Development and Implementation of Team-Based Panel Management Tools: Filling the Gap between Patient and Population Information Systems.

PubMed

Watts, Brook; Lawrence, Renée H; Drawz, Paul; Carter, Cameron; Shumaker, Amy Hirsch; Kern, Elizabeth F

2016-08-01

Effective team-based models of care, such as the Patient-Centered Medical Home, require electronic tools to support proactive population management strategies that emphasize care coordination and quality improvement. Despite the spread of electronic health records (EHRs) and vendors marketing population health tools, clinical practices still may lack the ability to have: (1) local control over types of data collected/reports generated, (2) timely data (eg, up-to-date data, not several months old), and accordingly (3) the ability to efficiently monitor and improve patient outcomes. This article describes a quality improvement project at the hospital system level to develop and implement a flexible panel management (PM) tool to improve care of subpopulations of patients (eg, panels of patients with diabetes) by clinical teams. An in-depth case analysis approach is used to explore barriers and facilitators in building a PM registry tool for team-based management needs using standard data elements (eg, laboratory values, pharmacy records) found in EHRs. Also described are factors that may contribute to sustainability; to date the tool has been adapted to 6 disease-focused subpopulations encompassing more than 200,000 patients. Two key lessons emerged from this initiative: (1) though challenging, team-based clinical end users and information technology needed to work together consistently to refine the product, and (2) locally developed population management tools can provide efficient data tracking for frontline clinical teams and leadership. The preliminary work identified critical gaps that were successfully addressed by building local PM registry tools from EHR-derived data and offers lessons learned for others engaged in similar work. (Population Health Management 2016;19:232-239).

76 FR 2394 - Proposed Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-13

... implementation of the Head Start Safe Families Safe Homes domestic violence training curriculum. The Office of... domestic violence service providers in local communities. Teams of trainers in each of five states will... service delivery related to domestic violence. All participants in the local trainings will be asked to...

Factors That Predict Financial Sustainability of Community Coalitions: Five Years of Findings from the PROSPER Partnership Project

PubMed Central

Greenberg, Mark T.; Feinberg, Mark E.; Johnson, Lesley E.; Perkins, Daniel F.; Welsh, Janet A.; Spoth, Richard L.

2014-01-01

This study is a longitudinal investigation of the PROSPER partnership model designed to evaluate the level of sustainability funding by community prevention teams, including which factors impact teams’ generation of sustainable funding. Community teams were responsible for choosing, implementing with quality, and sustaining evidence-based programs (EBPs) intended to reduce substance misuse and promote positive youth and family development. Fourteen US rural communities and small towns were studied. Data were collected from PROSPER community team members (N=164) and Prevention Coordinators (N=10), over a 5-year period. Global and specific aspects of team functioning were assessed over 6 waves. Outcome measures were the total funds (cash and in-kind) raised to implement prevention programs. All 14 community teams were sustained for the first five years. However, there was substantial variability in the amount of funds raised and these differences were predicted by earlier and concurrent team functioning and by team sustainability planning. Given the sufficient infrastructure and ongoing technical assistance provided by the PROSPER partnership model, local sustainability of EBPs is achievable. PMID:24706195

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

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.

Student Achievement and Fidelity of Implementation of the Middle School Concept in Middle Schools

ERIC Educational Resources Information Center

Jackson, Delilah A.

2013-01-01

This study, using qualitative, multiple case methodology, examined four middle schools within a Local Education Agency (LEA) in eastern North Carolina to determine whether the implementation of key middle school features; (a) interdisciplinary teaming, (b) flexible scheduling, (c) advisor/advisee relationships, and (d) an integrative, exploratory…

State and Local Implementation of the "No Child Left Behind Act." Volume III--Accountability under "NCLB" Interim Report

ERIC Educational Resources Information Center

Le Floch, Kerstin Carlson; Martinez, Felipe; O'Day, Jennifer; Stecher, Brian; Taylor, James; Cook, Andrea

2007-01-01

This report presents findings about accountability from two longitudinal studies, the National Longitudinal Study of "No Child Left Behind" (NLS-"NCLB"), and the Study of State Implementation of Accountability and Teacher Quality Under "No Child Left Behind" (SSI-"NCLB"). The research teams for these two…

Factors that predict financial sustainability of community coalitions: five years of findings from the PROSPER partnership project.

PubMed

Greenberg, Mark T; Feinberg, Mark E; Johnson, Lesley E; Perkins, Daniel F; Welsh, Janet A; Spoth, Richard L

2015-01-01

This study is a longitudinal investigation of the Promoting School-community-university Partnerships to Enhance Resilience (PROSPER) partnership model designed to evaluate the level of sustainability funding by community prevention teams, including which factors impact teams' generation of sustainable funding. Community teams were responsible for choosing, implementing with quality, and sustaining evidence-based programs (EBPs) intended to reduce substance misuse and promote positive youth and family development. Fourteen US rural communities and small towns were studied. Data were collected from PROSPER community team members (N = 164) and prevention coordinators (N = 10) over a 5-year period. Global and specific aspects of team functioning were assessed over six waves. Outcome measures were the total funds (cash and in-kind) raised to implement prevention programs. All 14 community teams were sustained for the first 5 years. However, there was substantial variability in the amount of funds raised, and these differences were predicted by earlier and concurrent team functioning and by team sustainability planning. Given the sufficient infrastructure and ongoing technical assistance provided by the PROSPER partnership model, local sustainability of EBPs is achievable.

Developing and Field Testing a Community Based Youth Initiative to Increase Tuberculosis Awareness in Remote Arctic Inuit Communities.

PubMed

Alvarez, Gonzalo G; Van Dyk, Deborah D; Colquhoun, Heather; Moreau, Katherine A; Mulpuru, Sunita; Graham, Ian D

2016-01-01

Inuit in Canada have the highest reported tuberculosis (TB) incidence rate in Canada, even higher than other Canadian Indigenous groups. The aim of this study was to increase TB awareness among Inuit youth and their communities by equipping those who can best reach this population with a community based, youth focused, education initiative built on interventions adapted from a previous TB awareness study. The Taima TB Youth Education Initiative was a field test case study of a knowledge translation (KT) strategy aimed at community members who provide health education in these communities. In the first stage of this study, interventions from a larger TB awareness campaign were adapted to focus on youth living in remote Inuit communities. During the second stage of the study, investigators field tested the initiative in two isolated Inuit communities. It was then applied by local implementation teams in two other communities. Evaluation criteria included feasibility, acceptability, knowledge uptake and health behavior change. Implementation of the adapted KT interventions resulted in participation of a total of 41 youth (19 females, 22 males) with an average age of 16 years (range 12-21 years) in four different communities in Nunavut. Community celebration events were attended by 271 community members where TB messaging were presented and discussed. All of the health care workers and community members surveyed reported that the adapted interventions were acceptable and a useful way of learning to some extent. Knowledge uptake measures indicated an average TB knowledge score of 64 out of 100. Local partners in all four communities indicated that they would use the Taima TB Youth Education Initiative again to raise awareness about TB among youth in their communities. The TB awareness interventions adapted for the Taima TB Youth Education Initiative were acceptable to the Inuit communities involved in the study. They resulted in uptake of knowledge among participants. Implementation by local implementation teams was feasible as evidenced by the participation and attendance of youth and community members in all communities. The ability to implement the interventions by local implementation teams indicates there is potential to scale up in other remote communities in the arctic setting.

Clinical nursing leaders', team members' and service managers' experiences of implementing evidence at a local level.

PubMed

Kitson, Alison; Silverston, Heidi; Wiechula, Rick; Zeitz, Kathryn; Marcoionni, Danni; Page, Tammy

2011-05-01

To describe the experiences of 14 clinical nursing leaders introducing a knowledge translation (KT) project into one metropolitan acute care hospital in South Australia. The study also explored team members' and service managers' experiences. KT strategies assume that local (nursing) clinical leaders have the capacity and capability to champion innovation combining positional leadership roles (ward leader) with a project lead role. There is limited evidence to support these assumptions. Semi-structured interviews of clinical nursing leaders and managers were undertaken at month 4 and 12 of the project. Data were also collected from the interdisciplinary team members (n = 28). Clinical nursing leaders identified risks and anxieties associated with taking on an additional leadership role, whereas managers acknowledged the multiple pressures on the system and the need for local level innovation. Team members generally reported positive experiences. With support, clinical nursing leaders can effectively embrace KT project leadership roles that complement their positional leadership roles. Clinical nursing leaders' experiences differed from nursing and medical managers' experiences.   Managers need to be more attuned to the personal risks local leaders experience, providing support for leaders to experiment and innovate. Managers need to integrate local priorities with broader system wide agendas. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

Community and District Empowerment for Scale-up (CODES): a complex district-level management intervention to improve child survival in Uganda: study protocol for a randomized controlled trial.

PubMed

Waiswa, Peter; O'Connell, Thomas; Bagenda, Danstan; Mullachery, Pricila; Mpanga, Flavia; Henriksson, Dorcus Kiwanuka; Katahoire, Anne Ruhweza; Ssegujja, Eric; Mbonye, Anthony K; Peterson, Stefan Swartling

2016-03-11

Innovative and sustainable strategies to strengthen districts and other sub-national health systems and management are urgently required to reduce child mortality. Although highly effective evidence-based and affordable child survival interventions are well-known, at the district level, lack of data, motivation, analytic and planning capacity often impedes prioritization and management weaknesses impede implementation. The Community and District Empowerment for Scale-up (CODES) project is a complex management intervention designed to test whether districts when empowered with data and management tools can prioritize and implement evidence-based child survival interventions equitably. The CODES strategy combines management, diagnostic, and evaluation tools to identify and analyze the causes of bottlenecks to implementation, build capacity of district management teams to implement context-specific solutions, and to foster community monitoring and social accountability to increase demand for services. CODES combines UNICEF tools designed to systematize priority setting, allocation of resources and problem solving with Community dialogues based on Citizen Report Cards and U-Reports used to engage and empower communities in monitoring health service provision and to demand for quality services. Implementation and all data collection will be by the districts teams or local Community-based Organizations who will be supported by two local implementing partners. The study will be evaluated as a cluster randomized trial with eight intervention and eight comparison districts over a period of 3 years. Evaluation will focus on differences in uptake of child survival interventions and will follow an intention-to-treat analysis. We will also document and analyze experiences in implementation including changes in management practices. By increasing the District Health Management Teams' capacity to prioritize and implement context-specific solutions, and empowering communities to become active partners in service delivery, coverage of child survival interventions will increase. Lessons learned on strengthening district-level managerial capacities and mechanisms for community monitoring may have implications, not only in Uganda but also in other similar settings, especially with regard to accelerating effective coverage of key child survival interventions using locally available resources. ISRCTN15705788 , Date of registration; 24 July 2015.

A Statewide Quality Improvement Collaborative to Increase Breastfeeding Rates in Tennessee.

PubMed

Ware, Julie L; Schetzina, Karen E; Morad, Anna; Barker, Brenda; Scott, Theresa A; Grubb, Peter H

2018-05-01

Tennessee has low breastfeeding rates and has identified opportunities for improvement to enhance maternity practices to support breastfeeding mothers. We sought a 10% relative increase in the aggregate Joint Commission measure of breastfeeding exclusivity at discharge (TJC PC-05) by focusing on high-reliability (≥90%) implementation of processes that promote breastfeeding in the delivery setting. A statewide, multidisciplinary development team reviewed evidence from the WHO-UNICEF "Ten Steps to Successful Breastfeeding" to create a consensus toolkit of process indicators aligned with the Ten Steps. Hospitals submitted monthly TJC PC-05 data for 6 months while studying local implementation of the Ten Steps to identify improvement opportunities, and for an additional 11 months while conducting tests of change to improve Ten Steps implementation using Plan-Do-Study-Act cycles, local process audits, and control charts. Data were aggregated at the state level and presented at 12 monthly webinars, 3 regional learning sessions, and 1 statewide meeting where teams shared their local data and implementation experiences. Thirteen hospitals accounting for 47% of live births in Tennessee submitted data on 31,183 mother-infant dyads from August 1, 2012, to December 31, 2013. Aggregate monthly mean PC-05 demonstrated "special cause" improvement increasing from 37.1% to 41.2%, an 11.1% relative increase. Five hospitals reported implementation of ≥5 of the Ten Steps and two hospitals reported ≥90% reliability on ≥5 of the Ten Steps using locally designed process audits. Using large-scale improvement methodology, a successful statewide collaborative led to >10% relative increase in breastfeeding exclusivity at discharge in participating Tennessee hospitals. Further opportunities for improvement in implementing breastfeeding supportive practices were identified.

Decentralization and Participatory Decision-Making: Implementing School-Based Management in the Abbott Districts.

ERIC Educational Resources Information Center

Walker, Elaine M.

2000-01-01

This study examined issues faced during implementation of school-based management (SBM) in New Jersey's special needs or Abbott districts, using a literature review, surveys of K-12 schools, and focus groups with central office administrators. The study examined forms of SBM, team operations, local autonomy versus state power, skills required to…

Balanced Learning and Assessment Systems in High School--A Report for State Education Leaders. Final Report from the Delaware Enhanced Assessment Grant

ERIC Educational Resources Information Center

Rindone, Douglas

2009-01-01

The Delaware Enhanced Assessment Grant (DE EAG) project was funded by the U.S. Department of Education in 2006 as an initiative to assist 10 state departments of education (SDE) teams, and local school district and high school teams, in implementing a comprehensive and balanced learning and assessment system (CBAS) with a strong emphasis on a…

Developing a network: the PMM process.

PubMed

Kamara, A

1997-11-01

Since 1988, the Prevention of Maternal Mortality (PMM) Network has developed, implemented and evaluated projects that focus directly on prevention of maternal deaths. The Network, which consists of 11 multidisciplinary teams in West Africa and one at Columbia University, grew from discussions between the Carnegie Corporation of New York and researchers at Columbia School of Public Health. Its goals are: to strengthen capacities in developing countries; to provide program models for preventing maternal deaths; and to inform policymakers about the importance of maternal mortality. This paper describes the development and functioning of the Network. The initial steps included identifying interested partners in Africa and encouraging them to form multidisciplinary teams. Each African team received two grants: one to perform a needs assessment and then another to develop and implement projects based on the results. The Columbia team provided technical assistance in a variety of ways, including site visits, workshops and correspondence. Teams tested program models and reported findings both to local policymakers and in international fora. Collaboration with government and community leaders helped facilitate progress at all stages. At the PMM Network Results Conference in 1996, the teams decided to continue their work by forming the Regional PMM (RPMM) Network, an entirely African entity.

