Papa, Jillian; Rodriguez, Gertrudes; Robinson, Deborah

2017-01-01

Introduction Obesity is a major health concern in every US age group. Approximately one in 4 children in Arizona’s Special Supplemental Nutrition Program for Women, Infants, and Children is overweight or obese. The Arizona Department of Health Services developed the Empower program to promote healthy environments in licensed child care facilities. The program consists of 10 standards, including one standard for each of these 5 areas: physical activity and screen time, breastfeeding, fruit juice and water, family-style meals, and staff training. The objective of this evaluation was to determine the level of implementation of these 5 Empower standards. Methods A self-assessment survey was completed from July 2013 through June 2015 by 1,850 facilities to evaluate the level of implementation of 5 Empower standards. We calculated the percentage of facilities that reported the degree to which they implemented each standard and identified common themes in comments recorded in the survey. Results All facilities reported either full or partial implementation of the 5 standards. Of 1,678 facilities, 21.7% (n = 364) reported full implementation of all standards, and 78.3% (n = 1,314) reported at least partial implementation. Staff training, which has only one component, had the highest level of implementation: 77.4% (n = 1,299) reported full implementation. Only 44.0% (n = 738) reported full implementation of the standard on a breastfeeding-friendly environment. Conclusion Arizona child care facilities have begun to implement the Empower program, but facilities will need more education, technical assistance, and support in some areas to fully implement the program. PMID:28880840

Implementation of Best Practices in Obesity Prevention in Child Care Facilities: The Arizona Empower Program, 2013-2015.

PubMed

Papa, Jillian; Agostinelli, Joan; Rodriguez, Gertrudes; Robinson, Deborah

2017-09-07

Obesity is a major health concern in every US age group. Approximately one in 4 children in Arizona's Special Supplemental Nutrition Program for Women, Infants, and Children is overweight or obese. The Arizona Department of Health Services developed the Empower program to promote healthy environments in licensed child care facilities. The program consists of 10 standards, including one standard for each of these 5 areas: physical activity and screen time, breastfeeding, fruit juice and water, family-style meals, and staff training. The objective of this evaluation was to determine the level of implementation of these 5 Empower standards. A self-assessment survey was completed from July 2013 through June 2015 by 1,850 facilities to evaluate the level of implementation of 5 Empower standards. We calculated the percentage of facilities that reported the degree to which they implemented each standard and identified common themes in comments recorded in the survey. All facilities reported either full or partial implementation of the 5 standards. Of 1,678 facilities, 21.7% (n = 364) reported full implementation of all standards, and 78.3% (n = 1,314) reported at least partial implementation. Staff training, which has only one component, had the highest level of implementation: 77.4% (n = 1,299) reported full implementation. Only 44.0% (n = 738) reported full implementation of the standard on a breastfeeding-friendly environment. Arizona child care facilities have begun to implement the Empower program, but facilities will need more education, technical assistance, and support in some areas to fully implement the program.

Community, intervention and provider support influences on implementation: reflections from a South African illustration of safety, peace and health promotion.

PubMed

van Niekerk, Ashley; Seedat, Mohamed; Kramer, Sherianne; Suffla, Shahnaaz; Bulbulia, Samed; Ismail, Ghouwa

2014-01-01

The development, implementation and evaluation of community interventions are important for reducing child violence and injuries in low- to middle-income contexts, with successful implementation critical to effective intervention outcomes. The assessment of implementation processes is required to identify the factors that influence effective implementation. This article draws on a child safety, peace and health initiative to examine key factors that enabled or hindered its implementation, in a context characterised by limited resources. A case study approach was employed. The research team was made up of six researchers and intervention coordinators, who led the development and implementation of the Ukuphepha Child Study in South Africa, and who are also the authors of this article. The study used author observations, reflections and discussions of the factors perceived to influence the implementation of the intervention. The authors engaged in an in-depth and iterative dialogic process aimed at abstracting the experiences of the intervention, with a recursive cycle of reflection and dialogue. Data were analysed utilising inductive content analysis, and categorised using classification frameworks for understanding implementation. The study highlights key factors that enabled or hindered implementation. These included the community context and concomitant community engagement processes; intervention compatibility and adaptability issues; community service provider perceptions of intervention relevance and expectations; and the intervention support system, characterised by training and mentorship support. This evaluation illustrated the complexity of intervention implementation. The study approach sought to support intervention fidelity by fostering and maintaining community endorsement and support, a prerequisite for the unfolding implementation of the intervention.

FastGCN: A GPU Accelerated Tool for Fast Gene Co-Expression Networks

PubMed Central

Liang, Meimei; Zhang, Futao; Jin, Gulei; Zhu, Jun

2015-01-01

Gene co-expression networks comprise one type of valuable biological networks. Many methods and tools have been published to construct gene co-expression networks; however, most of these tools and methods are inconvenient and time consuming for large datasets. We have developed a user-friendly, accelerated and optimized tool for constructing gene co-expression networks that can fully harness the parallel nature of GPU (Graphic Processing Unit) architectures. Genetic entropies were exploited to filter out genes with no or small expression changes in the raw data preprocessing step. Pearson correlation coefficients were then calculated. After that, we normalized these coefficients and employed the False Discovery Rate to control the multiple tests. At last, modules identification was conducted to construct the co-expression networks. All of these calculations were implemented on a GPU. We also compressed the coefficient matrix to save space. We compared the performance of the GPU implementation with those of multi-core CPU implementations with 16 CPU threads, single-thread C/C++ implementation and single-thread R implementation. Our results show that GPU implementation largely outperforms single-thread C/C++ implementation and single-thread R implementation, and GPU implementation outperforms multi-core CPU implementation when the number of genes increases. With the test dataset containing 16,000 genes and 590 individuals, we can achieve greater than 63 times the speed using a GPU implementation compared with a single-thread R implementation when 50 percent of genes were filtered out and about 80 times the speed when no genes were filtered out. PMID:25602758

FastGCN: a GPU accelerated tool for fast gene co-expression networks.

PubMed

Liang, Meimei; Zhang, Futao; Jin, Gulei; Zhu, Jun

2015-01-01

Gene co-expression networks comprise one type of valuable biological networks. Many methods and tools have been published to construct gene co-expression networks; however, most of these tools and methods are inconvenient and time consuming for large datasets. We have developed a user-friendly, accelerated and optimized tool for constructing gene co-expression networks that can fully harness the parallel nature of GPU (Graphic Processing Unit) architectures. Genetic entropies were exploited to filter out genes with no or small expression changes in the raw data preprocessing step. Pearson correlation coefficients were then calculated. After that, we normalized these coefficients and employed the False Discovery Rate to control the multiple tests. At last, modules identification was conducted to construct the co-expression networks. All of these calculations were implemented on a GPU. We also compressed the coefficient matrix to save space. We compared the performance of the GPU implementation with those of multi-core CPU implementations with 16 CPU threads, single-thread C/C++ implementation and single-thread R implementation. Our results show that GPU implementation largely outperforms single-thread C/C++ implementation and single-thread R implementation, and GPU implementation outperforms multi-core CPU implementation when the number of genes increases. With the test dataset containing 16,000 genes and 590 individuals, we can achieve greater than 63 times the speed using a GPU implementation compared with a single-thread R implementation when 50 percent of genes were filtered out and about 80 times the speed when no genes were filtered out.

Key ingredients for implementing intensive outpatient programs within patient-centered medical homes: A literature review and qualitative analysis.

PubMed

Breland, Jessica Y; Asch, Steven M; Slightam, Cindie; Wong, Ava; Zulman, Donna M

2016-03-01

Intensive outpatient programs aim to transform care while conserving resources for high-need, high-cost patients, but little is known about factors that influence their implementation within patient-centered medical homes (PCMHs). In this mixed-methods study, we reviewed the literature to identify factors affecting intensive outpatient program implementation, then used semi-structured interviews to determine how these factors influenced the implementation of an intensive outpatient program within the Veterans Affairs' (VA) PCMH. Interviewees included facility leadership and clinical staff who were involved in a pilot Intensive Management Patient Aligned Care Team (ImPACT) intervention for high-need, high-cost VA PCMH patents. We classified implementation factors in the literature review and qualitative analysis using the Consolidated Framework for Implementation Research (CFIR). The literature review (n=9 studies) and analyses of interviews (n=15) revealed key implementation factors in three CFIR domains. First, the Inner Setting (i.e., the organizational and PCMH environment), mostly enabled implementation through a culture of innovation, good networks and communication, and positive tension for change. Second, Characteristics of Individuals, including creativity, flexibility, and interpersonal skills, allowed program staff to augment existing PCMH services. Finally, certain Intervention Characteristics (e.g., adaptability) enabled implementation, while others (e.g., complexity) generated implementation barriers. Resources and structural features common to PCMHs can facilitate implementation of intensive outpatient programs, but program success is also dependent on staff creativity and flexibility, and intervention adaptations to meet patient and organizational needs. Established PCMHs likely provide resources and environments that permit accelerated implementation of intensive outpatient programs. V. Published by Elsevier Inc.

The cost-savings of implementing kangaroo mother care in Nicaragua.

PubMed

Broughton, Edward I; Gomez, Ivonne; Sanchez, Nieves; Vindell, Concepción

2013-09-01

To examine the costs of implementing kangaroo mother care (KMC) in a referral hospital in Nicaragua, including training, implementation, and ongoing operating costs, and to estimate the economic impact on the Nicaraguan health system if KMC were implemented in other maternity hospitals in the country. After receiving clinical training in KMC, the implementation team trained their colleagues, wrote guidelines for clinicians and education material for parents, and ensured adherence to the new guidelines. The intervention began September 2010 The study compared data on infant weight, medication use, formula consumption, incubator use, and hospitalization for six months before and after implementation. Cost data were collected from accounting records of the implementers and health ministry formularies. A total of 46 randomly selected infants before implementation were compared to 52 after implementation. Controlling for confounders, neonates after implementation had lower lengths of hospitalization by 4.64 days (P = 0.017) and 71% were exclusively breastfed (P < 0.001). The intervention cost US$ 23 113 but the money saved with shorter hospitalization, elimination of incubator use, and lower antibiotic and infant formula costs made up for this expense in 1 - 2 months. Extending KMC to 12 other facilities in Nicaragua is projected to save approximately US$ 166 000 (based on the referral hospital incubator use estimate) or US$ 233 000 after one year (based on the more conservative incubator use estimate). Treating premature and low-birth-weight infants in Nicaragua with KMC implemented as a quality improvement program saves money within a short period even without considering the beneficial health effects of KMC. Implementation in more facilities is strongly recommended.

Lean healthcare in developing countries: evidence from Brazilian hospitals.

PubMed

Costa, Luana Bonome Message; Filho, Moacir Godinho; Rentes, Antonio Freitas; Bertani, Thiago Moreno; Mardegan, Ronaldo

2017-01-01

The present study evaluates how five sectors of two Brazilian hospitals have implemented lean healthcare concepts in their operations. The main characteristics of the implementation process are analyzed in the present study: the motivational factor for implementation, implementation time, form (consultancy or internal), team (hospital and consultants), lean implementation continuity/sustainability, lean healthcare tools and methods implemented, problems/improvement opportunities, lean healthcare barriers faced during the implementation process, and critical factors that affected the implementation and the results obtained in each case. The case studies indicate that reducing patient lead times and costs and making financial improvements were the primary factors that motivated lean healthcare implementation in the hospitals studied. Several tools and methods were used in the cases studied, especially value stream mapping and DMAIC. The barriers found in both hospitals are primarily associated with the human factor. Additionally, the results obtained after implementation were analyzed and improvements in financial aspects, productivity and capacity, and lead time reduction of the analyzed sectors were observed. Further, this study also exhibited four propositions elaborated from the results obtained from the cases that highlighted barriers and challenges to lean healthcare implementation in developing countries. Two of these barriers are hospital organizational structure (and, consequently, how the senior management works with medical staff), and outsourcing hospital activities. This study also concluded that the initialization and maintenance of lean healthcare implementation rely heavily on external support because lean healthcare subject knowledge is not yet available in the healthcare organization, which represents a challenge. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Agency Leaders' Assessments of Feasibility and Desirability of Implementation of Evidence-Based Practices in Youth-Serving Organizations Using the Stages of Implementation Completion.

PubMed

Palinkas, Lawrence A; Campbell, Mark; Saldana, Lisa

2018-01-01

Background: This study examined influences on the decisions of administrators of youth-serving organizations to initiate and proceed with implementation of an evidence-based practice (EBP). Methods: Semi-structured interviews, developed using the Stages of Implementation Completion (SIC) as a framework, were conducted with 19 agency chief executive officers and program directors of 15 organizations serving children and adolescents. Results: Agency leaders' self-assessments of implementation feasibility and desirability prior to implementation (Pre-implementation) were influenced by intervention affordability, feasibility, requirements, validity, reliability, relevance, cost savings, positive outcomes, and adequacy of information; availability of funding, support from sources external to the agency, and adequacy of technical assistance; and staff availability and attitudes toward innovation in general and EBPs in particular, organizational capacity, fit between the EBP and agency mission and capacity, prior experience with implementation, experience with seeking evidence, and developing consensus. Assessments during the Implementation phase included intervention flexibility and requirements; availability of funding, adequacy of training and technical assistance, and getting sufficient and appropriate referrals; and staffing and implementing with fidelity. Assessments during the Sustainment phase included intervention costs and benefits; availability of funding, support from sources outside of the agency, and need for the EBP; and the fit between the EBP and the agency mission. Discussion: The results point to opportunities for using agency leader models to develop strategies to facilitate implementation of evidence-based and innovative practices for children and adolescents. The SIC provides a standardized framework for guiding agency leader self-assessments of implementation.

Agency Leaders' Assessments of Feasibility and Desirability of Implementation of Evidence-Based Practices in Youth-Serving Organizations Using the Stages of Implementation Completion

PubMed Central

Palinkas, Lawrence A.; Campbell, Mark; Saldana, Lisa

2018-01-01

Background: This study examined influences on the decisions of administrators of youth-serving organizations to initiate and proceed with implementation of an evidence-based practice (EBP). Methods: Semi-structured interviews, developed using the Stages of Implementation Completion (SIC) as a framework, were conducted with 19 agency chief executive officers and program directors of 15 organizations serving children and adolescents. Results: Agency leaders' self-assessments of implementation feasibility and desirability prior to implementation (Pre-implementation) were influenced by intervention affordability, feasibility, requirements, validity, reliability, relevance, cost savings, positive outcomes, and adequacy of information; availability of funding, support from sources external to the agency, and adequacy of technical assistance; and staff availability and attitudes toward innovation in general and EBPs in particular, organizational capacity, fit between the EBP and agency mission and capacity, prior experience with implementation, experience with seeking evidence, and developing consensus. Assessments during the Implementation phase included intervention flexibility and requirements; availability of funding, adequacy of training and technical assistance, and getting sufficient and appropriate referrals; and staffing and implementing with fidelity. Assessments during the Sustainment phase included intervention costs and benefits; availability of funding, support from sources outside of the agency, and need for the EBP; and the fit between the EBP and the agency mission. Discussion: The results point to opportunities for using agency leader models to develop strategies to facilitate implementation of evidence-based and innovative practices for children and adolescents. The SIC provides a standardized framework for guiding agency leader self-assessments of implementation. PMID:29896471

Community, intervention and provider support influences on implementation: reflections from a South African illustration of safety, peace and health promotion

PubMed Central

2014-01-01

Background The development, implementation and evaluation of community interventions are important for reducing child violence and injuries in low- to middle-income contexts, with successful implementation critical to effective intervention outcomes. The assessment of implementation processes is required to identify the factors that influence effective implementation. This article draws on a child safety, peace and health initiative to examine key factors that enabled or hindered its implementation, in a context characterised by limited resources. Methods A case study approach was employed. The research team was made up of six researchers and intervention coordinators, who led the development and implementation of the Ukuphepha Child Study in South Africa, and who are also the authors of this article. The study used author observations, reflections and discussions of the factors perceived to influence the implementation of the intervention. The authors engaged in an in-depth and iterative dialogic process aimed at abstracting the experiences of the intervention, with a recursive cycle of reflection and dialogue. Data were analysed utilising inductive content analysis, and categorised using classification frameworks for understanding implementation. Results The study highlights key factors that enabled or hindered implementation. These included the community context and concomitant community engagement processes; intervention compatibility and adaptability issues; community service provider perceptions of intervention relevance and expectations; and the intervention support system, characterised by training and mentorship support. Conclusions This evaluation illustrated the complexity of intervention implementation. The study approach sought to support intervention fidelity by fostering and maintaining community endorsement and support, a prerequisite for the unfolding implementation of the intervention. PMID:25081088

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.

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

76 FR 78009 - Information Collection; Implementation of Information Technology Security Provision

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-15

...] Information Collection; Implementation of Information Technology Security Provision AGENCY: General Services... collection requirement regarding Implementation of Information Technology Security Provision. Public comments... Information Collection 3090- 0294, Implementation of Information Technology Security Provision, by any of the...

Developing an active implementation model for a chronic disease management program

PubMed Central

Smidth, Margrethe; Christensen, Morten Bondo; Olesen, Frede; Vedsted, Peter

2013-01-01

Background Introduction and diffusion of new disease management programs in healthcare is usually slow, but active theory-driven implementation seems to outperform other implementation strategies. However, we have only scarce evidence on the feasibility and real effect of such strategies in complex primary care settings where municipalities, general practitioners and hospitals should work together. The Central Denmark Region recently implemented a disease management program for chronic obstructive pulmonary disease (COPD) which presented an opportunity to test an active implementation model against the usual implementation model. The aim of the present paper is to describe the development of an active implementation model using the Medical Research Council’s model for complex interventions and the Chronic Care Model. Methods We used the Medical Research Council’s five-stage model for developing complex interventions to design an implementation model for a disease management program for COPD. First, literature on implementing change in general practice was scrutinised and empirical knowledge was assessed for suitability. In phase I, the intervention was developed; and in phases II and III, it was tested in a block- and cluster-randomised study. In phase IV, we evaluated the feasibility for others to use our active implementation model. Results The Chronic Care Model was identified as a model for designing efficient implementation elements. These elements were combined into a multifaceted intervention, and a timeline for the trial in a randomised study was decided upon in accordance with the five stages in the Medical Research Council’s model; this was captured in a PaTPlot, which allowed us to focus on the structure and the timing of the intervention. The implementation strategies identified as efficient were use of the Breakthrough Series, academic detailing, provision of patient material and meetings between providers. The active implementation model was tested in a randomised trial (results reported elsewhere). Conclusion The combination of the theoretical model for complex interventions and the Chronic Care Model and the chosen specific implementation strategies proved feasible for a practice-based active implementation model for a chronic-disease-management-program for COPD. Using the Medical Research Council’s model added transparency to the design phase which further facilitated the process of implementing the program. Trial registration: http://www.clinicaltrials.gov/(NCT01228708). PMID:23882169

The Consolidated Framework for Implementation Research (CFIR): a useful theoretical framework for guiding and evaluating a guideline implementation process in a hospital-based nursing practice.

PubMed

Breimaier, Helga E; Heckemann, Birgit; Halfens, Ruud J G; Lohrmann, Christa

2015-01-01

Implementing clinical practice guidelines (CPGs) in healthcare settings is a complex intervention involving both independent and interdependent components. Although the Consolidated Framework for Implementation Research (CFIR) has never been evaluated in a practical context, it appeared to be a suitable theoretical framework to guide an implementation process. The aim of this study was to evaluate the comprehensiveness, applicability and usefulness of the CFIR in the implementation of a fall-prevention CPG in nursing practice to improve patient care in an Austrian university teaching hospital setting. The evaluation of the CFIR was based on (1) team-meeting minutes, (2) the main investigator's research diary, containing a record of a before-and-after, mixed-methods study design embedded in a participatory action research (PAR) approach for guideline implementation, and (3) an analysis of qualitative and quantitative data collected from graduate and assistant nurses in two Austrian university teaching hospital departments. The CFIR was used to organise data per and across time point(s) and assess their influence on the implementation process, resulting in implementation and service outcomes. Overall, the CFIR could be demonstrated to be a comprehensive framework for the implementation of a guideline into a hospital-based nursing practice. However, the CFIR did not account for some crucial factors during the planning phase of an implementation process, such as consideration of stakeholder aims and wishes/needs when implementing an innovation, pre-established measures related to the intended innovation and pre-established strategies for implementing an innovation. For the CFIR constructs reflecting & evaluating and engaging, a more specific definition is recommended. The framework and its supplements could easily be used by researchers, and their scope was appropriate for the complexity of a prospective CPG-implementation project. The CFIR facilitated qualitative data analysis and provided a structure that allowed project results to be organised and viewed in a broader context to explain the main findings. The CFIR was a valuable and helpful framework for (1) the assessment of the baseline, process and final state of the implementation process and influential factors, (2) the content analysis of qualitative data collected throughout the implementation process, and (3) explaining the main findings.

Barriers to Implementing Person-Centered Recovery Planning in Public Mental Health Organizations in Texas: Results from Nine Focus Groups.

PubMed

Lodge, Amy C; Kaufman, Laura; Stevens Manser, Stacey

2017-05-01

Despite being an established practice in the disabilities service systems, person-centered planning is a relatively new practice in the behavioral health system. As a result, little is known about the barriers that mental health organizations face in implementing person-centered recovery planning (PCRP). To fill this gap, results are presented from a qualitative analysis of nine focus groups at three public mental health organizations in Texas that have been implementing PCRP for at least 2 years. Findings suggest that organizations experienced 12 distinct barriers to PCRP implementation which were categorized into the Consolidated Framework for Implementation Research domains of intervention characteristics, the outer setting, the inner setting, characteristics of individuals, and the implementation process. Half of these 12 barriers fell within the inner setting domain, suggesting that implementation efforts should be flexible and adaptable to organizational culture and context. One-quarter of the barriers fell into the domain of characteristics of individuals involved in the intervention, which further suggests implementation efforts should assess the impact that both staff and consumers have on implementation success.

Crossing the implementation chasm: a proposal for bold action.

PubMed

Lorenzi, Nancy M; Novak, Laurie L; Weiss, Jacob B; Gadd, Cynthia S; Unertl, Kim M

2008-01-01

As health care organizations dramatically increase investment in information technology (IT) and the scope of their IT projects, implementation failures become critical events. Implementation failures cause stress on clinical units, increase risk to patients, and result in massive costs that are often not recoverable. At an estimated 28% success rate, the current level of investment defies management logic. This paper asserts that there are "chasms" in IT implementations that represent risky stages in the process. Contributors to the chasms are classified into four categories: design, management, organization, and assessment. The American College of Medical Informatics symposium participants recommend bold action to better understand problems and challenges in implementation and to improve the ability of organizations to bridge these implementation chasms. The bold action includes the creation of a Team Science for Implementation strategy that allows for participation from multiple institutions to address the long standing and costly implementation issues. The outcomes of this endeavor will include a new focus on interdisciplinary research and an inter-organizational knowledge base of strategies and methods to optimize implementations and subsequent achievement of organizational objectives.

User Perceptions of the Implementation of an Electronic Medication Management System in a Paediatric Setting.

PubMed

Hardie, Rae-Anne; Baysari, Melissa T; Lake, Rebecca; Richardson, Lauren; McCullagh, Cheryl; Westbrook, Johanna I

2017-01-01

The roll-out of a hospital-wide electronic medication management system (eMMS) is a challenging task, requiring planning, coordination, communication and change management. This research aimed to explore the views of doctors and nurses about the strategy used to implement an eMM system in a paediatric hospital. Semi-structured interviews were performed during the first week of the implementation on each ward, and were then followed up three and six weeks post implementation. In total, 90 users (60 nurses and 30 doctors) were asked about their impressions of the implementation, as well as their perceptions of training and IT support. Qualitative thematic analysis was performed by three researchers. Most users perceived the implementation of the eMM to be positive overall. Although perceptions of the implementation process remained largely consistent across the six weeks, users identified several areas where improvements were needed, especially early in implementation, including resources, planning, roll-out strategy and training. These findings are useful for future implementations of eMM systems in paediatric hospitals.

78 FR 17835 - Approval and Promulgation of Federal Implementation Plan for Oil and Natural Gas Well Production...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

...The EPA is taking final action to promulgate a Reservation- specific Federal Implementation Plan in order to regulate emissions from oil and natural gas production facilities located on the Fort Berthold Indian Reservation in North Dakota. The Federal Implementation Plan includes basic air quality regulations for the protection of communities in and adjacent to the Fort Berthold Indian Reservation. The Federal Implementation Plan requires owners and operators of oil and natural gas production facilities to reduce emissions of volatile organic compounds emanating from well completions, recompletions, and production and storage operations. This Federal Implementation Plan will be implemented by the EPA, or a delegated tribal authority, until replaced by a Tribal Implementation Plan. The EPA proposed a Reservation-specific Federal Implementation Plan concurrently with an interim final rule on August 15, 2012. This final Federal Implementation Plan replaces the interim final rule in all intents and purposes on the effective date of the final rule. The EPA is taking this action pursuant to the Clean Air Act (CAA).

46 CFR 531.11 - Implementation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 9 2014-10-01 2014-10-01 false Implementation. 531.11 Section 531.11 Shipping FEDERAL MARITIME COMMISSION REGULATIONS AFFECTING OCEAN SHIPPING IN FOREIGN COMMERCE NVOCC SERVICE ARRANGEMENTS Exceptions and Implementation § 531.11 Implementation. Generally. Performance under an NSA or amendment...

46 CFR 531.11 - Implementation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 9 2011-10-01 2011-10-01 false Implementation. 531.11 Section 531.11 Shipping FEDERAL MARITIME COMMISSION REGULATIONS AFFECTING OCEAN SHIPPING IN FOREIGN COMMERCE NVOCC SERVICE ARRANGEMENTS Exceptions and Implementation § 531.11 Implementation. Generally. Performance under an NSA or amendment...

46 CFR 531.11 - Implementation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 9 2012-10-01 2012-10-01 false Implementation. 531.11 Section 531.11 Shipping FEDERAL MARITIME COMMISSION REGULATIONS AFFECTING OCEAN SHIPPING IN FOREIGN COMMERCE NVOCC SERVICE ARRANGEMENTS Exceptions and Implementation § 531.11 Implementation. Generally. Performance under an NSA or amendment...

46 CFR 531.11 - Implementation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 9 2010-10-01 2010-10-01 false Implementation. 531.11 Section 531.11 Shipping FEDERAL MARITIME COMMISSION REGULATIONS AFFECTING OCEAN SHIPPING IN FOREIGN COMMERCE NVOCC SERVICE ARRANGEMENTS Exceptions and Implementation § 531.11 Implementation. Generally. Performance under an NSA or amendment...

46 CFR 531.11 - Implementation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 9 2013-10-01 2013-10-01 false Implementation. 531.11 Section 531.11 Shipping FEDERAL MARITIME COMMISSION REGULATIONS AFFECTING OCEAN SHIPPING IN FOREIGN COMMERCE NVOCC SERVICE ARRANGEMENTS Exceptions and Implementation § 531.11 Implementation. Generally. Performance under an NSA or amendment...

Disability Policy Implementation From a Cross-Cultural Perspective.

PubMed

Verdugo, Miguel A; Jenaro, Cristina; Calvo, Isabel; Navas, Patricia

2017-07-01

Implementation of disability policy is influenced by social, political, and cultural factors. Based on published work, this article discusses four guidelines considered critical for successful policy implementation from a cross-cultural perspective. These guidelines are to: (a) base policy implementation on a contextual analysis, (b) employ a value-based approach, (c) align the service delivery system both vertically and horizontally, and (d) engage in a partnership in policy implementation. Public policy should be understood from a systems perspective that includes cross-cultural issues, such as how different stakeholders are acting and the way they plan and implement policy.

From the Editor: An Introduction to the JSLHR Supplement on Implementation Science.

PubMed

Paul, Rhea

2015-12-01

The JSLHR Supplement on Implementation Science is aimed at providing discussion and examples of research in implementation science, the study of methods designed to promote the incorporation of research findings into clinical practice. Practitioners in the language science area were invited to submit articles that address their experience with various aspects of implementation science. Six articles from several research groups comprise this supplement. Implementation science is an aspect of intervention research that merits consideration by communication disorders scientists. More extensive practice of implementation science will improve uptake of evidence-based practice in the clinical community.

Design and implementation of a modulator-based free-space optical backplane for multiprocessor applications.

PubMed

Kirk, Andrew G; Plant, David V; Szymanski, Ted H; Vranesic, Zvonko G; Tooley, Frank A P; Rolston, David R; Ayliffe, Michael H; Lacroix, Frederic K; Robertson, Brian; Bernier, Eric; Brosseau, Daniel F

2003-05-10

Design and implementation of a free-space optical backplane for multiprocessor applications is presented. The system is designed to interconnect four multiprocessor nodes that communicate by using multiplexed 32-bit packets. Each multiprocessor node is electrically connected to an optoelectronic VLSI chip which implements the hyperplane interconnection architecture. The chips each contain 256 optical transmitters (implemented as dual-rail multiple quantum-well modulators) and 256 optical receivers. A rigid free-space microoptical interconnection system that interconnects the transceiver chips in a 512-channel unidirectional ring is implemented. Full design, implementation, and operational details are provided.

Design and implementation of a modulator-based free-space optical backplane for multiprocessor applications

NASA Astrophysics Data System (ADS)

Kirk, Andrew G.; Plant, David V.; Szymanski, Ted H.; Vranesic, Zvonko G.; Tooley, Frank A. P.; Rolston, David R.; Ayliffe, Michael H.; Lacroix, Frederic K.; Robertson, Brian; Bernier, Eric; Brosseau, Daniel F.

2003-05-01

Design and implementation of a free-space optical backplane for multiprocessor applications is presented. The system is designed to interconnect four multiprocessor nodes that communicate by using multiplexed 32-bit packets. Each multiprocessor node is electrically connected to an optoelectronic VLSI chip which implements the hyperplane interconnection architecture. The chips each contain 256 optical transmitters (implemented as dual-rail multiple quantum-well modulators) and 256 optical receivers. A rigid free-space microoptical interconnection system that interconnects the transceiver chips in a 512-channel unidirectional ring is implemented. Full design, implementation, and operational details are provided.