The demonstration of a theory-based approach to the design of localized patient safety interventions

PubMed Central

2013-01-01

Background There is evidence of unsafe care in healthcare systems globally. Interventions to implement recommended practice often have modest and variable effects. Ideally, selecting and adapting interventions according to local contexts should enhance effects. However, the means by which this can happen is seldom systematic, based on theory, or made transparent. This work aimed to demonstrate the applicability, feasibility, and acceptability of a theoretical domains framework implementation (TDFI) approach for co-designing patient safety interventions. Methods We worked with three hospitals to support the implementation of evidence-based guidance to reduce the risk of feeding into misplaced nasogastric feeding tubes. Our stepped process, informed by the TDF and key principles from implementation literature, entailed: involving stakeholders; identifying target behaviors; identifying local factors (barriers and levers) affecting behavior change using a TDF-based questionnaire; working with stakeholders to generate specific local strategies to address key barriers; and supporting stakeholders to implement strategies. Exit interviews and audit data collection were undertaken to assess the feasibility and acceptability of this approach. Results Following audit and discussion, implementation teams for each Trust identified the process of checking the positioning of nasogastric tubes prior to feeding as the key behavior to target. Questionnaire results indicated differences in key barriers between organizations. Focus groups generated innovative, generalizable, and adaptable strategies for overcoming barriers, such as awareness events, screensavers, equipment modifications, and interactive learning resources. Exit interviews identified themes relating to the benefits, challenges, and sustainability of this approach. Time trend audit data were collected for 301 patients over an 18-month period for one Trust, suggesting clinically significant improved use of pH and documentation of practice following the intervention. Conclusions The TDF is a feasible and acceptable framework to guide the implementation of patient safety interventions. The stepped TDFI approach engages healthcare professionals and facilitates contextualization in identifying the target behavior, eliciting local barriers, and selecting strategies to address those barriers. This approach may be of use to implementation teams and policy makers, although our promising findings confirm the need for a more rigorous evaluation; a balanced block evaluation is currently underway. PMID:24131864

Next-generation concurrent engineering: developing models to complement point designs

NASA Technical Reports Server (NTRS)

Morse, Elizabeth; Leavens, Tracy; Cohanim, Babak; Harmon, Corey; Mahr, Eric; Lewis, Brian

2006-01-01

Concurrent Engineering Design (CED) teams have made routine the rapid development of point designs for space missions. The Jet Propulsion Laboratory's Team X is now evolving into a 'next-generation CED; in addition to a point design, the Team develops a model of the local trade space. The process is a balance between the power of a model developing tools and the creativity of humal experts, enabling the development of a variety of trade models for any space mission. This paper reviews the modeling method and its practical implementation in the ED environment. Example results illustrate the benefit of this approach.

Cluster randomized trial of a multilevel evidence-based quality improvement approach to tailoring VA Patient Aligned Care Teams to the needs of women Veterans.

PubMed

Yano, Elizabeth M; Darling, Jill E; Hamilton, Alison B; Canelo, Ismelda; Chuang, Emmeline; Meredith, Lisa S; Rubenstein, Lisa V

2016-07-19

The Veterans Health Administration (VA) has undertaken a major initiative to transform care through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home (PCMH) concept, PACT aims to improve access, continuity, coordination, and comprehensiveness using team-based care that is patient-driven and patient-centered. However, how VA should adapt PACT to meet the needs of special populations, such as women Veterans (WVs), was not considered in initial implementation guidance. WVs' numerical minority in VA healthcare settings (approximately 7-8 % of users) creates logistical challenges to delivering gender-sensitive comprehensive care. The main goal of this study is to test an evidence-based quality improvement approach (EBQI) to tailoring PACT to meet the needs of WVs, incorporating comprehensive primary care services and gender-specific care in gender-sensitive environments, thereby accelerating achievement of PACT tenets for women (Women's Health (WH)-PACT). EBQI is a systematic approach to developing a multilevel research-clinical partnership that engages senior organizational leaders and local quality improvement (QI) teams in adapting and implementing new care models in the context of prior evidence and local practice conditions, with researchers providing technical support, formative feedback, and practice facilitation. In a 12-site cluster randomized trial, we will evaluate WH-PACT model achievement using patient, provider, staff, and practice surveys, in addition to analyses of secondary administrative and chart-based data. We will explore impacts of receipt of WH-PACT care on quality of chronic disease care and prevention, health status, patient satisfaction and experience of care, provider experience, utilization, and costs. Using mixed methods, we will assess pre-post practice contexts; document EBQI activities undertaken in participating facilities and their relationship to provider/staff and team actions/attitudes; document WH-PACT implementation; and examine barriers/facilitators to EBQI-supported WH-PACT implementation through a combination of semi-structured interviews and monthly formative progress narratives and administrative data. Lack of gender-sensitive comprehensive care has demonstrated consequences for the technical quality and ratings of care among WVs and may contribute to decisions to continue use or seek care elsewhere under the US Affordable Care Act. We hypothesize that tailoring PACT implementation through EBQI may improve the experience and quality of care at many levels. ClinicalTrials.gov, NCT02039856.

Integrated Assessment by the People: Insights from AgMIP Regional Teams in Sub-Saharan Africa and South Asia

NASA Astrophysics Data System (ADS)

Antle, J. M.

2017-12-01

AgMIP has developed innovative protocol-based methods for regional integrated assessment (RIA) that can be implemented by national researchers working with local and national stakeholders (http://www.agmip.org/regional-integrated-assessments-handbook/). The approach has been implemented by regional teams in Sub-Saharan Africa and South Asia. This presentation first summarizes novel elements of the AgMIP RIA methods, and their strengths and limitations, based on their application by AgMIP researchers. Key insights from the application of these methods for climate impact and adaptation in Sub-Saharan Africa and South Asia are presented. A major finding is that detailed, site-specific, systems-based analysis show much more local and regional variation in impacts than studies based on analysis of individual crops, and provide the basis for analysis of multi-faceted technology and policy options to facilitate the transition to sustainable and resilient development pathways. The presentation concludes with observations about advancing integrated assessments carried out by and for national and local researchers and stakeholders.

Piloting a nationally disseminated, interactive human subjects protection program for community partners: unexpected lessons learned from the field.

PubMed

Solomon, Stephanie; Bullock, Sherita; Calhoun, Karen; Crosby, Lori; Eakin, Brenda; Franco, Zeno; Hardwick, Emily; Holland, Samuel; Leinberger-Jabari, Andrea; Newton, Gail; Odell, Jere; Paberzs, Adam; Spellecy, Ryan

2014-04-01

Funders, institutions, and research organizations are increasingly recognizing the need for human subjects protections training programs for those engaged in academic research. Current programs tend to be online and directed toward an audience of academic researchers. Research teams now include many nonacademic members, such as community partners, who are less likely to respond to either the method or the content of current online trainings. A team at the CTSA-supported Michigan Institute for Clinical and Health Research at the University of Michigan developed a pilot human subjects protection training program for community partners that is both locally implemented and adaptable to local contexts, yet nationally consistent and deliverable from a central administrative source. Here, the developers of the program and the collaborators who participated in the pilot across the United States describe 10 important lessons learned that align with four major themes: The distribution of the program, the implementation of the program, the involvement of community engagement in the program, and finally lessons regarding the content of the program. These lessons are relevant to anyone who anticipates developing or improving a training program that is developed in a central location and intended for local implementation. © 2014 Wiley Periodicals, Inc.

Piloting a Nationally Disseminated, Interactive Human Subjects Protection Program for Community Partners: Unexpected Lessons Learned from the Field

PubMed Central

Bullock, Sherita; Calhoun, Karen; Crosby, Lori; Eakin, Brenda; Franco, Zeno; Hardwick, Emily; Leinberger‐Jabari, Andrea; Newton, Gail; Odell, Jere; Paberzs, Adam; Spellecy, Ryan

2014-01-01

Abstract Funders, institutions, and research organizations are increasingly recognizing the need for human subjects protections training programs for those engaged in academic research. Current programs tend to be online and directed toward an audience of academic researchers. Research teams now include many nonacademic members, such as community partners, who are less likely to respond to either the method or the content of current online trainings. A team at the CTSA‐supported Michigan Institute for Clinical and Health Research at the University of Michigan developed a pilot human subjects protection training program for community partners that is both locally implemented and adaptable to local contexts, yet nationally consistent and deliverable from a central administrative source. Here, the developers of the program and the collaborators who participated in the pilot across the United States describe 10 important lessons learned that align with four major themes: The distribution of the program, the implementation of the program, the involvement of community engagement in the program, and finally lessons regarding the content of the program. These lessons are relevant to anyone who anticipates developing or improving a training program that is developed in a central location and intended for local implementation. PMID:24720349

Using systems thinking to support clinical system transformation.

PubMed

Best, Allan; Berland, Alex; Herbert, Carol; Bitz, Jennifer; van Dijk, Marlies W; Krause, Christina; Cochrane, Douglas; Noel, Kevin; Marsden, Julian; McKeown, Shari; Millar, John

2016-05-16

Purpose - The British Columbia Ministry of Health's Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC's health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings. Design/methodology/approach - Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers and board members were validated through an online survey. Findings - The functional themes for managing large-scale clinical change included: creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system. Research limitations/implications - The action research methodology was designed to guide continuing improvement of implementation. A sample of initiatives was selected; it was not intended to compare and contrast facilitators and barriers across all initiatives and regions. Similarly, evaluating the results or process of guideline implementation was outside the scope; the methods were designed to enable conversations at multiple levels - policy, management and practice - about how to improve implementation. The study is best seen as a case study of LSC, offering a possible model for replication by others and a tool to shape further dialogue. Practical implications - Recommended action-oriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing change fatigue; ensuring adequate resources; providing consistent communication especially for front-line care providers; and supporting local teams to demonstrate the clinical value of the guidelines to their colleagues. Originality/value - Bringing a complex systems perspective to clinical guideline implementation resulted in a clear understanding of the challenges involved in LSC.

Building capacity in implementation science research training at the University of Nairobi.

PubMed

Osanjo, George O; Oyugi, Julius O; Kibwage, Isaac O; Mwanda, Walter O; Ngugi, Elizabeth N; Otieno, Fredrick C; Ndege, Wycliffe; Child, Mara; Farquhar, Carey; Penner, Jeremy; Talib, Zohray; Kiarie, James N

2016-03-08

Health care systems in sub-Saharan Africa, and globally, grapple with the problem of closing the gap between evidence-based health interventions and actual practice in health service settings. It is essential for health care systems, especially in low-resource settings, to increase capacity to implement evidence-based practices, by training professionals in implementation science. With support from the Medical Education Partnership Initiative, the University of Nairobi has developed a training program to build local capacity for implementation science. This paper describes how the University of Nairobi leveraged resources from the Medical Education Partnership to develop an institutional program that provides training and mentoring in implementation science, builds relationships between researchers and implementers, and identifies local research priorities for implementation science. The curriculum content includes core material in implementation science theory, methods, and experiences. The program adopts a team mentoring and supervision approach, in which fellows are matched with mentors at the University of Nairobi and partnering institutions: University of Washington, Seattle, and University of Maryland, Baltimore. A survey of program participants showed a high degree satisfaction with most aspects of the program, including the content, duration, and attachment sites. A key strength of the fellowship program is the partnership approach, which leverages innovative use of information technology to offer diverse perspectives, and a team model for mentorship and supervision. As health care systems and training institutions seek new approaches to increase capacity in implementation science, the University of Nairobi Implementation Science Fellowship program can be a model for health educators and administrators who wish to develop their program and curricula.

Using Theories of Change to inform implementation of health systems research and innovation: experiences of Future Health Systems consortium partners in Bangladesh, India and Uganda.

PubMed

Paina, Ligia; Wilkinson, Annie; Tetui, Moses; Ekirapa-Kiracho, Elizabeth; Barman, Debjani; Ahmed, Tanvir; Mahmood, Shehrin Shaila; Bloom, Gerry; Knezovich, Jeff; George, Asha; Bennett, Sara

2017-12-28

The Theory of Change (ToC) is a management and evaluation tool supporting critical thinking in the design, implementation and evaluation of development programmes. We document the experience of Future Health Systems (FHS) Consortium research teams in Bangladesh, India and Uganda with using ToC. We seek to understand how and why ToCs were applied and to clarify how they facilitate the implementation of iterative intervention designs and stakeholder engagement in health systems research and strengthening. This paper combines literature on ToC, with a summary of reflections by FHS research members on the motivation, development, revision and use of the ToC, as well as on the benefits and challenges of the process. We describe three FHS teams' experiences along four potential uses of ToCs, namely planning, communication, learning and accountability. The three teams developed ToCs for planning and evaluation purposes as required for their initial plans for FHS in 2011 and revised them half-way through the project, based on assumptions informed by and adjusted through the teams' experiences during the previous 2 years of implementation. All teams found that the revised ToCs and their accompanying narratives recognised greater feedback among intervention components and among key stakeholders. The ToC development and revision fostered channels for both internal and external communication, among research team members and with key stakeholders, respectively. The process of revising the ToCs challenged the teams' initial assumptions based on new evidence and experience. In contrast, the ToCs were only minimally used for accountability purposes. The ToC development and revision process helped FHS research teams, and occasionally key local stakeholders, to reflect on and make their assumptions and mental models about their respective interventions explicit. Other projects using the ToC should allow time for revising and reflecting upon the ToCs, to recognise and document the adaptive nature of health systems, and to foster the time, space and flexibility that health systems strengthening programmes must have to learn from implementation and stakeholder engagement.

Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre.

PubMed

Stergiopoulos, Vicky; Saab, Dima; Francombe Pridham, Kate; Aery, Anjana; Nakhost, Arash

2018-01-24

Across many jurisdictions, adults with complex mental health and social needs face challenges accessing appropriate supports due to system fragmentation and strict eligibility criteria of existing services. To support this underserviced population, Toronto's local health authority launched two novel community mental health models in 2014, inspired by Flexible Assertive Community Team principles. This study explores service user and provider perspectives on the acceptability of these services, and lessons learned during early implementation. We purposively sampled 49 stakeholders (staff, physicians, service users, health systems stakeholders) and conducted 17 semi-structured qualitative interviews and 5 focus groups between October 23, 2014 and March 2, 2015, exploring stakeholder perspectives on the newly launched team based models, as well as activities and strategies employed to support early implementation. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using thematic analysis. Findings revealed wide-ranging endorsement for the two team-based models' success in engaging the target population of adults with complex service needs. Implementation strengths included the broad recognition of existing service gaps, the use of interdisciplinary teams and experienced service providers, broad partnerships and collaboration among various service sectors, training and team building activities. Emerging challenges included lack of complementary support services such as suitable housing, organizational contexts reluctant to embrace change and risk associated with complexity, as well as limited service provider and organizational capacity to deliver evidence-based interventions. Findings identified implementation drivers at the practitioner, program, and system levels, specific to the implementation of community mental health interventions for adults with complex health and social needs. These can inform future efforts to address the health and support needs of this vulnerable population.

Iterative design, implementation and evaluation of a supplemental feeding program for underweight children ages 6-59 months in Western Uganda.