Designing Caregiver-Implemented Shared-Reading Interventions to Overcome Implementation Barriers

PubMed Central

Logan, Jessica R.; Damschroder, Laura

2015-01-01

Purpose This study presents an application of the theoretical domains framework (TDF; Michie et al., 2005), an integrative framework drawing on behavior-change theories, to speech-language pathology. Methods A multistep procedure was used to identify barriers affecting caregivers' implementation of shared-reading interventions with their children with language impairment (LI). The authors examined caregiver-level data corresponding to implementation issues from two randomized controlled trials and mapped these to domains in the TDF as well as empirically validated behavior-change techniques. Results Four barriers to implementation were identified as potentially affecting caregivers' implementation: time pressures, reading difficulties, discomfort with reading, and lack of awareness of benefits. These were mapped to 3 TDF domains: intentions, beliefs about capabilities, and skills. In turn, 4 behavior-change techniques were identified as potential vehicles for affecting these domains: reward, feedback, model, and encourage. An ongoing study is described that is determining the effects of these techniques for improving caregivers' implementation of a shared-reading intervention. Conclusions A description of the steps to identifying barriers to implementation, in conjunction with an ongoing experiment that will explicitly determine whether behavior-change techniques affect these barriers, provides a model for how implementation science can be used to identify and overcome implementation barriers in the treatment of communication disorders. PMID:26262941

The implementation of the ICF among Israeli rehabilitation centers--the case of physical therapy.

PubMed

Jacob, Tamar

2013-10-01

The extent of the implementation of the International Classification of Functioning, Disability and Health (ICF), developed by the WHO, in rehabilitation units and in physical therapy (PT) departments is unknown. The study aims to describe the extent to which the ICF has been implemented in PT services within rehabilitation units in Israel. To update data on ICF implementation since its inception. An online semi-structured survey was administered to 25 physiotherapists in charge of PT departments in all rehabilitation units throughout Israel. Rehabilitation units were grouped into three categories: general, geriatric and pediatric. The questionnaire included items regarding the ICF implementation, its strengths, and weaknesses. Twenty two physiotherapists (88%) completed the questionnaire. The majority was familiar with the ICF and nearly two thirds reported partial implementation in their units. Implementation focused mostly on adopting the biopsychosocial concepts and using ICF terms. The ICF was not used either for evaluating patients, or for reporting or encoding patient information. Physiotherapists, directors of most Israeli PT departments in rehabilitation units are familiar with the ICF; however, its clinical implementation is very limited. There is need for further research into the processes of knowledge transfer and implementation of the ICF, in order to better understand the factors that facilitate and those that impede ICF implementation.

The relationship between school-level characteristics and implementation fidelity of a coordinated school health childhood obesity prevention intervention.

PubMed

Lederer, Alyssa M; King, Mindy H; Sovinski, Danielle; Seo, Dong-Chul; Kim, Nayoung

2015-01-01

Curtailing childhood obesity is a public health imperative. Although multicomponent school-based programs reduce obesity among children, less is known about the implementation fidelity of these interventions. This study examines process evaluation findings for the Healthy, Energetic Ready, Outstanding, Enthusiastic, Schools (HEROES) Initiative, a tri-state school-based childhood obesity prevention intervention based on the coordinated school health (CSH) model. Site visits were conducted that included key stakeholder interviews, observation, and document review. Scores were given for 8 domains, and a total implementation score was calculated. Two-way analyses of variance were conducted to examine the relationship of 4 school-level characteristics: elementary vs. middle/high schools, public vs. private schools, district vs. building level implementation, and socioeconomic status on each implementation area. Overall, schools had high fidelity scores, although some domains were implemented more successfully than others. Three school-level characteristics were associated with 1 or more domains, with elementary schools and schools implementing at the building level consistently having higher implementation scores than their counterparts. Process evaluation findings provide insight into successes and challenges schools implementing the CSH approach may encounter. Although preliminary, these findings on school-level characteristics establish a new area of research related to school-based childhood obesity prevention programs' implementation fidelity. © 2014, American School Health Association.

Designing Caregiver-Implemented Shared-Reading Interventions to Overcome Implementation Barriers.

PubMed

Justice, Laura M; Logan, Jessica R; Damschroder, Laura

2015-12-01

This study presents an application of the theoretical domains framework (TDF; Michie et al., 2005), an integrative framework drawing on behavior-change theories, to speech-language pathology. A multistep procedure was used to identify barriers affecting caregivers' implementation of shared-reading interventions with their children with language impairment (LI). The authors examined caregiver-level data corresponding to implementation issues from two randomized controlled trials and mapped these to domains in the TDF as well as empirically validated behavior-change techniques. Four barriers to implementation were identified as potentially affecting caregivers' implementation: time pressures, reading difficulties, discomfort with reading, and lack of awareness of benefits. These were mapped to 3 TDF domains: intentions, beliefs about capabilities, and skills. In turn, 4 behavior-change techniques were identified as potential vehicles for affecting these domains: reward, feedback, model, and encourage. An ongoing study is described that is determining the effects of these techniques for improving caregivers' implementation of a shared-reading intervention. A description of the steps to identifying barriers to implementation, in conjunction with an ongoing experiment that will explicitly determine whether behavior-change techniques affect these barriers, provides a model for how implementation science can be used to identify and overcome implementation barriers in the treatment of communication disorders.

Systematic evaluation of implementation fidelity of complex interventions in health and social care

PubMed Central

2010-01-01

Background Evaluation of an implementation process and its fidelity can give insight into the 'black box' of interventions. However, a lack of standardized methods for studying fidelity and implementation process have been reported, which might be one reason for the fact that few prior studies in the field of health service research have systematically evaluated interventions' implementation processes. The aim of this project is to systematically evaluate implementation fidelity and possible factors influencing fidelity of complex interventions in health and social care. Methods A modified version of The Conceptual Framework for Implementation Fidelity will be used as a conceptual model for the evaluation. The modification implies two additional moderating factors: context and recruitment. A systematic evaluation process was developed. Multiple case study method is used to investigate implementation of three complex health service interventions. Each case will be investigated in depth and longitudinally, using both quantitative and qualitative methods. Discussion This study is the first attempt to empirically test The Conceptual Framework for Implementation Fidelity. The study can highlight mechanism and factors of importance when implementing complex interventions. Especially the role of the moderating factors on implementation fidelity can be clarified. Trial Registration Supported Employment, SE, among people with severe mental illness -- a randomized controlled trial: NCT00960024. PMID:20815872

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.

Perception of Science Standards' Effectiveness and Their Implementation by Science Teachers

NASA Astrophysics Data System (ADS)

Klieger, Aviva; Yakobovitch, Anat

2011-06-01

The introduction of standards into the education system poses numerous challenges and difficulties. As with any change, plans should be made for teachers to understand and implement the standards. This study examined science teachers' perceptions of the effectiveness of the standards for teaching and learning, and the extent and ease/difficulty of implementing science standards in different grades. The research used a mixed methods approach, combining qualitative and quantitative research methods. The research tools were questionnaires that were administered to elementary school science teachers. The majority of the teachers perceived the standards in science as effective for teaching and learning and only a small minority viewed them as restricting their pedagogical autonomy. Differences were found in the extent of implementation of the different standards and between different grades. The teachers perceived a different degree of difficulty in the implementation of the different standards. The standards experienced as easiest to implement were in the field of biology and materials, whereas the standards in earth sciences and the universe and technology were most difficult to implement, and are also those evaluated by the teachers as being implemented to the least extent. Exposure of teachers' perceptions on the effectiveness of standards and the implementation of the standards may aid policymakers in future planning of teachers' professional development for the implementation of standards.

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.

Initial investigation of organisational factors associated with the implementation of active support.

PubMed

Fyffe, Chris; McCubbery, Jeffrey; Reid, Katharine J

2008-09-01

Active support (AS) has been shown to increase the amount of time that residents in shared residential settings are involved in purposeful activities. The organisational processes required to implement AS have been less well researched. Staff in community houses answered questions about the occurrence of organisational activities and processes thought to assist AS implementation (e.g., training and teamwork), their understanding of engagement, and their experience of changes in staff practice consistent with AS (including implementation problems). Non-house-based managers were also interviewed about their role in AS implementation. Reported occurrence of organisational activities and processes (e.g., training and teamwork) and understanding of engagement were associated with more reports of changes in staff practice and fewer staff reports of implementation problems. Staff reports on the role of non-house-based managers were not associated with reports of changes in staff practice or with reports of fewer AS implementation problems. Non-house-based managers' reports overestimated their role in AS implementation when compared with reports from house-based staff groups. While there are limitations in the research design (including the reliance on staff reports), the findings support the importance of wider organisational factors (beyond training programs for direct support staff) as integral to the implementation of AS. There is a need for further research on AS implementation.

Cochrane Qualitative and Implementation Methods Group guidance series-paper 4: methods for assessing evidence on intervention implementation.

PubMed

Cargo, Margaret; Harris, Janet; Pantoja, Tomas; Booth, Andrew; Harden, Angela; Hannes, Karin; Thomas, James; Flemming, Kate; Garside, Ruth; Noyes, Jane

2018-05-01

This article provides reviewers with guidance on methods for identifying and processing evidence to understand intervention implementation. Strategies, tools, and methods are applied to the systematic review process to illustrate how process and implementation can be addressed using quantitative, qualitative, and other sources of evidence (i.e., descriptive textual and nonempirical). Reviewers can take steps to navigate the heterogeneity and level of uncertainty present in the concepts, measures, and methods used to assess implementation. Activities can be undertaken in advance of a Cochrane quantitative review to develop program theory and logic models that situate implementation in the causal chain. Four search strategies are offered to retrieve process and implementation evidence. Recommendations are made for addressing rigor or risk of bias in process evaluation or implementation evidence. Strategies are recommended for locating and extracting data from primary studies. The basic logic is presented to assist reviewers to make initial review-level judgments about implementation failure and theory failure. Although strategies, tools, and methods can assist reviewers to address process and implementation using quantitative, qualitative, and other forms of evidence, few exemplar reviews exist. There is a need for further methodological development and trialing of proposed approaches. Copyright © 2017 Elsevier Inc. All rights reserved.

Harnessing Implementation Science to Increase the Impact of Health Equity Research.

PubMed

Chinman, Matthew; Woodward, Eva N; Curran, Geoffrey M; Hausmann, Leslie R M

2017-09-01

Health disparities are differences in health or health care between groups based on social, economic, and/or environmental disadvantage. Disparity research often follows 3 steps: detecting (phase 1), understanding (phase 2), and reducing (phase 3), disparities. Although disparities have narrowed over time, many remain. We argue that implementation science could enhance disparities research by broadening the scope of phase 2 studies and offering rigorous methods to test disparity-reducing implementation strategies in phase 3 studies. We briefly review the focus of phase 2 and phase 3 disparities research. We then provide a decision tree and case examples to illustrate how implementation science frameworks and research designs could further enhance disparity research. Most health disparities research emphasizes patient and provider factors as predominant mechanisms underlying disparities. Applying implementation science frameworks like the Consolidated Framework for Implementation Research could help disparities research widen its scope in phase 2 studies and, in turn, develop broader disparities-reducing implementation strategies in phase 3 studies. Many phase 3 studies of disparity-reducing implementation strategies are similar to case studies, whose designs are not able to fully test causality. Implementation science research designs offer rigorous methods that could accelerate the pace at which equity is achieved in real-world practice. Disparities can be considered a "special case" of implementation challenges-when evidence-based clinical interventions are delivered to, and received by, vulnerable populations at lower rates. Bringing together health disparities research and implementation science could advance equity more than either could achieve on their own.

From Programs to Systems: Deploying Implementation Science and Practice for Sustained Real World Effectiveness in Services for Children and Families.

PubMed

Ghate, Deborah

2016-01-01

The transfer of knowledge of effective practice, especially into "usual care" settings, remains challenging. This article argues that to close this gap we need to recognize the particular challenges of whole-system improvement. We need to move beyond a limited focus on individual programs and experimental research on their effectiveness. The rapidly developing field of implementation science and practice (ISP) provides a particular lens and a set of important constructs that can helpfully accelerate progress. A review of selected key constructs and distinctive features of ISP, including recognizing invisible system infrastructure, co-construction involving active collaboration between stakeholders, and attention to active implementation, supports for providers beyond education and training. Key aspects of an implementation lens likely to be most helpful in sustaining effectiveness include assisting innovators to identify and accommodate the architecture of existing systems, understand the implementation process as a series of distinct but nonlinear stages, identify implementation outcomes as prerequisites for treatment outcomes, and analyse implementation challenges using frameworks of implementation drivers. In complex adaptive systems, how services are implemented may matter more than their specific content, and how services align and adapt to local context may determine their sustained usefulness. To improve implementation-relevant research, we need better process evaluation and cannot rely on experimental methods that do not capture complex systemic contexts. Deployment of an implementation lens may perhaps help to avoid future "rigor mortis," enabling more productively flexible and integrative approaches to both program design and evaluation.

Implementation of an Anesthesia Information Management System in an Ambulatory Surgery Center.

PubMed

Mudumbai, Seshadri C

2016-01-01

Anesthesia information management systems (AIMS) are increasingly being implemented throughout the United States. However, little information exists on the implementation process for AIMS within ambulatory surgery centers (ASC). The objectives of this descriptive study are to document: 1) the phases of implementation of an AIMS at an ASC; and 2) lessons learnt from a socio-technical perspective. The ASC, within the Veterans Health Administration (VHA), has hosted an AIMS since 2008. As a quality improvement effort, we implemented a new version of the AIMS. This new version involved fundamental software changes to enhance clinical care such as real-time importing of laboratory data and total hardware exchange. The pre-implementation phase involved coordinated preparation over six months between multiple informatics teams along with local leadership. During this time, we conducted component, integration, and validation testing to ensure correct data flow from medical devices to AIMS and centralized databases. The implementation phase occurred in September 2014 over three days and was successful. Over the next several months, during post-implementation phase, we addressed residual items like latency of the application. Important lessons learnt from the implementation included the utility of partnering early with executive leadership; ensuring end user acceptance of new clinical workflow; continuous testing of data flow; use of a staged rollout; and providing additional personnel throughout implementation. Implementation of an AIMS at an ASC can utilize methods developed for large hospitals. However, issues unique to an ASC such as limited number of support personnel and distinctive workflows must be considered.

From Classification to Causality: Advancing Understanding of Mechanisms of Change in Implementation Science.

PubMed

Lewis, Cara C; Klasnja, Predrag; Powell, Byron J; Lyon, Aaron R; Tuzzio, Leah; Jones, Salene; Walsh-Bailey, Callie; Weiner, Bryan

2018-01-01

The science of implementation has offered little toward understanding how different implementation strategies work. To improve outcomes of implementation efforts, the field needs precise, testable theories that describe the causal pathways through which implementation strategies function. In this perspective piece, we describe a four-step approach to developing causal pathway models for implementation strategies. First, it is important to ensure that implementation strategies are appropriately specified. Some strategies in published compilations are well defined but may not be specified in terms of its core component that can have a reliable and measureable impact. Second, linkages between strategies and mechanisms need to be generated. Existing compilations do not offer mechanisms by which strategies act, or the processes or events through which an implementation strategy operates to affect desired implementation outcomes. Third, it is critical to identify proximal and distal outcomes the strategy is theorized to impact, with the former being direct, measurable products of the strategy and the latter being one of eight implementation outcomes (1). Finally, articulating effect modifiers, like preconditions and moderators, allow for an understanding of where, when, and why strategies have an effect on outcomes of interest. We argue for greater precision in use of terms for factors implicated in implementation processes; development of guidelines for selecting research design and study plans that account for practical constructs and allow for the study of mechanisms; psychometrically strong and pragmatic measures of mechanisms; and more robust curation of evidence for knowledge transfer and use.

Reporting on the Strategies Needed to Implement Proven Interventions: An Example From a "Real-World" Cross-Setting Implementation Study.

PubMed

Gold, Rachel; Bunce, Arwen E; Cohen, Deborah J; Hollombe, Celine; Nelson, Christine A; Proctor, Enola K; Pope, Jill A; DeVoe, Jennifer E

2016-08-01

The objective of this study was to empirically demonstrate the use of a new framework for describing the strategies used to implement quality improvement interventions and provide an example that others may follow. Implementation strategies are the specific approaches, methods, structures, and resources used to introduce and encourage uptake of a given intervention's components. Such strategies have not been regularly reported in descriptions of interventions' effectiveness, or in assessments of how proven interventions are implemented in new settings. This lack of reporting may hinder efforts to successfully translate effective interventions into "real-world" practice. A recently published framework was designed to standardize reporting on implementation strategies in the implementation science literature. We applied this framework to describe the strategies used to implement a single intervention in its original commercial care setting, and when implemented in community health centers from September 2010 through May 2015. Per this framework, the target (clinic staff) and outcome (prescribing rates) remained the same across settings; the actor, action, temporality, and dose were adapted to fit local context. The framework proved helpful in articulating which of the implementation strategies were kept constant and which were tailored to fit diverse settings, and simplified our reporting of their effects. Researchers should consider consistently reporting this information, which could be crucial to the success or failure of implementing proven interventions effectively across diverse care settings. clinicaltrials.gov Identifier: NCT02299791. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

An introduction to implementation science for the non-specialist.

PubMed

Bauer, Mark S; Damschroder, Laura; Hagedorn, Hildi; Smith, Jeffrey; Kilbourne, Amy M

2015-09-16

The movement of evidence-based practices (EBPs) into routine clinical usage is not spontaneous, but requires focused efforts. The field of implementation science has developed to facilitate the spread of EBPs, including both psychosocial and medical interventions for mental and physical health concerns. The authors aim to introduce implementation science principles to non-specialist investigators, administrators, and policymakers seeking to become familiar with this emerging field. This introduction is based on published literature and the authors' experience as researchers in the field, as well as extensive service as implementation science grant reviewers. Implementation science is "the scientific study of methods to promote the systematic uptake of research findings and other EBPs into routine practice, and, hence, to improve the quality and effectiveness of health services." Implementation science is distinct from, but shares characteristics with, both quality improvement and dissemination methods. Implementation studies can be either assess naturalistic variability or measure change in response to planned intervention. Implementation studies typically employ mixed quantitative-qualitative designs, identifying factors that impact uptake across multiple levels, including patient, provider, clinic, facility, organization, and often the broader community and policy environment. Accordingly, implementation science requires a solid grounding in theory and the involvement of trans-disciplinary research teams. The business case for implementation science is clear: As healthcare systems work under increasingly dynamic and resource-constrained conditions, evidence-based strategies are essential in order to ensure that research investments maximize healthcare value and improve public health. Implementation science plays a critical role in supporting these efforts.

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.

47 CFR 90.629 - Extended implementation period.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 5 2013-10-01 2013-10-01 false Extended implementation period. 90.629 Section... 935-940 Mhz Bands § 90.629 Extended implementation period. Applicants requesting frequencies for... an extended implementation period. The justification must describe the proposed system, state the...

47 CFR 90.629 - Extended implementation period.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 5 2012-10-01 2012-10-01 false Extended implementation period. 90.629 Section... 935-940 Mhz Bands § 90.629 Extended implementation period. Applicants requesting frequencies for... an extended implementation period. The justification must describe the proposed system, state the...

47 CFR 90.629 - Extended implementation period.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 5 2010-10-01 2010-10-01 false Extended implementation period. 90.629 Section... 935-940 Mhz Bands § 90.629 Extended implementation period. Applicants requesting frequencies for... an extended implementation period. The justification must describe the proposed system, state the...

47 CFR 90.629 - Extended implementation period.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 5 2014-10-01 2014-10-01 false Extended implementation period. 90.629 Section... 935-940 Mhz Bands § 90.629 Extended implementation period. Applicants requesting frequencies for... an extended implementation period. The justification must describe the proposed system, state the...

47 CFR 90.629 - Extended implementation period.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 5 2011-10-01 2011-10-01 false Extended implementation period. 90.629 Section... 935-940 Mhz Bands § 90.629 Extended implementation period. Applicants requesting frequencies for... an extended implementation period. The justification must describe the proposed system, state the...

22 CFR 120.35 - Australia Implementing Arrangement.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Australia Implementing Arrangement. 120.35 Section 120.35 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS PURPOSE AND DEFINITIONS § 120.35 Australia Implementing Arrangement. Australia Implementing Arrangement means the...

Implementation of Knowledge Management in Organizations

ERIC Educational Resources Information Center

Winkler, Katrin; Mandl, Heinz

2007-01-01

In the context of learning implementation of new ideas e.g. knowledge management in organizations often is neglected. Concerning knowledge management measures we demonstrate its implementation in organizations. A theoretical framework was developed showing the necessary basic conditions for implementing knowledge management. Subsequently we…

Implementation of advance warning of end of green system (AWEGS) : implementation report.

DOT National Transportation Integrated Search

2008-10-01

The objective of this implementation project was to implement four AWEGS across Texas at intersections appropriate for the installation of AWEGS. After a survey across Texas, four sites were chosen in the Atlanta District, Pharr District, Odessa Dist...

Implementation Science: Buzzword or Game Changer?

ERIC Educational Resources Information Center

Douglas, Natalie F.; Campbell, Wenonah N.; Hinckley, Jacqueline J.

2015-01-01

Purpose: The purpose of this supplement article is to provide a resource of pertinent information concerning implementation science for immediate research application in communication sciences and disorders. Method: Key terminology related to implementation science is reviewed. Practical suggestions for the application of implementation science…

Effects of people-centred factors on enterprise resource planning implementation project success: empirical evidence from Sri Lanka

NASA Astrophysics Data System (ADS)

Wickramasinghe, Vathsala; Gunawardena, Vathsala

2010-08-01

Extant literature suggests people-centred factors as one of the major areas influencing enterprise resource planning (ERP) implementation project success. Yet, to date, few empirical studies attempted to validate the link between people-centred factors and ERP implementation project success. The purpose of this study is to empirically identify people-centred factors that are critical to ERP implementation projects in Sri Lanka. The study develops and empirically validates a framework for people-centred factors that influence the success of ERP implementation projects. Survey research methodology was used and collected data from 74 ERP implementation projects in Sri Lanka. The people-centred factors of 'project team competence', 'rewards' and 'communication and change' were found to predict significantly the ERP implementation project success.

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.

A mixed methods study of individual and organizational factors that affect implementation of interventions for children with autism in public schools.

PubMed

Locke, Jill; Beidas, Rinad S; Marcus, Steven; Stahmer, Aubyn; Aarons, Gregory A; Lyon, Aaron R; Cannuscio, Carolyn; Barg, Frances; Dorsey, Shannon; Mandell, David S

2016-10-10

The significant lifelong impairments associated with autism spectrum disorder (ASD), combined with the growing number of children diagnosed with ASD, have created urgency in improving school-based quality of care. Although many interventions have shown efficacy in university-based research, few have been effectively implemented and sustained in schools, the primary setting in which children with ASD receive services. Individual- and organizational-level factors have been shown to predict the implementation of evidence-based interventions (EBIs) for the prevention and treatment of other mental disorders in schools, and may be potential targets for implementation strategies in the successful use of autism EBIs in schools. The purpose of this study is to examine the individual- and organizational-level factors associated with the implementation of EBIs for children with ASD in public schools. We will apply the Domitrovich and colleagues (2008) framework that examines the influence of contextual factors (i.e., individual- and organizational-level factors) on intervention implementation in schools. We utilize mixed methods to quantitatively test whether the factors identified in the Domitrovich and colleagues (2008) framework are associated with the implementation of autism EBIs, and use qualitative methods to provide a more comprehensive understanding of the factors associated with successful implementation and sustainment of these interventions with the goal of tailoring implementation strategies. The results of this study will provide an in-depth understanding of individual- and organizational-level factors that influence the successful implementation of EBIs for children with ASD in public schools. These data will inform potential implementation targets and tailoring of strategies that will help schools overcome barriers to implementation and ultimately improve the services and outcomes for children with ASD.

Interagency Collaborative Team Model for Capacity Building to Scale-Up Evidence-Based Practice

PubMed Central

Hurlburt, Michael; Aarons, Gregory A; Fettes, Danielle; Willging, Cathleen; Gunderson, Lara; Chaffin, Mark J

2015-01-01

Background System-wide scale up of evidence-based practice (EBP) is a complex process. Yet, few strategic approaches exist to support EBP implementation and sustainment across a service system. Building on the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation framework, we developed and are testing the Interagency Collaborative Team (ICT) process model to implement an evidence-based child neglect intervention (i.e., SafeCare®) within a large children’s service system. The ICT model emphasizes the role of local agency collaborations in creating structural supports for successful implementation. Methods We describe the ICT model and present preliminary qualitative results from use of the implementation model in one large scale EBP implementation. Qualitative interviews were conducted to assess challenges in building system, organization, and home visitor collaboration and capacity to implement the EBP. Data collection and analysis centered on EBP implementation issues, as well as the experiences of home visitors under the ICT model. Results Six notable issues relating to implementation process emerged from participant interviews, including: (a) initial commitment and collaboration among stakeholders, (b) leadership, (c) communication, (d) practice fit with local context, (e) ongoing negotiation and problem solving, and (f) early successes. These issues highlight strengths and areas for development in the ICT model. Conclusions Use of the ICT model led to sustained and widespread use of SafeCare in one large county. Although some aspects of the implementation model may benefit from enhancement, qualitative findings suggest that the ICT process generates strong structural supports for implementation and creates conditions in which tensions between EBP structure and local contextual variations can be resolved in ways that support the expansion and maintenance of an EBP while preserving potential for public health benefit. PMID:27512239

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. Suggested implementation strategies include local monitoring of guideline implementation (e.g. team meetings, audits), increasing collaboration on implementation projects (e.g. managerial involvement, networking), and seeking speech pathologist input into guideline development.

Implementation and adaptation of the Re-Engineered Discharge (RED) in five California hospitals: a qualitative research study.

PubMed

Mitchell, S E; Weigel, G M; Laurens, V; Martin, J; Jack, B W

2017-04-19

Project Re-Engineered Discharge (RED) is an evidence-based strategy to reduce readmissions disseminated and adapted by various health systems across the country. To date, little is known about how adapting Project RED from its original protocol impacts RED implementation and/or sustainability. The goal of this study was to identify and characterize contextual factors influencing how five California hospitals adapted and implemented RED and the subsequent impact on RED program sustainability. Participant observation and key informant and focus group interviews with 64 individuals at five California hospitals implementing RED in 2012 and 2013 were conducted. These involved hospital leadership, personnel responsible for Project RED implementation, hospital staff, and clinicians. Interview transcripts were coded and analyzed using a modified grounded theory approach and constant comparative analysis. Both internal and external contextual factors were identified that influenced hospitals' decisions on RED adaptation and implementation. These also impacted RED sustainability. External factors included: impending federal penalties for hospitals with high readmission rates targeting specific diagnoses, and access to external funding and technical support to help hospitals implement RED. Internal or organizational level contextual factors included: committed leadership prioritizing Project RED; RED adaptations; depth, accountability and influence of the implementation team; sustainability planning; and hospital culture. Only three of the five hospitals continued Project RED beyond the implementation period. The sustainability of RED in participating hospitals was only possible when hospitals approached RED implementation as a transformational process rather than a patient safety project, maintained a high level of fidelity to the RED protocol, and had leadership and an implementation team who embraced change and failure in the pursuit of better patient care and outcomes. Hospitals who were unsuccessful in implementing a sustainable RED process lacked all or most of these components in their approach.

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-making, and dynamic evaluation and intervention design as integral parts of complex intervention implementation. NCT01967797. 18 October 2013. © Copyright 2018 by the American Board of Family Medicine.

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 TeamSTEPPS efforts.

Interagency Collaborative Team Model for Capacity Building to Scale-Up Evidence-Based Practice.

PubMed

Hurlburt, Michael; Aarons, Gregory A; Fettes, Danielle; Willging, Cathleen; Gunderson, Lara; Chaffin, Mark J

2014-04-01

System-wide scale up of evidence-based practice (EBP) is a complex process. Yet, few strategic approaches exist to support EBP implementation and sustainment across a service system. Building on the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation framework, we developed and are testing the Interagency Collaborative Team (ICT) process model to implement an evidence-based child neglect intervention (i.e., SafeCare®) within a large children's service system. The ICT model emphasizes the role of local agency collaborations in creating structural supports for successful implementation. We describe the ICT model and present preliminary qualitative results from use of the implementation model in one large scale EBP implementation. Qualitative interviews were conducted to assess challenges in building system, organization, and home visitor collaboration and capacity to implement the EBP. Data collection and analysis centered on EBP implementation issues, as well as the experiences of home visitors under the ICT model. Six notable issues relating to implementation process emerged from participant interviews, including: (a) initial commitment and collaboration among stakeholders, (b) leadership, (c) communication, (d) practice fit with local context, (e) ongoing negotiation and problem solving, and (f) early successes. These issues highlight strengths and areas for development in the ICT model. Use of the ICT model led to sustained and widespread use of SafeCare in one large county. Although some aspects of the implementation model may benefit from enhancement, qualitative findings suggest that the ICT process generates strong structural supports for implementation and creates conditions in which tensions between EBP structure and local contextual variations can be resolved in ways that support the expansion and maintenance of an EBP while preserving potential for public health benefit.

Effect of a provincial system of stroke care delivery on stroke care and outcomes

PubMed Central

Kapral, Moira K.; Fang, Jiming; Silver, Frank L.; Hall, Ruth; Stamplecoski, Melissa; O’Callaghan, Christina; Tu, Jack V.

2013-01-01

Background: Systems of stroke care delivery have been promoted as a means of improving the quality of stroke care, but little is known about their effectiveness. We assessed the effect of the Ontario Stroke System, a province-wide strategy of regionalized stroke care delivery, on stroke care and outcomes in Ontario, Canada. Methods: We used population-based provincial administrative databases to identify all emergency department visits and hospital admissions for acute stroke and transient ischemic attack from Jan. 1, 2001, to Dec. 31, 2010. Using piecewise regression analyses, we assessed the effect of the full implementation of the Ontario Stroke System in 2005 on the proportion of patients who received care at stroke centres, and on rates of discharge to long-term care facilities and 30-day mortality after stroke. Results: We included 243 287 visits by patients with acute stroke or transient ischemic attack. The full implementation of the Ontario Stroke System in 2005 was associated with an increase in rates of care at stroke centres (before implementation: 40.0%; after implementation: 46.5%), decreased rates of discharge to long-term care facilities (before implementation: 16.9%; after implementation: 14.8%) and decreased 30-day mortality for hemorrhagic (before implementation: 38.3%; after implementation: 34.4%) and ischemic stroke (before implementation: 16.3%; after implementation: 15.7%). The system’s implementation was also associated with marked increases in the proportion of patients who received neuroimaging, thrombolytic therapy, care in a stroke unit and antithrombotic therapy. Interpretation: The implementation of an organized system of stroke care delivery was associated with improved processes of care and outcomes after stroke. PMID:23713072

A mixed-methods exploration of implementation of a comprehensive school healthy eating model one year after scale-up.