PubMed

Jilcott, Stephanie B; Ickes, Scott B; Ammerman, Alice S; Myhre, Jennifer A

2010-03-01

In this paper we describe the development, implementation, evaluation, and subsequent improvements of a supplemental feeding program that provides community-based care to underweight children in a rural East African setting, using a locally-sourced and produced ready-to-use food (RUF). Production teams were trained to grind soybeans and groundnuts (peanuts), which were then mixed with moringa oleifera leaf powder to form an energy-dense supplemental food, designed for use as an RUF. Eligible children (based on low weight-for-age or mid-upper-arm circumference < 12 cm) received RUF of approximately 682 kcal per day for five weeks. Weekly growth monitoring and caregiver education were provided by trained health center staff and community volunteers. The program was evaluated by examining RUF nutrient composition, weight gain velocity, and qualitative data from key-informant interviews and home feeding observations. Locally-produced RUF had similar energy density but higher protein content than commercial RUTF (ready-to-use therapeutic food). Mean weight gain of children was 2.5 g/kg/day (range 0.9-6.0). Feeding observations revealed that caregivers were diluting the RUF fed to children. Production team members desired increased financial compensation for their work but were enthusiastic about the program as helpful to malnourished children. Locally-produced RUF is a promising strategy for community-based care of moderately malnourished children. Through the production team's entrepreneurship, a small business was formed, whereby financial incentives encouraged continued RUF production. Future efforts are needed to educate caregivers on correct RUF use and improve commercial viability in local markets.

Hotspotting: Development of an Interprofessional Education and Service Learning Program for Care Management in Home Care Patients.

PubMed

Zomorodi, Meg; Odom, Trish; Askew, Naomi C; Leonard, Christina R; Sanders, Kimberly A; Thompson, Daniel

2018-03-28

The purpose of this article is to describe a service learning opportunity where interprofessional teams of students worked together to address patients' social determinants of health through home visits. This article describes this process, known as "hotspotting," and presents the development of this project, including collaboration with a local home health agency, recruiting of students, and weekly team meetings for debriefing. Evaluation data, barriers with implementation, and next steps for sustainability are also discussed.

76 FR 34998 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-15

... implementation of the Head Start Safe Families Safe Homes (SFSH) domestic violence training curriculum. The... partnerships with domestic violence service providers in local communities. Teams of trainers in each of five..., state agency staff (e.g., Head Start Collaboration Directors, Domestic Violence Coalition Directors...

Evaluation of the implementation of the Montreal At Home/Chez Soi project.

PubMed

Fleury, Marie-Josée; Grenier, Guy; Vallée, Catherine

2014-11-28

Homelessness and mental disorders constitute a major problem in Canada. The purpose of the At Home/Chez Soi pilot project was to house and provide supports to marginalised groups. Policymakers are in a better position to nurture new, complex interventions if they know which key factors hinder or enable their implementation. This paper evaluates the implementation process for the Montreal site of this project. We collected data from 62 individuals, through individual interviews, focus groups, questionnaires, observations and documentation. The implementation process was analysed using a conceptual framework with five constructs: Intervention Characteristics (IC), Context of Implementation (CI), Implementation Process (IP), Organizational Characteristics (OC) and Strategies of Implementation (SI). The most serious obstacle to the project came from the CI construct, i.e., lack of support from provincial authorities and key local resources in the homelessness field. The second was within the OC construct. The chief hindrances were numerous structures, divergent values among stakeholders, frequent turnover of personnel and team leaders; lacking staff supervision and miscommunication. The third is related to IC: the complex, unyielding nature of the project undermined its chances of success. The greatest challenges from IP were the pressure to perform, along with stress caused by planning, deadlines and tension between teams. Conversely, SI construct conditions (e.g., effective governing structures, comprehensive training initiatives and toolkits) were generally very positive even with problems in power sharing and local leadership. For the four other constructs, the following proved useful: evidence of the project's scope and quality, great needs of services consolidation, generous financing and status as a research pilot project, enthusiasm and commitment toward the project, substantially improved services, and overall user satisfaction. This study demonstrated the difficulty of implementing a complex project in the healthcare system. While the project faced many barriers, minimal conditions were also achieved. At the end of the study period, major tensions between organizations and teams were significantly reduced, supporting its full implementation. However, in late 2013, the project was unsustainable, calling into question the relevance of achieving a significant number of positive conditions in each area of the framework.

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.

Replication of clinical innovations in multiple medical practices.

PubMed

Henley, N S; Pearce, J; Phillips, L A; Weir, S

1998-11-01

Many clinical innovations had been successfully developed and piloted in individual medical practice units of Kaiser Permanente in North Carolina during 1995 and 1996. Difficulty in replicating these clinical innovations consistently throughout all 21 medical practice units led to development of the interdisciplinary Clinical Innovation Implementation Team, which was formed by using existing resources from various departments across the region. REPLICATION MODEL: Based on a model of transfer of best practices, the implementation team developed a process and tools (master schedule and activity matrix) to quickly replicate successful pilot projects throughout all medical practice units. The process involved the following steps: identifying a practice and delineating its characteristics and measures (source identification); identifying a team to receive the (new) practice; piloting the practice; and standardizing, including the incorporation of learnings. The model includes the following components for each innovation: sending and receiving teams, an innovation coordinator role, an innovation expert role, a location expert role, a master schedule, and a project activity matrix. Communication depended on a partnership among the location experts (local knowledge and credibility), the innovation coordinator (process expertise), and the innovation experts (content expertise). Results after 12 months of working with the 21 medical practice units include integration of diabetes care team services into the practices, training of more than 120 providers in the use of personal computers and an icon-based clinical information system, and integration of a planwide self-care program into the medical practices--all with measurable improved outcomes. The model for sequential replication and the implementation team structure and function should be successful in other organizational settings.

The Oregon Public Health Policy Institute: Building Competencies for Public Health Practice.

PubMed

Luck, Jeff; Yoon, Jangho; Bernell, Stephanie; Tynan, Michael; Alvarado, Carla Sarai; Eversole, Tom; Mosbaek, Craig; Beathard, Candice

2015-08-01

The Oregon Public Health Policy Institute (PHPI) was designed to enhance public health policy competencies among state and local health department staff. The Oregon Health Authority funded the College of Public Health and Human Sciences at Oregon State University to develop the PHPI curriculum in 2012 and offer it to participants from 4 state public health programs and 5 local health departments in 2013. The curriculum interspersed short instructional sessions on policy development, implementation, and evaluation with longer hands-on team exercises in which participants applied these skills to policy topics their teams had selected. Panel discussions provided insights from legislators and senior Oregon health experts. Participants reported statistically significant increases in public health policy competencies and high satisfaction with PHPI overall.

Promoting Local Ownership: Lessons Learned from Process of Transitioning Clinical Mentoring of HIV Care and Treatment in Ethiopia.

PubMed

Kassie, Getnet M; Belay, Teklu; Sharma, Anjali; Feleke, Getachew

2018-01-01

Focus on improving access and quality of HIV care and treatment gained acceptance in Ethiopia through the work of the International Training and Education Center for Health. The initiative deployed mobile field-based teams and capacity building teams to mentor health care providers on clinical services and program delivery in three regions, namely Tigray, Amhara, and Afar. Transitioning of the clinical mentoring program (CMP) began in 2012 through capacity building and transfer of skills and knowledge to local health care providers and management. The initiative explored the process of transitioning a CMP on HIV care and treatment to local ownership and documented key lessons learned. A mixed qualitative design was used employing focus group discussions, individual in-depth interviews, and review of secondary data. The participants included regional focal persons, mentors, mentees, multidisciplinary team members, and International Training and Education Center for Health (I-TECH) staff. Three facilities were selected in each region. Data were collected by trained research assistants using customized guides for interviews and with data extraction format. The interviews were recorded and fully transcribed. Open Code software was used for coding and categorizing the data. A total of 16 focus group discussions and 20 individual in-depth interviews were conducted. The critical processes for transitioning a project were: establishment of a mentoring transition task force, development of a roadmap to define steps and directions for implementing the transition, and signing of a memorandum of understanding (MOU) between the respective regional health bureaus and I-TECH Ethiopia to formalize the transition. The elements of implementation included mentorship and capacity building, joint mentoring, supportive supervision, review meetings, and independent mentoring supported by facility-based mechanisms: multidisciplinary team meetings, case-based discussions, and catchment area meetings. The process of transitioning the CMP to local ownership involved signing an MOU, training of mentors, and building capacity of mentoring in each region. The experience shed light on how to transition donor-supported work to local country ownership, with key lessons related to strengthening the structures of regional health bureaus, and other facilities addressing critical issues and ensuring continuity of the facility-based activities.

Emergency preparedness academy adds public health to readiness equation.

PubMed

Livet, Melanie; Richter, Jane; Ellison, LuAnne; Dease, Bill; McClure, Lawrence; Feigley, Charles; Richter, Donna L

2005-11-01

From November 2003 to May 2004, the University of South Carolina Center for Public Health Preparedness and the South Carolina Department of Health and Environmental Control co-sponsored a 6-month-long Academy for Public Health Emergency Preparedness. Six-member teams made up of public health staff and community partner representatives (N = 78) attended from their respective health districts. The Academy consisted of three 6-day training sessions designed to prepare the teams to complete a team-based covert biological bioterrorism tabletop exercise. Program evaluation results revealed increases in (1) public health emergency preparedness core competencies; (2) capacity to plan, implement, and evaluate a tabletop exercise; and (3) successful collaboration and partnership formation between participating Public Health District teams and their local partner agencies. Lessons learned are also described.

2011 John M. Eisenberg Patient Safety and Quality Awards. Mentored implementation: building leaders and achieving results through a collaborative improvement model. Innovation in patient safety and quality at the national level.

PubMed

Maynard, Gregory A; Budnitz, Tina L; Nickel, Wendy K; Greenwald, Jeffrey L; Kerr, Kathleen M; Miller, Joseph A; Resnic, JoAnne N; Rogers, Kendall M; Schnipper, Jeffrey L; Stein, Jason M; Whitcomb, Winthrop F; Williams, Mark V

2012-07-01

The Society of Hospital Medicine (SHM) created "Mentored Implementation" (MI) programs with the dual aims of educating and mentoring hospitalists and their quality improvement (QI) teams and accelerating improvement in the inpatient setting in three signature programs: Venous Thromboembolism (VTE) Prevention, Glycemic Control, and Project BOOST (Better Outcomes for Older adults through Safe Transitions). More than 300 hospital improvement teams were enrolled in SHM MI programs in a series of cohorts. Hospitalist mentors worked with individual hospitals/health systems to guide local teams through the life cycle of a QI project. Implementation Guides and comprehensive Web-based "Resource Rooms," as well as the mentor's own experience, provided best-practice definitions, practical implementation tips, measurement strategies, and other tools. E-mail interactions and mentoring were augmented by regularly scheduled teleconferences; group webinars; and, in some instances, a site visit. Performance was tracked in a centralized data tracking center. Preliminary data on all three MI programs show significant improvement in patient outcomes, as well as enhancements of communication and leadership skills of the hospitalists and their QI teams. Although objective data on outcomes and process measures for the MI program's efficacy remain preliminary at this time, the maturing data tracking system, multiple awards, and early results indicate that the MI programs are successful in providing QI training and accelerating improvement efforts.

The pediatrician's role in development and implementation of an Individual Education Plan (IEP) and/or an Individual Family Service Plan (IFSP). American Academy of Pediatrics. Committee on Children with Disabilities.

PubMed

1999-07-01

The Individual Education Plan and Individual Family Service Plan are legally mandated documents developed by a multidisciplinary team assessment that specifies goals and services for each child eligible for special educational services or early intervention services. Pediatricians need to be knowledgeable of federal, state, and local requirements; establish linkages with early intervention, educational professionals, and parent support groups; and collaborate with the team working with individual children.

U.S. Associated Pacific Islands Health Care Teams Chart a Course for Improved Health Systems: Implementation and Evaluation of a Non-communicable Disease Collaborative Model

PubMed Central

Hosey, Gwendolyn M.; Rengiil, Augusta; Maddison, Robert; Agapito, Angelica U.; Lippwe, Kipier; Wally, Omengkar Damien; Agapito, Dennis D.; Seremai, Johannes; Primo, Selma; Luther, X-ner; Ikerdeu, Edolem; Satterfield, Dawn

2017-01-01

Summary The burden of non-communicable disease (NCD) is increasing in the U.S. Associated Pacific Islands (USAPI). We describe the implementation and evaluation of a NCD Collaborative pilot, using local trainers, as an evidence-based strategy to systematically strengthen NCD health care quality and outcomes, focusing on diabetes preventive care across five health systems in the region. PMID:27818410

searchSCF: Using MongoDB to Enable Richer Searches of Locally Hosted Science Data Repositories

NASA Astrophysics Data System (ADS)

Knosp, B.

2016-12-01

Science teams today are in the unusual position of almost having too much data available to them. Modern sensors and models are capable of outputting terabytes of data per day, which can make it difficult to find specific subsets of data. The sheer size of files can also make it time consuming to retrieve this big data from national data archive centers. Thus, many science teams choose to store what data they can on their local systems, but they are not always equipped with tools to help them intelligently organize and search their data. In its local data repository, the Aura Microwave Limb Sounder (MLS) science team at NASA's Jet Propulsion Laboratory has collected over 300TB of atmospheric science data from 71 missions/models that aid in validation, algorithm development, and research activities. When the project began, the team developed a MySQL database to aid in data queries, but this database was only designed to keep track of MLS and a few ancillary data sets, leving much of the data uncatalogued. The team has also seen database query time rise over the life of the mission. Even though the MLS science team's data holdings are not the size of a national data center's, team members still need tools to help them discover and utilize the data that they have on-hand. Over the past year, members of the science team have been looking for solutions to (1) store information on all the data sets they have collected in a single database, (2) store more metadata about each data file, (3) develop queries that can find relationships among these disparate data types, and (4) plug any new functions developed around this database into existing analysis, visualization, and web tools, transparently to users. In this presentation, I will discuss the searchSCF package that is currently under development. This package includes a NoSQL database management system (MongoDB) and a set of Python tools that both ingests data into the database and supports user queries. I will also highlight case studies of how this system could be used by the MLS science team, and how it could be implemented by other science teams with local data repositories.

A Descriptive Case Study of the Implementation of the Departmentalized Looping Team Model

ERIC Educational Resources Information Center

Miller, Cody R.

2011-01-01

The conceptual framework guiding this study focuses on local, state, and federal standards as well as demands on schools to improve performance of underserved student populations as impetuses for school structure changes. As related to the aforementioned framework, many schools have developed innovative school restructuring methods such as the…

Preparing Teachers for the Common Core: Aligning Preparation Program Curricula. Ask the Team

ERIC Educational Resources Information Center

Paliokas, Kathleen

2014-01-01

Implementing new college and career readiness standards, along with readying teachers and students for new assessments, is a monumental undertaking by multiple national, state, and local education leaders and organizations. One critical policy area for states to consider is supports for educator preparation programs to ensure that new teachers…

Suicide Prevention. A Guide to Curriculum Planning. Bulletin No. 0500.

ERIC Educational Resources Information Center

Wisconsin State Dept. of Public Instruction, Madison.

This guide is intended to reduce the youth suicide rate by teaching decision-making skills and coping mechanisms, and helping students develop self-esteem and communication skills. It was designed to be used by a local suicide prevention curriculum committee or team responsible for the development, implementation, and evaluation of the local…

Implementing LibGuides 2: An Academic Case Study

ERIC Educational Resources Information Center

Duncan, Vicky; Lucky, Shannon; McLean, Jaclyn

2015-01-01

Since 1997, the University of Saskatchewan Library has used "subject pages" to highlight key library resources. When Springshare announced it was launching LibGuides v2, a project team was assembled to transition a mixture of locally produced guides and guides created with the original LibGuides v1 software. This article synthesizes best…

The Oregon Public Health Policy Institute: Building Competencies for Public Health Practice

PubMed Central

Yoon, Jangho; Bernell, Stephanie; Tynan, Michael; Alvarado, Carla Sarai; Eversole, Tom; Mosbaek, Craig; Beathard, Candice

2015-01-01

The Oregon Public Health Policy Institute (PHPI) was designed to enhance public health policy competencies among state and local health department staff. The Oregon Health Authority funded the College of Public Health and Human Sciences at Oregon State University to develop the PHPI curriculum in 2012 and offer it to participants from 4 state public health programs and 5 local health departments in 2013. The curriculum interspersed short instructional sessions on policy development, implementation, and evaluation with longer hands-on team exercises in which participants applied these skills to policy topics their teams had selected. Panel discussions provided insights from legislators and senior Oregon health experts. Participants reported statistically significant increases in public health policy competencies and high satisfaction with PHPI overall. PMID:26066925

Multimethod evaluation of the VA's peer-to-peer Toolkit for patient-centered medical home implementation.

PubMed

Luck, Jeff; Bowman, Candice; York, Laura; Midboe, Amanda; Taylor, Thomas; Gale, Randall; Asch, Steven

2014-07-01

Effective implementation of the patient-centered medical home (PCMH) in primary care practices requires training and other resources, such as online toolkits, to share strategies and materials. The Veterans Health Administration (VA) developed an online Toolkit of user-sourced tools to support teams implementing its Patient Aligned Care Team (PACT) medical home model. To present findings from an evaluation of the PACT Toolkit, including use, variation across facilities, effect of social marketing, and factors influencing use. The Toolkit is an online repository of ready-to-use tools created by VA clinic staff that physicians, nurses, and other team members may share, download, and adopt in order to more effectively implement PCMH principles and improve local performance on VA metrics. Multimethod evaluation using: (1) website usage analytics, (2) an online survey of the PACT community of practice's use of the Toolkit, and (3) key informant interviews. Survey respondents were PACT team members and coaches (n = 544) at 136 VA facilities. Interview respondents were Toolkit users and non-users (n = 32). For survey data, multivariable logistic models were used to predict Toolkit awareness and use. Interviews and open-text survey comments were coded using a "common themes" framework. The Consolidated Framework for Implementation Research (CFIR) guided data collection and analyses. The Toolkit was used by 6,745 staff in the first 19 months of availability. Among members of the target audience, 80 % had heard of the Toolkit, and of those, 70 % had visited the website. Tools had been implemented at 65 % of facilities. Qualitative findings revealed a range of user perspectives from enthusiastic support to lack of sufficient time to browse the Toolkit. An online Toolkit to support PCMH implementation was used at VA facilities nationwide. Other complex health care organizations may benefit from adopting similar online peer-to-peer resource libraries.

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

Zarate, M.A.; Slotnick, J.; Ramos, M.

The development and implementation of a solid waste management program served to build local capacity in San Mateo Ixtatan between 2002 and 2003 as part of a public health action plan. The program was developed and implemented in two phases: (1) the identification and education of a working team from the community; and (2) the completion of a solid waste classification and quantification study. Social capital and the water cycle were two public health approaches utilized to build a sustainable program. The activities accomplished gained support from the community and municipal authorities. A description of the tasks completed and findingsmore » of the solid waste classification and quantification performed by a local working group are presented in this paper.« less

Improving care for advanced COPD through practice change: Experiences of participation in a Canadian spread collaborative

PubMed Central

Verma, Jennifer Y; Amar, Claudia; Sibbald, Shannon

2017-01-01

Chronic obstructive pulmonary disease (COPD) is a leading cause of death, morbidity, and health-care spending. The Halifax, Nova Scotia-based INSPIRED COPD Outreach Program™ has proved highly beneficial for patients and the health-care system. With direct investment of <$1-million CAD, a pan-Canadian quality improvement collaborative (QIC) supported the spread of INSPIRED to 19 teams in the 10 Canadian provinces contingent upon participation in evaluation. The collaborative evaluation followed a mixed-methods summative approach relying on collated quantitative data, team documents, and surveys sent to core members of the 19 teams. Survey questions included a series of multiple-choice responses, Likert scale ratings, and open-ended questions. The qualitative evaluation entailed key informant interviews and focus groups undertaken between February and April 2016 post-collaborative. Teams reported that the year-long QIC helped bring focus to a needed, though often overlooked area of improvement, facilitating innovation spread. They report examples of new work practices as well as unanticipated cultural change (given the short QIC time frame). Most teams gained new skills in quality improvement (QI) and evidence-based medicine, showing progress in their ability to measure and implement COPD care improvements. Teams felt networking with other teams across the country toward a common solution as well as learning from a team of clinical innovators and evidence-based innovation were critical to their success. Factors affecting sustainability included local leadership support, involvement of frontline clinicians, and sharing milestones to motivate continued QI. The INSPIRED QIC enabled teams across Canada to adapt and implement a new COPD care model for high users of health-care with rapid improvements to work practices, cultural change, and skill sets, and at relatively low cost. PMID:28612657

Minimizing the Human Capital Aspect of Productivity Disruption During Implementation of an Enterprise Resource Planning (ERP) System

DTIC Science & Technology

2009-06-01

world’s largest corporations following suite. Coca - Cola , for example, has a single instance of SAP ERP that binds together 15,000 users in 45 countries...communications, but the team was not sure they would ever actually deploy so they did not advertise . Likewise, European plant locals did not believe it was...Key dates were advertised as implementation got close and milestones and training dates were published. However, most communication stopped at the

Exploring interpersonal behavior and team sensemaking during health information technology implementation.

PubMed

Kitzmiller, Rebecca R; McDaniel, Reuben R; Johnson, Constance M; Lind, E Allan; Anderson, Ruth A

2013-01-01

We examine how interpersonal behavior and social interaction influence team sensemaking and subsequent team actions during a hospital-based health information technology (HIT) implementation project. Over the course of 18 months, we directly observed the interpersonal interactions of HIT implementation teams using a sensemaking lens. We identified three voice-promoting strategies enacted by team leaders that fostered team member voice and sensemaking; communicating a vision; connecting goals to team member values; and seeking team member input. However, infrequent leader expressions of anger quickly undermined team sensemaking, halting dialog essential to problem solving. By seeking team member opinions, team leaders overcame the negative effects of anger. Leaders must enact voice-promoting behaviors and use them throughout a team's engagement. Further, training teams in how to use conflict to achieve greater innovation may improve sensemaking essential to project risk mitigation. Health care work processes are complex; teams involved in implementing improvements must be prepared to deal with conflicting, contentious issues, which will arise during change. Therefore, team conflict training may be essential to sustaining sensemaking. Future research should seek to identify team interactions that foster sensemaking, especially when topics are difficult or unwelcome, then determine the association between staff sensemaking and the impact on HIT implementation outcomes. We are among the first to focus on project teams tasked with HIT implementation. This research extends our understanding of how leaders' behaviors might facilitate or impeded speaking up among project teams in health care settings.

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda

PubMed Central

2014-01-01

Background Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. Methods In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys. Discussion EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings. Trial registration PACTR201311000681314 PMID:24690284

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda.

PubMed

Hanson, Claudia; Waiswa, Peter; Marchant, Tanya; Marx, Michael; Manzi, Fatuma; Mbaruku, Godfrey; Rowe, Alex; Tomson, Göran; Schellenberg, Joanna; Peterson, Stefan

2014-04-02

Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys. EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings. PACTR201311000681314.

[An assessment of the Family Health Program in municipalities of Northeast Brazil: old and new challenges].

PubMed

Rocha, Paulo de Medeiros; Uchoa, Alice da Costa; Rocha, Nadja de Sá Pinto Dantas; Souza, Elizabethe Cristina Fagundes de; Rocha, Marconi de Lima; Pinheiro, Themis Xavier de Albuquerque

2008-01-01

This article presents part of the results from the Baseline Studies, an evaluative research conducted in 21 municipalities with more than 100,000 inhabitants each, in three States of Northeast Brazil. The overall objective was to assess experiences in the implementation of the Family Health Program (FHP), with a focus on inductions in the PROESF. An implementation analysis was performed, using the case study method. The analysis focused on these dimensions: political-institutional, health organization, and comprehensive care. Outstanding advances included: prioritize the FHP in high-risk areas; institutional learning, with qualification of managers and teams; definition of institutional levels for regulating the FHP; and health team-user bonds and positive perceptions concerning the program. Challenges included: strengthening of local policy and decision-making capacity; allocation of primary care resources; greater employment security for human resources; effective implementation of the health care network; strengthening of social participation; upgrading of monitoring and evaluation for decision-making; receptivity; waiting lines for tests, appointments, and hospital admissions; implementation of teamwork; health promotion and inter-sector activities.

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.

Coasts under multiple stresses: lessons learned from ARSTISTICC's eight coastal study sites.

NASA Astrophysics Data System (ADS)

Vanderlinden, J. P.; Berman, M.; Chouinard, O.; Kane, A.; Nikulkina, I.; Ragueneau, O.; Thomson, T. K.; Baztan, J.; Cordier, M.; Curry, T.; Da Cunha, C.; Gaye, N.; Huctin, J. M.; Kennedy, G.; Kofinas, G.; Maze, C.; Quensiere, J.; Raimonet, M.; Remvikos, Y.; Seck, A.; Surette, C.; Zhu, Z.

2016-12-01

The "Adaptation Research a Transdisciplinary community and policy centered approach" (ARTisticc) project has as goal to apply innovative standardized transdisciplinary art and science integrative approaches to foster robust, socially, culturally and scientifically, community centered adaptation to climate change. Fieldwork has been implemented in coastal communities in France (Brest, Britany), Senegal (Mbour, Petite Côte), India (Kochi, Kerala and Kanyakumari, Tamil nadu), Russia (Tiksi, Yakutia), Greenland (Uummannaq), the United States (Wainwright, Alaska), and Canada (Cocagne and Grande Digue, New Bunswick). It involved transdisciplinary teams of scientists, community members and artists. Preliminary results of the project will be presented. These pertain to two dimensions: a substantive dimension, i.e. better understanding of the role of knowledge and knowledge systems in adaptation, and a procedural dimension, i.e. better understanding of the implementation of transdisciplinary approaches to adaptation science. On the substantive front we will focus on presenting how, within such a high diversity of contexts, regularities were identifiable and why these are relevant to policy making. We are focusing this analysis on: scale, agents involved in the adaptation dynamics, dominant paradigm that are being mobilized and the drivers and enablers of local actions - all in relationship with knowledge use. These specifics are engaged in an interplay that calls for attention before any local level actions can be implemented. On the procedural front we will highlight the challenges, discovered along the way, of dovetailing science and art as a way to better apprehend and share the knowledge base on adaptation to climate change. What is the role of science, as perceived by local communities? What is the role of art? Can the joint implementation of both facilitate or hinder an adaptation process? The answer to these questions is again conditional to the nature of the teams that are involved and to local narratives and historical dimension that may allow for the joint practice of art and science.

Building local human resources to implement SLMTA with limited donor funding: The Ghana experience

PubMed Central

van der Puije, Beatrice; Bekoe, Veronica; Adukpo, Rowland; Kotey, Nii A.; Yao, Katy; Fonjungo, Peter N.; Luman, Elizabeth T.; Duh, Samuel; Njukeng, Patrick A.; Addo, Nii A.; Khan, Fazle N.; Woodfill, Celia J.I.

2014-01-01

Background In 2009, Ghana adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme in order to improve laboratory quality. The programme was implemented successfully with limited donor funding and local human resources. Objectives To demonstrate how Ghana, which received very limited PEPFAR funding, was able to achieve marked quality improvement using local human resources. Method Local partners led the SLMTA implementation and local mentors were embedded in each laboratory. An in-country training-of-trainers workshop was conducted in order to increase the pool of local SLMTA implementers. Three laboratory cohorts were enrolled in SLMTA in 2011, 2012 and 2013. Participants from each cohort attended in a series of three workshops interspersed with improvement projects and mentorship. Supplemental training on internal audit was provided. Baseline, exit and follow-up audits were conducted using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. In November 2013, four laboratories underwent official SLIPTA audits by the African Society for Laboratory Medicine (ASLM). Results The local SLMTA team successfully implemented three cohorts of SLMTA in 15 laboratories. Seven out of the nine laboratories that underwent follow-up audits have reached at least one star. Three out of the four laboratories that underwent official ASLM audits were awarded four stars. Patient satisfaction increased from 25% to 70% and sample rejection rates decreased from 32% to 10%. On average, $40 000 was spent per laboratory to cover mentors’ salaries, SLMTA training and improvement project support. Conclusion Building in-country capacity through local partners is a sustainable model for improving service quality in resource-constrained countries such as Ghana. Such models promote country ownership, capacity building and the use of local human resources for the expansion of SLMTA. PMID:26937417

Building local human resources to implement SLMTA with limited donor funding: The Ghana experience.

PubMed

Nkrumah, Bernard; van der Puije, Beatrice; Bekoe, Veronica; Adukpo, Rowland; Kotey, Nii A; Yao, Katy; Fonjungo, Peter N; Luman, Elizabeth T; Duh, Samuel; Njukeng, Patrick A; Addo, Nii A; Khan, Fazle N; Woodfill, Celia J I

2014-11-03

In 2009, Ghana adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme in order to improve laboratory quality. The programme was implemented successfully with limited donor funding and local human resources. To demonstrate how Ghana, which received very limited PEPFAR funding, was able to achieve marked quality improvement using local human resources. Local partners led the SLMTA implementation and local mentors were embedded in each laboratory. An in-country training-of-trainers workshop was conducted in order to increase the pool of local SLMTA implementers. Three laboratory cohorts were enrolled in SLMTA in 2011, 2012 and 2013. Participants from each cohort attended in a series of three workshops interspersed with improvement projects and mentorship. Supplemental training on internal audit was provided. Baseline, exit and follow-up audits were conducted using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. In November 2013, four laboratories underwent official SLIPTA audits by the African Society for Laboratory Medicine (ASLM). The local SLMTA team successfully implemented three cohorts of SLMTA in 15 laboratories. Seven out of the nine laboratories that underwent follow-up audits have reached at least one star. Three out of the four laboratories that underwent official ASLM audits were awarded four stars. Patient satisfaction increased from 25% to 70% and sample rejection rates decreased from 32% to 10%. On average, $40 000 was spent per laboratory to cover mentors' salaries, SLMTA training and improvement project support. Building in-country capacity through local partners is a sustainable model for improving service quality in resource-constrained countries such as Ghana. Such models promote country ownership, capacity building and the use of local human resources for the expansion of SLMTA.