PubMed

Naylor, Patti-Jean; McKay, Heather A; Valente, Maria; Mâsse, Louise C

2016-04-01

To study the implementation of a school-based healthy eating (HE) model one year after scale-up in British Columbia (BC). Specifically, to examine implementation of Action Schools! BC (AS! BC) and its influence on implementation of classroom HE activities, and to explore factors associated with implementation. Diffusion of Innovations, Social Cognitive and Organizational Change theories guided our approach. We used a mixed-methods research design including focus group interviews (seven schools, sixty-two implementers) and a cross-sectional multistage survey to principals (n 36, 92 % response rate) and teachers of grades 4 to 7 (n 168, 70 % response rate). Self-reported implementation of classroom HE activities and reported use of specific AS! BC HE activities were primary implementation measures. Thematic analysis of focus group data and multilevel mixed-effect logistic regression analyses of survey data were conducted. Elementary schools across BC, Canada. Thirty-nine school districts, thirty-six principals, 168 grade 4 to 7 teachers. Forty-two per cent of teachers in registered schools were implementing AS! BC HE in their classrooms. Users were 6·25 times more likely to have delivered a HE lesson in the past week. Implementation facilitators were school champions, technical support and access to resources; barriers were lack of time, loss of leadership or momentum. Implementation predictors were teacher training, self-efficacy, experience with the physical activity component of AS! BC, supportive school climate and parental post-secondary education. Our findings reinforce that continued teacher training and support are important public health investments that contribute to successful implementation of school-based HE models after scale-up.

Exploring the variation in implementation of a COPD disease management programme and its impact on health outcomes: a post hoc analysis of the RECODE cluster randomised trial.

PubMed

Boland, Melinde R S; Kruis, Annemarije L; Huygens, Simone A; Tsiachristas, Apostolos; Assendelft, Willem J J; Gussekloo, Jacobijn; Blom, Coert M G; Chavannes, Niels H; Rutten-van Mölken, Maureen P M H

2015-12-17

This study aims to (1) examine the variation in implementation of a 2-year chronic obstructive pulmonary disease (COPD) management programme called RECODE, (2) analyse the facilitators and barriers to implementation and (3) investigate the influence of this variation on health outcomes. Implementation variation among the 20 primary-care teams was measured directly using a self-developed scale and indirectly through the level of care integration as measured with the Patient Assessment of Chronic Illness Care (PACIC) and the Assessment of Chronic Illness Care (ACIC). Interviews were held to obtain detailed information regarding the facilitators and barriers to implementation. Multilevel models were used to investigate the association between variation in implementation and change in outcomes. The teams implemented, on average, eight of the 19 interventions, and the specific package of interventions varied widely. Important barriers and facilitators of implementation were (in)sufficient motivation of healthcare provider and patient, the high starting level of COPD care, the small size of the COPD population per team, the mild COPD population, practicalities of the information and communication technology (ICT) system, and hurdles in reimbursement. Level of implementation as measured with our own scale and the ACIC was not associated with health outcomes. A higher level of implementation measured with the PACIC was positively associated with improved self-management capabilities, but this association was not found for other outcomes. There was a wide variety in the implementation of RECODE, associated with barriers at individual, social, organisational and societal level. There was little association between extent of implementation and health outcomes.

Exploring the variation in implementation of a COPD disease management programme and its impact on health outcomes: a post hoc analysis of the RECODE cluster randomised trial

PubMed Central

Boland, Melinde R S; Kruis, Annemarije L; Huygens, Simone A; Tsiachristas, Apostolos; Assendelft, Willem J J; Gussekloo, Jacobijn; Blom, Coert M G; Chavannes, Niels H; Rutten-van Mölken, Maureen P M H

2015-01-01

This study aims to (1) examine the variation in implementation of a 2-year chronic obstructive pulmonary disease (COPD) management programme called RECODE, (2) analyse the facilitators and barriers to implementation and (3) investigate the influence of this variation on health outcomes. Implementation variation among the 20 primary-care teams was measured directly using a self-developed scale and indirectly through the level of care integration as measured with the Patient Assessment of Chronic Illness Care (PACIC) and the Assessment of Chronic Illness Care (ACIC). Interviews were held to obtain detailed information regarding the facilitators and barriers to implementation. Multilevel models were used to investigate the association between variation in implementation and change in outcomes. The teams implemented, on average, eight of the 19 interventions, and the specific package of interventions varied widely. Important barriers and facilitators of implementation were (in)sufficient motivation of healthcare provider and patient, the high starting level of COPD care, the small size of the COPD population per team, the mild COPD population, practicalities of the information and communication technology (ICT) system, and hurdles in reimbursement. Level of implementation as measured with our own scale and the ACIC was not associated with health outcomes. A higher level of implementation measured with the PACIC was positively associated with improved self-management capabilities, but this association was not found for other outcomes. There was a wide variety in the implementation of RECODE, associated with barriers at individual, social, organisational and societal level. There was little association between extent of implementation and health outcomes. PMID:26677770

Testing the Implementation of the Veder Contact Method: A Theatre-Based Communication method in Dementia Care.

PubMed

Boersma, Petra; van Weert, Julia C M; Lissenberg-Witte, Birgit I; van Meijel, Berno; Dröes, Rose-Marie

2018-01-08

There is a lack of research on implementation of person-centered care in nursing home care. The purpose of this study was to assess the implementation of the Veder contact method (VCM), a new person-centered method using theatrical, poetic and musical communication for application in 24-hr care. Caregivers (n = 136) and residents (n = 141) participated in a 1-year quasi-experimental study. Foundation Theater Veder implemented VCM on six experimental wards and rated implementation quality. Six control wards delivered care-as-usual. Before and after implementation, caregiver behavior was assessed during observations using the Veder-observation list and Quality of Caregivers' Behavior-list. Caregiver attitude was rated with the Approaches to Dementia Questionnaire. Quality of life, behavior, and mood of the residents were measured with QUALIDEM, INTERACT and FACE. Residents' care plans were examined for person-centered background information. Significant improvements in caregivers' communicative behavior (i.e., the ability to apply VCM, establishing positive interactions) and some aspects of residents' behavior and quality of life (i.e., positive affect, social relations) were found on the experimental wards with a high implementation score, as compared to the experimental wards with a low implementation score, and the control wards. No significant differences were found between the groups in caregivers' attitudes, residents' care plans, or mood. The positive changes in caregivers' behavior and residents' well-being on the high implementation score wards confirm the partly successful VCM implementation. Distinguishing between wards with a high and low implementation score provided insight into factors which are crucial for successful implementation. © The Author(s) 2018. 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.

The art of successful implementation of psychosocial interventions in residential dementia care: a systematic review of the literature based on the RE-AIM framework.

PubMed

Boersma, Petra; van Weert, Julia C M; Lakerveld, Jeroen; Dröes, Rose-Marie

2015-01-01

In the past decades many psychosocial interventions for elderly people with dementia have been developed and implemented. Relatively little research has been done on the extent to which these interventions were implemented in the daily care. The aim of this study was to obtain insight into strategies for successful implementation of psychosocial interventions in the daily residential dementia care. Using a modified RE-AIM framework, the indicators that are considered important for effective and sustainable implementation were defined. A systematic literature search was undertaken in PubMed, PsycINFO, and Cinahl, followed by a hand search for key papers. The included publications were mapped based on the dimensions of the RE-AIM framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Fifty-four papers met the inclusion criteria and described various psychosocial interventions. A distinction was made between studies that used one and studies that used multiple implementation strategies. This review shows that to improve their knowledge, caregivers needed at least multiple implementation strategies, only education is not enough. For increasing a more person-centered attitude, different types of knowledge transfer can be effective. Little consideration is given to the adoption of the method by caregivers and to the long-term sustainability (maintenance). This review shows that in order to successfully implement a psychosocial method the use of multiple implementation strategies is recommended. To ensure sustainability of a psychosocial care method in daily nursing home care, innovators as well as researchers should specifically pay attention to the dimensions Adoption, Implementation, and Maintenance of the RE-AIM implementation framework.

A tailored implementation strategy to reduce the duration of intravenous antibiotic treatment in community-acquired pneumonia: a controlled before-and-after study.

PubMed

Engel, M F; Bruns, A H W; Hulscher, M E J L; Gaillard, C A J M; Sankatsing, S U C; Teding van Berkhout, F; Emmelot-Vonk, M H; Kuck, E M; Steeghs, M H M; den Breeijen, J H; Stellato, R K; Hoepelman, A I M; Oosterheert, J J

2014-11-01

We previously showed that 40 % of clinically stable patients hospitalised for community-acquired pneumonia (CAP) are not switched to oral therapy in a timely fashion because of physicians' barriers. We aimed to decrease this proportion by implementing a novel protocol. In a multi-centre controlled before-and-after study, we evaluated the effect of an implementation strategy tailored to previously identified barriers to an early switch. In three Dutch hospitals, a protocol dictating a timely switch strategy was implemented using educational sessions, pocket reminders and active involvement of nursing staff. Primary outcomes were the proportion of patients switched timely and the duration of intravenous antibiotic therapy. Length of hospital stay (LOS), patient outcome, education effects 6 months after implementation and implementation costs were secondary outcomes. Statistical analysis was performed using mixed-effects models. Prior to implementation, 146 patients were included and, after implementation, 213 patients were included. The case mix was comparable. The implementation did not change the proportion of patients switched on time (66 %). The median duration of intravenous antibiotic administration decreased from 4 days [interquartile range (IQR) 2-5] to 3 days (IQR 2-4), a decrease of 21 % [95 % confidence interval (CI) 11 %; 30 %) in the multi-variable analysis. LOS and patient outcome were comparable before and after implementation. Forty-three percent (56/129) of physicians attended the educational sessions. After 6 months, 24 % (10/42) of the interviewed attendees remembered the protocol's main message. Cumulative implementation costs were 5,798 (20/reduced intravenous treatment day). An implementation strategy tailored to previously identified barriers reduced the duration of intravenous antibiotic administration in hospitalised CAP patients by 1 day, at minimal cost.

Estimating the Cost-Effectiveness of Implementation: Is Sufficient Evidence Available?

PubMed

Whyte, Sophie; Dixon, Simon; Faria, Rita; Walker, Simon; Palmer, Stephen; Sculpher, Mark; Radford, Stefanie

2016-01-01

Timely implementation of recommended interventions can provide health benefits to patients and cost savings to the health service provider. Effective approaches to increase the implementation of guidance are needed. Since investment in activities that improve implementation competes for funding against other health generating interventions, it should be assessed in term of its costs and benefits. In 2010, the National Institute for Health and Care Excellence released a clinical guideline recommending natriuretic peptide (NP) testing in patients with suspected heart failure. However, its implementation in practice was variable across the National Health Service in England. This study demonstrates the use of multi-period analysis together with diffusion curves to estimate the value of investing in implementation activities to increase uptake of NP testing. Diffusion curves were estimated based on historic data to produce predictions of future utilization. The value of an implementation activity (given its expected costs and effectiveness) was estimated. Both a static population and a multi-period analysis were undertaken. The value of implementation interventions encouraging the utilization of NP testing is shown to decrease over time as natural diffusion occurs. Sensitivity analyses indicated that the value of the implementation activity depends on its efficacy and on the population size. Value of implementation can help inform policy decisions of how to invest in implementation activities even in situations in which data are sparse. Multi-period analysis is essential to accurately quantify the time profile of the value of implementation given the natural diffusion of the intervention and the incidence of the disease. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Integrated versus fragmented implementation of complex innovations in acute health care

PubMed Central

Woiceshyn, Jaana; Blades, Kenneth; Pendharkar, Sachin R.

2017-01-01

Background: Increased demand and escalating costs necessitate innovation in health care. The challenge is to implement complex innovations—those that require coordinated use across the adopting organization to have the intended benefits. Purpose: We wanted to understand why and how two of five similar hospitals associated with the same health care authority made more progress with implementing a complex inpatient discharge innovation whereas the other three experienced more difficulties in doing so. Methodology: We conducted a qualitative comparative case study of the implementation process at five comparable urban hospitals adopting the same inpatient discharge innovation mandated by their health care authority. We analyzed documents and conducted 39 interviews of the health care authority and hospital executives and frontline managers across the five sites over a 1-year period while the implementation was ongoing. Findings: In two and a half years, two of the participating hospitals had made significant progress with implementing the innovation and had begun to realize benefits; they exemplified an integrated implementation mode. Three sites had made minimal progress, following a fragmented implementation mode. In the former mode, a semiautonomous health care organization developed a clear overall purpose and chose one umbrella initiative to implement it. The integrative initiative subsumed the rest and guided resource allocation and the practices of hospital executives, frontline managers, and staff who had bought into it. In contrast, in the fragmented implementation mode, the health care authority had several overlapping, competing innovations that overwhelmed the sites and impeded their implementation. Practice Implications: Implementing a complex innovation across hospital sites required (a) early prioritization of one initiative as integrative, (b) the commitment of additional (traded off or new) human resources, (c) deliberate upfront planning and continual support for and evaluation of implementation, and (d) allowance for local customization within the general principles of standardization. PMID:26469705

Controlled ecological evaluation of an implemented exercise training programme to prevent lower limb injuries in sport: differences in implementation activity.

PubMed

Donaldson, Alex; Gabbe, Belinda J; Lloyd, David G; Cook, Jill; Finch, Caroline F

2018-04-24

The public health benefits of injury prevention programmes are maximised when programmes are widely adopted and adhered to. Therefore, these programmes require appropriate implementation support. This study evaluated implementation activity outcomes associated with the implementation of FootyFirst, an exercise training injury prevention programme for community Australian football, both with (FootyFirst+S) and without (FootyFirst+NS) implementation support. An evaluation plan based on the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) Sports Setting Matrix was applied in a controlled ecological evaluation of the implementation of FootyFirst. RE-AIM dimension-specific (range: 0-2) and total RE-AIM scores (range: 0-10) were derived by triangulating data from a number of sources (including surveys, interviews, direct observations and notes) describing FootyFirst implementation activities. The mean dimension-specific and total scores were compared for clubs in regions receiving FootyFirst+S and FootyFirst+NS, through analysis of variance. The mean total RE-AIM score forclubs in the FootyFirst+S regions was 2.4 times higher than for clubs in the FootyFirst+NS region (4.73 vs 1.94; 95% CI for the difference: 1.64 to 3.74). Similarly, all dimension-specific scores were significantly higher for clubs in the FootyFirst+S regions compared with clubs in the FootyFirst+NS region. In all regions, the dimension-specific scores were highest for reach and adoption, and lowest for implementation. Implementing exercise training injury prevention programmes in community sport is challenging. Delivering programme content supported by a context-specific and evidence-informed implementation plan leads to greater implementation activity, which is an important precursor to injury reductions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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 improve implementation outcomes. Successfully achieving this requires undertaking formative research on the possible constraining and inhibiting factors, and incorporating the findings in the design and implementation of MDA for LF.

Implementing a pressure ulcer prevention bundle in an adult intensive care.

PubMed

Tayyib, Nahla; Coyer, Fiona; Lewis, Peter A

2016-12-01

The incidence of pressure ulcers (PUs) in intensive care units (ICUs) is high and numerous strategies have been implemented to address this issue. One approach is the use of a PU prevention bundle. However, to ensure success care bundle implementation requires monitoring to evaluate the care bundle compliance rate, and to evaluate the effectiveness of implementation strategies in facilitating practice change. The aims of this study were to appraise the implementation of a series of high impact intervention care bundle components directed at preventing the development of PUs, within ICU, and to evaluate the effectiveness of strategies used to enhance the implementation compliance. An observational prospective study design was used. Implementation strategies included regular education, training, audit and feed-back and the presence of a champion in the ICU. Implementation compliance was measured along four time points using a compliance checklist. Of the 60 registered nurses (RNs) working in the critical care setting, 11 participated in this study. Study participants demonstrated a high level of compliance towards the PU prevention bundle implementation (78.1%), with 100% participant acceptance. No significant differences were found between participants' demographic characteristics and the compliance score. There was a significant effect for time in the implementation compliance (Wilks Lambda=0.29, F (3, 8)=6.35, p<0.016), indicating that RNs needed time to become familiar with the bundle and routinely implement it into their practice. PU incidence was not influenced by the compliance level of participants. The implementation strategies used showed a positive impact on compliance. Assessing and evaluating implementation compliance is critical to achieve a desired outcome (reduction in PU incidence). This study's findings also highlighted that while RNs needed time to familiarise themselves with the care bundle elements, their clinical practice was congruent with the bundle elements. Copyright © 2016 Elsevier Ltd. All rights reserved.

Integrating evidence-based practices for increasing cancer screenings in safety net health systems: a multiple case study using the Consolidated Framework for Implementation Research.

PubMed

Liang, Shuting; Kegler, Michelle C; Cotter, Megan; Emily, Phillips; Beasley, Derrick; Hermstad, April; Morton, Rentonia; Martinez, Jeremy; Riehman, Kara

2016-08-02

Implementing evidence-based practices (EBPs) to increase cancer screenings in safety net primary care systems has great potential for reducing cancer disparities. Yet there is a gap in understanding the factors and mechanisms that influence EBP implementation within these high-priority systems. Guided by the Consolidated Framework for Implementation Research (CFIR), our study aims to fill this gap with a multiple case study of health care safety net systems that were funded by an American Cancer Society (ACS) grants program to increase breast and colorectal cancer screening rates. The initiative funded 68 safety net systems to increase cancer screening through implementation of evidence-based provider and client-oriented strategies. Data are from a mixed-methods evaluation with nine purposively selected safety net systems. Fifty-two interviews were conducted with project leaders, implementers, and ACS staff. Funded safety net systems were categorized into high-, medium-, and low-performing cases based on the level of EBP implementation. Within- and cross-case analyses were performed to identify CFIR constructs that influenced level of EBP implementation. Of 39 CFIR constructs examined, six distinguished levels of implementation. Two constructs were from the intervention characteristics domain: adaptability and trialability. Three were from the inner setting domain: leadership engagement, tension for change, and access to information and knowledge. Engaging formally appointed internal implementation leaders, from the process domain, also distinguished level of implementation. No constructs from the outer setting or individual characteristics domain differentiated systems by level of implementation. Our study identified a number of influential CFIR constructs and illustrated how they impacted EBP implementation across a variety of safety net systems. Findings may inform future dissemination efforts of EBPs for increasing cancer screening in similar settings. Moreover, our analytic approach is similar to previous case studies using CFIR and hence could facilitate comparisons across studies.

Investigating and Learning Lessons from Early Experiences of Implementing ePrescribing Systems into NHS Hospitals: A Questionnaire Study

PubMed Central

Cresswell, Kathrin; Coleman, Jamie; Slee, Ann; Williams, Robin; Sheikh, Aziz

2013-01-01

Background ePrescribing systems have significant potential to improve the safety and efficiency of healthcare, but they need to be carefully selected and implemented to maximise benefits. Implementations in English hospitals are in the early stages and there is a lack of standards guiding the procurement, functional specifications, and expected benefits. We sought to provide an updated overview of the current picture in relation to implementation of ePrescribing systems, explore existing strategies, and identify early lessons learned. Methods A descriptive questionnaire-based study, which included closed and free text questions and involved both quantitative and qualitative analysis of the data generated. Results We obtained responses from 85 of 108 NHS staff (78.7% response rate). At least 6% (n = 10) of the 168 English NHS Trusts have already implemented ePrescribing systems, 2% (n = 4) have no plans of implementing, and 34% (n = 55) are planning to implement with intended rapid implementation timelines driven by high expectations surrounding improved safety and efficiency of care. The majority are unclear as to which system to choose, but integration with existing systems and sophisticated decision support functionality are important decisive factors. Participants highlighted the need for increased guidance in relation to implementation strategy, system choice and standards, as well as the need for top-level management support to adequately resource the project. Although some early benefits were reported by hospitals that had already implemented, the hoped for benefits relating to improved efficiency and cost-savings remain elusive due to a lack of system maturity. Conclusions Whilst few have begun implementation, there is considerable interest in ePrescribing systems with ambitious timelines amongst those hospitals that are planning implementations. In order to ensure maximum chances of realising benefits, there is a need for increased guidance in relation to implementation strategy, system choice and standards, as well as increased financial resources to fund local activities. PMID:23335961

24 CFR 598.605 - Implementation plan.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 3 2014-04-01 2013-04-01 true Implementation plan. 598.605 Section 598.605 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued... Grants § 598.605 Implementation plan. (a) Implementation plan content. An EZ must submit an...

10 CFR 960.3 - Implementation guidelines.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this subpart...

10 CFR 960.3 - Implementation guidelines.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this subpart...

10 CFR 960.3 - Implementation guidelines.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this subpart...

10 CFR 960.3 - Implementation guidelines.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this subpart...

6 CFR 27.115 - Implementation.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 6 Domestic Security 1 2012-01-01 2012-01-01 false Implementation. 27.115 Section 27.115 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS General § 27.115 Implementation. The Assistant Secretary may implement the section 550 program in...

6 CFR 27.115 - Implementation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 6 Domestic Security 1 2011-01-01 2011-01-01 false Implementation. 27.115 Section 27.115 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS General § 27.115 Implementation. The Assistant Secretary may implement the section 550 program in...

6 CFR 27.115 - Implementation.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 6 Domestic Security 1 2013-01-01 2013-01-01 false Implementation. 27.115 Section 27.115 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS General § 27.115 Implementation. The Assistant Secretary may implement the section 550 program in...

6 CFR 27.115 - Implementation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Implementation. 27.115 Section 27.115 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS General § 27.115 Implementation. The Assistant Secretary may implement the Section 550 program in...

6 CFR 27.115 - Implementation.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 6 Domestic Security 1 2014-01-01 2014-01-01 false Implementation. 27.115 Section 27.115 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS General § 27.115 Implementation. The Assistant Secretary may implement the section 550 program in...

22 CFR 103.1 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-04-01

... DEPARTMENT OF STATE ECONOMIC AND OTHER FUNCTIONS REGULATIONS FOR IMPLEMENTATION OF THE CHEMICAL WEAPONS CONVENTION AND THE CHEMICAL WEAPONS CONVENTION IMPLEMENTATION ACT OF 1998 ON THE TAKING OF SAMPLES AND ON... intended to implement sections 304(f)(1) and 501 of the Chemical Weapons Convention Implementation Act of...

22 CFR 103.1 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-04-01

... DEPARTMENT OF STATE ECONOMIC AND OTHER FUNCTIONS REGULATIONS FOR IMPLEMENTATION OF THE CHEMICAL WEAPONS CONVENTION AND THE CHEMICAL WEAPONS CONVENTION IMPLEMENTATION ACT OF 1998 ON THE TAKING OF SAMPLES AND ON... intended to implement sections 304(f)(1) and 501 of the Chemical Weapons Convention Implementation Act of...

77 FR 41279 - Approval and Promulgation of Air Quality Implementation Plans; Pennsylvania; Regional Haze State...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-13

... Promulgation of Air Quality Implementation Plans; Pennsylvania; Regional Haze State Implementation Plan AGENCY... the Regional Haze State Implementation Plan (SIP) (hereafter RH SIP) revision submitted by the... anthropogenic impairment of visibility in mandatory Class I areas [[Page 41280

Implementation Evaluation in a Private Nonprofit Setting: A Mixed-Methods Approach

ERIC Educational Resources Information Center

Walker, Jacquelyn Ann

2013-01-01

Demand for quality service provision in the human services industry requires that private nonprofit organizations have the administrative and management capacities to ensure successful implementation and sustain staff development programs. Unfamiliarity with implementation challenges, and limited awareness of implementation strategies, can trigger…

10 CFR 960.3 - Implementation guidelines.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this subpart...

Implementation of Discharge Plans for Chronically Ill Elders Discharged Home.

ERIC Educational Resources Information Center

Proctor, Enola K.; And Others

1996-01-01

Addresses the extent to which discharge plans for elderly patients with congestive heart failure were implemented as planned, tested the consequences of implementation problems, and identified factors associated with implementation problems. Implications for hospital discharge planners and home health care are discussed. (KW)

10 CFR 63.143 - Implementation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Implementation. 63.143 Section 63.143 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) DISPOSAL OF HIGH-LEVEL RADIOACTIVE WASTES IN A GEOLOGIC REPOSITORY AT YUCCA MOUNTAIN, NEVADA Quality Assurance § 63.143 Implementation. DOE shall implement a quality assurance program...

76 FR 12945 - Instructions for Implementing Climate Change Adaptation Planning in Accordance With Executive...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-09

... COUNCIL ON ENVIRONMENTAL QUALITY Instructions for Implementing Climate Change Adaptation Planning... Availability of Climate Change Adaptation Planning Implementing Instructions. SUMMARY: The Chair of the Council... for Implementing Climate Change Adaptation Planning are now available at: http://www.whitehouse.gov...

Determinants of Web Site Implementation in Small Businesses.

ERIC Educational Resources Information Center

Raymond, Louis

2001-01-01

A survey of 54 Canadian travel agencies identified various factors determining the assimilation of electronic commerce by small enterprises in the form of informational, transactional, and strategic implementation of a Web site. Results indicate informational implementation and transactional implementation are determined by the environmental…

Research Implementation.

ERIC Educational Resources Information Center

Trochim, William M. K.

Investigated is the topic of research implementation and how it can affect evaluation results. Even when evaluations are well planned, the obtained results can be misleading if the conscientiously-constructed research plan is not correctly implemented in practice. In virtually every research arena, one finds major difficulties in implementing the…

22 CFR 120.36 - United Kingdom Implementing Arrangement.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false United Kingdom Implementing Arrangement. 120.36 Section 120.36 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS PURPOSE AND DEFINITIONS § 120.36 United Kingdom Implementing Arrangement. United Kingdom Implementing Arrangement means...

22 CFR 120.36 - United Kingdom Implementing Arrangement.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false United Kingdom Implementing Arrangement. 120.36 Section 120.36 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS PURPOSE AND DEFINITIONS § 120.36 United Kingdom Implementing Arrangement. United Kingdom Implementing Arrangement means...

22 CFR 120.36 - United Kingdom Implementing Arrangement.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false United Kingdom Implementing Arrangement. 120.36 Section 120.36 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS PURPOSE AND DEFINITIONS § 120.36 United Kingdom Implementing Arrangement. United Kingdom Implementing Arrangement means...

Focus on Implementation: Assessing and Promoting Treatment Fidelity

ERIC Educational Resources Information Center

Collier-Meek, Melissa A.; Fallon, Lindsay M.; Sanetti, Lisa M. H.; Maggin, Daniel M.

2013-01-01

Implementation, or treatment fidelity, is the link between evidence-based interventions and changes in student outcomes. Although higher levels of implementation are generally associated with more efficient improvements in student outcomes, research indicates that many adults struggle to consistently implement student interventions. As school…

40 CFR 63.698 - Implementation and enforcement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 10 2010-07-01 2010-07-01 false Implementation and enforcement. 63.698 Section 63.698 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS....698 Implementation and enforcement. (a) This subpart can be implemented and enforced by the U.S. EPA...

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.

OpenSHMEM-UCX : Evaluation of UCX for implementing OpenSHMEM Programming Model

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

Baker, Matthew B; Gorentla Venkata, Manjunath; Aderholdt, William Ferrol

2016-01-01

The OpenSHMEM reference implementation was developed towards the goal of developing an open source and high-performing Open- SHMEM implementation. To achieve portability and performance across various networks, the OpenSHMEM reference implementation uses GAS- Net and UCCS for network operations. Recently, new network layers have emerged with the promise of providing high-performance, scalabil- ity, and portability for HPC applications. In this paper, we implement the OpenSHMEM reference implementation to use the UCX framework for network operations. Then, we evaluate its performance and scalabil- ity on Cray XK systems to understand UCX s suitability for developing the OpenSHMEM programming model. Further, wemore » develop a bench- mark called SHOMS for evaluating the OpenSHMEM implementation. Our experimental results show that OpenSHMEM-UCX outperforms the vendor supplied OpenSHMEM implementation in most cases on the Cray XK system by up to 40% with respect to message rate and up to 70% for the execution of application kernels.« less

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

The openEHR Java reference implementation project.

PubMed

Chen, Rong; Klein, Gunnar

2007-01-01

The openEHR foundation has developed an innovative design for interoperable and future-proof Electronic Health Record (EHR) systems based on a dual model approach with a stable reference information model complemented by archetypes for specific clinical purposes.A team from Sweden has implemented all the stable specifications in the Java programming language and donated the source code to the openEHR foundation. It was adopted as the openEHR Java Reference Implementation in March 2005 and released under open source licenses. This encourages early EHR implementation projects around the world and a number of groups have already started to use this code. The early Java implementation experience has also led to the publication of the openEHR Java Implementation Technology Specification. A number of design changes to the specifications and important minor corrections have been directly initiated by the implementation project over the last two years. The Java Implementation has been important for the validation and improvement of the openEHR design specifications and provides building blocks for future EHR systems.

Innovation implementation in the public sector: an integration of institutional and collective dynamics.

PubMed

Choi, Jin Nam; Chang, Jae Yoon

2009-01-01

The present study integrates institutional factors and employee-based collective processes as predictors of 2 key implementation outcomes: implementation effectiveness and innovation effectiveness (Klein, Conn, & Sorra, 2001). Specifically, the authors proposed that institutional factors shape employees' collective implementation efficacy and innovation acceptance. The authors further hypothesized that these employee-based collective processes mediate the effects of institutional factors on implementation outcomes. This integrative framework was examined in the context of 47 agencies and ministries of the Korean Government that were implementing a process innovation called E-Government. Three-wave longitudinal data were collected from 60 external experts and 1,732 government employees. The results reveal the importance of management support for collective implementation efficacy, which affected employees' collective acceptance of the innovation. As hypothesized, these collective employee dynamics mediated the effects of institutional enablers on successful implementation as well as the amount of long-term benefit that accrued to the agencies and ministries. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Implementation Science: Buzzword or Game Changer?

PubMed

Douglas, Natalie F; Campbell, Wenonah N; Hinckley, Jacqueline J

2015-12-01

The purpose of this supplement article is to provide a resource of pertinent information concerning implementation science for immediate research application in communication sciences and disorders. Key terminology related to implementation science is reviewed. Practical suggestions for the application of implementation science theories and methodologies are provided, including an overview of hybrid research designs that simultaneously investigate clinical effectiveness and implementation as well as an introduction to approaches for engaging stakeholders in the research process. A detailed example from education is shared to show how implementation science was utilized to move an intervention program for autism into routine practice in the public school system. In particular, the example highlights the value of strong partnership among researchers, policy makers, and frontline practitioners in implementing and sustaining new evidence-based practices. Implementation science is not just a buzzword. This is a new field of study that can make a substantive contribution in communication sciences and disorders by informing research agendas, reducing health and education disparities, improving accountability and quality control, increasing clinician satisfaction and competence, and improving client outcomes.

Agile Implementation: A Blueprint for Implementing Evidence-Based Healthcare Solutions.

PubMed

Boustani, Malaz; Alder, Catherine A; Solid, Craig A

2018-03-07

To describe the essential components of an Agile Implementation (AI) process, which rapidly and effectively implements evidence-based healthcare solutions, and present a case study demonstrating its utility. Case demonstration study. Integrated, safety net healthcare delivery system in Indianapolis. Interdisciplinary team of clinicians and administrators. Reduction in dementia symptoms and caregiver burden; inpatient and outpatient care expenditures. Implementation scientists were able to implement a collaborative care model for dementia care and sustain it for more than 9 years. The model was implemented and sustained by using the elements of the AI process: proactive surveillance and confirmation of clinical opportunities, selection of the right evidence-based healthcare solution, localization (i.e., tailoring to the local environment) of the selected solution, development of an evaluation plan and performance feedback loop, development of a minimally standardized operation manual, and updating such manual annually. The AI process provides an effective model to implement and sustain evidence-based healthcare solutions. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Safe and successful implementation of CPOE for chemotherapy at a children's cancer center.

PubMed

Hoffman, James M; Baker, Donald K; Howard, Scott C; Laver, Joseph H; Shenep, Jerry L

2011-02-01

Computerized prescriber order entry (CPOE) for medications has been implemented in only approximately 1 in 6 United States hospitals, with CPOE for chemotherapy lagging behind that for nonchemotherapy medications. The high risks associated with chemotherapy combined with other aspects of cancer care present unique challenges for the safe and appropriate use of CPOE. This article describes the process for safe and successful implementation of CPOE for chemotherapy at a children's cancer center. A core principle throughout the development and implementation of this system was that it must be as safe (and eventually safer) as existing paper systems and processes. The history of requiring standardized, regimen-specific, preprinted paper order forms served as the foundation for safe implementation of CPOE for chemotherapy. Extensive use of electronic order sets with advanced functionality; formal process redesign and system analysis; automated clinical decision support; and a phased implementation approach were essential strategies for safe implementation of CPOE. With careful planning and adequate resources, CPOE for chemotherapy can be safely implemented.

Accessibility and implementation in UK services of an effective depression relapse prevention programme – mindfulness-based cognitive therapy (MBCT): ASPIRE study protocol

PubMed Central

2014-01-01

Background Mindfulness-based cognitive therapy (MBCT) is a cost-effective psychosocial prevention programme that helps people with recurrent depression stay well in the long term. It was singled out in the 2009 National Institute for Health and Clinical Excellence (NICE) Depression Guideline as a key priority for implementation. Despite good evidence and guideline recommendations, its roll-out and accessibility across the UK appears to be limited and inequitably distributed. The study aims to describe the current state of MBCT accessibility and implementation across the UK, develop an explanatory framework of what is hindering and facilitating its progress in different areas, and develop an Implementation Plan and related resources to promote better and more equitable availability and use of MBCT within the UK National Health Service. Methods/Design This project is a two-phase qualitative, exploratory and explanatory research study, using an interview survey and in-depth case studies theoretically underpinned by the Promoting Action on Implementation in Health Services (PARIHS) framework. Interviews will be conducted with stakeholders involved in commissioning, managing and implementing MBCT services in each of the four UK countries, and will include areas where MBCT services are being implemented successfully and where implementation is not working well. In-depth case studies will be undertaken on a range of MBCT services to develop a detailed understanding of the barriers and facilitators to implementation. Guided by the study’s conceptual framework, data will be synthesized across Phase 1 and Phase 2 to develop a fit for purpose implementation plan. Discussion Promoting the uptake of evidence-based treatments into routine practice and understanding what influences these processes has the potential to support the adoption and spread of nationally recommended interventions like MBCT. This study could inform a larger scale implementation trial and feed into future implementation of MBCT with other long-term conditions and associated co-morbidities. It could also inform the implementation of interventions that are acceptable and effective, but are not widely accessible or implemented. PMID:24884603

Implementation and dissemination of a transition of care program for rural veterans: a controlled before and after study.

PubMed

Leonard, Chelsea; Lawrence, Emily; McCreight, Marina; Lippmann, Brandi; Kelley, Lynette; Mayberry, Ashlea; Ladebue, Amy; Gilmartin, Heather; Côté, Murray J; Jones, Jacqueline; Rabin, Borsika A; Ho, P Michael; Burke, Robert

2017-10-23

Adapting promising health care interventions to local settings is a critical component in the dissemination and implementation process. The Veterans Health Administration (VHA) rural transitions nurse program (TNP) is a nurse-led, Veteran-centered intervention designed to improve transitional care for rural Veterans funded by VA national offices for dissemination to other VA sites serving a predominantly rural Veteran population. Here, we describe our novel approach to the implementation and evaluation = the TNP. This is a controlled before and after study that assesses both implementation and intervention outcomes. During pre-implementation, we assessed site context using a mixed method approach with data from diverse sources including facility-level quantitative data, key informant and Veteran interviews, observations of the discharge process, and a group brainstorming activity. We used the Practical Robust Implementation and Sustainability Model (PRISM) to inform our inquiries, to integrate data from all sources, and to identify factors that may affect implementation. In the implementation phase, we will use internal and external facilitation, paired with audit and feedback, to encourage appropriate contextual adaptations. We will use a modified Stirman framework to document adaptations. During the evaluation phase, we will measure intervention and implementation outcomes at each site using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). We will conduct a difference-in-differences analysis with propensity-matched Veterans and VA facilities as a control. Our primary intervention outcome is 30-day readmission and Emergency Department visit rates. We will use our findings to develop an implementation toolkit that will inform the larger scale-up of the TNP across the VA. The use of PRISM to inform pre-implementation evaluation and synthesize data from multiple sources, coupled with internal and external facilitation, is a novel approach to engaging sites in adapting interventions while promoting fidelity to the intervention. Our application of PRISM to pre-implementation and midline evaluation, as well as documentation of adaptations, provides an opportunity to identify and address contextual factors that may impede or enhance implementation and sustainability of health interventions and inform dissemination.

Explaining outcomes in major system change: a qualitative study of implementing centralised acute stroke services in two large metropolitan regions in England.

PubMed

Fulop, Naomi J; Ramsay, Angus I G; Perry, Catherine; Boaden, Ruth J; McKevitt, Christopher; Rudd, Anthony G; Turner, Simon J; Tyrrell, Pippa J; Wolfe, Charles D A; Morris, Stephen

2016-06-03

Implementing major system change in healthcare is not well understood. This gap may be addressed by analysing change in terms of interrelated components identified in the implementation literature, including decision to change, intervention selection, implementation approaches, implementation outcomes, and intervention outcomes. We conducted a qualitative study of two cases of major system change: the centralisation of acute stroke services in Manchester and London, which were associated with significantly different implementation outcomes (fidelity to referral pathway) and intervention outcomes (provision of evidence-based care, patient mortality). We interviewed stakeholders at national, pan-regional, and service-levels (n = 125) and analysed 653 documents. Using a framework developed for this study from the implementation science literature, we examined factors influencing implementation approaches; how these approaches interacted with the models selected to influence implementation outcomes; and their relationship to intervention outcomes. London and Manchester's differing implementation outcomes were influenced by the different service models selected and implementation approaches used. Fidelity to the referral pathway was higher in London, where a 'simpler', more inclusive model was used, implemented with a 'big bang' launch and 'hands-on' facilitation by stroke clinical networks. In contrast, a phased approach of a more complex pathway was used in Manchester, and the network acted more as a platform to share learning. Service development occurred more uniformly in London, where service specifications were linked to financial incentives, and achieving standards was a condition of service launch, in contrast to Manchester. 'Hands-on' network facilitation, in the form of dedicated project management support, contributed to achievement of these standards in London; such facilitation processes were less evident in Manchester. Using acute stroke service centralisation in London and Manchester as an example, interaction between model selected and implementation approaches significantly influenced fidelity to the model. The contrasting implementation outcomes may have affected differences in provision of evidence-based care and patient mortality. The framework used in this analysis may support planning and evaluating major system changes, but would benefit from application in different healthcare contexts.

The design of a real-time formative evaluation of the implementation process of lifestyle interventions at two worksites using a 7-step strategy (BRAVO@Work).

PubMed

Wierenga, Debbie; Engbers, Luuk H; van Empelen, Pepijn; Hildebrandt, Vincent H; van Mechelen, Willem

2012-08-07

Worksite health promotion programs (WHPPs) offer an attractive opportunity to improve the lifestyle of employees. Nevertheless, broad scale and successful implementation of WHPPs in daily practice often fails. In the present study, called BRAVO@Work, a 7-step implementation strategy was used to develop, implement and embed a WHPP in two different worksites with a focus on multiple lifestyle interventions.This article describes the design and framework for the formative evaluation of this 7-step strategy under real-time conditions by an embedded scientist with the purpose to gain insight into whether this this 7-step strategy is a useful and effective implementation strategy. Furthermore, we aim to gain insight into factors that either facilitate or hamper the implementation process, the quality of the implemented lifestyle interventions and the degree of adoption, implementation and continuation of these interventions. This study is a formative evaluation within two different worksites with an embedded scientist on site to continuously monitor the implementation process. Each worksite (i.e. a University of Applied Sciences and an Academic Hospital) will assign a participating faculty or a department, to implement a WHPP focusing on lifestyle interventions using the 7-step strategy. The primary focus will be to describe the natural course of development, implementation and maintenance of a WHPP by studying [a] the use and adherence to the 7-step strategy, [b] barriers and facilitators that influence the natural course of adoption, implementation and maintenance, and [c] the implementation process of the lifestyle interventions. All data will be collected using qualitative (i.e. real-time monitoring and semi-structured interviews) and quantitative methods (i.e. process evaluation questionnaires) applying data triangulation. Except for the real-time monitoring, the data collection will take place at baseline and after 6, 12 and 18 months. This is one of the few studies to extensively and continuously monitor the natural course of the implementation process of a WHPP by a formative evaluation using a mix of quantitative and qualitative methods on different organizational levels (i.e. management, project group, employees) with an embedded scientist on site. NTR2861.

Historical short stories as nature of science instruction in secondary science classrooms: Science teachers' implementation and students' reactions

NASA Astrophysics Data System (ADS)

Reid-Smith, Jennifer Ann

This study explores the use of historical short stories as nature of science (NOS) instruction in thirteen secondary science classes. The stories focus on the development of science ideas and include statements and questions to draw students' and teachers' attention to key NOS ideas and misconceptions. This study used mixed methods to examine how teachers implement the stories, factors influencing teachers' implementation, the impact on students' NOS understanding, students' interest in the stories and factors correlated with their interest. Teachers' implementation decisions were influenced by their NOS understanding, curricula, time constraints, perceptions of student ability and resistance, and student goals. Teachers implementing stories at a high-level of effectiveness were more likely to make instructional decisions to mitigate constraints from the school environment and students. High-level implementers frequently referred to their learning goals for students as a rationale for implementing the stories even when facing constraints. Teachers implementing at a low-level of effectiveness were more likely to express that constraints inhibited effective implementation. Teachers at all levels of implementation expressed concern regarding the length of the stories and time required to fully implement the stories. Additionally, teachers at all levels of implementation expressed a desire for additional resources regarding effective story implementation and reading strategies. Evidence exists that the stories can be used to improve students' NOS understanding. However, under what conditions the stories are effective is still unclear. Students reported finding the stories more interesting than textbook readings and many students enjoyed learning about scientists and the development of science idea. Students' interest in the stories is correlated with their attitudes towards reading, views of effective science learning, attributions of academic success, and interest in a science-related career. If NOS instructional materials are to be used effectively, designers must take into account the needs of classroom teachers by limiting the length of the materials and providing additional teacher support resources. Many teachers will likely require professional development opportunities to build their NOS understanding, develop a compelling rationale for teaching NOS and using the stories, observe modeling of effective implementation, and collaborate with other teachers regarding how to mitigate constraints.

Formal semantic specifications as implementation blueprints for real-time programming languages

NASA Technical Reports Server (NTRS)

Feyock, S.

1981-01-01

Formal definitions of language and system semantics provide highly desirable checks on the correctness of implementations of programming languages and their runtime support systems. If these definitions can give concrete guidance to the implementor, major increases in implementation accuracy and decreases in implementation effort can be achieved. It is shown that of the wide variety of available methods the Hgraph (hypergraph) definitional technique (Pratt, 1975), is best suited to serve as such an implementation blueprint. A discussion and example of the Hgraph technique is presented, as well as an overview of the growing body of implementation experience of real-time languages based on Hgraph semantic definitions.

Health-Based Capitation Risk Adjustment in Minnesota Public Health Care Programs

PubMed Central

Gifford, Gregory A.; Edwards, Kevan R.; Knutson, David J.

2004-01-01

This article documents the history and implementation of health-based capitation risk adjustment in Minnesota public health care programs, and identifies key implementation issues. Capitation payments in these programs are risk adjusted using an historical, health plan risk score, based on concurrent risk assessment. Phased implementation of capitation risk adjustment for these programs began January 1, 2000. Minnesota's experience with capitation risk adjustment suggests that: (1) implementation can accelerate encounter data submission, (2) administrative decisions made during implementation can create issues that impact payment model performance, and (3) changes in diagnosis data management during implementation may require changes to the payment model. PMID:25372356

Participatory System Dynamics Modeling: Increasing Stakeholder Engagement and Precision to Improve Implementation Planning in Systems.

PubMed

Zimmerman, Lindsey; Lounsbury, David W; Rosen, Craig S; Kimerling, Rachel; Trafton, Jodie A; Lindley, Steven E

2016-11-01

Implementation planning typically incorporates stakeholder input. Quality improvement efforts provide data-based feedback regarding progress. Participatory system dynamics modeling (PSD) triangulates stakeholder expertise, data and simulation of implementation plans prior to attempting change. Frontline staff in one VA outpatient mental health system used PSD to examine policy and procedural "mechanisms" they believe underlie local capacity to implement evidence-based psychotherapies (EBPs) for PTSD and depression. We piloted the PSD process, simulating implementation plans to improve EBP reach. Findings indicate PSD is a feasible, useful strategy for building stakeholder consensus, and may save time and effort as compared to trial-and-error EBP implementation planning.

Method and apparatus for controlling an earthworking implement to preserve a crown on a road surface

NASA Technical Reports Server (NTRS)

Lundquist, Steve D. (Inventor); Staub, Michael D. (Inventor); Alster, Louis G. (Inventor)

1999-01-01

A method and apparatus for controlling an earthworking implement on an earthworking machine to preserve a crown on the surface of a road, including determining the position of the crown on the road surface, choosing a sloped grade on one side of the crown, positioning the earthworking implement on the sloped grade so that a first end of the earthworking implement is on the road surface. The processor determines a desired position of a second end of the earthworking implement so that the second end overlaps the crown and the earthworking implement does not cut the crown.

The Role of Lean Process Improvement in Implementation of Evidence-Based Practices in Behavioral Health Care.

PubMed

Steinfeld, Bradley; Scott, Jennifer; Vilander, Gavin; Marx, Larry; Quirk, Michael; Lindberg, Julie; Koerner, Kelly

2015-10-01

To effectively implement evidence-based practices (EBP) in behavioral health care, an organization needs to have operating structures and processes that can address core EBP implementation factors and stages. Lean, a widely used quality improvement process, can potentially address the factors crucial to successful implementation of EBP. This article provides an overview of Lean and the relationship between Lean process improvement steps, and EBP implementation models. Examples of how Lean process improvement methodologies can be used to help plan and carry out implementation of EBP in mental health delivery systems are presented along with limitations and recommendations for future research and clinical application.

The Productive Ward: releasing Time to Care(™)--what we can learn from the literature for implementation.

PubMed

White, Mark; Wells, John Sg; Butterworth, Tony

2014-10-01

This paper reviews the Productive Ward: Releasing Time to Care™ literature, identifying and discussing the key characteristics that may contribute to successful implementation. It is 5 years since the official UK launch of the Productive Ward, and the Republic of Ireland commenced a phased, national implementation programme in 2011. Thus it is timely to reflect on the implementation lessons learned to date and described in the literature. Using taxonomic mapping, this paper evaluates the current state of the literature that pertains to Productive Ward implementation experience; success factors; reports, and assessments. Seven common contextual characteristics were identified: robust and engaging communication; enabling and empowering roles; appropriate training; project planning and management; leadership; corporate/management engagement and support; and financial and human resource commitment. The key characteristics identified have a direct impact on the implementation of the Productive Ward. The interplay between these key characteristics and how this interplay influences successful implementation of the Productive Ward warrants further research. Acknowledging and embracing the seven characteristics during implementation will positively improve the progress and success of the initiatives implementation. © 2013 John Wiley & Sons Ltd.

Implementation of an all-ages mandatory helmet policy for ice skating.

PubMed

Thibault-Halman, Ginette; Fenerty, Lynne; Wheadon-Hore, Kathie; Walling, Simon; Cusimano, Michael D; Clarke, David B

2015-12-01

Ice skaters sustain a significant number of head injuries each winter. We are the first to implement an all-ages helmet policy at a university-based Canadian arena. We report our experience from a cross-sectional observational study as well as the policy's consequences on helmet use and skating participation. Educational programming was provided prior to policy implementation. Observations of helmet use, falls and skater demographics were conducted prior to education/implementation and after policy implementation. The number of skaters observed was essentially unchanged by the policy; 361 skaters were observed pre-implementation, while 358 were observed post-implementation during the same number of observation-hours. Pre-implementation, helmet use ranged from 97% among children under 12 to 10% among adults; post-implementation use in all skaters was 99%. Falls were observed among all age groups, with preponderance among those aged 4-12. An all-ages helmet policy was successful both in achieving helmet use among all skaters and in maintaining participation rates. 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/

Process evaluation of the implementation of scorecard-based antenatal risk assessment, care pathways and interdisciplinary consultation: the Healthy Pregnancy 4 All study.

PubMed

Vos, A A; van Voorst, S F; Posthumus, A G; Waelput, A J M; Denktaş, S; Steegers, E A P

2017-09-01

To evaluate the implementation of a complex intervention in the antenatal healthcare field in 14 Dutch municipalities. The intervention consisted of the implementation of a systematic scorecard-based risk assessment in pregnancy, subsequent patient-tailored care pathways, and consultations of professionals from different medical and social disciplines. Saunders's seven-step method was used for the development of a programme implementation monitoring plan, with specific attention to the setting and context of the programme. Data were triangulated from multiple sources, and prespecified criteria were applied to examine the evidence for implementation. Six out of 11 municipalities (54%) met the implementation criteria for the entire risk assessment programme, whereas three municipalities (27%) met the criteria if the three components of implementation were analysed separately. A process evaluation of implementation of a complex intervention is possible. The results can be used to improve understanding of the associations between specific programme elements and programme outcomes on effectiveness of the intervention. Additionally, the results are important for formative purposes to assess how future implementation of antenatal risk assessment can be improved in comparable contexts. Copyright © 2017. Published by Elsevier Ltd.

Factors Influencing Implementation of a Physical Activity Intervention in Residential Children's Homes.

PubMed

Lau, Erica Y; Saunders, Ruth P; Pate, Russell R

2016-11-01

The Environmental Intervention in Children's Homes (ENRICH) study was the first published physical activity intervention undertaken in residential children's homes (RCHs). The study revealed differences in implementation across the homes, which may be a key factor that affects program effectiveness. The purpose of this study was to examine the direct and indirect effects of organizational capacity, provider characteristics, and quality of prevention support system on level of implementation of the ENRICH intervention. This study analyzed the ENRICH process evaluation data collected from 24 RCHs. Bayesian Path analysis was used to examine the direct and indirect effects of organizational capacity, provider characteristics, and quality of prevention support system on level of implementation. Level of implementation across RCHs was variable, ranging from 38 to 97 % (M = 68.3, SD = 14.45). Results revealed that organizational capacity and provider characteristics had significant direct associations with level of implementation. Neither direct nor indirect associations between quality of prevention support system and level of implementation reached statistical significance. Conducting formative assessments on organizational capacity and provider characteristics and incorporating such information in implementation planning may increase the likelihood of achieving higher levels of implementation in future studies.

Preparing for national implementation of an evidence-based, effective HIV prevention program among bahamian sixth-grade students.

PubMed

Knowles, Valerie; Wang, Bo; Deveaux, Lynette; Lunn, Sonja; Rolle, Glenda; Jones, Giavana; Harris, Carole; Kaljee, Linda; Li, Xiaoming; Koci, Veronica; Chen, Xinguang; Marshall, Sharon; Stanton, Bonita

2012-01-01

Using data from the preparatory phase prior to national implementation of an effective HIV prevention program (Focus on Youth in the Caribbean; FOYC) in all Bahamian government sixth-grade classes, we describe (1) actual FOYC implementation, (2) factors that influenced implementation, and (3) the relationship of implementation with intervention outcome. Six elementary schools (with 17 grade six classrooms) were selected to participate in the preparatory phase. The 17 teachers were invited to attend a training workshop, coordinate administration of questionnaires to the students, teach the 10 sessions of FOYC and complete self-assessment checklists. A total of 395 students submitted baseline and 311 students submitted year-end questionnaires. Thirteen teachers initiated FOYC; five completed all 10 sessions. Implementation of FOYC was not related to teacher FOYC workshop experience but did cluster by school. There were significant positive correlations between improved student knowledge of HIV/AIDS, protective health skills, perceived parental monitoring and reduced risk behaviours with the number of FOYC sessions delivered. Implementation was impeded by logistics issues, structural issues with the measures, and comfort-level issues, most of which can be addressed for national implementation. Degree of FOYC implementation is correlated with positive student outcomes.

Implementing quality initiatives in healthcare organizations: drivers and challenges.

PubMed

Abdallah, Abdallah

2014-01-01

Various quality initiatives seem to have successful implementation in some healthcare organizations yet fail in others. This paper sets out to study the literature trying to understand drivers and challenges facing quality initiatives implementation in healthcare organizations then compare findings from literature with those of a structured questionnaire answered by 60 representatives from 18 hospitals. Finally it proposes a framework that mitigates challenges and utilizes drivers to ensure best implementation results. Literature regarding implementing various quality initiatives in the healthcare sector was reviewed. Representatives from several healthcare organizations were surveyed. Results from both approaches are compared to highlight the key challenges and drivers facing implementers. This research reveals that internal factors related to leadership and employees greatly affect quality initiative success or failure. Design and relevance play a major role in successful implementation. PRACTICAL IMPLICATIONs: This research offers healthcare professionals greater success when implementing certain quality initiatives by taking success/failure factors into consideration. A general framework for successful implementation in the healthcare sector is provided. This article uncovers reasons behind success or failure in a comprehensive and practical way. It also explores how most popular quality initiatives are applied in hospitals.

Who are the innovators? Nursing homes implementing culture change.

PubMed

Grabowski, David C; Elliot, Amy; Leitzell, Brigitt; Cohen, Lauren W; Zimmerman, Sheryl

2014-02-01

A key directive of the Affordable Care Act of 2010 is to transform both institutional and community-based long-term care into a more person-centered system. In the nursing home industry, the culture change movement is central to this shift in philosophy. If policymakers are to further encourage implementation of culture change, they need to better understand the factors associated with implementation. Using logistic regression (N = 16,835), we examined the extent to which resident, facility, and state characteristics relate to a nursing home being identified by experts as having implemented culture change over the period 2004 through 2011. At baseline, the 291 facilities that were later identified by experts to have implemented culture change were more often nonprofit-owned, larger in size, and had fewer Medicaid and Medicare residents. Implementers also had better baseline quality with fewer health-related survey deficiencies and greater licensed practical nurse and nurse aide staffing. States experienced greater culture change implementation when they paid a higher Medicaid per diem. To date, nursing home culture change has been implemented differentially by higher resource facilities, and nursing homes have been responsive to state policy factors when implementing culture change.

A Review of Studies on the System-Wide Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in the Veterans Health Administration.

PubMed

Rosen, C S; Matthieu, M M; Wiltsey Stirman, S; Cook, J M; Landes, S; Bernardy, N C; Chard, K M; Crowley, J; Eftekhari, A; Finley, E P; Hamblen, J L; Harik, J M; Kehle-Forbes, S M; Meis, L A; Osei-Bonsu, P E; Rodriguez, A L; Ruggiero, K J; Ruzek, J I; Smith, B N; Trent, L; Watts, B V

2016-11-01

Since 2006, the Veterans Health Administration (VHA) has instituted policy changes and training programs to support system-wide implementation of two evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). To assess lessons learned from this unprecedented effort, we used PubMed and the PILOTS databases and networking with researchers to identify 32 reports on contextual influences on implementation or sustainment of EBPs for PTSD in VHA settings. Findings were initially organized using the exploration, planning, implementation, and sustainment framework (EPIS; Aarons et al. in Adm Policy Ment Health Health Serv Res 38:4-23, 2011). Results that could not be adequately captured within the EPIS framework, such as implementation outcomes and adopter beliefs about the innovation, were coded using constructs from the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework (Glasgow et al. in Am J Public Health 89:1322-1327, 1999) and Consolidated Framework for Implementation Research (CFIR; Damschroder et al. in Implement Sci 4(1):50, 2009). We highlight key areas of progress in implementation, identify continuing challenges and research questions, and discuss implications for future efforts to promote EBPs in large health care systems.

Program and Teacher Characteristics Predicting the Implementation of Banking Time with Preschoolers Who Display Disruptive Behaviors.

PubMed

Williford, Amanda P; Wolcott, Catherine Sanger; Whittaker, Jessica Vick; Locasale-Crouch, Jennifer

2015-11-01

This study examined the relationship among baseline program and teacher characteristics and subsequent implementation of Banking Time. Banking Time is a dyadic intervention intended to improve a teacher's interaction quality with a specific child. Banking Time implementation was examined in the current study using a sample of 59 teachers and preschool children displaying disruptive behaviors in the classroom (~three children per classroom). Predictors included preschool program type, teacher demographic characteristics (personal and professional), and teacher beliefs (self-efficacy, authoritarian beliefs, and negative attributions about child disruptive behavior). Multiple measures and methods (i.e., teacher report, consultant report, independent observations) were used to assess implementation. We created three implementation composite measures (dosage, quality, and generalized practice) that had high internal consistencies within each composite but were only modestly associated with one another, suggesting unique constructs of implementation. We found that type of preschool program was associated with dosage and quality. Aspects of teacher demographics related to all three implementation composites. Teacher beliefs predicted dosage and generalized practice. Results suggest that the factors that predict the implementation of Banking Time vary as a function of the type of implementation being assessed.

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.

Effectiveness-implementation Hybrid Designs

PubMed Central

Curran, Geoffrey M.; Bauer, Mark; Mittman, Brian; Pyne, Jeffrey M.; Stetler, Cheryl

2013-01-01

Objectives This study proposes methods for blending design components of clinical effectiveness and implementation research. Such blending can provide benefits over pursuing these lines of research independently; for example, more rapid translational gains, more effective implementation strategies, and more useful information for decision makers. This study proposes a “hybrid effectiveness-implementation” typology, describes a rationale for their use, outlines the design decisions that must be faced, and provides several real-world examples. Results An effectiveness-implementation hybrid design is one that takes a dual focus a priori in assessing clinical effectiveness and implementation. We propose 3 hybrid types: (1) testing effects of a clinical intervention on relevant outcomes while observing and gathering information on implementation; (2) dual testing of clinical and implementation interventions/strategies; and (3) testing of an implementation strategy while observing and gathering information on the clinical intervention’s impact on relevant outcomes. Conclusions The hybrid typology proposed herein must be considered a construct still in evolution. Although traditional clinical effectiveness and implementation trials are likely to remain the most common approach to moving a clinical intervention through from efficacy research to public health impact, judicious use of the proposed hybrid designs could speed the translation of research findings into routine practice. PMID:22310560

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

Towards implementing coordinated healthy lifestyle promotion in primary care: a mixed method study.

PubMed

Thomas, Kristin; Bendtsen, Preben; Krevers, Barbro

2015-01-01

Primary care is increasingly being encouraged to integrate healthy lifestyle promotion in routine care. However, implementation has been suboptimal. Coordinated care could facilitate lifestyle promotion practice but more empirical knowledge is needed about the implementation process of coordinated care initiatives. This study aimed to evaluate the implementation of a coordinated healthy lifestyle promotion initiative in a primary care setting. A mixed method, convergent, parallel design was used. Three primary care centres took part in a two-year research project. Data collection methods included individual interviews, document data and questionnaires. The General Theory of Implementation was used as a framework in the analysis to integrate the data sources. Multi-disciplinary teams were implemented in the centres although the role of the teams as a resource for coordinated lifestyle promotion was not fully embedded at the centres. Embedding of the teams was challenged by differences among the staff, patients and team members on resources, commitment, social norms and roles. The study highlights the importance of identifying and engaging key stakeholders early in an implementation process. The findings showed how the development phase influenced the implementation and embedding processes, which add aspects to the General Theory of Implementation.

Healthcare Managers' Experiences of Leading the Implementation of Video Conferencing in Discharge Planning Sessions: An Interview Study.

PubMed

Hofflander, Malin; Nilsson, Lina; Eriksén, Sara; Borg, Christel

2016-03-01

This article describes healthcare managers' experiences of leading the implementation of video conferencing in discharge planning sessions as a new tool in everyday practice. Data collection took place through individual interviews and the interviews were analyzed using qualitative content analysis with an inductive approach. The results indicate that managers identified two distinct leadership perspectives when they reflected on the implementation process. They described a desired way of leading the implementation and communicating about the upcoming change, understanding and securing support for decisions, as well as ensuring that sufficient time is available throughout the change process. They also, however, described how they perceived that the implementation process was actually taking place, highlighting the lack of planning and preparation as well as the need for support and to be supportive, and having the courage to adopt and lead the implementation. It is suggested that managers at all levels require more information and training in how to encourage staff to become involved in designing their everyday work and in the implementation process. Managers, too, need ongoing organizational support for good leadership throughout the implementation of video conferencing in discharge planning sessions, including planning, start-up, implementation, and evaluation.

Evidence that self-incentives increase fruit consumption: a randomized exploratory trial among high-risk romanian adolescents.

PubMed

Armitage, Christopher J

2014-04-01

High mortality rates associated with cancer and cardiovascular disease in Romania have been partly attributed to low fruit consumption. The aim of the present research was to test whether self-incentives delivered via implementation intentions could increase fruit consumption among 238 high-risk Romanian adolescents. Participants were randomly allocated to either: (1) a control condition (asked to plan to increase their fruit intake but given no further instruction), (2) a standard implementation intention condition (asked to form an implementation intention using standard open-ended instructions), or (3) a self-incentivizing implementation intention condition (asked to reward themselves at the end of the week if they had successfully consumed an extra portion of fruit each day). There were significant increases in fruit consumption in the self-incentivizing implementation intention condition, but not in the control condition or-contrary to predictions-in the standard implementation intention condition. The findings support the use of implementation intentions to deliver self-incentives and increase fruit consumption, and suggest that providing children with a structured prompt might enhance the effectiveness of implementation intention-based interventions compared with standard implementation intention instructions.

Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers.