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.

Use of a Surgical Safety Checklist to Improve Team Communication.

PubMed

Cabral, Richard A; Eggenberger, Terry; Keller, Kathryn; Gallison, Barry S; Newman, David

2016-09-01

To improve surgical team communication, a team at Broward Health Imperial Point Hospital, Ft Lauderdale, Florida, implemented a program for process improvement using a locally adapted World Health Organization Surgical Safety Checklist. This program included a standardized, comprehensive time out and a briefing/debriefing process. Postimplementation responses to the Safety Attitudes Questionnaire revealed a significant increase in the surgical team's perception of communication compared with that reported on the pretest (6% improvement resulting in t79 = -1.72, P < .05, d = 0.39). Perceptions of communication increased significantly for nurses (12% increase, P = .002), although the increase for surgeons and surgical technologists was lower (4% for surgeons, P = .15 and 2.3% for surgical technologists, P = .06). As a result of this program, we have observed improved surgical teamwork behaviors and an enhanced culture of safety in the OR. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Retrofitting Las Vegas. Implementing Energy Efficiency in Two Las Vegas Test Homes

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

Puttagunta, S.

2013-04-01

In 2009, the state of Nevada received nearly $40 million in Neighborhood Stabilization Funds from the Department of Housing and Urban Development to use to stabilize communities that have suffered from foreclosures and abandonment. In order to provide guidance to local officials and maximize how effectively this NSP funding is used in retrofitting homes, the CARB team provided design specifications, energy modeling, and technical support for the BARA team and its local partners—Better Building Performance, Nevada Energy Star Partners Green Alliance, and Home Free Nevada—for two retrofit test homes. One home demonstrated a modest retrofit and the other a deepmore » energy retrofit. This report describes the retrofit packages, which were used as an educational experience for home performance professionals, building trades, remodelers, and the general public.« less

Improving mapping for Ebola response through mobilising a local community with self-owned smartphones: Tonkolili District, Sierra Leone, January 2015.

PubMed

Nic Lochlainn, Laura M; Gayton, Ivan; Theocharopoulos, Georgios; Edwards, Robin; Danis, Kostas; Kremer, Ronald; Kleijer, Karline; Tejan, Sumaila M; Sankoh, Mohamed; Jimissa, Augustin; Greig, Jane; Caleo, Grazia

2018-01-01

During the 2014-16 Ebola virus disease (EVD) outbreak, the Magburaka Ebola Management Centre (EMC) operated by Médecins Sans Frontières (MSF) in Tonkolili District, Sierra Leone, identified that available district maps lacked up-to-date village information to facilitate timely implementation of EVD control strategies. In January 2015, we undertook a survey in chiefdoms within the MSF EMC catchment area to collect mapping and village data. We explore the feasibility and cost to mobilise a local community for this survey, describe validation against existing mapping sources and use of the data to prioritise areas for interventions, and lessons learned. We recruited local people with self-owned Android smartphones installed with open-source survey software (OpenDataKit (ODK)) and open-source navigation software (OpenStreetMap Automated Navigation Directions (OsmAnd)). Surveyors were paired with local motorbike drivers to travel to eligible villages. The collected mapping data were validated by checking for duplication and comparing the village names against a pre-existing village name and location list using a geographic distance and text string-matching algorithm. The survey teams gained sufficient familiarity with the ODK and OsmAnd software within 1-2 hours. Nine chiefdoms in Tonkolili District and three in Bombali District were surveyed within two weeks. Following de-duplication, the surveyors collected data from 891 villages with an estimated 127,021 households. The overall survey cost was €3,395; €3.80 per village surveyed. The MSF GIS team (MSF-OCG) created improved maps for the MSF Magburaka EMC team which were used to support surveillance, investigation of suspect EVD cases, hygiene-kit distribution and EVD survivor support. We shared the mapping data with OpenStreetMap, the local Ministry of Health and Sanitation and Sierra Leone District and National Ebola Response Centres. Involving local community and using accessible technology allowed rapid implementation, at moderate cost, of a survey to collect geographic and essential village information, and creation of updated maps. These methods could be used for future emergencies to facilitate response.

Improving mapping for Ebola response through mobilising a local community with self-owned smartphones: Tonkolili District, Sierra Leone, January 2015

PubMed Central

Gayton, Ivan; Theocharopoulos, Georgios; Edwards, Robin; Danis, Kostas; Kremer, Ronald; Kleijer, Karline; Tejan, Sumaila M.; Sankoh, Mohamed; Jimissa, Augustin; Greig, Jane; Caleo, Grazia

2018-01-01

Background During the 2014–16 Ebola virus disease (EVD) outbreak, the Magburaka Ebola Management Centre (EMC) operated by Médecins Sans Frontières (MSF) in Tonkolili District, Sierra Leone, identified that available district maps lacked up-to-date village information to facilitate timely implementation of EVD control strategies. In January 2015, we undertook a survey in chiefdoms within the MSF EMC catchment area to collect mapping and village data. We explore the feasibility and cost to mobilise a local community for this survey, describe validation against existing mapping sources and use of the data to prioritise areas for interventions, and lessons learned. Methods We recruited local people with self-owned Android smartphones installed with open-source survey software (OpenDataKit (ODK)) and open-source navigation software (OpenStreetMap Automated Navigation Directions (OsmAnd)). Surveyors were paired with local motorbike drivers to travel to eligible villages. The collected mapping data were validated by checking for duplication and comparing the village names against a pre-existing village name and location list using a geographic distance and text string-matching algorithm. Results The survey teams gained sufficient familiarity with the ODK and OsmAnd software within 1–2 hours. Nine chiefdoms in Tonkolili District and three in Bombali District were surveyed within two weeks. Following de-duplication, the surveyors collected data from 891 villages with an estimated 127,021 households. The overall survey cost was €3,395; €3.80 per village surveyed. The MSF GIS team (MSF-OCG) created improved maps for the MSF Magburaka EMC team which were used to support surveillance, investigation of suspect EVD cases, hygiene-kit distribution and EVD survivor support. We shared the mapping data with OpenStreetMap, the local Ministry of Health and Sanitation and Sierra Leone District and National Ebola Response Centres. Conclusions Involving local community and using accessible technology allowed rapid implementation, at moderate cost, of a survey to collect geographic and essential village information, and creation of updated maps. These methods could be used for future emergencies to facilitate response. PMID:29298314

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

PubMed

Donnellan, Claire; Sweetman, S; Shelley, E

2013-08-01

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

Attitudes of pediatric intensive care unit physicians towards the use of cognitive aids: a qualitative study.

PubMed

Weiss, Matthew J; Kramer, Chelsea; Tremblay, Sébastien; Côté, Luc

2016-05-21

Cognitive aids are increasingly recommended in clinical practice, yet little is known about the attitudes of physicians towards these tools. We employed a qualitative, descriptive design to explore physician attitudes towards cognitive aids in pediatric intensive care units (PICUs). Semi-structured interviews elicited the opinions of a convenience sample of practicing PICU physicians towards the use of cognitive aids. We analyzed interview data for thematic content to examine the three factors of intention to use cognitive aids as defined by the Theory of Planned Behavior (TPB), attitudes, social norms, and perceived control. Analysis of 14 interviews suggested that in the PICU setting, cognitive aids are widely used. Discovered themes related to their use touched on all three TPB factors of intention and included: aids are perceived to improve team communication; aids may improve patient safety; aids may hinder clinician judgment; physicians may resist implementation if it occurs prior to demonstration of benefit; effective adoption requires cognitive aids to be integrated into local workplace culture; and implementation should take physician concerns into account. Our sample of PICU physicians were open to cognitive aids in their practice, as long as such aids preserve the primacy of clinical judgment, focus on team communication, demonstrate effectiveness through preliminary testing, and are designed and implemented with the local culture and work environment in mind. Future knowledge translation efforts to implement cognitive aids would benefit from consideration of these issues.

Community Disaster and Sustainability Teams for Civil Protection

NASA Astrophysics Data System (ADS)

Kelman, I.; Cordonnier, B.

2009-04-01

Many examples of community-based teams for civil protection and disaster risk reduction exist. Turkey has a Community Disaster Volunteer Training Program while the USA has Community Emergency Response Teams which have been extended into secondary schools as Teen School Emergency Response Training. The principles and practices of these teams further apply directly to other development and sustainability endeavours, all of which are intricately linked to disaster risk reduction and civil protection. An example is keeping local water courses and storm drains clear from rubbish. That improves community health and cleanliness while assisting rainfall drainage to reduce flood risk. The "community teams" concept, as implemented for civil protection and disaster risk reduction, therefore connects with day-to-day living, such as ensuring that all community members have adequate access to water, food, waste management, shelter, health care, education, and energy. Community teams should be based on the best science and pedagogy available to ensure that concepts, training, skills, and implementation are effective and are maintained over the long-term. That entails going beyond the interest that is commonly generated by highlighting high-profile events, such as hurricanes and earthquakes, or high-profile concerns, such as climate change or terrorism. When community teams are focused on high-profile challenges, maintaining interest can be difficult without specific manifestations of the perceived "number one threat". Incorporating day-to-day concerns into civil protection can overcome that. For example, the community teams' talents and energy could be used for picking up rubbish, for educating about health and waste disposal, and for conducting vulnerability assessments in order to inspire action for continual vulnerability reduction. In addition to the examples given above, Japan's Jishu-bosai-soshiki community activities and Asia's "Townwatch" initiative adopt wider and deeper perspectives and actions, connecting disaster and civil protection to development and sustainability.

Open access in the patient-centered medical home: lessons from the Veterans Health Administration.

PubMed

True, Gala; Butler, Anneliese E; Lamparska, Bozena G; Lempa, Michele L; Shea, Judy A; Asch, David A; Werner, Rachel M

2013-04-01

The Veterans Health Administration (VHA) has undertaken a 5-year initiative to transform to a patient-centered medical home model. An early focus of implementation was on creating open access, defined as continuity and capacity in primary care. We describe the impact of readiness for implementation on efforts of pilot teams to make changes to improve access and identify successful strategies used by early adopters to overcome barriers to change. A qualitative, formative evaluation of the first 18 months of implementation in one Veterans Integrated Service Network (VISN) spread across six states. Members of local implementation teams including administrators, primary care providers, and staff from primary care clinics located at 10 medical centers and 45 outpatient clinics. We conducted site visits during the first 6 months of implementation, observations at Learning Collaboratives, semi-structured interviews, and review of internal organizational documents. All data collection took place between April 2010 and December 2011. Early adopters employed various strategies to enhance access, with a focus on decreasing demand for face-to-face care, increasing supply of different types of primary care encounters, and improving clinic efficiencies. Our interviews with key contacts revealed three important areas where readiness for implementation (or lack thereof) had an impact on interventions to improve access: leadership engagement, staffing resources, and access to information and knowledge. Key factors related to readiness for implementation had an impact on which interventions pilot teams could put into place, as well as the viability and sustainability of access gains. Wide variations in interventions to improve access occurring across sites situated within one organization have important implications for efforts to measure the impact of enhanced access on patient outcomes, costs, and other systems-level indicators of the Medical Home.

Toward fidelity between specification and implementation

NASA Technical Reports Server (NTRS)

Callahan, John R.; Montgomery, Todd L.; Morrison, Jeff; Wu, Yunqing

1994-01-01

This paper describes the methods used to specify and implement a complex communications protocol that provides reliable delivery of data in multicast-capable, packet-switching telecommunication networks. The protocol, called the Reliable Multicasting Protocol (RMP), was developed incrementally by two complementary teams using a combination of formal and informal techniques in an attempt to ensure the correctness of the protocol implementation. The first team, called the Design team, initially specified protocol requirements using a variant of SCR requirements tables and implemented a prototype solution. The second team, called the V&V team, developed a state model based on the requirements tables and derived test cases from these tables to exercise the implementation. In a series of iterative steps, the Design team added new functionality to the implementation while the V&V team kept the state model in fidelity with the implementation through testing. Test cases derived from state transition paths in the formal model formed the dialogue between teams during development and served as the vehicles for keeping the model and implementation in fidelity with each other. This paper describes our experiences in developing our process model, details of our approach, and some example problems found during the development of RMP.

AgMIP's Transdisciplinary Agricultural Systems Approach to Regional Integrated Assessment of Climate Impacts, Vulnerability, and Adaptation

NASA Technical Reports Server (NTRS)

Antle, John M.; Valdivia, Roberto O.; Boote, Kenneth J.; Janssen, Sander; Jones, James W.; Porter, Cheryl H.; Rosenzweig, Cynthia; Ruane, Alexander C.; Thorburn, Peter J.

2015-01-01

This chapter describes methods developed by the Agricultural Model Intercomparison and Improvement Project (AgMIP) to implement a transdisciplinary, systems-based approach for regional-scale (local to national) integrated assessment of agricultural systems under future climate, biophysical, and socio-economic conditions. These methods were used by the AgMIP regional research teams in Sub-Saharan Africa and South Asia to implement the analyses reported in their respective chapters of this book. Additional technical details are provided in Appendix 1.The principal goal that motivates AgMIP's regional integrated assessment (RIA) methodology is to provide scientifically rigorous information needed to support improved decision-making by various stakeholders, ranging from local to national and international non-governmental and governmental organizations.

An analysis of the adaptability of a professional development program in public health: results from the ALPS Study.

PubMed

Richard, Lucie; Torres, Sara; Tremblay, Marie-Claude; Chiocchio, François; Litvak, Éric; Fortin-Pellerin, Laurence; Beaudet, Nicole

2015-06-14

Professional development is a key component of effective public health infrastructures. To be successful, professional development programs in public health and health promotion must adapt to practitioners' complex real-world practice settings while preserving the core components of those programs' models and theoretical bases. An appropriate balance must be struck between implementation fidelity, defined as respecting the core nature of the program that underlies its effects, and adaptability to context to maximize benefit in specific situations. This article presents a professional development pilot program, the Health Promotion Laboratory (HPL), and analyzes how it was adapted to three different settings while preserving its core components. An exploratory analysis was also conducted to identify team and contextual factors that might have been at play in the emergence of implementation profiles in each site. This paper describes the program, its core components and adaptive features, along with three implementation experiences in local public health teams in Quebec, Canada. For each setting, documentary sources were analyzed to trace the implementation of activities, including temporal patterns throughout the project for each program component. Information about teams and their contexts/settings was obtained through documentary analysis and semi-structured interviews with HPL participants, colleagues and managers from each organization. While each team developed a unique pattern of implementing the activities, all the program's core components were implemented. Differences of implementation were observed in terms of numbers and percentages of activities related to different components of the program as well as in the patterns of activities across time. It is plausible that organizational characteristics influencing, for example, work schedule flexibility or learning culture might have played a role in the HPL implementation process. This paper shows how a professional development program model can be adapted to different contexts while preserving its core components. Capturing the heterogeneity of the intervention's exposure, as was done here, will make possible in-depth impact analyses involving, for example, the testing of program-context interactions to identify program outcomes predictors. Such work is essential to advance knowledge on the action mechanisms of professional development programs.