PubMed

Alidina, Shehnaz; Goldhaber-Fiebert, Sara N; Hannenberg, Alexander A; Hepner, David L; Singer, Sara J; Neville, Bridget A; Sachetta, James R; Lipsitz, Stuart R; Berry, William R

2018-03-26

Operating room (OR) crises are high-acuity events requiring rapid, coordinated management. Medical judgment and decision-making can be compromised in stressful situations, and clinicians may not experience a crisis for many years. A cognitive aid (e.g., checklist) for the most common types of crises in the OR may improve management during unexpected and rare events. While implementation strategies for innovations such as cognitive aids for routine use are becoming better understood, cognitive aids that are rarely used are not yet well understood. We examined organizational context and implementation process factors influencing the use of cognitive aids for OR crises. We conducted a cross-sectional study using a Web-based survey of individuals who had downloaded OR cognitive aids from the websites of Ariadne Labs or Stanford University between January 2013 and January 2016. In this paper, we report on the experience of 368 respondents from US hospitals and ambulatory surgical centers. We analyzed the relationship of more successful implementation (measured as reported regular cognitive aid use during applicable clinical events) with organizational context and with participation in a multi-step implementation process. We used multivariable logistic regression to identify significant predictors of reported, regular OR cognitive aid use during OR crises. In the multivariable logistic regression, small facility size was associated with a fourfold increase in the odds of a facility reporting more successful implementation (p = 0.0092). Completing more implementation steps was also significantly associated with more successful implementation; each implementation step completed was associated with just over 50% higher odds of more successful implementation (p ≤ 0.0001). More successful implementation was associated with leadership support (p < 0.0001) and dedicated time to train staff (p = 0.0189). Less successful implementation was associated with resistance among clinical providers to using cognitive aids (p < 0.0001), absence of an implementation champion (p = 0.0126), and unsatisfactory content or design of the cognitive aid (p = 0.0112). Successful implementation of cognitive aids in ORs was associated with a supportive organizational context and following a multi-step implementation process. Building strong organizational support and following a well-planned multi-step implementation process will likely increase the use of OR cognitive aids during intraoperative crises, which may improve patient outcomes.

The European Society of Human Reproduction and Embryology guideline for the diagnosis and treatment of endometriosis: an electronic guideline implementability appraisal

PubMed Central

2011-01-01

Background Clinical guidelines are intended to improve healthcare. However, even if guidelines are excellent, their implementation is not assured. In subfertility care, the European Society of Human Reproduction and Embryology (ESHRE) guidelines have been inventoried, and their methodological quality has been assessed. To improve the impact of the ESHRE guidelines and to improve European subfertility care, it is important to optimise the implementability of guidelines. We therefore investigated the implementation barriers of the ESHRE guideline with the best methodological quality and evaluated the used instrument for usability and feasibility. Methods We reviewed the ESHRE guideline for the diagnosis and treatment of endometriosis to assess its implementability. We used an electronic version of the guideline implementability appraisal (eGLIA) instrument. This eGLIA tool consists of 31 questions grouped into 10 dimensions. Seven items address the guideline as a whole, and 24 items assess the individual recommendations in the guideline. The eGLIA instrument identifies factors that influence the implementability of the guideline recommendations. These factors can be divided into facilitators that promote implementation and barriers that oppose implementation. A panel of 10 experts from three European countries appraised all 36 recommendations of the guideline. They discussed discrepancies in a teleconference and completed a questionnaire to evaluate the ease of use and overall utility of the eGLIA instrument. Results Two of the 36 guideline recommendations were straightforward to implement. Five recommendations were considered simply statements because they contained no actions. The remaining 29 recommendations were implementable with some adjustments. We found facilitators of the guideline implementability in the quality of decidability, presentation and formatting, apparent validity, and novelty or innovation of the recommendations. Vaguely defined actions, lack of facilities, immeasurable outcomes, and inflexibility within the recommendations formed barriers to implementation. The eGLIA instrument was generally useful and easy to use. However, assessment with the eGLIA instrument is very time-consuming. Conclusions The ESHRE guideline for the diagnosis and treatment of endometriosis could be improved to facilitate its implementation in daily practice. The eGLIA instrument is a helpful tool for identifying obstacles to implementation of a guideline. However, we recommend a concise version of this instrument. PMID:21247418

Toward optimal implementation of cancer prevention and control programs in public health: a study protocol on mis-implementation.

PubMed

Padek, Margaret; Allen, Peg; Erwin, Paul C; Franco, Melissa; Hammond, Ross A; Heuberger, Benjamin; Kasman, Matt; Luke, Doug A; Mazzucca, Stephanie; Moreland-Russell, Sarah; Brownson, Ross C

2018-03-23

Much of the cancer burden in the USA is preventable, through application of existing knowledge. State-level funders and public health practitioners are in ideal positions to affect programs and policies related to cancer control. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones. Greater attention to mis-implementation should lead to use of effective interventions and more efficient expenditure of resources, which in the long term, will lead to more positive cancer outcomes. This is a three-phase study that takes a comprehensive approach, leading to the elucidation of tactics for addressing mis-implementation. Phase 1: We assess the extent to which mis-implementation is occurring among state cancer control programs in public health. This initial phase will involve a survey of 800 practitioners representing all states. The programs represented will span the full continuum of cancer control, from primary prevention to survivorship. Phase 2: Using data from phase 1 to identify organizations in which mis-implementation is particularly high or low, the team will conduct eight comparative case studies to get a richer understanding of mis-implementation and to understand contextual differences. These case studies will highlight lessons learned about mis-implementation and identify hypothesized drivers. Phase 3: Agent-based modeling will be used to identify dynamic interactions between individual capacity, organizational capacity, use of evidence, funding, and external factors driving mis-implementation. The team will then translate and disseminate findings from phases 1 to 3 to practitioners and practice-related stakeholders to support the reduction of mis-implementation. This study is innovative and significant because it will (1) be the first to refine and further develop reliable and valid measures of mis-implementation of public health programs; (2) bring together a strong, transdisciplinary team with significant expertise in practice-based research; (3) use agent-based modeling to address cancer control implementation; and (4) use a participatory, evidence-based, stakeholder-driven approach that will identify key leverage points for addressing mis-implementation among state public health programs. This research is expected to provide replicable computational simulation models that can identify leverage points and public health system dynamics to reduce mis-implementation in cancer control and may be of interest to other health areas.

Teacher Perceptions about New Evaluation Model Implementations

ERIC Educational Resources Information Center

Bush, Charles D.

2017-01-01

The challenge of designing and implementing teacher evaluation reform throughout the U.S. has been represented by different policies, teacher evaluation components, and difficulties with implementation. The purpose of this qualitative embedded single case study was to explore teacher perceptions about new evaluation model implementations and how…

24 CFR 598.605 - Implementation plan.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 3 2012-04-01 2012-04-01 false Implementation plan. 598.605 Section 598.605 Housing and Urban Development Regulations Relating to Housing and Urban Development... Empowerment Zone Grants § 598.605 Implementation plan. (a) Implementation plan content. An EZ must submit an...

24 CFR 598.605 - Implementation plan.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 3 2013-04-01 2013-04-01 false Implementation plan. 598.605 Section 598.605 Housing and Urban Development Regulations Relating to Housing and Urban Development... Empowerment Zone Grants § 598.605 Implementation plan. (a) Implementation plan content. An EZ must submit an...

Supporting Implementation of Evidence-Based Practices through Practice-Based Coaching

ERIC Educational Resources Information Center

Snyder, Patricia A; Hemmeter, Mary Louise; Fox, Lise

2015-01-01

In active implementation science frameworks, coaching has been described as an important competency "driver" to ensure evidence-based practices are implemented as intended. Empirical evidence also has identified coaching as a promising job-embedded professional development strategy to support implementation of quality teaching practices.…

77 FR 48061 - Approval and Promulgation of Air Quality Implementation Plans; Pennsylvania; Regional Haze State...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-13

... Promulgation of Air Quality Implementation Plans; Pennsylvania; Regional Haze State Implementation Plan...'s limited approval of Pennsylvania's Regional Haze State Implementation Plan (SIP). DATES: Effective... announcing our limited approval of Pennsylvania's Regional Haze SIP. In this document, we inadvertently...

Providing Feasible Implementation Support: Direct Training and Implementation Planning in Consultation

ERIC Educational Resources Information Center

Collier-Meek, Melissa A.; Sanetti, Lisa M. H.; Boyle, Ashley M.

2016-01-01

To deliver interventions completely and consistently (i.e., with adequate treatment integrity) and, thus, have a positive impact on student outcomes, implementers, such as teachers and paraprofessionals, often require support. To efficiently deliver implementation support, school psychologists could embed research-based strategies into their…

34 CFR 300.150 - SEA implementation of procedural safeguards.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 2 2012-07-01 2012-07-01 false SEA implementation of procedural safeguards. 300.150... EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility Sea Responsibility for General Supervision and Implementation of Procedural Safeguards § 300.150 SEA implementation of procedural safeguards. The SEA (and any...

34 CFR 300.150 - SEA implementation of procedural safeguards.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 2 2013-07-01 2013-07-01 false SEA implementation of procedural safeguards. 300.150... EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility Sea Responsibility for General Supervision and Implementation of Procedural Safeguards § 300.150 SEA implementation of procedural safeguards. The SEA (and any...

34 CFR 300.150 - SEA implementation of procedural safeguards.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 2 2014-07-01 2013-07-01 true SEA implementation of procedural safeguards. 300.150... EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility Sea Responsibility for General Supervision and Implementation of Procedural Safeguards § 300.150 SEA implementation of procedural safeguards. The SEA (and any...

34 CFR 300.150 - SEA implementation of procedural safeguards.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true SEA implementation of procedural safeguards. 300.150... EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility Sea Responsibility for General Supervision and Implementation of Procedural Safeguards § 300.150 SEA implementation of procedural safeguards. The SEA (and any...

34 CFR 300.150 - SEA implementation of procedural safeguards.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 2 2010-07-01 2010-07-01 false SEA implementation of procedural safeguards. 300.150... EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility Sea Responsibility for General Supervision and Implementation of Procedural Safeguards § 300.150 SEA implementation of procedural safeguards. The SEA (and any...

CAS as Environments for Implementing Mathematical Microworlds.

ERIC Educational Resources Information Center

Alpers, Burkhard

2002-01-01

Investigates whether computer algebra systems (CAS) are suitable environments for implementing mathematical microworlds. Recalls what constitutes a microworld and explores how CAS can be used for implementation, stating potentials as well as limitations. Provides as an example the microworld "Formula 1", implemented in Maple Software. (Author/KHR)

45 CFR 162.920 - Availability of implementation specifications.

Code of Federal Regulations, 2010 CFR

2010-10-01

... implementation specifications and the Technical Reports Type 3 described in subparts I through S of this part... implementation specifications, which include the Technical Reports Type 3 described in this section, for... part 51. The implementation specifications and Technical Reports Type 3 described in this section are...

Teachers Teaching Differently: A Qualitative Study of Implementation Fidelity to Professional Development

ERIC Educational Resources Information Center

Woolley, Michael E.; Rose, Roderick A.; Mercado, Micaela; Orthner, Dennis K.

2013-01-01

Intervention researchers in school settings often implement interventions that involve professional development to schoolteachers or other professional staff to implement school-based interventions. In terms of classroom interventions, teachers are the primary implementation agents; therefore, the fidelity of such interventions depends on teacher…

Disability Policy Implementation from a Cross-Cultural Perspective

ERIC Educational Resources Information Center

Verdugo, Miguel A.; Jenaro, Cristina; Calvo, Isabel; Navas, Patricia

2017-01-01

Implementation of disability policy is influenced by social, political, and cultural factors. Based on published work, this article discusses four guidelines considered critical for successful policy implementation from a cross-cultural perspective. These guidelines are to: (a) base policy implementation on a contextual analysis, (b) employ a…

78 FR 68005 - Approval and Promulgation of Implementation Plans; Mississippi; Transportation Conformity SIP...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-13

... this Federal Register, EPA is approving the State's implementation plan revision as a direct final rule...] Approval and Promulgation of Implementation Plans; Mississippi; Transportation Conformity SIP--Memorandum... proposing to approve a State Implementation Plan revision submitted by the Mississippi Department of...

45 CFR 162.920 - Availability of implementation specifications and operating rules.

Code of Federal Regulations, 2011 CFR

2011-10-01

... publications is consistent with the policies of other publishers of standards. The transaction implementation... publications is consistent with the policies of other publishers of standards. The transaction implementation... 45 Public Welfare 1 2011-10-01 2011-10-01 false Availability of implementation specifications and...

Interprofessional Health Team Communication About Hospital Discharge: An Implementation Science Evaluation Study.

PubMed

Bahr, Sarah J; Siclovan, Danielle M; Opper, Kristi; Beiler, Joseph; Bobay, Kathleen L; Weiss, Marianne E

The Consolidated Framework for Implementation Research guided formative evaluation of the implementation of a redesigned interprofessional team rounding process. The purpose of the redesigned process was to improve health team communication about hospital discharge. Themes emerging from interviews of patients, nurses, and providers revealed the inherent value and positive characteristics of the new process, but also workflow, team hierarchy, and process challenges to successful implementation. The evaluation identified actionable recommendations for modifying the implementation process.

Design requirements for SRB production control system. Volume 4: Implementation

NASA Technical Reports Server (NTRS)

1981-01-01

The implementation plan which is presented was developed to provide the means for the successful implementation of the automated production control system. There are three factors which the implementation plan encompasses: detailed planning; phased implementation; and user involvement. The plan is detailed to the task level in terms of necessary activities as the system is developed, refined, installed, and tested. These tasks are scheduled, on a preliminary basis, over a two-and-one-half-year time frame.

Software Defined GPS API: Development and Implementation of GPS Correlator Architectures Using MATLAB with Focus on SDR Implementations

DTIC Science & Technology

2014-05-18

intention of offering improved software libraries for GNSS signal acquisition. It has been the team mission to implement new and improved techniques...with the intention of offering improved software libraries for GNSS signal acquisition. It has been the team mission to implement new and improved...intention of offering improved software libraries for GNSS signal acquisition. It has been the team mission to implement new and improved techniques to

Implementing advanced nurse practitioner roles in acute care: an evaluation of organizational change.

PubMed

Cummings, Greta G; Fraser, Kim; Tarlier, Denise S

2003-03-01

Medical shortages are seen as the driving force behind the recent implementation of the advanced nurse practitioner (ANP) role in some Canadian hospitals. The authors analyzed the implementation of the ANP role in one tertiary care teaching hospital from the organizational change perspective. Despite successful implementation, issues of role definition, scope of practice boundaries, and staff reactions remain unresolved. Recommendations are discussed for implementing ANP roles in other acute care facilities.

Why TQM does not work in Iranian healthcare organisations.

PubMed

Mosadeghrad, Ali Mohammad

2014-01-01

Despite the potential benefits of total quality management (TQM), many healthcare organisations encountered difficulties in its implementation. The purpose of this paper is to explore the barriers to successful implementation of TQM in healthcare organisations of Iran. This study involved a mixed research design. In-depth interviews were conducted with TQM practitioners to explore TQM implementation obstacles in Iranian healthcare organisations. In addition, this study involved survey-based research on the obstacles associated with successful TQM transformation. TQM implementation and its impact depend on the ability of managers to adopt and adapt its values and concepts in professional healthcare organisations. Unsuccessful TQM efforts in Iranian healthcare organisations can be attributed to the non-holistic approach adopted in its implementation, inadequate knowledge of managers' about TQM implementation, frequent top management turnover, poor planning, vague and short-termed improvement goals, lack of consistent managers' and employees' commitment to and involvement in TQM implementation, lack of a corporate quality culture, lack of team orientation, lack of continuous education and training and lack of customer focus. Human resource problems, cultural and strategic problems were the most important obstacles to TQM successful implementation, respectively. Understanding the factors that are likely to obstruct TQM implementation would enable managers to develop more viable strategies for achieving business excellence. Understanding the factors that are likely to obstruct TQM implementation will help organisations in planning better TQM models.

Analog hardware implementation of neocognitron networks

NASA Astrophysics Data System (ADS)

Inigo, Rafael M.; Bonde, Allen, Jr.; Holcombe, Bradford

1990-08-01

This paper deals with the analog implementation of neocognitron based neural networks. All of Fukushima''s and related work on the neocognitron is based on digital computer simulations. To fully take advantage of the power of this network paradigm an analog electronic approach is proposed. We first implemented a 6-by-6 sensor network with discrete analog components and fixed weights. The network was given weight values to recognize the characters U L and F. These characters are recognized regardless of their location on the sensor and with various levels of distortion and noise. The network performance has also shown an excellent correlation with software simulation results. Next we implemented a variable weight network which can be trained to recognize simple patterns by means of self-organization. The adaptable weights were implemented with PETs configured as voltage-controlled resistors. To implement a variable weight there must be some type of " memory" to store the weight value and hold it while the value is reinforced or incremented. Two methods were evaluated: an analog sample-hold circuit and a digital storage scheme using binary counters. The latter is preferable for VLSI implementation because it uses standard components and does not require the use of capacitors. The analog design and implementation of these small-scale networks demonstrates the feasibility of implementing more complicated ANNs in electronic hardware. The circuits developed can also be designed for VLSI implementation. 1.

Characterizing implementation strategies using a systems engineering survey and interview tool: a comparison across 10 prevention programs for drug abuse and HIV sexual risk behavior.

PubMed

Czaja, Sara J; Valente, Thomas W; Nair, Sankaran N; Villamar, Juan A; Brown, C Hendricks

2016-05-17

Although many behavioral interventions have proven to be efficacious, new methodologies are required beyond efficacy trials to understand how to adopt, implement with fidelity, and sustain behavioral interventions in community settings. In this paper, we present a new approach, based on systems engineering concepts and methods, for characterizing implementation strategies that are used to deliver evidence-based behavioral interventions in health and social service settings. We demonstrate the use of this approach with implementation strategies, used or being used for broader dissemination of 10 evidence-based prevention program projects focused on the prevention of drug or HIV sex risk behaviors. The results indicate that there are wide variations in intervention approaches and that there are challenges in program implementation including maintaining program fidelity, serving community needs, and adequate resources. The results also indicate that implementation requires a committed partnership between the program developers, implementation researchers, and community partners. In addition, there is a need for adaptability within programs to meet community needs, resources, and priorities while maintaining program fidelity. Our methodological approach enabled us to highlight challenges associated with the community implementation of health risk prevention interventions. We also demonstrate how comprehensive descriptions of interventions facilitate understanding of the requirements of program implementation and decisions about the feasibility of implementing a program in community settings.

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.

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 app to improve client use, and its ease of use. The mobile phone itself was a strong motivation for clients to opt in to use the app in settings that provided phones. App access was limited in settings that did not provide phones owing to lack of mobile phone ownership or incompatibility of the app with clients' mobile phones. Individual differences in technology literacy and provider beliefs about substance use care either facilitated or challenged implementation. Awareness of patient needs and resources facilitated implementation, whereas external policies and regulations regarding technology use introduced barriers to implementation. The conceptually grounded facilitators and barriers identified in this study can guide systematic targeting of strategies to improve implementation of mobile phone interventions in community treatment settings. Results also inform the design of technology-based therapeutic tools. This study highlights directions for research with regard to implementation of technology-based behavioral health care approaches.

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 usual care, the ability to adapt the app to improve client use, and its ease of use. The mobile phone itself was a strong motivation for clients to opt in to use the app in settings that provided phones. App access was limited in settings that did not provide phones owing to lack of mobile phone ownership or incompatibility of the app with clients’ mobile phones. Individual differences in technology literacy and provider beliefs about substance use care either facilitated or challenged implementation. Awareness of patient needs and resources facilitated implementation, whereas external policies and regulations regarding technology use introduced barriers to implementation. Conclusions The conceptually grounded facilitators and barriers identified in this study can guide systematic targeting of strategies to improve implementation of mobile phone interventions in community treatment settings. Results also inform the design of technology-based therapeutic tools. This study highlights directions for research with regard to implementation of technology-based behavioral health care approaches. PMID:27352884

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 three provinces. A total of 203 barriers/facilitators were extracted across the ten implementation studies, most of which related to the environmental context and resources (ECR; n = 86; 37.4%), beliefs about consequences (n = 41; 17.8%), and social influences (n = 36; 15.7%) TDF domains. With the limited research examining the DPA policy in Canada, the current status and approaches used to implement DPA and the student-level effectiveness is not well understood; however, this review revealed that DPA deliverers often report many barriers to DPA implementation. Most importantly, in conducting a TDF-based analysis of the barriers/facilitators affecting implementation, this review provides a theoretical basis by which researchers and policy-makers can design interventions to better target these problems in the future. A protocol for this review was not registered.

Risk assessment for enterprise resource planning (ERP) system implementations: a fault tree analysis approach

NASA Astrophysics Data System (ADS)

Zeng, Yajun; Skibniewski, Miroslaw J.

2013-08-01

Enterprise resource planning (ERP) system implementations are often characterised with large capital outlay, long implementation duration, and high risk of failure. In order to avoid ERP implementation failure and realise the benefits of the system, sound risk management is the key. This paper proposes a probabilistic risk assessment approach for ERP system implementation projects based on fault tree analysis, which models the relationship between ERP system components and specific risk factors. Unlike traditional risk management approaches that have been mostly focused on meeting project budget and schedule objectives, the proposed approach intends to address the risks that may cause ERP system usage failure. The approach can be used to identify the root causes of ERP system implementation usage failure and quantify the impact of critical component failures or critical risk events in the implementation process.

Succesful Lean Manufacturing Implementation: Internal Key Influencing Factors

NASA Astrophysics Data System (ADS)

Virginia, Iuga; Claudiu, Kifor

2015-09-01

Manufacturing sectors and companies all over the world are successfully implementing lean principles within their processes. Nowadays, lean has become an indispensable part of global players. Companies worldwide need to be aware of multiple factors which weigh heavily on the success or failure of lean implementation. This paper focuses on giving a brief and structured overview over the fundamental organizational factors which play a substantial role for the lean manufacturing (LM) implementation process. The study below focuses on internal factors which are indispensable for a successful LM implementation within organizations. It is imperative that these internal factors are known, recognized and taken into consideration during the whole LM implementation process. Ignoring their influence on the process's implementation may lead to endangering the expected results or to making the process more difficult which could result in much higher human resource consumption.

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.

Clinical Practice Guideline Implementation Strategy Patterns in Veterans Affairs Primary Care Clinics

PubMed Central

Hysong, Sylvia J; Best, Richard G; Pugh, Jacqueline A

2007-01-01

Background The Department of Veterans Affairs (VA) mandated the system-wide implementation of clinical practice guidelines (CPGs) in the mid-1990s, arming all facilities with basic resources to facilitate implementation; despite this resource allocation, significant variability still exists across VA facilities in implementation success. Objective This study compares CPG implementation strategy patterns used by high and low performing primary care clinics in the VA. Research Design Descriptive, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low performance on six CPGs. Subjects One hundred and two employees (management, quality improvement, clinic personnel) involved with guideline implementation at each VAMC primary care clinic. Measures Participants reported specific strategies used by their facility to implement guidelines in 1-hour semi-structured interviews. Facilities were classified as high or low performers based on their guideline adherence scores calculated through independently conducted chart reviews. Findings High performing facilities (HPFs) (a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, (b) invested dedicated resources to guideline-related initiatives, and (c) exhibited a clear direction in their strategy choices. Low performing facilities exhibited (a) earlier stages of development for their electronic medical record, (b) reliance on preexisting resources for guideline implementation, with little local adaptation, and (c) no clear direction in their strategy choices. Conclusion A multifaceted, yet targeted, strategic approach to guideline implementation emphasizing dedicated resources and local adaptation may result in more successful implementation and higher guideline adherence than relying on standardized resources and taxing preexisting channels. PMID:17355583

Factors that affect implementation of a nurse staffing directive: results from a qualitative multi-case evaluation.

PubMed

Robinson, Claire H; Annis, Ann M; Forman, Jane; Krein, Sarah L; Yankey, Nicholas; Duffy, Sonia A; Taylor, Beth; Sales, Anne E

2016-08-01

To assess implementation of the Veterans Health Administration staffing methodology directive. In 2010 the Veterans Health Administration promulgated a staffing methodology directive for inpatient nursing units to address staffing and budget forecasting. A qualitative multi-case evaluation approach assessed staffing methodology implementation. Semi-structured telephone interviews were conducted from March - June 2014 with Nurse Executives and their teams at 21 facilities. Interviews focused on the budgeting process, implementation experiences, use of data, leadership support, and training. An implementation score was created for each facility using a 4-point rating scale. The scores were used to select three facilities (low, medium and high implementation) for more detailed case studies. After analysing interview summaries, the evaluation team developed a four domain scoring structure: (1) integration of staffing methodology into budget development; (2) implementation of the Directive elements; (3) engagement of leadership and staff; and (4) use of data to support the staffing methodology process. The high implementation facility had leadership understanding and endorsement of staffing methodology, confidence in and ability to work with data, and integration of staffing methodology results into the budgeting process. The low implementation facility reported poor leadership engagement and little understanding of data sources and interpretation. Implementation varies widely across facilities. Implementing staffing methodology in facilities with complex and changing staffing needs requires substantial commitment at all organizational levels especially for facilities that have traditionally relied on historical levels to budget for staffing. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

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.

Barriers and Enablers to Implementation of Dietary Guidelines in Early Childhood Education Centers in Australia: Application of the Theoretical Domains Framework.

PubMed

Grady, Alice; Seward, Kirsty; Finch, Meghan; Fielding, Alison; Stacey, Fiona; Jones, Jannah; Wolfenden, Luke; Yoong, Sze Lin

2018-03-01

To identify perceived barriers and enablers to implementation of dietary guidelines reported by early childhood education center cooks, and barriers and enablers associated with greater implementation based on assessment of center menu compliance. Cross-sectional telephone interview. Early childhood education centers, New South Wales, Australia. A total of 202 cooks responsible for menu planning; 70 centers provided a menu for review of compliance with dietary guidelines. Barriers and enablers to dietary guideline implementation were determined using a tool assessing constructs of the Theoretical Domains Framework (TDF). Higher scores (≥6) for each construct indicated enablers to guideline implementation; lower scores (<6) suggested barriers. Multivariable linear regression identified TDF constructs associated with greater guideline implementation. Scores were lowest for reinforcement (mean, 5.85) and goals (mean, 5.89) domains, and highest for beliefs about consequences (mean, 6.51) and social/professional role and identity (mean, 6.50). The skills domain was positively associated with greater implementation of guidelines based on menu review (P = .01). Cooks perceived social/professional role and identity, and beliefs about consequences to be enablers to dietary guideline implementation; however, only the skills domain was associated with greater implementation. There are opportunities to target the incongruence in perceptions vs reality of the barriers and enablers to implementation. Future research could examine the utility of the TDF to identify barriers and enablers to implementation to inform intervention development and for evaluating interventions to examine intervention mechanisms. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Investigating variations in implementation fidelity of an organizational-level occupational health intervention.

PubMed

Augustsson, Hanna; von Thiele Schwarz, Ulrica; Stenfors-Hayes, Terese; Hasson, Henna

2015-06-01

The workplace has been suggested as an important arena for health promotion, but little is known about how the organizational setting influences the implementation of interventions. The aims of this study are to evaluate implementation fidelity in an organizational-level occupational health intervention and to investigate possible explanations for variations in fidelity between intervention units. The intervention consisted of an integration of health promotion, occupational health and safety, and a system for continuous improvements (Kaizen) and was conducted in a quasi-experimental design at a Swedish hospital. Implementation fidelity was evaluated with the Conceptual Framework for Implementation Fidelity and implementation factors used to investigate variations in fidelity with the Framework for Evaluating Organizational-level Interventions. A multi-method approach including interviews, Kaizen notes, and questionnaires was applied. Implementation fidelity differed between units even though the intervention was introduced and supported in the same way. Important differences in all elements proposed in the model for evaluating organizational-level interventions, i.e., context, intervention, and mental models, were found to explain the differences in fidelity. Implementation strategies may need to be adapted depending on the local context. Implementation fidelity, as well as pre-intervention implementation elements, is likely to affect the implementation success and needs to be assessed in intervention research. The high variation in fidelity across the units indicates the need for adjustments to the type of designs used to assess the effects of interventions. Thus, rather than using designs that aim to control variation, it may be necessary to use those that aim at exploring and explaining variation, such as adapted study designs.

REACH VA: Moving from Translation to System Implementation.

PubMed

Nichols, Linda O; Martindale-Adams, Jennifer; Burns, Robert; Zuber, Jeffrey; Graney, Marshall J

2016-02-01

Resources for Enhancing All Caregivers Health in the Department of Veterans Affairs (REACH VA) has been implemented in the VA system as a national program for caregivers. We describe the trajectory of REACH VA from national randomized clinical trial through translation to national implementation. The implementation is examined through the six stages of the Fixsen and Blasé implementation process model: exploration and adoption, program installation, initial implementation, full operation, innovation, and sustainability. Different drivers that move the implementation process forward are important at each stage, including staff selection, staff training, consultation and coaching, staff evaluation, administrative support, program evaluation/fidelity, and systems interventions. Caregivers in the REACH VA 4 session intervention currently implemented in the VA had similar outcomes to longer REACH interventions, including Resources for Enhancing Alzheimer's Caregivers Health (REACH II). Caregivers experienced significant decreases in burden, depression, anxiety, number of troubling patient behaviors reported, caregiving frustrations, stress symptoms (feeling overwhelmed, feeling like crying, being frustrated as a result of caregiving, being lonely), and general stress. Effect sizes (Cohen's d) for these significant variables were between small and medium ranging from .24 to .46. The implementation of REACH VA provides a road map for implementation of other behavioral interventions in health care delivery settings. Lessons learned include the importance of implementing a proven, needed intervention, support from both leadership and clinical staff, willingness to respond to staff and organization needs and modify the intervention while preserving its integrity, and fitting the intervention into ongoing routines and practices. Published by Oxford University Press on behalf of the Gerontological Society of America 2014.

Taking Root: a grounded theory on evidence-based nursing implementation in China.

PubMed

Cheng, L; Broome, M E; Feng, S; Hu, Y

2018-06-01

Evidence-based nursing is widely recognized as the critical foundation for quality care. To develop a middle-range theory on the process of evidence-based nursing implementation in Chinese context. A grounded theory study using unstructured in-depth individual interviews was conducted with 56 participants who were involved in 24 evidence-based nursing implementation projects in Mainland China from September 2015 to September 2016. A middle-range grounded theory of 'Taking Root' was developed. The theory describes the evidence implementation process consisting of four components (driving forces, process, outcome, sustainment/regression), three approaches (top-down, bottom-up and outside-in), four implementation strategies (patient-centred, nurses at the heart of change, reaching agreement, collaboration) and two patterns (transformational and adaptive implementation). Certain perspectives may have not been captured, as the retrospective nature of the interviewing technique did not allow for 'real-time' assessment of the actual implementation process. The transferability of the findings requires further exploration as few participants with negative experiences were recruited. This is the first study that explored evidence-based implementation process, strategies, approaches and patterns in the Chinese nursing practice context to inform international nursing and health policymaking. The theory of Taking Root described various approaches to evidence implementation and how the implementation can be transformational for the nurses and the setting in which they work. Nursing educators, managers and researchers should work together to improve nurses' readiness for evidence implementation. Healthcare systems need to optimize internal mechanisms and external collaborations to promote nursing practice in line with evidence and achieve clinical outcomes and sustainability. © 2017 International Council of Nurses.

Harnessing Implementation Science to Increase the Impact of Health Disparity Research

PubMed Central

Chinman, Matthew; Woodward, Eva N.; Curran, Geoffrey M.; Hausmann, Leslie R. M.

2017-01-01

Background Health disparities are differences in health or health care between groups based on social, economic, and/or environmental disadvantage. Disparity research often follows three steps: detecting (Phase 1), understanding (Phase 2), and reducing (Phase 3), disparities. While disparities have narrowed over time, many remain. Objectives We argue that implementation science could enhance disparities research by broadening the scope of Phase 2 studies and offering rigorous methods to test disparity-reducing implementation strategies in Phase 3 studies. Methods We briefly review the focus of Phase 2 and Phase 3 disparities research. We then provide a decision tree and case examples to illustrate how implementation science frameworks and research designs could further enhance disparity research. Results Most health disparities research emphasizes patient and provider factors as predominant mechanisms underlying disparities. Applying implementation science frameworks like the Consolidated Framework for Implementation Research could help disparities research widen its scope in Phase 2 studies and, in turn, develop broader disparities-reducing implementation strategies in Phase 3 studies. Many Phase 3 studies of disparity reducing implementation strategies are similar to case studies, whose designs are not able to fully test causality. Implementation science research designs offer rigorous methods that could accelerate the pace at which equity is achieved in real world practice. Conclusions Disparities can be considered a “special case” of implementation challenges—when evidence-based clinical interventions are delivered to, and received by, vulnerable populations at lower rates. Bringing together health disparities research and implementation science could advance equity more than either could achieve on their own. PMID:28806362

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.

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.

Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study.

PubMed

Waltz, Thomas J; Powell, Byron J; Matthieu, Monica M; Damschroder, Laura J; Chinman, Matthew J; Smith, Jeffrey L; Proctor, Enola K; Kirchner, JoAnn E

2015-08-07

Poor terminological consistency for core concepts in implementation science has been widely noted as an obstacle to effective meta-analyses. This inconsistency is also a barrier for those seeking guidance from the research literature when developing and planning implementation initiatives. The Expert Recommendations for Implementing Change (ERIC) study aims to address one area of terminological inconsistency: discrete implementation strategies involving one process or action used to support a practice change. The present report is on the second stage of the ERIC project that focuses on providing initial validation of the compilation of 73 implementation strategies that were identified in the first phase. Purposive sampling was used to recruit a panel of experts in implementation science and clinical practice (N = 35). These key stakeholders used concept mapping sorting and rating activities to place the 73 implementation strategies into similar groups and to rate each strategy's relative importance and feasibility. Multidimensional scaling analysis provided a quantitative representation of the relationships among the strategies, all but one of which were found to be conceptually distinct from the others. Hierarchical cluster analysis supported organizing the 73 strategies into 9 categories. The ratings data reflect those strategies identified as the most important and feasible. This study provides initial validation of the implementation strategies within the ERIC compilation as being conceptually distinct. The categorization and strategy ratings of importance and feasibility may facilitate the search for, and selection of, strategies that are best suited for implementation efforts in a particular setting.

What determines successful implementation of inpatient information technology systems?

PubMed

Spetz, Joanne; Burgess, James F; Phibbs, Ciaran S

2012-03-01

To identify the factors and strategies that were associated with successful implementation of hospital-based information technology (IT) systems in US Department of Veterans Affairs (VA) hospitals, and how these might apply to other hospitals. Qualitative analysis of 118 interviews conducted at 7 VA hospitals. The study focused on the inpatient setting, where nurses are the main patient-care providers; thus, the research emphasized the impact of Computerized Patient Record System and Bar Code Medication Administration on nurses. Hospitals were selected to represent a range of IT implementation dates, facility sizes, and geography. The subjects included nurses, pharmacists, physicians, IT staff, and managers. Interviews were guided by a semi-structured interview protocol, and a thematic analysis was conducted, with initial codes drawn from the content of the interview guides. Additional themes were proposed as the coding was conducted. Five broad themes arose as factors which affected the process and success of implementation: (1) organizational stability and implementation team leadership, (2) implementation timelines, (3) equipment availability and reliability, (4) staff training, and (5) changes in work flow Overall IT implementation success in the VA depended on: (1) whether there was support for change from both leaders and staff, (2) development of a gradual and flexible implementation approach, (3) allocation of adequate resources for equipment and infrastructure, hands-on support, and deployment of additional staff, and (4) how the implementation team planned for setbacks, and continued the process to achieve success. Problems that developed in the early stages of implementation tended to become persistent, and poor implementation can lead to patient harm.

Characteristics of Local Health Departments Associated with Implementation of Electronic Health Records and Other Informatics Systems.

PubMed

Shah, Gulzar H; Leider, Jonathon P; Castrucci, Brian C; Williams, Karmen S; Luo, Huabin

2016-01-01

Assessing local health departments' (LHDs') informatics capacities is important, especially within the context of broader, systems-level health reform. We assessed a nationally representative sample of LHDs' adoption of information systems and the factors associated with adoption and implementation by examining electronic health records, health information exchange, immunization registry, electronic disease reporting system, and electronic laboratory reporting. We used data from the National Association of County and City Health Officials' 2013 National Profile of LHDs. We performed descriptive statistics and multinomial logistic regression for the five implementation-oriented outcome variables of interest, with three levels of implementation (implemented, plan to implement, and no activity). Independent variables included infrastructural and financial capacity and other characteristics associated with informatics capacity. Of 505 LHDs that responded to the survey, 69 (13.5%) had implemented health information exchanges, 122 (22.2%) had implemented electronic health records, 245 (47.5%) had implemented electronic laboratory reporting, 368 (73.0%) had implemented an electronic disease reporting system, and 416 (83.8%) had implemented an immunization registry. LHD characteristics associated with health informatics adoption included provision of greater number of clinical services, greater per capita public health expenditures, health information systems specialists on staff, larger population size, decentralized governance system, one or more local boards of health, metropolitan jurisdiction, and top executive with more years in the job. Many LHDs lack health informatics capacity, particularly in smaller, rural jurisdictions. Cross-jurisdictional sharing, investment in public health informatics infrastructure, and additional training may help address these shortfalls.

32 CFR 2004.11 - Agency Implementing Regulations, Internal Rules, or Guidelines [102(b)(3)].

Code of Federal Regulations, 2014 CFR

2014-07-01

..., or Guidelines [102(b)(3)]. 2004.11 Section 2004.11 National Defense Other Regulations Relating to... NATIONAL INDUSTRIAL SECURITY PROGRAM DIRECTIVE NO. 1 Implementation and Oversight § 2004.11 Agency Implementing Regulations, Internal Rules, or Guidelines [102(b)(3)]. (a) Reviews and Updates. All implementing...

32 CFR 2004.11 - Agency Implementing Regulations, Internal Rules, or Guidelines [102(b)(3)].

Code of Federal Regulations, 2012 CFR

2012-07-01

..., or Guidelines [102(b)(3)]. 2004.11 Section 2004.11 National Defense Other Regulations Relating to... NATIONAL INDUSTRIAL SECURITY PROGRAM DIRECTIVE NO. 1 Implementation and Oversight § 2004.11 Agency Implementing Regulations, Internal Rules, or Guidelines [102(b)(3)]. (a) Reviews and Updates. All implementing...

32 CFR 2004.11 - Agency Implementing Regulations, Internal Rules, or Guidelines [102(b)(3)].

Code of Federal Regulations, 2013 CFR

2013-07-01

..., or Guidelines [102(b)(3)]. 2004.11 Section 2004.11 National Defense Other Regulations Relating to... NATIONAL INDUSTRIAL SECURITY PROGRAM DIRECTIVE NO. 1 Implementation and Oversight § 2004.11 Agency Implementing Regulations, Internal Rules, or Guidelines [102(b)(3)]. (a) Reviews and Updates. All implementing...

32 CFR 2004.11 - Agency Implementing Regulations, Internal Rules, or Guidelines [102(b)(3)].

Code of Federal Regulations, 2011 CFR

2011-07-01

..., or Guidelines [102(b)(3)]. 2004.11 Section 2004.11 National Defense Other Regulations Relating to... NATIONAL INDUSTRIAL SECURITY PROGRAM DIRECTIVE NO. 1 Implementation and Oversight § 2004.11 Agency Implementing Regulations, Internal Rules, or Guidelines [102(b)(3)]. (a) Reviews and Updates. All implementing...

Implementation of Multiple Intelligences Supported Project-Based Learning in EFL/ESL Classrooms

ERIC Educational Resources Information Center

Bas, Gokhan

2008-01-01

This article deals with the implementation of Multiple Intelligences supported Project-Based learning in EFL/ESL Classrooms. In this study, after Multiple Intelligences supported Project-based learning was presented shortly, the implementation of this learning method into English classrooms. Implementation process of MI supported Project-based…

75 FR 82277 - Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-30

...-AA06 Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient... Register (FR Doc 2010-29596 (75 FR 74864)) entitled ``Health Insurance Issuers Implementing Medical Loss... request for comments entitled ``Health Insurance Issuers Implementing Medical Loss Ratio (MLR...

78 FR 40654 - Approval, Disapproval and Promulgation of Implementation Plans; State of Wyoming; Regional Haze...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-08

..., Disapproval and Promulgation of Implementation Plans; State of Wyoming; Regional Haze State Implementation Plan; Federal Implementation Plan for Regional Haze; Notice of Public Hearings AGENCY: Environmental...) addressing regional haze under. We are making this change in response to letters submitted by the Governor of...

Protection or Attack? Young People Carrying Knives and Dangerous Implements

ERIC Educational Resources Information Center

Brown, Jac; Sutton, Jeanna

2007-01-01

The incidence and circumstances of young people carrying knives and dangerous implements was investigated through surveys conducted with 150 "street youth" and 184 "school youth" in Sydney. It was found that a significant proportion of both samples carry and use knives/dangerous implements and that these implements had been…

34 CFR 300.147 - Implementation by SEA.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 2 2014-07-01 2013-07-01 true Implementation by SEA. 300.147 Section 300.147 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND... Agencies § 300.147 Implementation by SEA. In implementing § 300.146, the SEA must— (a) Monitor compliance...

34 CFR 300.147 - Implementation by SEA.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 2 2012-07-01 2012-07-01 false Implementation by SEA. 300.147 Section 300.147 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION... Referred by Public Agencies § 300.147 Implementation by SEA. In implementing § 300.146, the SEA must— (a...

34 CFR 300.147 - Implementation by SEA.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 2 2010-07-01 2010-07-01 false Implementation by SEA. 300.147 Section 300.147 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION... Referred by Public Agencies § 300.147 Implementation by SEA. In implementing § 300.146, the SEA must— (a...

34 CFR 300.147 - Implementation by SEA.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true Implementation by SEA. 300.147 Section 300.147 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND... Agencies § 300.147 Implementation by SEA. In implementing § 300.146, the SEA must— (a) Monitor compliance...

34 CFR 300.147 - Implementation by SEA.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 2 2013-07-01 2013-07-01 false Implementation by SEA. 300.147 Section 300.147 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION... Referred by Public Agencies § 300.147 Implementation by SEA. In implementing § 300.146, the SEA must— (a...

Implementer-Initiated Adaptation of Evidence-Based Interventions: Kids Remember the Blue Wig

ERIC Educational Resources Information Center

Gibbs, D. A.; Krieger, K. E.; Cutbush, S. L.; Clinton-Sherrod, A. M.; Miller, S.

2016-01-01

Adaptation of evidence-based interventions by implementers is widespread. Although frequently viewed as departures from fidelity, adaptations may be positive in impact and consistent with fidelity. Research typically catalogs adaptations but rarely includes the implementers' perspectives on adaptation. We report data on individuals implementing an…

25 CFR 275.4 - Implementing regulations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Implementing regulations. 275.4 Section 275.4 Indians... ACT PROGRAM STAFFING § 275.4 Implementing regulations. Regulations to implement section 105 of the Act will be issued by the Civil Service Commission. The regulations will cover the situations described in...

25 CFR 275.4 - Implementing regulations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Implementing regulations. 275.4 Section 275.4 Indians... ACT PROGRAM STAFFING § 275.4 Implementing regulations. Regulations to implement section 105 of the Act will be issued by the Civil Service Commission. The regulations will cover the situations described in...

Implementation of Precision Verification Solvents on the External Tank

NASA Technical Reports Server (NTRS)

Campbell, M.

1998-01-01

This paper presents the Implementation of Precision Verification Solvents on the External Tank. The topics include: 1) Background; 2) Solvent Usages; 3) TCE (Trichloroethylene) Reduction; 4) Solvent Replacement Studies; 5) Implementation; 6) Problems Occuring During Implementation; and 7) Future Work. This paper is presented in viewgraph form.

Design Based Research: The Way of Developing and Implementing

ERIC Educational Resources Information Center

Štemberger, Tina; Cencic, Majda

2016-01-01

The appropriate implementation of innovation is a crucial factor in improving educational practice. In the implementation process, there is, however, often a lack of interaction between designers and practitioners that would enable the latter to become competent enough to implement theoretical knowledge into practice and to have an ongoing support…

Some Key Factors in Policy Implementation.

ERIC Educational Resources Information Center

Rowen, Henry

Business policy texts identify numerous steps that make up the policy implementation process for private firms. On the surface, these steps also appear applicable to the implementation of public policies. However, the problems of carrying out these implementing steps in the public sector are significantly different than in the private sector due…

MICROSPED Information Bulletin, Issues 1-10, 1984. Microcomputers in the Schools--Implementation in Special Education.

ERIC Educational Resources Information Center

Hanley, Tom V., Ed.; And Others

1984-01-01

Ten information bulletins on the implementation of microcomputers in special education are presented. Topics covered include the following: (1) implementation issues (including a description of a study assessing microcomputer applications in 12 local school districts' special education programs); (2) implementation strategies (which focuses on…

Implementation of School Self-Evaluation in Secondary Schools: Teachers' Perspective

ERIC Educational Resources Information Center

Wong, Wai Lun

2010-01-01

The study investigates how teacher administrators and teachers in Hong Kong secondary schools experienced the implementation process of School Self-Evaluation (SSE), perceived the effects of SSE and described the implementation approach of SSE from the perspectives of policy implementation within the policy studies in education. Given that this…

78 FR 78310 - Approval and Promulgation of Implementation Plans; North Carolina; Transportation Conformity...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-26

... Federal Register, EPA is approving the State's implementation plan revision as a direct final rule without...] Approval and Promulgation of Implementation Plans; North Carolina; Transportation Conformity Memorandum of... Implementation Plan submitted on July 12, 2013, through the North Carolina Department of Environment and Natural...

77 FR 58072 - Finding of Substantial Inadequacy of Implementation Plan; Call for California State...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-19

... Substantial Inadequacy of Implementation Plan; Call for California State Implementation Plan Revision; South Coast AGENCY: Environmental Protection Agency (EPA). ACTION: Proposed rule. SUMMARY: In response to a... that the California State Implementation Plan (SIP) for the Los Angeles-South Coast Air Basin (South...

A Practitioner Implementation of a Tier 2 First-Grade Mathematics Intervention

ERIC Educational Resources Information Center

Strand Cary, Mari G.; Clarke, Ben; Doabler, Christian T.; Smolkowski, Keith; Fien, Hank; Baker, Scott K.

2017-01-01

We report on a practitioner implementation of Fusion, a first-grade mathematics intervention. Studies such as this evaluation of a loose implementation under realistic conditions are important to curriculum developers' understanding of how evidence-based programs and tools work under a variety of implementation scenarios. In this…

78 FR 30770 - Approval and Promulgation of Air Quality Implementation Plans; Illinois; Air Quality Standards...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-23

... Promulgation of Air Quality Implementation Plans; Illinois; Air Quality Standards Revision AGENCY... Illinois state implementation plan (SIP) to reflect current National Ambient Air Quality Standards (NAAQS... Implementation Plan at 35 Illinois Administrative Code part 243, which updates National Ambient Air Quality...

Implementing and Sustaining School Improvement. The Informed Educator Series

ERIC Educational Resources Information Center

Protheroe, Nancy

2011-01-01

This "Informed Educator" examines research-proven strategies for implementing and sustaining school improvement by looking at the key elements of the process, enabling conditions for improvement, issues of school culture, and implementation. It also looks at school turnarounds and how to sustain school improvement once reforms are implemented.

20 CFR 627.906 - Determinations on State and SDA implementation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... questioned costs related to the implementation of the provisions described in paragraph (b) of this section... implementation. 627.906 Section 627.906 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF... § 627.906 Determinations on State and SDA implementation. (a) The Department expects that the States and...

28 CFR 19.6 - Responsibility of DOJ organizational units for program implementation and implementation procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... consent to use the photograph and biographical information. See 28 CFR 0.1, Organizational Structure of... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Responsibility of DOJ organizational... Responsibility of DOJ organizational units for program implementation and implementation procedures. (a) The...

Principals as Change Agents: Their Role in the Curriculum Implementation Process.

ERIC Educational Resources Information Center

Binda, K. P.

Findings from a study that examined ways in which principals implement new or revised curricula are presented in this paper, which focuses on how personal constructs influence the curriculum implementation process. Data about principals' implementation styles were obtained from interviews with 10 principals and 10 female teachers, inschool…

Finite element implementation of Robinson's unified viscoplastic model and its application to some uniaxial and multiaxial problems

NASA Technical Reports Server (NTRS)

Arya, V. K.; Kaufman, A.

1989-01-01

A description of the finite element implementation of Robinson's unified viscoplastic model into the General Purpose Finite Element Program (MARC) is presented. To demonstrate its application, the implementation is applied to some uniaxial and multiaxial problems. A comparison of the results for the multiaxial problem of a thick internally pressurized cylinder, obtained using the finite element implementation and an analytical solution, is also presented. The excellent agreement obtained confirms the correct finite element implementation of Robinson's model.

Finite element implementation of Robinson's unified viscoplastic model and its application to some uniaxial and multiaxial problems

NASA Technical Reports Server (NTRS)

Arya, V. K.; Kaufman, A.

1987-01-01

A description of the finite element implementation of Robinson's unified viscoplastic model into the General Purpose Finite Element Program (MARC) is presented. To demonstrate its application, the implementation is applied to some uniaxial and multiaxial problems. A comparison of the results for the multiaxial problem of a thick internally pressurized cylinder, obtained using the finite element implementation and an analytical solution, is also presented. The excellent agreement obtained confirms the correct finite element implementation of Robinson's model.

Recommendations on Implementing the Energy Conservation Building Code in Visakhapatnam, AP, India

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

Evans, Meredydd; Madanagobalane, Samhita S.; Yu, Sha

Visakhapatnam can play an important role in improving energy efficiency in its buildings by implementing ECBC. This document seeks to capture stakeholder recommendations on a road map for implementation, which can help all market players plan for implementation. Visakhapatnam also has an opportunity to serve as a role model for other Smart Cities and cities in general in India. The road map and steps that VUDA adopts to implement ECBC can provide helpful examples to these other cities.

The cost-effectiveness of quality improvement projects: a conceptual framework, checklist and online tool for considering the costs and consequences of implementation-based quality improvement.

PubMed

Thompson, Carl; Pulleyblank, Ryan; Parrott, Steve; Essex, Holly

2016-02-01

In resource constrained systems, decision makers should be concerned with the efficiency of implementing improvement techniques and technologies. Accordingly, they should consider both the costs and effectiveness of implementation as well as the cost-effectiveness of the innovation to be implemented. An approach to doing this effectively is encapsulated in the 'policy cost-effectiveness' approach. This paper outlines some of the theoretical and practical challenges to assessing policy cost-effectiveness (the cost-effectiveness of implementation projects). A checklist and associated (freely available) online application are also presented to help services develop more cost-effective implementation strategies. © 2015 John Wiley & Sons, Ltd.

Using an Evidence-Based Approach to EMR Implementation to Optimize Outcomes and Avoid Unintended Consequences

PubMed Central

Longhurst, Christopher A.; Palma, Jonathan P.; Grisim, Lisa M.; Widen, Eric; Chan, Melanie; Sharek, Paul J.

2013-01-01

Implementation of an electronic medical record (EMR) with computerized physician order entry (CPOE) can provide an important foundation for preventing harm and improving outcomes. Incentivized by the recent economic stimulus initiative, healthcare systems are implementing vendor-based EMR systems at an unprecedented rate. Accumulating evidence suggests that local implementation decisions, rather than the specific EMR product or technology selected, are the primary drivers of the quality improvement performance of these systems. However, limited attention has been paid to effective approaches to EMR implementation. In this case report, we outline the evidence-based approach we used to make EMR implementation decisions in a pragmatic structure intended for replication at other sites. PMID:24771994

Multilevel Mechanisms of Implementation Strategies in Mental Health: Integrating Theory, Research, and Practice

PubMed Central

2015-01-01

A step toward the development of optimally effective, efficient, and feasible implementation strategies that increase evidence-based treatment integration in mental health services involves identification of the multilevel mechanisms through which these strategies influence implementation outcomes. This article (a) provides an orientation to, and rationale for, consideration of multilevel mediating mechanisms in implementation trials, and (b) systematically reviews randomized controlled trials that examined mediators of implementation strategies in mental health. Nine trials were located. Mediation-related methodological deficiencies were prevalent and no trials supported a hypothesized mediator. The most common reason was failure to engage the mediation target. Discussion focuses on directions to accelerate implementation strategy development in mental health. PMID:26474761

Planning what not to eat: ironic effects of implementation intentions negating unhealthy habits.

PubMed

Adriaanse, Marieke A; van Oosten, Johanna M F; de Ridder, Denise T D; de Wit, John B F; Evers, Catharine

2011-01-01

The present studies tested the effectiveness of implementation intentions with an "if [situation], then not [habitual response]" structure. Based on ironic process theory and the literature on the processing of negations, it was expected that these "negation implementation intentions" would, ironically, strengthen the habit (situation-response association) one aims to break. In line with the hypotheses, forming negation implementation intentions resulted in cognitive ironic rebound effects as well as behavioral ironic rebound effects compared to an intention only condition or a replacement implementation intention. Additionally, it was found that negation implementation intentions are most likely to result in ironic rebound effects when the habit to be negated is strong. Although implementation intentions are generally highly effective in facilitating behavior change even when this involves breaking unwanted habits, the present research suggests that they are ineffective when they have a negating structure.

Measuring Costs to Community-Based Agencies for Implementation of an Evidence-Based Practice.

PubMed

Lang, Jason M; Connell, Christian M

2017-01-01

Healthcare reform has led to an increase in dissemination of evidence-based practices. Cost is frequently cited as a significant yet rarely studied barrier to dissemination of evidence-based practices and the associated improvements in quality of care. This study describes an approach to measuring the incremental, unreimbursed costs in staff time and direct costs to community-based clinics implementing an evidence-based practice through participating in a learning collaborative. Initial implementation costs exceeding those for providing "treatment as usual" were collected for ten clinics implementing trauma-focused cognitive behavioral therapy through participation in 10-month learning collaboratives. Incremental implementation costs of these ten community-based clinic teams averaged the equivalent of US$89,575 (US$ 2012). The most costly activities were training, supervision, preparation time, and implementation team meetings. Recommendations are made for further research on implementation costs, dissemination of evidence-based practices, and implications for researchers and policy makers.

Parent Management Training-Oregon Model (PMTO™) in Mexico City: Integrating Cultural Adaptation Activities in an Implementation Model

PubMed Central

Baumann, Ana A.; Domenech Rodríguez, Melanie M.; Amador, Nancy G.; Forgatch, Marion S.; Parra-Cardona, J. Rubén

2015-01-01

This article describes the process of cultural adaptation at the start of the implementation of the Parent Management Training intervention-Oregon model (PMTO) in Mexico City. The implementation process was guided by the model, and the cultural adaptation of PMTO was theoretically guided by the cultural adaptation process (CAP) model. During the process of the adaptation, we uncovered the potential for the CAP to be embedded in the implementation process, taking into account broader training and economic challenges and opportunities. We discuss how cultural adaptation and implementation processes are inextricably linked and iterative and how maintaining a collaborative relationship with the treatment developer has guided our work and has helped expand our research efforts, and how building human capital to implement PMTO in Mexico supported the implementation efforts of PMTO in other places in the United States. PMID:26052184

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

Seal Apparatus and Methods to Manufacture Thereof

NASA Technical Reports Server (NTRS)

Richard, James A. (Inventor)

2013-01-01

In some implementations, apparatus and methods are provided through which a dynamic cryogenic seal is manufactured. In some implementations, the seal includes a retainer and a spring-seal assembly, the assembly being comprised of a main spring housing and fluorine-containing polymer seals. In some implementations, either a radial seal, or an axial (or "piston seal") is provided. In some implementations, methods of manufacturing the dynamic cryogenic seal are also provided. In some implementations, the methods include assembling the components while either heated or cooled, taking advantage of thermal expansion and contraction, such that there is a strong interference fit between the components at room temperature. In some implementations, this process ensures that the weaker fluorine-containing polymer seal is forced to expand and contract with the stronger retainer and spring and is under constant preload. In some implementations, the fluorine-containing polymer is therefore fluidized and retained, and can not lift off.

Organizational characteristics influence implementation of worksite health protection and promotion programs: Evidence from smaller businesses

PubMed Central

McLellan, Deborah L.; Cabán-Martinez, Alberto J.; Nelson, Candace C.; Pronk, Nicolaas P.; Katz, Jeffrey N.; Allen, Jennifer D.; Davis, Kia L.; Wagner, Gregory R.; Sorensen, Glorian

2015-01-01

Objective We explored associations between organizational factors (size, sector, leadership support, and organizational capacity) and implementation of Occupational Safety and Health (OSH) and Worksite Health Promotion (WHP) programs in smaller businesses. Methods We conducted a web-based survey of Human Resource Managers of 117 smaller businesses (<750 employees) and analyzed factors associated with implementation of OSH and WHP among these sites using multivariate analyses. Results Implementation of OSH but not WHP activities were related to industry sector (p= 0.003). Leadership support was positively associated with OSH activities (p<.001), but negatively associated with WHP implementation. Organizational capacity (budgets, staffing, and committee involvement) was associated with implementation of both OSH and WHP. Size was related to neither. Conclusions Leadership support and specifically allocated resources reflecting that support are important factors for implementing OSH and WHP in smaller organizations. PMID:26340290

Brief Strategic Family Therapy: Implementing evidence-based models in community settings

PubMed Central

Szapocznik, José; Muir, Joan A.; Duff, Johnathan H.; Schwartz, Seth J.; Brown, C. Hendricks

2014-01-01

Reflecting a nearly 40-year collaborative partnership between clinical researchers and clinicians, the present article reviews the authors’ experience in developing, investigating, and implementing the Brief Strategic Family Therapy (BSFT) model. The first section of the article focuses on the theory, practice, and studies related to this evidence-based family therapy intervention targeting adolescent drug abuse and delinquency. The second section focuses on the implementation model created for the BSFT intervention– a model that parallels many of the recommendations furthered within the implementation science literature. Specific challenges encountered during the BSFT implementation process are reviewed, along with ways of conceptualizing and addressing these challenges from a systemic perspective. The implementation approach that we employ uses the same systemic principles and intervention techniques as those that underlie the BSFT model itself. Recommendations for advancing the field of implementation science, based on our on-the-ground experiences, are proposed. PMID:24274187

The Role of School Context in Implementing a Statewide Anti-Bullying Policy and Protecting Students

PubMed Central

Hall, William J.; Chapman, Mimi V.

2016-01-01

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 examined the influence of school context on educators’ capacity to implement a statewide bullying law and protect students from bullying following the enactment of the policy. Data were collected from 505 educators in 324 schools. School administrators tended to rate fidelity of policy implementation and teacher protection of students higher than teachers, education support professionals, and student service professionals. Policy implementation fidelity scores were higher in high schools than elementary schools. School size and the prevalence of student suspensions were inversely related to implementation fidelity. Higher levels of teacher protection were reported in elementary schools.

The Role of School Context in Implementing a Statewide Anti-Bullying Policy and Protecting Students.

PubMed

Hall, William J; Chapman, Mimi V

2018-06-01

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 examined the influence of school context on educators' capacity to implement a statewide bullying law and protect students from bullying following the enactment of the policy. Data were collected from 505 educators in 324 schools. School administrators tended to rate fidelity of policy implementation and teacher protection of students higher than teachers, education support professionals, and student service professionals. Policy implementation fidelity scores were higher in high schools than elementary schools. School size and the prevalence of student suspensions were inversely related to implementation fidelity. Higher levels of teacher protection were reported in elementary schools.

Analysis and implementation of a World Health Organization health report: methodological concepts and strategies.

PubMed

von Groote, Per Maximilian; Giustini, Alessandro; Bickenbach, Jerome Edmond

2014-01-01

A long-standing scientific discourse on the use of health research evidence to inform policy has come to produce multiple implementation theories, frameworks, models, and strategies. It is from this extensive body of research that the authors extract and present essential components of an implementation process in the health domain, gaining valuable guidance on how to successfully meet the challenges of implementation. Furthermore, this article describes how implementation content can be analyzed and reorganized, with a special focus on implementation at different policy, systems and services, and individual levels using existing frameworks and tools. In doing so, the authors aim to contribute to the establishment and testing of an implementation framework for reports such as the World Health Organization World Report on Disability, the World Health Organization International Perspectives on Spinal Cord Injury, and other health policy reports or technical health guidelines.

The spirit of democracy in the implementation of public information policy at the provincial government of West Java

NASA Astrophysics Data System (ADS)

Sjoraida, D. F.; Asmawi, A.; Anwar, R. K.

2018-03-01

This article analyses the implementation of Law Number 14/2008 on Public Information Disclosure on the Provincial Government of West Java. This descriptive-qualitative study presents a discussion of the spirit of democracy in the implementation of the abovem-entioned policy in West Java Province. With the theory of policy implementation and democratization, data obtains that the element of democratic spirit in the implementation of public information policy in the government of West Java is quite thick. Therefore, there must be a massification of the implementation of the law in West Java, especially its socialization to districts/cities and society in general. It was found that the democratization of the West Java Provincial Government in implementing the Act has been well received in the community. However, the lack of publicity about this Law can reduce the strength of moral messages that exist in the law to the public.

Analysis of factors that inhibiting implementation of Information Security Management System (ISMS) based on ISO 27001

NASA Astrophysics Data System (ADS)

Tatiara, R.; Fajar, A. N.; Siregar, B.; Gunawan, W.