A new disaster victim identification management strategy targeting "near identification-threshold" cases: Experiences from the Boxing Day tsunami.

PubMed

Wright, Kirsty; Mundorff, Amy; Chaseling, Janet; Forrest, Alexander; Maguire, Christopher; Crane, Denis I

2015-05-01

The international disaster victim identification (DVI) response to the Boxing Day tsunami, led by the Royal Thai Police in Phuket, Thailand, was one of the largest and most complex in DVI history. Referred to as the Thai Tsunami Victim Identification operation, the group comprised a multi-national, multi-agency, and multi-disciplinary team. The traditional DVI approach proved successful in identifying a large number of victims quickly. However, the team struggled to identify certain victims due to incomplete or poor quality ante-mortem and post-mortem data. In response to these challenges, a new 'near-threshold' DVI management strategy was implemented to target presumptive identifications and improve operational efficiency. The strategy was implemented by the DNA Team, therefore DNA kinship matches that just failed to reach the reporting threshold of 99.9% were prioritized, however the same approach could be taken by targeting, for example, cases with partial fingerprint matches. The presumptive DNA identifications were progressively filtered through the Investigation, Dental and Fingerprint Teams to add additional information necessary to either strengthen or conclusively exclude the identification. Over a five-month period 111 victims from ten countries were identified using this targeted approach. The new identifications comprised 87 adults, 24 children and included 97 Thai locals. New data from the Fingerprint Team established nearly 60% of the total near-threshold identifications and the combined DNA/Physical method was responsible for over 30%. Implementing the new strategy, targeting near-threshold cases, had positive management implications. The process initiated additional ante-mortem information collections, and established a much-needed, distinct "end-point" for unresolved cases. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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.

Tracking Vaccination Teams During Polio Campaigns in Northern Nigeria by Use of Geographic Information System Technology: 2013-2015.

PubMed

Touray, Kebba; Mkanda, Pascal; Tegegn, Sisay G; Nsubuga, Peter; Erbeto, Tesfaye B; Banda, Richard; Etsano, Andrew; Shuaib, Faisal; Vaz, Rui G

2016-05-01

Nigeria is among the 3 countries in which polio remains endemic. The country made significant efforts to reduce polio transmission but remains challenged by poor-quality campaigns and poor team performance in some areas. This article demonstrates the application of geographic information system technology to track vaccination teams to monitor settlement coverage, reduce the number of missed settlements, and improve team performance. In each local government area where tracking was conducted, global positioning system-enabled Android phones were given to each team on a daily basis and were used to record team tracks. These tracks were uploaded to a dashboard to show the level of coverage and identify areas missed by the teams. From 2012 to June 2015, tracking covered 119 immunization days. A total of 1149 tracking activities were conducted. Of these, 681 (59%) were implemented in Kano state. There was an improvement in the geographic coverage of settlements and an overall reduction in the number of missed settlements. The tracking of vaccination teams provided significant feedback during polio campaigns and enabled supervisors to evaluate performance of vaccination teams. The reports supported other polio program activities, such as review of microplans and the deployment of other interventions, for increasing population immunity in northern Nigeria. © 2016 World Health Organization; licensee Oxford Journals.

Building Blocks for Peer Success: Lessons Learned from a Train-the-Trainer Program

PubMed Central

Downes, Alicia; Eddens, Shalini; Ruiz, John

2012-01-01

Abstract The National HIV/AIDS Strategy (NHAS) calls for a reduction in health disparities, a reduction in new HIV infections, and improved retention in HIV care and treatment. It acknowledges that HIV-positive peers can play an important role in supporting these aims. However, peer training must be comprehensive enough to equip peers with the knowledge and skills needed for this work. This article describes the development of a national train the trainer (TTT) model for HIV peer educators, and the results of its implementation and replication. A mixed methods evaluation identified who was trained locally as a result of TTT implementation, what aspects of the TTT were most useful to trainers in implementing local training sessions, and areas for improvement. Over the course of 1 year, 91 individuals were trained at 1 of 6 TTT sessions. These individuals then conducted 26 local training sessions for 272 peers. Factors that facilitated local replication training included the teach-back/feedback model, faculty modeling of facilitation styles, financial support for training logistics, and faculty support in designing and implementing the training. The model could be improved by providing instruction on how to incorporate peers as part of the training team. TTT programs that are easily replicable in the community will be an important asset in developing a peer workforce that can help implement the National AIDS Strategy. PMID:22103430

An international model for staffing maternal and child health research: the use of undergraduate students.

PubMed

Wallis, Anne Baber; Chereches, Răzvan; Oprescu, Florin; Brînzaniuc, Alexandra; Dungy, Claibourne I

2007-09-01

Constrained resources in Central and Eastern Europe limit the capacity of local and national health ministries to study breastfeeding practices or implement evidence-based breastfeeding support programs. This paper describes an innovative model for studying an important maternal and child health (MCH) problem by training undergraduate students to strengthen local capacity for research. An international team of researchers from Romania and the United States designed a study conducted at Babeş-Bolyai University and two academic maternity hospitals in Cluj-Napoca, Romania. The objectives were to (1) spark interest in breastfeeding research among undergraduates, (2) develop empirical knowledge about breastfeeding, and (3) train a team of undergraduate students to collect, manage, and enter study data. A team of carefully selected undergraduate students was trained in survey design, data collection, data entry, and interviewing skills. Internet technology was used to facilitate communication and to transfer data. The project resulted in a trained cadre of undergraduate students able to conduct survey research on breastfeeding practices with skills ranging from questionnaire design and implementation to descriptive data analysis. Empirical data obtained from the study will be used for student projects, to stimulate new breastfeeding support policies and programs, and to apply for research grants. Undergraduate students in developing countries in Central and Eastern Europe are a valuable, untapped resource for expanding MCH capacity. We recommend adoption of this cost-effective approach to foster high-quality MCH research.

Building Comprehensive Strategies for Obstetric Safety: Simulation Drills and Communication.

PubMed

Austin, Naola; Goldhaber-Fiebert, Sara; Daniels, Kay; Arafeh, Julie; Grenon, Veronique; Welle, Dana; Lipman, Steven

2016-11-01

As pioneers in the field of patient safety, anesthesiologists are uniquely suited to help develop and implement safety strategies to minimize preventable harm on the labor and delivery unit. Most existing obstetric safety strategies are not comprehensive, lack input from anesthesiologists, are designed with a relatively narrow focus, or lack implementation details to allow customization for different units. This article attempts to address these gaps and build more comprehensive strategies by discussing the available evidence and multidisciplinary authors' local experience with obstetric simulation drills and optimization of team communication.

Verification and validation of a reliable multicast protocol

NASA Technical Reports Server (NTRS)

Callahan, John R.; Montgomery, Todd L.

1995-01-01

This paper describes the methods used to specify and implement a complex communications protocol that provides reliable delivery of data in multicast-capable, packet-switching telecommunication networks. The protocol, called the Reliable Multicasting Protocol (RMP), was developed incrementally by two complementary teams using a combination of formal and informal techniques in an attempt to ensure the correctness of the protocol implementation. The first team, called the Design team, initially specified protocol requirements using a variant of SCR requirements tables and implemented a prototype solution. The second team, called the V&V team, developed a state model based on the requirements tables and derived test cases from these tables to exercise the implementation. In a series of iterative steps, the Design team added new functionality to the implementation while the V&V team kept the state model in fidelity with the implementation through testing. Test cases derived from state transition paths in the formal model formed the dialogue between teams during development and served as the vehicles for keeping the model and implementation in fidelity with each other. This paper describes our experiences in developing our process model, details of our approach, and some example problems found during the development of RMP.

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

PubMed

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

2016-02-24

The patient-centered medical home (PCMH) is a team-based, comprehensive model of primary care. When effectively implemented, PCMH is associated with higher patient satisfaction, lower staff burnout, and lower hospitalization for ambulatory care-sensitive conditions. However, less is known about what factors contribute to (or hinder) PCMH implementation. We explored the associations of specific facilitators and barriers reported by primary care employees with a previously validated, clinic-level measure of PCMH implementation, the Patient Aligned Care Team Implementation Progress Index (Pi(2)). We used a 2012 survey of primary care employees in the Veterans Health Administration to perform cross-sectional, respondent-level multinomial regressions. The dependent variable was the Pi(2) categorized as high implementation (top decile, 54 clinics, 235 respondents), medium implementation (middle eight deciles, 547 clinics, 4537 respondents), and low implementation (lowest decile, 42 clinics, 297 respondents) among primary care clinics. The independent variables were ordinal survey items rating 19 barriers to patient-centered care and 10 facilitators of PCMH implementation. For facilitators, we explored clinic Pi(2) score decile both as a function of respondent-reported availability of facilitators and of rating of facilitator helpfulness. The availability of five facilitators was associated with higher odds of a respondent's clinic's Pi(2) scores being in the highest versus lowest decile: teamlet huddles (OR = 3.91), measurement tools (OR = 3.47), regular team meetings (OR = 2.88), information systems (OR = 2.42), and disease registries (OR = 2.01). The helpfulness of four facilitators was associated with higher odds of a respondent's clinic's Pi(2) scores being in the highest versus lowest decile. Six barriers were associated with significantly higher odds of a respondent's clinic's Pi(2) scores being in the lowest versus highest decile, with the strongest associations for the difficulty recruiting and retaining providers (OR = 2.37) and non-provider clinicians (OR = 2.17). Results for medium versus low Pi(2) score clinics were similar, with fewer, smaller significant associations, all in the expected direction. A number of specific barriers and facilitators were associated with PCMH implementation, notably recruitment and retention of clinicians, team huddles, and local education. These findings can guide future research, and may help healthcare policy makers and leaders decide where to focus attention and limited resources.

Interprofessional Team's Perception of Care Delivery After Implementation of a Pediatric Pain and Sedation Protocol.

PubMed

Staveski, Sandra L; Wu, May; Tesoro, Tiffany M; Roth, Stephen J; Cisco, Michael J

2017-06-01

Pain and agitation are common experiences of patients in pediatric cardiac intensive care units. Variability in assessments by health care providers, communication, and treatment of pain and agitation creates challenges in management of pain and sedation. To develop guidelines for assessment and treatment of pain, agitation, and delirium in the pediatric cardiac intensive unit in an academic children's hospital and to document the effects of implementation of the guidelines on the interprofessional team's perception of care delivery and team function. Before and after implementation of the guidelines, interprofessional team members were surveyed about the members' perception of analgesia, sedation, and delirium management RESULTS: Members of the interprofessional team felt more comfortable with pain and sedation management after implementation of the guidelines. Team members reported improvements in team communication on patients' comfort. Members thought that important information was less likely to be lost during transfer of care. They also noted that the team carried out comfort management plans and used pharmacological and nonpharmacological therapies better after implementation of the guidelines than they did before implementation. Guidelines for pain and sedation management were associated with perceived improvements in team function and patient care by members of the interprofessional team. ©2017 American Association of Critical-Care Nurses.

Piloting a Nationally Disseminated, Interactive Human Subjects Protection Program for Community Partners: Design, Content, and Evaluation

PubMed Central

Eakin, Brenda; Kirk, Rosalind; Piechowski, Patricia; Thomas, Barbara

2014-01-01

Abstract Funders, institutions, and research organizations are increasingly recognizing the need for human subjects protections training programs for those engaged in academic research. Current programs tend to be online and directed toward an audience of academic researchers. Research teams now include many nonacademic members, such as community partners, who are less likely to respond to either the method or the content of current online trainings. A team at the CTSA‐supported Michigan Institute for Clinical and Health Research at the University of Michigan developed a pilot human subjects protection training program for community partners that is both locally implemented and adaptable to local contexts, yet nationally consistent and deliverable from a central administrative source. Here, the developers and the analysts of this program discuss its development, its content, and the results of its evaluation. PMID:24720288

National health and medical services response to incidents of chemical and biological terrorism.

PubMed

Tucker, J B

1997-08-06

In response to the growing threat of terrorism with chemical and biological weapons, the US government has developed a national concept of operations for emergency health and medical services response. This capability was developed and tested for the first time during the Atlanta Olympic Games in the summer of 1996. In the event of a chemical or biological terrorist incident that exceeded local and state-level response capabilities, federal agencies would provide specialized teams and equipment to help manage the consequences of the attack and treat, decontaminate, and evacuate casualties. The US Congress has also established a Domestic Preparedness Program that provides for enhanced training of local first-responders and the formation of metropolitan medical strike teams in major cities around the country. While these national response capabilities are promising, their implementation to date has been problematic and their ultimate effectiveness is uncertain.

Piloting a nationally disseminated, interactive human subjects protection program for community partners: design, content, and evaluation.

PubMed

Solomon, Stephanie; Eakin, Brenda; Kirk, Rosalind; Piechowski, Patricia; Thomas, Barbara

2014-04-01

Funders, institutions, and research organizations are increasingly recognizing the need for human subjects protections training programs for those engaged in academic research. Current programs tend to be online and directed toward an audience of academic researchers. Research teams now include many nonacademic members, such as community partners, who are less likely to respond to either the method or the content of current online trainings. A team at the CTSA-supported Michigan Institute for Clinical and Health Research at the University of Michigan developed a pilot human subjects protection training program for community partners that is both locally implemented and adaptable to local contexts, yet nationally consistent and deliverable from a central administrative source. Here, the developers and the analysts of this program discuss its development, its content, and the results of its evaluation. © 2014 Wiley Periodicals, Inc.

Developing and testing an instrument to measure the presence of conditions for successful implementation of quality improvement collaboratives.

PubMed

Dückers, Michel L A; Wagner, Cordula; Groenewegen, Peter P

2008-08-11

In quality improvement collaboratives (QICs) teams of practitioners from different health care organizations are brought together to systematically improve an aspect of patient care. Teams take part in a series of meetings to learn about relevant best practices, quality methods and change ideas, and share experiences in making changes in their own local setting. The purpose of this study was to develop an instrument for measuring team organization, external change agent support and support from the team's home institution in a Dutch national improvement and dissemination programme for hospitals based on several QICs. The exploratory methodological design included two phases: a) content development and assessment, resulting in an instrument with 15 items, and b) field testing (N = 165). Internal consistency reliability was tested via Cronbach's alpha coefficient. Principal component analyses were used to identify underlying constructs. Tests of scaling assumptions according to the multi trait/multi-item matrix, were used to confirm the component structure. Three components were revealed, explaining 65% of the variability. The components were labelled 'organizational support', 'team organization' and 'external change agent support'. One item not meeting item-scale criteria was removed. This resulted in a 14 item instrument. Scale reliability ranged from 0.77 to 0.91. Internal item consistency and divergent validity were satisfactory. On the whole, the instrument appears to be a promising tool for assessing team organization and internal and external support during QIC implementation. The psychometric properties were good and warrant application of the instrument for the evaluation of the national programme and similar improvement programmes.