2018-03-01

The purpose of this research is to determine multi factors that inhibiting the implementation of the ISMS based on ISO 2700. It is also to propose a follow-up recommendation on the factors that inhibit the implementation of the ISMS. Data collection is derived from questionnaires to 182 respondents from users in data center operation (DCO) at bca, Indonesian telecommunication international (telin), and data centre division at Indonesian Ministry of Health. We analysing data collection with multiple linear regression analysis and paired t-test. The results are multiple factors which inhibiting the implementation of the ISMS from the three organizations which has implement and operate the ISMS, ISMS documentation management, and continual improvement. From this research, we concluded that the processes of implementation in ISMS is the necessity of the role of all parties in succeeding the implementation of the ISMS continuously.

Implementation Intentions Reduce Implicit Stereotype Activation and Application.

PubMed

Rees, Heather Rose; Rivers, Andrew Michael; Sherman, Jeffrey W

2018-05-01

Research has found that implementation intentions, if-then action plans (e.g., "if I see a Black face, I will think safe"), reduce stereotyping on implicit measures. However, it is unknown by what process(es) implementation intentions reduce implicit stereotyping. The present research examines the effects of implementation intentions on stereotype activation (e.g., extent to which stereotypic information is accessible) and stereotype application (e.g., extent to which accessible stereotypes are applied in judgment). In addition, we assessed the efficiency of implementation intentions by manipulating cognitive resources (e.g., digit-span, restricted response window) while participants made judgments on an implicit stereotyping measure. Across four studies, implementation intentions reduced implicit stereotyping. This decrease in stereotyping was associated with reductions in both stereotype activation and application. In addition, these effects of implementation intentions were highly efficient and associated with reduced stereotyping even for groups for which people may have little practice inhibiting stereotypes (e.g., gender).

Parent Management Training-Oregon Model (PMTO™) in Mexico City: Integrating Cultural Adaptation Activities in an Implementation Model.

PubMed

Baumann, Ana A; Domenech Rodríguez, Melanie M; Amador, Nancy G; Forgatch, Marion S; Parra-Cardona, J Rubén

2014-03-01

This article describes the process of cultural adaptation at the start of the implementation of the Parent Management Training intervention-Oregon model (PMTO) in Mexico City. The implementation process was guided by the model, and the cultural adaptation of PMTO was theoretically guided by the cultural adaptation process (CAP) model. During the process of the adaptation, we uncovered the potential for the CAP to be embedded in the implementation process, taking into account broader training and economic challenges and opportunities. We discuss how cultural adaptation and implementation processes are inextricably linked and iterative and how maintaining a collaborative relationship with the treatment developer has guided our work and has helped expand our research efforts, and how building human capital to implement PMTO in Mexico supported the implementation efforts of PMTO in other places in the United States.

Implementation and Testing of Low Cost Uav Platform for Orthophoto Imaging

NASA Astrophysics Data System (ADS)

Brucas, D.; Suziedelyte-Visockiene, J.; Ragauskas, U.; Berteska, E.; Rudinskas, D.

2013-08-01

Implementation of Unmanned Aerial Vehicles for civilian applications is rapidly increasing. Technologies which were expensive and available only for military use have recently spread on civilian market. There is a vast number of low cost open source components and systems for implementation on UAVs available. Using of low cost hobby and open source components ensures considerable decrease of UAV price, though in some cases compromising its reliability. In Space Science and Technology Institute (SSTI) in collaboration with Vilnius Gediminas Technical University (VGTU) researches have been performed in field of constructing and implementation of small UAVs composed of low cost open source components (and own developments). Most obvious and simple implementation of such UAVs - orthophoto imaging with data download and processing after the flight. The construction, implementation of UAVs, flight experience, data processing and data implementation will be further covered in the paper and presentation.

A model-guided symbolic execution approach for network protocol implementations and vulnerability detection.

PubMed

Wen, Shameng; Meng, Qingkun; Feng, Chao; Tang, Chaojing

2017-01-01

Formal techniques have been devoted to analyzing whether network protocol specifications violate security policies; however, these methods cannot detect vulnerabilities in the implementations of the network protocols themselves. Symbolic execution can be used to analyze the paths of the network protocol implementations, but for stateful network protocols, it is difficult to reach the deep states of the protocol. This paper proposes a novel model-guided approach to detect vulnerabilities in network protocol implementations. Our method first abstracts a finite state machine (FSM) model, then utilizes the model to guide the symbolic execution. This approach achieves high coverage of both the code and the protocol states. The proposed method is implemented and applied to test numerous real-world network protocol implementations. The experimental results indicate that the proposed method is more effective than traditional fuzzing methods such as SPIKE at detecting vulnerabilities in the deep states of network protocol implementations.

Improved Equivalent Linearization Implementations Using Nonlinear Stiffness Evaluation

NASA Technical Reports Server (NTRS)

Rizzi, Stephen A.; Muravyov, Alexander A.

2001-01-01

This report documents two new implementations of equivalent linearization for solving geometrically nonlinear random vibration problems of complicated structures. The implementations are given the acronym ELSTEP, for "Equivalent Linearization using a STiffness Evaluation Procedure." Both implementations of ELSTEP are fundamentally the same in that they use a novel nonlinear stiffness evaluation procedure to numerically compute otherwise inaccessible nonlinear stiffness terms from commercial finite element programs. The commercial finite element program MSC/NASTRAN (NASTRAN) was chosen as the core of ELSTEP. The FORTRAN implementation calculates the nonlinear stiffness terms and performs the equivalent linearization analysis outside of NASTRAN. The Direct Matrix Abstraction Program (DMAP) implementation performs these operations within NASTRAN. Both provide nearly identical results. Within each implementation, two error minimization approaches for the equivalent linearization procedure are available - force and strain energy error minimization. Sample results for a simply supported rectangular plate are included to illustrate the analysis procedure.

Integrated System Health Management (ISHM): Systematic Capability Implementation

NASA Technical Reports Server (NTRS)

Figueroa, Fernando; Holland, Randy; Schmalzwel, John; Duncavage, Dan

2006-01-01

This paper provides a credible approach for implementation of ISHM capability in any system. The requirements and processes to implement ISHM capability are unique in that a credible capability is initially implemented at a low level, and it evolves to achieve higher levels by incremental augmentation. In contrast, typical capabilities, such as thrust of an engine, are implemented once at full Functional Capability Level (FCL), which is not designed to change during the life of the product. The approach will describe core ingredients (e.g. technologies, architectures, etc.) and when and how ISHM capabilities may be implemented. A specific architecture/taxonomy/ontology will be described, as well as a prototype software environment that supports development of ISHM capability. This paper will address implementation of system-wide ISHM as a core capability, and ISHM for specific subsystems as expansions and evolution, but always focusing on achieving an integrated capability.

76 FR 4360 - Draft Guidance for Industry: Questions and Answers Regarding Implementation of the Menu Labeling...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-25

...] Draft Guidance for Industry: Questions and Answers Regarding Implementation of the Menu Labeling...: Questions and Answers Regarding Implementation of the Menu Labeling Provisions of Section 4205 of the... Implementation of the Menu Labeling Provisions of Section 4205 of the Patient Protection and Affordable Care Act...

Student Teachers' Skills in the Implementation of Collaborative Learning: A Multilevel Approach

ERIC Educational Resources Information Center

Ruys, Ilse; Van Keer, Hilde; Aelterman, Antonia

2011-01-01

This study explores the development of student teachers' skills in implementing collaborative learning (CL) using a multilevel repeated measures design. Participants were 105 pre-service teachers that were trained in CL implementation. The results indicate that student teachers generally perform well in implementing CL. Further, it appears that…

Workplace Learning for the Public Good: Implementation of a Standardized, Competency-Based Curriculum in Texas WIC

ERIC Educational Resources Information Center

Kessler, Seth A.; Horton, Karissa D.; Gottlieb, Nell H.; Atwood, Robin

2012-01-01

Purpose: The purpose of this study is to describe preceptors' implementation experiences after implementing a workplace learning program in Texas WIC (women, infant, and children) agencies and identify implementation best practices. Design/methodology/approach: This research used qualitative description methodology. Data collection consisted of 11…

Guidelines for Implementing NCHRP 1-37A M-E Design Procedures in Ohio : Volume 1 -- Summary of Findings, Implementation Plan, and Next Steps

DOT National Transportation Integrated Search

2009-11-01

Highway agencies across the nation are moving towards implementation of the new AASHTO Mechanistic-Empirical Pavement Design Guide (MEPDG) for pavement design. The benefits of implementing the MEPDG for routine use in Ohio includes (1) achieving more...

40 CFR 52.1392 - Federal Implementation Plan for the Billings/Laurel Area.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 4 2013-07-01 2013-07-01 false Federal Implementation Plan for the Billings/Laurel Area. 52.1392 Section 52.1392 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Montana § 52.1392 Federal Implementation Plan for...

40 CFR 52.1392 - Federal Implementation Plan for the Billings/Laurel Area.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 4 2012-07-01 2012-07-01 false Federal Implementation Plan for the Billings/Laurel Area. 52.1392 Section 52.1392 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Montana § 52.1392 Federal Implementation Plan for...

40 CFR 52.1392 - Federal Implementation Plan for the Billings/Laurel Area.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 4 2014-07-01 2014-07-01 false Federal Implementation Plan for the Billings/Laurel Area. 52.1392 Section 52.1392 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Montana § 52.1392 Federal Implementation Plan for...

40 CFR 52.1392 - Federal Implementation Plan for the Billings/Laurel Area.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 4 2011-07-01 2011-07-01 false Federal Implementation Plan for the Billings/Laurel Area. 52.1392 Section 52.1392 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Montana § 52.1392 Federal Implementation Plan for...

Leadership Challenges in the Implementation of ICT in Public Secondary Schools, Kenya

ERIC Educational Resources Information Center

Mingaine, Laaria

2013-01-01

Many authors argue that school leadership determines how Information Communication Technology (ICT) is implemented and its subsequent impact on teaching and learning. This involves Principal as a school leader to lead in implementation. A positive attitude of school leader towards implementation of ICT will encourage the school community to be…

Implementation science: how to jump‐start infection prevention.

PubMed

Saint, Sanjay; Howell, Joel D; Krein, Sarah L

2010-11-01

Implementing evidence‐based infection prevention practices is challenging. Implementation science, which is the study of methods promoting the uptake of evidence into practice, addresses the gap between theory and practice. Just as healthcare epidemiology has emerged as a paradigm for patient safety, infection prevention may serve as a clinical model for implementation researchers.

40 CFR 35.929-3 - Implementation of the user charge system.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Implementation of the user charge... Water Act § 35.929-3 Implementation of the user charge system. (a) When a grantee's user charge system is approved, implementation of the approved system shall become a condition of the grant. (b) The...

40 CFR 35.929-3 - Implementation of the user charge system.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Implementation of the user charge... Water Act § 35.929-3 Implementation of the user charge system. (a) When a grantee's user charge system is approved, implementation of the approved system shall become a condition of the grant. (b) The...

40 CFR 35.929-3 - Implementation of the user charge system.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Implementation of the user charge... Water Act § 35.929-3 Implementation of the user charge system. (a) When a grantee's user charge system is approved, implementation of the approved system shall become a condition of the grant. (b) The...

40 CFR 35.929-3 - Implementation of the user charge system.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Implementation of the user charge... Water Act § 35.929-3 Implementation of the user charge system. (a) When a grantee's user charge system is approved, implementation of the approved system shall become a condition of the grant. (b) The...

Critical Stakeholder Determinants to the Implementation of Intersectoral Community Approaches Targeting Childhood Obesity

ERIC Educational Resources Information Center

van der Kleij, R. M. J. J.; Crone, M. R.; Reis, R.; Paulussen, T. G. W. M.

2016-01-01

Several intersectoral community approaches targeting childhood obesity (IACOs) have been launched in the Netherlands. Translation of these approaches into practice is however arduous and implementation. We therefore studied the implementation of five IACOs in the Netherlands for one-and-a-half years. IACO implementation was evaluated via an…

Challenges of Implementing E-Learning in Kenya: A Case of Kenyan Public Universities

ERIC Educational Resources Information Center

Tarus, John K.; Gichoya, David; Muumbo, Alex

2015-01-01

In this paper, we discuss the challenges experienced by Kenyan public universities in implementation of e-learning and recommend possible solutions towards its successful implementation. In the last few years, most Kenyan public universities have adopted e-learning as a new approach to teaching and learning. However, the implementation challenges…

77 FR 64734 - Approval and Promulgation of Implementation Plans; North Dakota: Prevention of Significant...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-23

... Permitting Authority and Tailoring Rule; PM 2.5 NSR Implementation Rule AGENCY: Environmental Protection... Implementation Plan (SIP) relating to regulation of Greenhouse Gases (GHGs) and fine particulate matter (PM 2.5... Tailoring Final Rule'' and the final rule for ``Implementation of the New Source Review (NSR) Program for PM...

77 FR 16937 - Approval and Promulgation of Air Quality Implementation Plans; West Virginia; Regional Haze State...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-23

... Promulgation of Air Quality Implementation Plans; West Virginia; Regional Haze State Implementation Plan AGENCY... limited disapproval of West Virginia's Regional Haze State Implementation Plan (SIP) revision. EPA is... mandatory Class I areas through a regional haze program. EPA is also approving this revision as meeting the...

77 FR 5191 - Approval and Promulgation of Air Quality Implementation Plans; District of Columbia; Regional...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-02

... Promulgation of Air Quality Implementation Plans; District of Columbia; Regional Haze State Implementation Plan... of Columbia Regional Haze Plan, a revision to the District of Columbia State Implementation Plan (SIP... existing anthropogenic impairment of visibility in mandatory Class I areas through a regional haze program...

43 CFR 4110.3-3 - Implementing changes in active use.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Implementing changes in active use. 4110.3... ALASKA Qualifications and Preference § 4110.3-3 Implementing changes in active use. (a)(1) After... responsibility for managing resources within the area, the authorized officer will implement changes in active...

43 CFR 4110.3-3 - Implementing changes in active use.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Implementing changes in active use. 4110.3... ALASKA Qualifications and Preference § 4110.3-3 Implementing changes in active use. (a)(1) After... responsibility for managing resources within the area, the authorized officer will implement changes in active...

43 CFR 4110.3-3 - Implementing changes in active use.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Implementing changes in active use. 4110.3... ALASKA Qualifications and Preference § 4110.3-3 Implementing changes in active use. (a)(1) After... responsibility for managing resources within the area, the authorized officer will implement changes in active...

43 CFR 4110.3-3 - Implementing changes in active use.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Implementing changes in active use. 4110.3... ALASKA Qualifications and Preference § 4110.3-3 Implementing changes in active use. (a)(1) After... responsibility for managing resources within the area, the authorized officer will implement changes in active...

Making Sense, Making Do: Local District Implementation of a New State Induction Policy

ERIC Educational Resources Information Center

Ellis, Chad D.

2016-01-01

Connecticut's Teacher Education and Mentoring (TEAM) program is in its early stages of implementation. This study examined how local school districts implemented TEAM and identified factors that affected implementation. It was based on interviews with twenty-two participants at the state, district, and local school levels. The intentions of the…

40 CFR 109.5 - Development and implementation criteria for State, local and regional oil removal contingency plans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... OIL REMOVAL CONTINGENCY PLANS § 109.5 Development and implementation criteria for State, local and regional oil removal contingency plans. Criteria for the development and implementation of State, local and... 40 Protection of Environment 23 2012-07-01 2012-07-01 false Development and implementation...

Evaluating the Implementation of Performance Improvement Training: The E[superscript 3] Process for Success

ERIC Educational Resources Information Center

Larbi-Apau, Josephine A.; Moseley, James L.

2008-01-01

This article provides a comprehensive approach to careful review and evaluation of the implementation of performance training intervention. It discusses the E[superscript 3] process for success, a basic framework for evaluating the implementation phase of a training program implemented as a broad-based performance improvement strategy. The intent…

77 FR 3922 - Rules for Investigations Relating to Global and Bilateral Safeguards Actions, Market Disruption...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-26

... Agreement Implementation Act, section 311(b) of the United States-Colombia Trade Promotion Agreement... Trade Agreement Implementation Act, section 311(b) of the United States-Panama Trade Promotion Agreement Implementation Act, section 311(b) of the United States-Peru Trade Promotion Agreement Implementation Act, and...

Assessing the Implementation Fidelity of Check-In Check-Out Behavioral Interventions in Elementary and Middle Schools

ERIC Educational Resources Information Center

Ruiz, María Isolina; Smith, Traci N.; Naquin, Gale M.; Morgan-D'Atrio, Cynthia; Dellinger, Amy B.

2014-01-01

Implementation fidelity is crucial to the success of behavioral interventions. However, measuring and maintaining intervention implementation fidelity in schools' natural settings can be challenging. This article reports findings from a study examining the implementation fidelity of check-in check-out interventions at an urban school district…

78 FR 49789 - Request for Comments and Notice of Public Hearing Concerning Russia's Implementation of Its WTO...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-15

... Concerning Russia's Implementation of Its WTO Obligations AGENCY: Office of the United States Trade Representative. ACTION: Request for comments and notice of public hearing concerning Russia's implementation of... on Russia's implementation of its obligations as a Member of the WTO. DATES: Written comments are due...

The Implementer Disposition of Teacher Certification Policy in Indonesia

ERIC Educational Resources Information Center

Malkab, Marnih; Nawawi, Juanda; Mahmud, Alimuddin; Sujiono, Eko Hadi

2015-01-01

This research aims to examine and analyze the implementers disposition in the implementation of teacher certification policy in Makassar City and to know how is the disposition affects in successful implementation policy. This research is descriptive by using a qualitative approach. Sources of data in this study are primary data from the…

78 FR 62367 - Changes To Implement the Patent Law Treaty

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-21

... Office 37 CFR Parts 1, 3 and 11 Changes To Implement the Patent Law Treaty; Final Rule #0;#0;Federal... 0651-AC85 Changes To Implement the Patent Law Treaty AGENCY: United States Patent and Trademark Office, Commerce. ACTION: Final rule. SUMMARY: The Patent Law Treaties Implementation Act of 2012 (PLTIA) amends...

77 FR 30900 - Approval and Promulgation of Implementation Plans; New Mexico; Albuquerque/Bernalillo County...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-24

... in implementing the New Mexico Air Quality Control Act, the joint Air Quality Control Board (AQCB... Department in implementing the New Mexico Air Quality Control Act, the joint Air Quality Control Board (AQCB... Promulgation of Implementation Plans; New Mexico; Albuquerque/Bernalillo County; Fees for Permits and...

An Analysis of the Relative Importance of Ely's Eight Implementation Conditions

ERIC Educational Resources Information Center

Surry, Daniel W.; Jackson, Katherine; Porter, Barry E.; Ensminger, David, C.

2006-01-01

This paper reports the results of a study to determine implementation profiles within a sample of 179 participants from a variety of education and business fields. Implementation profiling identifies the conditions that participants perceive are most important when implementing an innovation. Information about the relative importance of the eight…

Critical Features Predicting Sustained Implementation of School-Wide Positive Behavioral Interventions and Supports

ERIC Educational Resources Information Center

Mathews, Susanna; McIntosh, Kent; Frank, Jennifer L.; May, Seth L.

2014-01-01

The current study explored the extent to which a common measure of perceived implementation of critical features of Positive Behavioral Interventions and Supports (PBIS) predicted fidelity of implementation 3 years later. Respondents included school personnel from 261 schools across the United States implementing PBIS. School teams completed the…

75 FR 40756 - Implementation Guidance for Physical Protection of Byproduct Material; Category 1 and Category 2...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-14

...-2010-0194] RIN 3150-AI12 Implementation Guidance for Physical Protection of Byproduct Material... licensee or applicant for implementation of proposed 10 CFR part 37, ``Physical Protection of Byproduct... ``Implementation Guidance for 10 CFR part 37 Physical Protection of Byproduct Material, Category 1 and Category 2...

29 CFR 779.371 - Some automobile, truck, and farm implement establishments may qualify for exemption under section...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Some automobile, truck, and farm implement establishments... OR SERVICES Exemptions for Certain Retail or Service Establishments Automobile, Truck, Farm Implement, Trailer, and Aircraft Sales and Services § 779.371 Some automobile, truck, and farm implement...

Examining the Implementation of Technology-Based Blended Algebra I Curriculum at Scale

ERIC Educational Resources Information Center

Karam, Rita; Pane, John F.; Griffin, Beth Ann; Robyn, Abby; Phillips, Andrea; Daugherty, Lindsay

2017-01-01

Studies on blended education pay little attention to implementation, thus limiting the understanding of how such programs contribute to student math learning. This article examines the implementation of a widely used blended algebra curriculum and the relationship between implementation and student outcomes. The study was conducted in 74 middle…

Three Decades of Implementation Research in Higher Education: Limitations and Prospects of Theory Development

ERIC Educational Resources Information Center

Kohoutek, Jan

2013-01-01

The article adopts a comparative approach to review three periods of theory development in research into higher education policy implementation. Given the conceptual affinity between Cerych and Sabatier's 1986 seminal study into higher education policy implementation and public policy implementation theory, the field of public policy is chosen for…

77 FR 65151 - Finding of Substantial Inadequacy of Implementation Plan; Call for California State...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-25

... the Federal Register on September 19, 2012. In that action, in response to a remand by the Ninth... Substantial Inadequacy of Implementation Plan; Call for California State Implementation Plan Revision; South... State Implementation Plan (SIP) for the Los Angeles-South Coast Air Basin (South Coast) is substantially...

Implementing Human Resources Management (HRM) within Dutch VET Institutions: Examining the Fostering and Hindering Factors

ERIC Educational Resources Information Center

Runhaar, Piety; Sanders, Karin

2013-01-01

Vocational Education and Training (VET) Institutions face serious challenges, like the implementation of competence-based education and upcoming teacher shortages, which urge them to implement Human Resources Management policy and practices (HRM). The implementation of HRM, however, often stagnates. This paper describes a qualitative study--in…

Challenges to Common Core State Standards Implementation: Views from Six States

ERIC Educational Resources Information Center

Smith, Joanna; Thier, Michael

2017-01-01

The implementation of the Common Core State Standards has posed a number of challenges for school leaders. This study applies a policy implementation conceptual framework to analyze data gathered from 46 interviews in six states. Findings suggest the existence of multiple barriers to Common Core State Standards implementation. To promote…

Barriers to Implementing the Response to Intervention Framework in Secondary Schools: Interviews with Secondary Principals

ERIC Educational Resources Information Center

Bartholomew, Mitch; De Jong, David

2017-01-01

Despite the successful implementation of the Response to Intervention (RtI) framework in many elementary schools, there is little evidence of successful implementation in high school settings. Several themes emerged from the interviews of nine secondary principals, including a lack of knowledge and training for successful implementation, the…

Grant Funding to Implement PREPaRE Training in Your School District

ERIC Educational Resources Information Center

Paige, Leslie Z.

2010-01-01

Implementing an effective crisis management program in a school district has associated costs. The most precious resource in a school system is time. Time is necessary for acquiring and practicing new skills, and for developing and implementing strategies to introduce and expand the change throughout a school or district. Implementing an effective…

Programme Implementation in Social and Emotional Learning: Basic Issues and Research Findings

ERIC Educational Resources Information Center

Durlak, Joseph A.

2016-01-01

This paper discusses the fundamental importance of achieving quality implementation when assessing the impact of social and emotional learning interventions. Recent findings in implementation science are reviewed that include a definition of implementation, its relation to programme outcomes, current research on the factors that affect…

The Problematic Implementation of Teacher Evaluation Policy: School Failure or Governmental Pitfall?

ERIC Educational Resources Information Center

Tuytens, Melissa; Devos, Geert

2014-01-01

Teacher evaluation policy is implemented in many countries to improve the teaching quality in schools. This paper explores the implementation of teacher evaluation policy in secondary schools in Flanders (Belgium). The case study method is used to explore the implementation process in six schools, which are selected based upon teachers' perception…

Academics' Responses to the Implementation of a Quality Agenda

ERIC Educational Resources Information Center

Brunetto, Yvonne; Farr-Wharton, Rod

2005-01-01

This paper proposes a new implementation model that bases implementation outcomes on the responses of academics to a new policy. The model is derived from a review of policy and organisational behaviour literature. The model was tested within the context of the implementation of significant reforms aimed at changing the work practices of academics…

Multi-Tiered System of Supports (MTSS) and Implementation Science

ERIC Educational Resources Information Center

Dillard, Christina

2017-01-01

Many districts and schools are having difficulty implementing Multi-Tiered System of Supports (MTSS) in school settings. This quantitative study set out to examine the stage of MTSS implementation schools are at and identify factors from the implementation science framework that account for the different reported student outcomes related to MTSS…

40 CFR 35.928-3 - Implementation of the industrial cost recovery system.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Implementation of the industrial cost...-Clean Water Act § 35.928-3 Implementation of the industrial cost recovery system. (a) When a grantee's industrial cost recovery system is approved, implementation of the approved system shall become a condition...

77 FR 65125 - Approval and Promulgation of Implementation Plans; Georgia 110(a)(1) and (2) Infrastructure...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-25

... controls are enforced through the associated SIP rules or Federal Implementation Plans (FIPs). Any purchase... Promulgation of Implementation Plans; Georgia 110(a)(1) and (2) Infrastructure Requirements for the 1997 and... Agency (EPA). ACTION: Final rule. SUMMARY: EPA is taking final action to approve the State Implementation...

Implementation of Local Wellness Policies in Schools: Role of School Systems, School Health Councils, and Health Disparities

ERIC Educational Resources Information Center

Hager, Erin R.; Rubio, Diana S.; Eidel, G. Stewart; Penniston, Erin S.; Lopes, Megan; Saksvig, Brit I.; Fox, Renee E.; Black, Maureen M.

2016-01-01

Background: Written local wellness policies (LWPs) are mandated in school systems to enhance opportunities for healthy eating/activity. LWP effectiveness relies on school-level implementation. We examined factors associated with school-level LWP implementation. Hypothesized associations included system support for school-level implementation and…

Assessing Legislative Control of Bureaucracy: The Implementation Contract.

ERIC Educational Resources Information Center

Wohlstetter, Priscilla

Findings from a study that explored the motivations of legislators to oversee and control program implementation are presented in this paper. Implementation is viewed as a contract between the legislative and executive branches with legislators acting as monitors who use oversight to control the agencies contracted to implement policy. A total of…

Implementation of national guidelines for the prevention and treatment of overweight and obesity in children and adolescents: a phenomenographic analysis of public health nurses' perceptions.

PubMed

Nordstrand, Aina; Fridlund, Bengt; Sollesnes, Ragnhild

2016-01-01

To explore and describe how public health nurses (PHNs) perceive the implementation of national guidelines for the prevention and treatment of overweight and obesity among children and adolescents in well-baby clinics and school health services. An explorative descriptive design was carried out through individual interviews with 18 PHNs and analysed according to the phenomenographic tradition. Four implementation strategies were described and assigned a metaphor: the structured PHN, pragmatic PHN, critical PHN, and the resigned PHN. Competence, patient receptiveness, internal consensus, interdisciplinary collaboration, resources, and organizational embedding were the determinants identified that most frequently affect implementation, and these determinants were distributed at different levels of the organization. The extent of facilitation seemed to determine which implementation strategy would be used. How PHNs implemented the guidelines for overweight and obesity were affected by determinants at different organizational levels. Contextual facilitation of implementation seemed better in larger organizations, but factors such as leadership, drive, and experience compensated in smaller municipalities. The implementation of guidelines was hindered when the barriers exceeded the benefits.

[Implementation of clinical practice guidelines: how can we close the evidence-practice gap?].

PubMed

Muche-Borowski, Cathleen; Nothacker, M; Kopp, I

2015-01-01

Guidelines are intended as instruments of knowledge transfer to support decision-making by physicians, other health professionals and patients in clinical practice and thereby contribute to quality improvements in healthcare. To date they are an indispensable tool for healthcare. Their benefit for patients can only be seen in application, i.e. the implementation of guideline recommendations. For successful implementation, implementability and practicability play a crucial role and these characteristics can be influenced and should be promoted by the guideline development group. In addition, a force field analysis to identify barriers against and facilitators for the implementation of specific guideline recommendations from the perspective of physicians and patients is recommended to guide the development of an individual implementation strategy and the selection of appropriate interventions. However, implementation cannot be achieved by the guideline development group alone and a universal implementation strategy does not exist. Therefore, a process using theory, analysis, experience and shared responsibility of stakeholders in healthcare is recommended, with the aim to achieve sustainable behavioral change and improve the quality of care by guideline-oriented behavior.

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.

Implementing ecosystem management in public agencies: lessons from the U.S. Bureau of Land Management and the Forest Service.

PubMed

Koontz, Tomas M; Bodine, Jennifer

2008-02-01

Ecosystem management was formally adopted over a decade ago by many U.S. natural resource agencies, including the Forest Service and the Bureau of Land Management. This approach calls for management based on stakeholder collaboration; interagency cooperation; integration of scientific, social, and economic information; preservation of ecological processes; and adaptive management. Results of previous studies indicate differences in the extent to which particular components of ecosystem management would be implemented within the U.S. Forest Service and the Bureau of Land Management and suggest a number of barriers thought to impede implementation. Drawing on survey and interview data from agency personnel and stakeholders, we compared levels of ecosystem-management implementation in the Forest Service and Bureau of Land Management and identified the most important barriers to implementation. Agency personnel perceived similarly high levels of implementation on many ecosystem-management components, whereas stakeholders perceived lower levels. Agencies were most challenged by implementation of preservation of ecological processes, adaptive management, and integration of social and economic information, whereas the most significant barriers to implementation were political, cultural, and legal.

Digital telephony analysis model and issues

NASA Astrophysics Data System (ADS)

Keuthan, Lynn M.

1995-09-01

Experts in the fields of digital telephony and communications security have stated the need for an analytical tool for evaluating complex issues. Some important policy issues discussed by experts recently include implementing digital wire-taps, implementation of the 'Clipper Chip', required registration of encryption/decryption keys, and export control of cryptographic equipment. Associated with the implementation of these policies are direct costs resulting from implementation, indirect cost benefits from implementation, and indirect costs resulting from the risks of implementation or factors reducing cost benefits. Presented herein is a model for analyzing digital telephony policies and systems and their associated direct costs and indirect benefit and risk factors. In order to present the structure of the model, issues of national importance and business-related issues are discussed. The various factors impacting the implementation of the associated communications systems and communications security are summarized, and various implementation tradeoffs are compared based on economic benefits/impact. The importance of the issues addressed herein, as well as other digital telephony issues, has greatly increased with the enormous increases in communication system connectivity due to the advance of the National Information Infrastructure.

How much does it cost to change the behavior of health professionals? A mathematical model and an application to academic detailing.