Implementation of a team-based learning course: Work required and perceptions of the teaching team.

PubMed

Morris, Jenny

2016-11-01

Team-based learning was selected as a strategy to help engage pre-registration undergraduate nursing students in a second-year evidence-informed decision making course. To detail the preparatory work required to deliver a team-based learning course; and to explore the perceptions of the teaching team of their first experience using team-based learning. Descriptive evaluation. Information was extracted from a checklist and process document developed by the course leader to document the work required prior to and during implementation. Members of the teaching team were interviewed by a research assistant at the end of the course using a structured interview schedule to explore perceptions of first time implementation. There were nine months between the time the decision was made to use team-based learning and the first day of the course. Approximately 60days were needed to reconfigure the course for team-based learning delivery, develop the knowledge and expertise of the teaching team, and develop and review the resources required for the students and the teaching team. This reduced to around 12days for the subsequent delivery. Interview data indicated that the teaching team were positive about team-based learning, felt prepared for the course delivery and did not identify any major problems during this first implementation. Implementation of team-based learning required time and effort to prepare the course materials and the teaching team. The teaching team felt well prepared, were positive about using team-based learning and did not identify any major difficulties. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Implementation of a health data-sharing infrastructure across diverse primary care organizations.

PubMed

Cole, Allison M; Stephens, Kari A; Keppel, Gina A; Lin, Ching-Ping; Baldwin, Laura-Mae

2014-01-01

Practice-based research networks bring together academic researchers and primary care clinicians to conduct research that improves health outcomes in real-world settings. The Washington, Wyoming, Alaska, Montana, and Idaho region Practice and Research Network implemented a health data-sharing infrastructure across 9 clinics in 3 primary care organizations. Following implementation, we identified challenges and solutions. Challenges included working with diverse primary care organizations, adoption of health information data-sharing technology in a rapidly changing local and national landscape, and limited resources for implementation. Overarching solutions included working with a multidisciplinary academic implementation team, maintaining flexibility, and starting with an established network for primary care organizations. Approaches outlined may generalize to similar initiatives and facilitate adoption of health data sharing in other practice-based research networks.

Implementation of a Health Data-Sharing Infrastructure Across Diverse Primary Care Organizations

PubMed Central

Cole, Allison M.; Stephens, Kari A.; Keppel, Gina A.; Lin, Ching-Ping; Baldwin, Laura-Mae

2014-01-01

Practice-based research networks bring together academic researchers and primary care clinicians to conduct research that improves health outcomes in real-world settings. The Washington, Wyoming, Alaska, Montana, and Idaho region Practice and Research Network implemented a health data-sharing infrastructure across 9 clinics in 3 primary care organizations. Following implementation, we identified challenges and solutions. Challenges included working with diverse primary care organizations, adoption of health information data-sharing technology in a rapidly changing local and national landscape, and limited resources for implementation. Overarching solutions included working with a multidisciplinary academic implementation team, maintaining flexibility, and starting with an established network for primary care organizations. Approaches outlined may generalize to similar initiatives and facilitate adoption of health data sharing in other practice-based research networks. PMID:24594564

Implementing new models of care: Lessons from the new care models programme in England.

PubMed

Starling, Anna

2018-06-01

In 2014, the body that leads the National Health Service in England published a new strategic vision for the National Health Service. A major part of this strategy was a three-year-long national programme to develop new care models to coordinate care across primary care, community services and hospitals that could be replicated across the country. Local 'vanguard sites' were selected to develop five types of new care model with support from a national team. The new care models programme provided support for local leaders to enable them to collaborate to improve care for their local populations. We interviewed leaders in the vanguard sites to better understand how they made changes to care locally. Drawing on the insights from these interviews and the literature on cross-organisational change and improvement we devised a framework of 10 lessons for health and care leaders seeking to develop and implement new models of care. The framework emphasises the importance of developing relationships and building capability locally to enable areas to continuously develop and test new ideas.

Applying Lean principles and Kaizen rapid improvement events in public health practice.

PubMed

Smith, Gene; Poteat-Godwin, Annah; Harrison, Lisa Macon; Randolph, Greg D

2012-01-01

This case study describes a local home health and hospice agency's effort to implement Lean principles and Kaizen methodology as a rapid improvement approach to quality improvement. The agency created a cross-functional team, followed Lean Kaizen methodology, and made significant improvements in scheduling time for home health nurses that resulted in reduced operational costs, improved working conditions, and multiple organizational efficiencies.

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

PubMed

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

2015-07-01

Reflective practice is used increasingly to enhance team functioning and service effectiveness; however, there is little evidence of its use in interdisciplinary teams. This paper presents the qualitative evaluation of the Interdisciplinary Management Tool (IMT), an evidence-based change tool designed to enhance interdisciplinary teamwork through structured team reflection. The IMT incorporates three components: an evidence-based resource guide; a reflective implementation framework based on Structured, Facilitated Action Research for Implementation methodology; and formative and summative evaluation components. The IMT was implemented with intermediate care teams supported by independent facilitators in England. Each intervention lasted 6 months and was evaluated over a 12-month period. Data sources include interviews, a focus group with facilitators, questionnaires completed by team members and documentary feedback from structured team reports. Data were analysed qualitatively using the Framework approach. The IMT was implemented with 10 teams, including 253 staff from more than 10 different disciplines. Team challenges included lack of clear vision; communication issues; limited career progression opportunities; inefficient resource use; need for role clarity and service development. The IMT successfully engaged staff in the change process, and resulted in teams developing creative strategies to address the issues identified. Participants valued dedicated time to focus on the processes of team functioning; however, some were uncomfortable with a focus on teamwork at the expense of delivering direct patient care. The IMT is a relatively low-cost, structured, reflective way to enhance team function. It empowers individuals to understand and value their own, and others' roles and responsibilities within the team; identify barriers to effective teamwork, and develop and implement appropriate solutions to these. To be successful, teams need protected time to take for reflection, and executive support to be able to broker changes that are beyond the scope of the team. © 2014 John Wiley & Sons Ltd.

Planned change or emergent change implementation approach and nurses' professional clinical autonomy.

PubMed

Luiking, Marie-Louise; Aarts, Leon; Bras, Leo; Grypdonck, Maria; van Linge, Roland

2017-11-01

Nurses' clinical autonomy is considered important for patients' outcome and influenced by the implementation approach of innovations. Emergent change approach with participation in the implementation process is thought to increase clinical autonomy. Planned change approach without this participation is thought not to increase clinical autonomy. Evidence of these effects on clinical autonomy is however limited. To examine the changes in clinical autonomy and in personal norms and values for a planned change and emergent change implementation of an innovation, e.g. intensive insulin therapy. Prospective comparative study with two geographically separated nurses' teams on one intensive care unit (ICU), randomly assigned to the experimental conditions. Data were collected from March 2008 to January 2009. Pre-existing differences in perception of team and innovation characteristics were excluded using instruments based on the innovation contingency model. The Nursing Activity Scale was used to measure clinical autonomy. The Personal Values and Norms instrument was used to assess orientation towards nursing activities and the Team Learning Processes instrument to assess learning as a team. Pre-implementation the measurements did not differ. Post-implementation, clinical autonomy was increased in the emergent change team and decreased in the planned change team. The Personal Values and Norms instrument showed in the emergent change team a decreased hierarchic score and increased developmental and rational scores. In the planned change team the hierarchical and group scores were increased. Learning as a team did not differ between the teams. In both teams there was a change in clinical autonomy and orientation towards nursing activities, in line with the experimental conditions. Emergent change implementation resulted in more clinical autonomy than planned change implementation. If an innovation requires the nurses to make their own clinical decisions, an emergent change implementation should help to establish this clinical autonomy. © 2015 British Association of Critical Care Nurses.

Tracking Vaccination Teams During Polio Campaigns in Northern Nigeria by Use of Geographic Information System Technology: 2013–2015

PubMed Central

Touray, Kebba; Mkanda, Pascal; Tegegn, Sisay G.; Nsubuga, Peter; Erbeto, Tesfaye B.; Banda, Richard; Etsano, Andrew; Shuaib, Faisal; Vaz, Rui G.

2016-01-01

Introduction. Nigeria is among the 3 countries in which polio remains endemic. The country made significant efforts to reduce polio transmission but remains challenged by poor-quality campaigns and poor team performance in some areas. This article demonstrates the application of geographic information system technology to track vaccination teams to monitor settlement coverage, reduce the number of missed settlements, and improve team performance. Methods. In each local government area where tracking was conducted, global positioning system–enabled Android phones were given to each team on a daily basis and were used to record team tracks. These tracks were uploaded to a dashboard to show the level of coverage and identify areas missed by the teams. Results. From 2012 to June 2015, tracking covered 119 immunization days. A total of 1149 tracking activities were conducted. Of these, 681 (59%) were implemented in Kano state. There was an improvement in the geographic coverage of settlements and an overall reduction in the number of missed settlements. Conclusions. The tracking of vaccination teams provided significant feedback during polio campaigns and enabled supervisors to evaluate performance of vaccination teams. The reports supported other polio program activities, such as review of microplans and the deployment of other interventions, for increasing population immunity in northern Nigeria. PMID:26609004

Statistical synthesis of contextual knowledge to increase the effectiveness of theory-based behaviour change interventions.

PubMed

Hanbury, Andria; Thompson, Carl; Mannion, Russell

2011-07-01

Tailored implementation strategies targeting health professionals' adoption of evidence-based recommendations are currently being developed. Research has focused on how to select an appropriate theoretical base, how to use that theoretical base to explore the local context, and how to translate theoretical constructs associated with the key factors found to influence innovation adoption into feasible and tailored implementation strategies. The reasons why an intervention is thought not to have worked are often cited as being: inappropriate choice of theoretical base; unsystematic development of the implementation strategies; and a poor evidence base to guide the process. One area of implementation research that is commonly overlooked is how to synthesize the data collected in a local context in order to identify what factors to target with the implementation strategies. This is suggested to be a critical process in the development of a theory-based intervention. The potential of multilevel modelling techniques to synthesize data collected at different hierarchical levels, for example, individual attitudes and team level variables, is discussed. Future research is needed to explore further the potential of multilevel modelling for synthesizing contextual data in implementation studies, as well as techniques for synthesizing qualitative and quantitative data.

Reduction in Mortality Following Pediatric Rapid Response Team Implementation.

PubMed

Kolovos, Nikoleta S; Gill, Jeff; Michelson, Peter H; Doctor, Allan; Hartman, Mary E

2018-05-01

To evaluate the effectiveness of a physician-led rapid response team program on morbidity and mortality following unplanned admission to the PICU. Before-after study. Single-center quaternary-referral PICU. All unplanned PICU admissions from the ward from 2005 to 2011. The dataset was divided into pre- and post-rapid response team groups for comparison. A Cox proportional hazards model was used to identify the patient characteristics associated with mortality following unplanned PICU admission. Following rapid response team implementation, Pediatric Risk of Mortality, version 3, illness severity was reduced (28.7%), PICU length of stay was less (19.0%), and mortality declined (22%). Relative risk of death following unplanned admission to the PICU after rapid response team implementation was 0.685. For children requiring unplanned admission to the PICU, rapid response team implementation is associated with reduced mortality, admission severity of illness, and length of stay. Rapid response team implementation led to more proximal capture and aggressive intervention in the trajectory of a decompensating pediatric ward patient.

Making sense of health information technology implementation: A qualitative study protocol.

PubMed

Kitzmiller, Rebecca R; Anderson, Ruth A; McDaniel, Reuben R

2010-11-29

Implementing new practices, such as health information technology (HIT), is often difficult due to the disruption of the highly coordinated, interdependent processes (e.g., information exchange, communication, relationships) of providing care in hospitals. Thus, HIT implementation may occur slowly as staff members observe and make sense of unexpected disruptions in care. As a critical organizational function, sensemaking, defined as the social process of searching for answers and meaning which drive action, leads to unified understanding, learning, and effective problem solving -- strategies that studies have linked to successful change. Project teamwork is a change strategy increasingly used by hospitals that facilitates sensemaking by providing a formal mechanism for team members to share ideas, construct the meaning of events, and take next actions. In this longitudinal case study, we aim to examine project teams' sensemaking and action as the team prepares to implement new information technology in a tiertiary care hospital. Based on management and healthcare literature on HIT implementation and project teamwork, we chose sensemaking as an alternative to traditional models for understanding organizational change and teamwork. Our methods choices are derived from this conceptual framework. Data on project team interactions will be prospectively collected through direct observation and organizational document review. Through qualitative methods, we will identify sensemaking patterns and explore variation in sensemaking across teams. Participant demographics will be used to explore variation in sensemaking patterns. Outcomes of this research will be new knowledge about sensemaking patterns of project teams, such as: the antecedents and consequences of the ongoing, evolutionary, social process of implementing HIT; the internal and external factors that influence the project team, including team composition, team member interaction, and interaction between the project team and the larger organization; the ways in which internal and external factors influence project team processes; and the ways in which project team processes facilitate team task accomplishment. These findings will lead to new methods of implementing HIT in hospitals.

Making sense of health information technology implementation: A qualitative study protocol

PubMed Central

2010-01-01

Background Implementing new practices, such as health information technology (HIT), is often difficult due to the disruption of the highly coordinated, interdependent processes (e.g., information exchange, communication, relationships) of providing care in hospitals. Thus, HIT implementation may occur slowly as staff members observe and make sense of unexpected disruptions in care. As a critical organizational function, sensemaking, defined as the social process of searching for answers and meaning which drive action, leads to unified understanding, learning, and effective problem solving -- strategies that studies have linked to successful change. Project teamwork is a change strategy increasingly used by hospitals that facilitates sensemaking by providing a formal mechanism for team members to share ideas, construct the meaning of events, and take next actions. Methods In this longitudinal case study, we aim to examine project teams' sensemaking and action as the team prepares to implement new information technology in a tiertiary care hospital. Based on management and healthcare literature on HIT implementation and project teamwork, we chose sensemaking as an alternative to traditional models for understanding organizational change and teamwork. Our methods choices are derived from this conceptual framework. Data on project team interactions will be prospectively collected through direct observation and organizational document review. Through qualitative methods, we will identify sensemaking patterns and explore variation in sensemaking across teams. Participant demographics will be used to explore variation in sensemaking patterns. Discussion Outcomes of this research will be new knowledge about sensemaking patterns of project teams, such as: the antecedents and consequences of the ongoing, evolutionary, social process of implementing HIT; the internal and external factors that influence the project team, including team composition, team member interaction, and interaction between the project team and the larger organization; the ways in which internal and external factors influence project team processes; and the ways in which project team processes facilitate team task accomplishment. These findings will lead to new methods of implementing HIT in hospitals. PMID:21114860

Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes

PubMed Central

Kohler, Graeme; Sampalli, Tara; Ryer, Ashley; Porter, Judy; Wood, Les; Bedford, Lisa; Higgins-Bowser, Irene; Edwards, Lynn; Christian, Erin; Dunn, Susan; Gibson, Rick; Ryan Carson, Shannon; Vallis, Michael; Zed, Joanna; Tugwell, Barna; Van Zoost, Colin; Canfield, Carolyn; Rivoire, Eleanor

2017-01-01

Background: Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. Methods: The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. Results: The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. Conclusion: This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care) perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability. PMID:29179292

Integrating clinical performance improvement across physician organizations: the PhyCor experience.