PubMed

Gandjour, Afschin; Lauterbach, Karl Wilhelm

2005-01-01

Several strategies have shown to be effective at enhancing the implementation of research findings in daily practice. These implementation strategies improve the delivery of preventive or therapeutic care by successfully educating health professionals. On the other hand, little is known about the costs of these implementation strategies. The goal of this article is to present a mathematical model that predicts implementation costs by using published data. As an important feature, the model portrays the relationship between the degree of treatment underuse and implementation costs. Two application examples of outreach programs for the prevention of stroke and coronary disease analyze the relevance of implementation costs with respect to the cost-effectiveness ratio and total costs. They demonstrate that implementation costs may have little impact on the cost-effectiveness ratio but may nevertheless be relevant to a 3rd-party payer who needs to stay within the budget and ensure that care is provided to a large underserved population. The model and its consideration of implementation costs may contribute to a more efficient use of health care resources.

The constraints of good governance practice in national solid waste management policy (NSWMP) implementation: A case study of Malaysia

NASA Astrophysics Data System (ADS)

Wee, Seow Ta; Abas, Muhamad Azahar; Chen, Goh Kai; Mohamed, Sulzakimin

2017-10-01

Nowadays, international donors have emphasised on the adoption of good governance practices in solid waste management which include policy implementation. In Malaysia, the National Solid Waste Management Policy (NSWMP) was introduced as the main guideline for its solid waste management and the Malaysian government has adopted good governance practice in the NSMWP implementation. However, the good governance practices implemented by the Malaysian government encountered several challenges. This study was conducted to explore the good governance constraints experienced by stakeholders in the NSWMP implementation. An exploratory research approach is applied in this study through in-depth interviews with several government agencies and concessionaires that involved in the NSWMP implementation in Malaysia. A total of six respondents took part in this study. The findings revealed three main good governance constraints in the NSWMP implementation, namely inadequate fund, poor staff's competency, and ambiguity of policy implementation system. Moreover, this study also disclosed that the main constraint influenced the other constraints. Hence, it is crucial to identify the main constraint in order to minimise its impact on the other constraints.

Teen Pregnancy Prevention: Implementation of a Multicomponent, Community-Wide Approach.

PubMed

Mueller, Trisha; Tevendale, Heather D; Fuller, Taleria R; House, L Duane; Romero, Lisa M; Brittain, Anna; Varanasi, Bala

2017-03-01

This article provides an overview and description of implementation activities of the multicomponent, community-wide initiatives of the Teenage Pregnancy Prevention Program initiated in 2010 by the Office of Adolescent Health and the Centers for Disease Control and Prevention. The community-wide initiatives applied the Interactive Systems Framework for dissemination and implementation through training and technical assistance on the key elements of the initiative: implementation of evidence-based teen pregnancy prevention (TPP) interventions; enhancing quality of and access to youth-friendly reproductive health services; educating stakeholders about TPP; working with youth in communities most at risk of teen pregnancy; and mobilizing the community to garner support. Of nearly 12,000 hours of training and technical assistance provided, the majority was for selecting, implementing, and evaluating an evidence-based TPP program. Real-world implementation of a community-wide approach to TPP takes time and effort. This report describes implementation within each of the components and shares lessons learned during planning and implementation phases of the initiative. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Implementation-intention encoding in a prospective memory task enhances spontaneous retrieval of intentions.

PubMed

Rummel, Jan; Einstein, Gilles O; Rampey, Hilary

2012-01-01

Although forming implementation intentions (Gollwitzer, 1999) has been demonstrated to generally improve prospective memory, the underlying cognitive mechanisms are not completely understood. It has been proposed that implementation-intention encoding encourages spontaneous retrieval (McDaniel & Scullin, 2010). Alternatively one could assume the positive effect of implementation-intention encoding is caused by increased or more efficient monitoring for target cues. To test these alternative explanations and to further investigate the cognitive mechanisms underlying implementation-intention benefits, in two experiments participants formed the intention to respond to specific target cues in a lexical decision task with a special key, but then had to suspend this intention during an intervening word-categorisation task. Response times on trials directly following the occurrence of target cues in the intervening task were significantly slower with implementation-intention encoding than with standard encoding, indicating that spontaneous retrieval was increased (Experiment 1). However, when activation of the target cues was controlled for, similar slowing was found with both standard and implementation-intention encoding (Experiment 2). The results imply that implementation-intention encoding as well as increased target-cue activation foster spontaneous retrieval processes.

An empirical analysis of strategy implementation process and performance of construction companies

NASA Astrophysics Data System (ADS)

Zaidi, F. I.; Zawawi, E. M. A.; Nordin, R. M.; Ahnuar, E. M.

2018-02-01

Strategy implementation is known as action stage where it is to be considered as the most difficult stage in strategic planning. Strategy implementation can influence the whole texture of a company including its performance. The aim of this research is to provide the empirical relationship between strategy implementation process and performance of construction companies. This research establishes the strategy implementation process and how it influences the performance of construction companies. This research used quantitative method approached via questionnaire survey. Respondents were G7 construction companies in Klang Valley, Selangor. Pearson correlation analysis indicate a strong positive relationship between strategy implementation process and construction companies’ performance. The most importance part of strategy implementation process is to provide sufficient training for employees which directly influence the construction companies’ profit growth and employees’ growth. This research results will benefit top management in the construction companies to conduct strategy implementation in their companies. This research may not reflect the whole construction industry in Malaysia. Future research may be resumed to small and medium grades contractors and perhaps in other areas in Malaysia.

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

Increased analgesia administration in emergency medicine after implementation of revised guidelines.

PubMed

Van Woerden, Geesje; Van Den Brand, Crispijn L; Den Hartog, Cornelis F; Idenburg, Floris J; Grootendorst, Diana C; Van Der Linden, M Christien

2016-12-01

The most common complaint of patients attending the emergency department (ED) is pain, caused by different diseases. Yet the treatment of pain at the ED is suboptimal, and oligoanalgesia remains common. The objective of this study is to determine whether the administration of analgesia at the ED increases by implementation of revised guidelines in pain management. We conducted a prospective pre-post intervention cohort study with implementation of a revised guideline for pain management at our ED, in which nurses are allowed to administer analgesia (including low-dosage piritramid (opioid) intravenous) without doctor intervention. Numeric Rating Scales (NRS) were measured, and administration of medication (main outcome) was documented. We included every adult patient presenting with pain (NRS 4-10) at the ED. A total of 2107 patients (1089 pre-implementation phase and 1018 post-implementation phase) were included in our study. During pre-implementation, 25.4 % of the patients with NRS between 4 and 10 received analgesia. After implementation, 32.0 % of these patients received analgesia (p < 0.001). After implementation of the revised guidelines in pain management at the ED, the administration of pain medication increased significantly. Nevertheless, the percentage of patients in pain receiving analgesia remain low (32 % after implementation).

Factors associated with the implementation of community-based peer-led health promotion programs: A scoping review.

PubMed

Lorthios-Guilledroit, Agathe; Richard, Lucie; Filiatrault, Johanne

2018-06-01

Peer education is growing in popularity as a useful health promotion strategy. However, optimal conditions for implementing peer-led health promotion programs (HPPs) remain unclear. This scoping review aimed to describe factors that can influence implementation of peer-led HPPs targeting adult populations. Five databases were searched using the keywords "health promotion/prevention", "implementation", "peers", and related terms. Studies were included if they reported at least one factor associated with the implementation of community-based peer-led HPPs. Fifty-five studies were selected for the analysis. The method known as "best fit framework synthesis" was used to analyze the factors identified in the selected papers. Many factors included in existing implementation conceptual frameworks were deemed applicable to peer-led HPPs. However, other factors related to individuals, programs, and implementation context also emerged from the analysis. Based on this synthesis, an adapted theoretical framework was elaborated, grounded in a complex adaptive system perspective and specifying potential mechanisms through which factors may influence implementation of community-based peer-led HPPs. Further research is needed to test the theoretical framework against empirical data. Findings from this scoping review increase our knowledge of the optimal conditions for implementing peer-led HPPs and thereby maximizing the benefits of such programs. Copyright © 2018 Elsevier Ltd. All rights reserved.

Factors Influencing Teachers’ Implementation of an Innovative Tobacco Prevention Curriculum for Multiethnic Youth: Project SPLASH

PubMed Central

Sy, Angela; Glanz, Karen

2013-01-01

BACKGROUND The effectiveness of school-based tobacco use prevention programs depends on proper implementation. This study examined factors associated with teachers’ implementation of a smoking prevention curriculum in a cluster randomized trial called Project SPLASH (Smoking Prevention Launch Among Students in Hawaii). METHODS A process evaluation was conducted and a cross-condition comparison used to examine whether teacher characteristics, teacher training, external facilitators and barriers, teacher attitudes, and curriculum attributes were associated with the dose of teacher implementation in the intervention and control arms of the study. Data were collected from a total of 62 middle school teachers in 20 public schools in Hawaii, during the 2000-2001 and 2001-2002 school years. Sources included teacher questionnaires and interviews. Chi-square test and t test revealed that implementation dose was related to teachers’ disciplinary backgrounds and skills and student enjoyment of the curriculum. RESULTS Content analysis, within case, and cross-case analyses of qualitative data revealed that implementing the curriculum in a yearlong class schedule and high teacher self-efficacy supported implementation, while high perceived curriculum complexity was associated with less complete implementation. CONCLUSIONS The results have implications for research, school health promotion practice, and the implementation of evidence-based youth tobacco use prevention curricula. PMID:18387026

Developing a "toolkit" to measure implementation of concurrent palliative care in rural community cancer centers.

PubMed

Zubkoff, Lisa; Dionne-Odom, J Nicholas; Pisu, Maria; Babu, Dilip; Akyar, Imatullah; Smith, Tasha; Mancarella, Gisella A; Gansauer, Lucy; Sullivan, Margaret Murray; Swetz, Keith M; Azuero, Andres; Bakitas, Marie A

2018-02-01

Despite national guidelines recommending early concurrent palliative care for individuals newly diagnosed with metastatic cancer, few community cancer centers, especially those in underserved rural areas do so. We are implementing an early concurrent palliative care model, ENABLE (Educate, Nurture, Advise, Before Life Ends) in four, rural-serving community cancer centers. Our objective was to develop a "toolkit" to assist community cancer centers that wish to integrate early palliative care for patients with newly diagnosed advanced cancer and their family caregivers. Guided by the RE-AIM (Reach, Effectiveness-Adoption, Implementation, Maintenance) framework, we undertook an instrument-development process based on the literature, expert and site stakeholder review and feedback, and pilot testing during site visits. We developed four instruments to measure ENABLE implementation: (1) the ENABLE RE-AIM Self-Assessment Tool to assess reach, adoption, implementation, and maintenance; (2) the ENABLE General Organizational Index to assess institutional implementation; (3) an Implementation Costs Tool; and (4) an Oncology Clinicians' Perceptions of Early Concurrent Oncology Palliative Care survey. We developed four measures to determine early palliative care implementation. These measures have been pilot-tested, and will be integrated into a comprehensive "toolkit" to assist community cancer centers to measure implementation outcomes. We describe the lessons learned and recommend strategies for promoting long-term program sustainability.

The science of quality improvement implementation: developing capacity to make a difference.

PubMed

Alexander, Jeffrey A; Hearld, Larry R

2011-12-01

Quality improvement (QI) holds promise to improve quality of care; however, organizations often struggle with its implementation. It has been recommended that practitioners, managers, and researchers attempt to increase systematic understanding of the structure, practices, and context of organizations that facilitate or impede the implementation of QI innovations. To critically review the empirical research on QI implementation in health care organizations. A literature review of 107 studies that examined the implementation of QI innovations in health care organizations. Studies were classified into 4 groups based on the types of predictors that were assumed to affect implementation (content of QI innovation, organizational processes, internal context, and external context). Internal context and organizational processes were the most frequently studied categories. External context and organizational process categories exhibited the highest rate of positive effects on QI implementation. The review revealed several important gaps in the QI implementation literature. Studies often lacked clear conceptual frameworks to guide the research, which may hinder efforts to compare relationships across studies. Studies also tended to adopt designs that were narrowly focused on independent effects of predictors and did not include holistic frameworks to capture interactions among the many factors involved in implementation. Other design limitations included the use of cross-sectional designs, single-source data collection, and potential selection bias among study participants.

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.

Study protocol Implementation of the Veder contact method (VCM) in daily nursing home care for people with dementia: an evaluation based on the RE-AIM framework.

PubMed

Boersma, Petra; Van Weert, Julia C M; van Meijel, Berno; van de Ven, Peter M; Dröes, Rose-Marie

2017-07-01

People with dementia in nursing homes benefit from person-centred care methods. Studies examining the effect of these methods often fail to report about the implementation of these methods. The present study aims to describe the implementation of the Veder contact method (VCM) in daily nursing home care. A process analysis will be conducted based on qualitative data from focus groups with caregivers and interviews with key figures. To investigate whether the implementation of VCM is reflected in the attitude and behaviour of caregivers and in the behaviour and quality of life of people with dementia, a controlled observational cohort study will be conducted. Six nursing home wards implementing VCM will be compared with six control wards providing Care As Usual. Quantitative data from caregivers and residents will be collected before (T0), and 9-12 months after the implementation (T1). Qualitative analysis and multilevel analyses will be carried out on the collected data and structured based on the constructs of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). By using the RE-AIM framework this study introduces a structured and comprehensive way of investigating the implementation process and implementation effectiveness of person-centred care methods in daily dementia care.

The Instrument for Measuring the Implementation Situation of Traditional Chinese Medicine Guideline: Evaluation and Application

PubMed Central

Wang, Yangyang; Chen, Yaolong; Wang, Xiaoyun; Deng, Jingwen

2017-01-01

Clinical practice guidelines play an important role in reducing the variations in clinical practices and improving the quality of care. To assess the real effect, measuring its implementation situation is needed. The implementation situation can be reflected by testing the consistency between the actual clinical practice and the guideline. We constructed an instrument to measure the implementation situation of Traditional Chinese Medicine (TCM) guideline through consistency testing. The main objectives of our study were to validate the instrument and evaluate the implementation situation of menopause syndrome guideline of TCM, using the data from the consistency test of comparing the medical records with the guideline. A total of 621 cases were included for data analysis. Cronbach's Alpha coefficient is 0.73. The model fit of 7 items in four dimensions was good (SRMR = 0.04; GFI = 0.97; NFI = 0.97; TLI = 0.96; CFI = 0.98; AGFI = 0.90). This instrument is of good reliability and validity. It can help the guideline developers to measure the implementation situation, find the reasons affecting the implementation, and revise the guideline. The method of using consistency test to measure the implementation situation may provide a sample for evaluating the guideline implementation in other fields. PMID:29234379

Nurse adoption of continuous patient monitoring on acute post-surgical units: managing technology implementation.

PubMed

Jeskey, Mary; Card, Elizabeth; Nelson, Donna; Mercaldo, Nathaniel D; Sanders, Neal; Higgins, Michael S; Shi, Yaping; Michaels, Damon; Miller, Anne

2011-10-01

To report an exploratory action-research process used during the implementation of continuous patient monitoring in acute post-surgical nursing units. Substantial US Federal funding has been committed to implementing new health care technology, but failure to manage implementation processes may limit successful adoption and the realisation of proposed benefits. Effective approaches for managing barriers to new technology implementation are needed. Continuous patient monitoring was implemented in three of 13 medical/surgical units. An exploratory action-feedback approach, using time-series nurse surveys, was used to identify barriers and develop and evaluate responses. Post-hoc interviews and document analysis were used to describe the change implementation process. Significant differences were identified in night- and dayshift nurses' perceptions of technology benefits. Research nurses' facilitated the change process by evolving 'clinical nurse implementation specialist' expertise. Health information technology (HIT)-related patient outcomes are mediated through nurses' acting on new information but HIT designed for critical care may not transfer to acute care settings. Exploratory action-feedback approaches can assist nurse managers in assessing and mitigating the real-world effects of HIT implementations. It is strongly recommended that nurse managers identify stakeholders and develop comprehensive plans for monitoring the effects of HIT in their units. © 2011 Blackwell Publishing Ltd.

Increasing the Frequency and Timeliness of Pain Assessment and Management in Long-Term Care: Knowledge Transfer and Sustained Implementation.

PubMed

Hadjistavropoulos, Thomas; Williams, Jaime; Kaasalainen, Sharon; Hunter, Paulette V; Savoie, Maryse L; Wickson-Griffiths, Abigail

2016-01-01

Background. Although feasible protocols for pain assessment and management in long-term care (LTC) have been developed, these have not been implemented on a large-scale basis. Objective. To implement a program of regular pain assessment in two LTC facilities, using implementation science principles, and to evaluate the process and success of doing so. Methods. The implementation protocol included a pain assessment workshop and the establishment of a nurse Pain Champion. Quality indicators were tracked before and after implementation. Focus groups and interviews with staff were also conducted. Results. The implementation effort was successful in increasing and regularizing pain assessments. This was sustained during the follow-up period. Staff members reported enthusiasm about the protocol at baseline and positive results following its implementation. Despite the success in increasing assessments, we did not identify changes in the percentages of patients reported as having moderate-to-severe pain. Discussion. It is our hope that our feasibility demonstration will encourage more facilities to improve their pain assessment/management practices. Conclusions. It is feasible to implement regular and systematic pain assessment in LTC. Future research should focus on ensuring effective clinical practices in response to assessment results, and determination of longer-term sustainability.

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

Implementing enhanced recovery pathways: a literature review with realist synthesis.

PubMed

Coxon, Astrid; Nielsen, Karina; Cross, Jane; Fox, Chris

2017-10-01

Enhanced Recovery Pathways (ERPs) are an increasingly popular, evidenced-based approach to surgery, designed to improve patient outcomes and reduce costs. Despite evidence demonstrating the benefits of these pathways, implementation and adherence have been inconsistent. Using realist synthesis, this review explored the current literature surrounding the implementation of ERPs in the UK. Knowledge consolidation between authors and consulting with field experts helped to guide the search strategy. Relevant medical and social science databases were searched from 2000 to 2016, as well as a general web search. A total of 17 papers were identified, including original research, reviews, case studies and guideline documents. Full texts were analysed, cross-examined, and data extracted and synthesised. Several implementation strategies were identified, including the contexts in which these operated, the subsequent mechanisms of action that were triggered, and the outcome patterns they produced. Context-Mechanism-Outcome (CMO) configurations were generated, tested, and refined. These were grouped to develop two programme theories concerning ERP implementation, one related to the strategy of consulting with staff, the other with appointing a change agent to coordinate and drive the implementation process. These theories highlight instances in which implementation could be improved. Current literature in ERP research is primarily focussed on measuring patient outcomes and cost effectiveness, and as a result, important detail regarding the implementation process is often not reported or described robustly. This review not only provides recommendations for future improvements in ERP implementation, but also highlights specific areas of focus for furthering ERP implementation research.

"More bang for the buck": exploring optimal approaches for guideline implementation through interviews with international developers.

PubMed

Gagliardi, Anna R

2012-11-15

Population based studies show that guidelines are underused. Surveys of international guideline developers found that many do not implement their guidelines. The purpose of this research was to interview guideline developers about implementation approaches and resources. Semi-structured telephone interviews were conducted with representatives of guideline development agencies identified in the National Guideline Clearinghouse and sampled by country, type of developer, and guideline clinical indication. Participants were asked to comment on the benefits and resource implications of three approaches for guideline implementation that varied by responsibility: developers, intermediaries, or users. Thirty individuals from seven countries were interviewed, representing government (n = 12) and professional (n = 18) organizations that produced guidelines for a variety of clinical indications. Organizations with an implementation mandate featured widely inconsistent funding and staffing models, variable approaches for choosing promotional strategies, and an array of dissemination activities. When asked to choose a preferred approach, most participants selected the option of including information within guidelines that would help users to implement them. Given variable mandate and resources for implementation, it was considered the most feasible approach, and therefore most likely to have impact due to potentially broad use. While implementation approaches and strategies need not be standardized across organizations, the findings may be used by health care policy makers and managers, and guideline developers to generate strategic and operational plans that optimize implementation capacity. Further research is needed to examine how to optimize implementation capacity by guideline developers, intermediaries and users.

Implementation Science Supports Core Clinical Competencies: An Overview and Clinical Example.

PubMed

Kirchner, JoAnn E; Woodward, Eva N; Smith, Jeffrey L; Curran, Geoffrey M; Kilbourne, Amy M; Owen, Richard R; Bauer, Mark S

2016-12-08

Instead of asking clinicians to work faster or longer to improve quality of care, implementation science provides another option. Implementation science is an emerging interdisciplinary field dedicated to studying how evidence-based practice can be adopted into routine clinical care. This article summarizes principles and methods of implementation science, illustrates how they can be applied in a routine clinical setting, and highlights their importance to practicing clinicians as well as clinical trainees. A hypothetical clinical case scenario is presented that explains how implementation science improves clinical practice. The case scenario is also embedded within a real-world implementation study to improve metabolic monitoring for individuals prescribed antipsychotics. Context, recipient, and innovation (ie, the evidence-based practice) factors affected improvement of metabolic monitoring. To address these factors, an external facilitator and a local quality improvement team developed an implementation plan involving a multicomponent implementation strategy that included education, performance reports, and clinician follow-up. The clinic remained compliant with recommended metabolic monitoring at 1-year follow up. Implementation science improves clinical practice by addressing context, recipient, and innovation factors and uses this information to develop and utilize specific strategies that improve clinical practice. It also enriches clinical training, aligning with core competencies by the Accreditation Council for Graduate Medical Education and American Boards of Medical Specialties. By learning how to change clinical practice through implementation strategies, clinicians are more able to adapt in complex systems of practice. © Copyright 2016 Physicians Postgraduate Press, Inc.

A nutrition labeling intervention in worksite cafeterias: an implementation evaluation across two large catering companies in the Netherlands.

PubMed

Vyth, Ellis L; Van Der Meer, Esther W C; Seidell, Jacob C; Steenhuis, Ingrid H M

2012-06-01

By both increasing the availability of healthy foods and labeling these products with the Choices logo, caterers may facilitate employees to make a healthier choice in their worksite cafeterias. The aim of this study was to explore which attributes influence the implementation of the Choices logo in worksite cafeterias in the Netherlands. Questionnaires were completed by catering managers of 316 cafeterias of two large caterers in the Netherlands (response rate 49.8%). Attributes from the Diffusion of Innovations Theory were used to investigate whether they could predict implementation. Compatibility (consistency with the beliefs of the catering manager; OR = 1.52), voluntariness (perception of the implementation as voluntary; OR = 0.50), result demonstrability (ability to communicate the implementation; OR = 1.52) and complexity in the sense of time (time needed for implementation; OR = 0.70) were the best predictors for the frequency of offering fresh Choices products (all significant). For the frequency of using Choices promotion material, voluntariness (OR = 0.54), result demonstrability (OR = 1.51) and relative advantage (perceived advantage of the implementation; OR = 1.44) were the best predictors (all significant). In conclusion, this study provides unique insights into which perceived attributes influence the implementation of a nutrition logo in worksite cafeterias. To increase the implementation, the Choices logo should be consistent with catering managers' ideas about healthy food, the workload of implementing the logo should be limited and it could be recommended to incorporate the logo in the health policy of the caterer.

Implementing a province-wide mandatory vaccinate-or-mask policy at healthcare facilities in British Columbia, Canada.

PubMed

Nunn, Alexandra; Campbell, Audrey C; Naus, Monika; Kwong, Jeffrey C; Puddicombe, David; Quach, Susan; Henry, Bonnie

2018-01-08

In 2012, British Columbia (BC) became the first Canadian province to implement an influenza prevention policy requiring healthcare workers (HCW) to either be vaccinated annually against influenza or wear a mask in patient care areas during the influenza season. This study describes an evaluation of influenza policy implementation processes and identifies supports and challenges related to successful policy implementation at the level of healthcare facilities, during the second policy year (2013/14). Implementation leaders from 262 long-term care (LTC) and acute care facilities, mostly in three of BC's five regional Health Authorities, were invited to participate in an online survey following the 2013/14 influenza season. Descriptive quantitative and qualitative analyses identified common and effective strategies for improving vaccination coverage and policy compliance. A total of 127 respondents completed the survey on behalf of 33 acute care and 99 LTC facilities, representing 36% of acute care and 27% of LTC facilities in BC. Respondents agreed that the policy was successfully implemented at 89% of facilities, and implementation was reported to be easy at 52% of facilities. The findings elaborate on communication and leadership strategies, campaign logistics and enforcement approaches involved in policy implementation. Implementation of a vaccinate-or-mask influenza policy is complex. This study provides insight for other jurisdictions considering implementing such a policy and offers practical recommendations for facilities and health authorities. Copyright © 2017 Elsevier Ltd. All rights reserved.

The struggle of translating science into action: Foundational concepts of implementation science

PubMed Central

Clay‐Williams, Robyn; Churruca, Kate; Shih, Patti; Hogden, Anne; Braithwaite, Jeffrey

2017-01-01

Abstract Rationale, aims, and objectives “Implementation science,” the scientific study of methods translating research findings into practical, useful outcomes, is contested and complex, with unpredictable use of results from routine clinical practice and different levels of continuing assessment of implementable interventions. The authors aim to reveal how implementation science is presented and understood in health services research contexts and clarify the foundational concepts: diffusion, dissemination, implementation, adoption, and sustainability, to progress knowledge in the field. Method Implementation science models, theories, and frameworks are critiqued, and their value for laying the groundwork from which to implement a study's findings is emphasised. The paper highlights the challenges of turning research findings into practical outcomes that can be successfully implemented and the need for support from change agents, to ensure improvements to health care provision, health systems, and policy. The paper examines how researchers create implementation plans and what needs to be considered for study outputs to lead to sustainable interventions. This aspect needs clear planning, underpinned by appropriate theoretical paradigms that rigorously respond to a study's aims and objectives. Conclusion Researchers might benefit from a return to first principles in implementation science, whereby applications that result from research endeavours are both effective and readily disseminated and where interventions can be supported by appropriate health care personnel. These should be people specifically identified to promote change in service organisation, delivery, and policy that can be systematically evaluated over time, to ensure high‐quality, long‐term improvements to patients' health. PMID:28371050

Health promotion interventions in social economy companies in Flanders (Belgium).

PubMed

Hublet, Anne; Maes, Lea; Mommen, Jasmine; Deforche, Benedicte; De Bourdeaudhuij, Ilse

2016-01-05

Disadvantaged groups are often not reached by mainstream health promotion interventions. Implementing health promotion (HP) interventions in social economy companies, can be an opportunity to reach those people. The implementation of these interventions in social economy companies was studied. Factors that could be related to the implementation of HP and being supportive towards implementation in the future, were investigated. An online, quantitative survey was sent to all 148 sheltered and social workshops in Flanders. In the questionnaire, the status of HP interventions and characteristics of the workshop were explored. Personal factors (such as attitudes towards HP, behavioural control, social norms and moral responsibility) were asked to the person responsible for implementation of HP interventions. Univariate and multivariate logistic regressions were performed. Respondents of 88 workshops completed the questionnaire. Almost 60% of the workshops implemented environmental or policy interventions. Having a positive attitude towards HP, being more morally responsible, and having the subjective norm that employees are positive towards health promotion at work, were related to being more supportive towards the implementation of HP in the univariate analyses. Only attitude stayed significantly related to being more supportive towards the implementation of HP in the multivariate analyses. Sheltered and social workshops are open to HP interventions, but more can be done to optimize the implementation. To persuade persons responsible for the implementation of HP to invest more in HP, changing attitudes concerning the benefits of health promotion for the employee and the company, is an important strategy.

Fail to prepare and you can prepare to fail: the experience of financing path changes in teaching hospitals in Iran.

PubMed

Doshmangir, Leila; Rashidian, Arash; Jafari, Mehdi; Ravaghi, Hamid; Takian, Amirhossein

2016-04-21

In 1995, teaching and public hospitals that are affiliated with the ministry of health and medical education (MOHME) in Iran were granted financial self-sufficiency to practice contract-based relations with insurance organizations. The so-called "hospital autonomy" policy involved giving authority to the insurance organizations to purchase health services. The policy aimed at improving hospitals' performance, hoping to reduce government's costs. However, the policy was never implemented as intended. This was because most participating hospitals gave up to implement autonomous financing and took other financing pathways. This paper analyses the reasons for the gap between the intended policy and its execution. The lessons learned from this analysis can inform, we envisage, the implementation of similar initiatives in other settings. We conducted semi-structured interviews with 28 national and 13 regional health policy experts. We also gathered a comprehensive and purposeful set of related documents and analyzed their content. The qualitative data were analyzed by thematic inductive-deductive approach. We found a number of prerequisites and requirements that were not prepared prior to the implementing hospital autonomy policy and categorized them into policy content (sources of funds for the policy), implementation context (organization of insurance organizations, medical tariffs, hospitals' organization, feasibility of policy implementation, actors and stakeholders' support), and implementation approach (implementation method, blanket approach to the implementation and timing of implementation). These characteristics resulted in unsuitable platform for policy implementation and eventually led to policy failure. Autonomy of teaching hospitals and their exclusive financing through insurance organizations did not achieve the desired goals of purchaser-provider split in Iran. Unless contextual preparations are in place, hospital autonomy will not succeed and problematic financial relations between service providers and patients in autonomous hospitals may not be ceased as a result.

Developments in Assisting Countries in Implementing the IAEA Additional Protocol

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

Killinger, Mark H.; Hansen, Linda H.; Cain, Ronald A.

In 2008, the U.S. Department of Energy (DOE) began assisting selected non-nuclear weapon states in planning and preparing for implementation of the International Atomic Energy Agency’s Additional Protocol (AP). Since then, the AP international implementation program has contributed to the substantial progress made by Vietnam, Thailand, Iraq, and Malaysia in preparing for entry-into-force of the AP. An overall engagement plan has been developed with components designed to train government AP implementing agencies, inform policy makers, conduct outreach to industry and universities, make AP reporting software available and useful, and plan a detailed approach for implementing the declaration and complementary accessmore » provisions of the AP. DOE recently began collaborating with Indonesia, which has already entered the AP into force, requiring a second method of engagement somewhat different from that taken with countries that have not entered the AP into force. The AP international implementation program, administered by the International Nuclear Safeguards and Engagement Program, is working more closely with DOE’s International Nonproliferation Export Control Program to ensure countries are aware of and prepared to implement the export/import provisions of the AP. As the AP implementation program matures and helps move countries closer to entry-into-force or improved AP implementation, it is identifying characteristics of a country’s “end-state” that indicate that DOE assistance is no longer required. The U.S. AP Implementation Act and Senate Resolution of Ratification require the Administration to report annually to Congress on measures taken to achieve the adoption of the AP in non-nuclear weapon states. DOE’s AP international implementation program is a significant part of these measures. This paper describes recent developments to increase the scope and effectiveness of the program.« less