PubMed

Loeppke, R; Howell, J W

1999-02-01

There is a paucity of literature describing the implementation of clinical performance improvement (CPI) efforts across geographically dispersed multispecialty group practices and independent practice associations. PhyCor, a physician management company based in Nashville, Tennessee, has integrated CPI initiatives into its operating infrastructure. PhyCor CPI INITIATIVES: The strategic framework guiding PhyCor's CPI initiatives is built around a physician-driven, patient-centered model. Physician/administrator leadership teams develop and implement a clinical and financial strategic plan for performance improvement; adopt local clinical and operational performance indicators; and agree on and gain consensus with local physician champions to engage in CPI initiatives. The area/regional leadership councils integrate and coordinate regional medical management and CPI initiatives among local groups and independent practice associations. In addition to these councils and a national leadership council, condition-specific care management councils have also been established. These councils develop condition-specific protocols and outcome measures and lead the implementation of CPI initiatives at their own clinics. Key resources supporting CPI initiatives include information/knowledge management, education and training, and patient education and consumer decision support. Localized efforts in both the asthma care and diabetes management initiatives have led to some preliminary improvements in quality of care indicators. Physician leadership and strategic vision, CPI-oriented organizational infrastructure, broad-based physician involvement in CPI, providing access to performance data, parallel incentives, and creating a sense of urgency for accelerated change are all critical success factors to the implementation of CPI strategies at the local, regional, and national levels.

Childhood Asthma Disparities in Chicago: Developing Approaches to Health Inequities.

PubMed

Martin, Molly A; Kapheim, Melissa Gutierrez; Erwin, Kim; Ignoffo, Stacy; McMahon, Kate; OʼRourke, Amy; Gerald, Lynn B; Barrett, Meredith; Press, Valerie G; Darabi, Houshang; Krishnan, Jerry A

We conducted a needs assessment to develop an evidence-based, locally tailored asthma care implementation plan for high-risk children with asthma in Chicago. Our team of health policy experts, clinicians, researchers, and designers included extensive stakeholder engagement (N = 162) in a mixed-methods community needs assessment. Results showed the lines of communication and collaboration across sectors were weak; caregivers were the only consistent force and could not always manage this burden. A series of recommendations for interventions and how to implement and measure them were generated. Cooperative, multidisciplinary efforts grounded in the community can target wicked problems such as asthma.

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

Barr, Jonathan L.; Taira, Randal Y.; Orr, Heather M.

The purpose of this document is to describe the operating concepts, capabilities, and benefits of RAMS including descriptions of how the system implementations can improve emergency response, damage assessment, task prioritization, and situation awareness. This CONOPS provides general information on operational processes and procedures required to utilize RAMS, and expected performance benefits of the system. The primary audiences for this document are the end users of RAMS (including flight operators and incident commanders) and the RAMS management team. Other audiences include interested offices within the Department of Homeland Security (DHS), and officials from other state and local jurisdictions who wantmore » to implement similar systems.« less

Interprofessional Education: A Summary of Reports and Barriers to Recommendations.

PubMed

Meleis, Afaf I

2016-01-01

Effective, quality care to achieve the newly developed sustainable development goals requires the development of collaborative teams and is predicated on implementing transformative interprofessional education and on team members who are equally empowered. This is a report on The Lancet commission on transformative education for health professionals and the National Academy of Medicine's dialogues on developing and implementing innovations to enhance collaborations and to facilitate the effectiveness of healthcare teams. Using postcolonial feminist theory for critical analysis and integrations of findings from both reports, as well as for identification of barriers to achieving equity in team functioning. The global Lancet commission and the National Academy of Medicine/Institute of Medicine forum developed frameworks that could be used to educate the next generation of professionals based on identifying the local needs of communities within a global context. Recommendations included breaking down silos that exists between schools and using an equity and justice framework in developing educational programs; utilizing contemporary innovations in teaching that correspond with innovations in healthcare systems; and insuring investments in time, energy, and resources in interprofessional education. However, without addressing the silos created through professional identities and power differentials, goals of interprofessional education and collaborative practice may not be achieved. While a great deal has been written about interprofessional education, it is imperative for faculty in the different professional schools and for members of healthcare teams to engage in dialogues that address the fundamental and most obstinate barriers to forming equitable teams, which is the consistent narrative of medical privilege and centrism. The dialogues about medical privilege and physician centrism in education and health care could drive the development of programmatic approaches to enhancing interprofessional education and teamwork based on justice and equity frameworks. © 2015 Sigma Theta Tau International.

Implementing a rapid response team: factors influencing success.

PubMed

Murray, Theresa; Kleinpell, Ruth

2006-12-01

Rapid response teams (RRTs), or medical emergency teams, focus on preventing a patient crisis by addressing changes in patient status before a cardiopulmonary arrest occurs. Responding to acute changes, RRTs and medical emergency teams are similar to "code" teams. The exception, however is that they step into action before a patient arrests. Although RRTs are acknowledge as an important initiative, implementation can present many challenges. This article reports on the implementation and ongoing use of a RRT at a community health care setting, highlighting important considerations and strategies for success.

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.

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

An Approach to Verification and Validation of a Reliable Multicasting Protocol

NASA Technical Reports Server (NTRS)

Callahan, John R.; Montgomery, Todd L.

1994-01-01

This paper describes the process of implementing a complex communications protocol that provides reliable delivery of data in multicast-capable, packet-switching telecommunication networks. The protocol, called the Reliable Multicasting Protocol (RMP), was developed incrementally using a combination of formal and informal techniques in an attempt to ensure the correctness of its implementation. Our development process involved three concurrent activities: (1) the initial construction and incremental enhancement of a formal state model of the protocol machine; (2) the initial coding and incremental enhancement of the implementation; and (3) model-based testing of iterative implementations of the protocol. These activities were carried out by two separate teams: a design team and a V&V team. The design team built the first version of RMP with limited functionality to handle only nominal requirements of data delivery. In a series of iterative steps, the design team added new functionality to the implementation while the V&V team kept the state model in fidelity with the implementation. This was done by generating test cases based on suspected errant or offnominal behaviors predicted by the current model. If the execution of a test was different between the model and implementation, then the differences helped identify inconsistencies between the model and implementation. The dialogue between both teams drove the co-evolution of the model and implementation. Testing served as the vehicle for keeping the model and implementation in fidelity with each other. This paper describes (1) our experiences in developing our process model; and (2) three example problems found during the development of RMP.

An approach to verification and validation of a reliable multicasting protocol

NASA Technical Reports Server (NTRS)

Callahan, John R.; Montgomery, Todd L.

1995-01-01

This paper describes the process of implementing a complex communications protocol that provides reliable delivery of data in multicast-capable, packet-switching telecommunication networks. The protocol, called the Reliable Multicasting Protocol (RMP), was developed incrementally using a combination of formal and informal techniques in an attempt to ensure the correctness of its implementation. Our development process involved three concurrent activities: (1) the initial construction and incremental enhancement of a formal state model of the protocol machine; (2) the initial coding and incremental enhancement of the implementation; and (3) model-based testing of iterative implementations of the protocol. These activities were carried out by two separate teams: a design team and a V&V team. The design team built the first version of RMP with limited functionality to handle only nominal requirements of data delivery. In a series of iterative steps, the design team added new functionality to the implementation while the V&V team kept the state model in fidelity with the implementation. This was done by generating test cases based on suspected errant or off-nominal behaviors predicted by the current model. If the execution of a test was different between the model and implementation, then the differences helped identify inconsistencies between the model and implementation. The dialogue between both teams drove the co-evolution of the model and implementation. Testing served as the vehicle for keeping the model and implementation in fidelity with each other. This paper describes (1) our experiences in developing our process model; and (2) three example problems found during the development of RMP.

A Statewide Partnership for Implementing Inquiry Science

NASA Astrophysics Data System (ADS)

Lytle, Charles

The North Carolina Infrastructure for Science Education (NC-ISE) is a statewide partnership for implementing standards-based inquiry science using exemplary curriculum materials in the public schools of North Carolina. North Carolina is the 11th most populous state in the USA with 8,000,000 residents, 117 school districts and a geographic area of 48,718 miles. NC-ISE partners include the state education agency, local school systems, three branches of the University of North Carolina, the state mathematics and science education network, businesses, and business groups. The partnership, based upon the Science for All Children model developed by the National Science Resources Centre, was initiated in 1997 for improvement in teaching and learning of science and mathematics. This research-based model has been successfully implemented in several American states during the past decade. Where effectively implemented, the model has led to significant improvements in student interest and student learning. It has also helped reduce the achievement gap between minority and non-minority students and among students from different economic levels. A key program element of the program is an annual Leadership Institute that helps teams of administrators and teachers develop a five-year strategic plan for their local systems. Currently 33 of the117 local school systems have joined the NC-ISE Program and are in various stages of implementation of inquiry science in grades K-8.

Self-Managed Work Teams in Nursing Homes: Implementing and Empowering Nurse Aide Teams

ERIC Educational Resources Information Center

Yeatts, Dale E.; Cready, Cynthia; Ray, Beth; DeWitt, Amy; Queen, Courtney

2004-01-01

Purpose: This article describes the progress of our study to examine the advantages and costs of using self-managed nurse aide teams in nursing homes, steps that are being taken to implement such teams, and management strategies being used to manage the teams. Design and Methods: A quasi-experimental design is underway where certified nurse aide…

Health care multidisciplinary teams: The sociotechnical approach for an integrated system-wide perspective.

PubMed

Marsilio, Marta; Torbica, Aleksandra; Villa, Stefano

The current literature on the enabling conditions of multidisciplinary teams focuses on the singular dimensions of the organizations (i.e., human resources, clinical pathways, objects) without shedding light on to the way in which these organizational factors interact and mutually influence one another. Drawing on a system perspective of organizations, the authors analyze the organizational patterns that promote and support multidisciplinary teams and how they interrelate and interact to enforce the organization work system. The authors develop a modified sociotechnical system (STS) model to understand how the two dimensions of technical (devices/tools, layout/organization of space, core process standardization) and social (organizational structure, management of human resources and operations) can facilitate the implementation of multidisciplinary teams in health care. The study conducts an empirical analysis based on a sample of hospital adopters of transcatheter aortic valve implantation using the revised STS model. The modified STS model applied to the case studies improves our understanding of the critical implementation factors of a multidisciplinary approach and the importance of coordinating radical changes in the technical and the social subsystems of health care organizations. The analysis informs that the multidisciplinary effort is not a sequential process and that the interplay between the two subsystems needs to be managed efficaciously as an integrated organizational whole to deliver the goals set. Hospital managers must place equal focus on the closely interrelated technical and social dimensions by investing in (a) shared layouts and spaces that cross the boundaries of the specialized health care units, (b) standardization of the core processes through the implementation of local clinical pathways, (c) structured knowledge management mechanisms, (d) the creation of clinical directorates, and (e) the design of a planning and budgeting system that integrates the multidisciplinary concept.

Implementing the Team Approach in Higher Education: Important Questions and Advice for Administrators

ERIC Educational Resources Information Center

Lara, Tracy M.; Hughey, Aaron W.

2008-01-01

Many companies have implemented the team approach as a way to empower their employees in an effort to enhance productivity, quality and overall profitability. While application of the concept to higher education administration has been limited, colleges and universities could benefit from the team approach if implemented appropriately and…

Taking kangaroo mother care forward in South Africa: The role of district clinical specialist teams.

PubMed

Feucht, Ute Dagmar; van Rooyen, Elise; Skhosana, Rinah; Bergh, Anne-Marie

2015-11-20

The global agenda for improved neonatal care includes the scale-up of kangaroo mother care (KMC) services. The establishment of district clinical specialist teams (DCSTs) in South Africa (SA) provides an excellent opportunity to enhance neonatal care at district level and ensure translation of policies, including the requirement for KMC implementation, into everyday clinical practice. Tshwane District in Gauteng Province, SA, has been experiencing an increasing strain on obstetric and neonatal services at central, tertiary and regional hospitals in recent years as a result of growing population numbers and rapid up-referral of patients, with limited down-referral of low-risk patients to district-level services. We describe a successful multidisciplinary quality improvement initiative under the leadership of the Tshwane DCST, in conjunction with experienced local KMC implementers, aimed at expanding the district's KMC services. The project subsequently served as a platform for improvement of other areas of neonatal care by means of a systematic approach.

Does team training work? Principles for health care.

PubMed

Salas, Eduardo; DiazGranados, Deborah; Weaver, Sallie J; King, Heidi

2008-11-01

Teamwork is integral to a working environment conducive to patient safety and care. Team training is one methodology designed to equip team members with the competencies necessary for optimizing teamwork. There is evidence of team training's effectiveness in highly complex and dynamic work environments, such as aviation and health care. However, most quantitative evaluations of training do not offer any insight into the actual reasons why, how, and when team training is effective. To address this gap in understanding, and to provide guidance for members of the health care community interested in implementing team training programs, this article presents both quantitative results and a specific qualitative review and content analysis of team training implemented in health care. Based on this review, we offer eight evidence-based principles for effective planning, implementation, and evaluation of team training programs specific to health care.

Work-team implementation.

PubMed

Reiste, K K; Hubrich, A

1996-02-01

The authors describe the implementation of the Work-Team Concept at the Frigidaire plans in Jefferson, Iowa. By forming teams, plant staff have made significant improvements in worker safety, product quality, customer service, cost-effectiveness, and overall employee well-being.

A statewide Crisis Intervention Team (CIT) initiative: evolution of the Georgia CIT program.

PubMed

Oliva, Janet R; Compton, Michael T

2008-01-01

In late 2004, Georgia began implementation of a statewide Crisis Intervention Team (CIT) program to train a portion of its law enforcement officers to respond safely and effectively to individuals with mental illnesses who are in crisis. This overview provides a description of the evolution of the Georgia CIT, including discussions of the historical context in which the program developed; the program's vision, mission, and objectives; the importance of the multidisciplinary Georgia CIT Advisory Board; the training curriculum; the role played by state and local coordinators; the value of stakeholders' meetings; practical operations of the program; the importance of considering the adequacy of community-based and hospital-based psychiatric services; costs and funding; the program's expansion plan; and evaluation, research, and academic collaborations. These detailed descriptions of the Georgia CIT program may be useful for professionals involved in local, regional, or state CIT program planning and may provide a practical synopsis of one example of this collaborative model that is being rapidly disseminated across the U.S.

Methodological quality of the injury surveillance system used in international athletics championships.

PubMed

Edouard, Pascal; Branco, Pedro; Alonso, Juan Manuel; Junge, Astrid

2016-12-01

Incidence and prevalence data obtained from injury surveillance studies could be biased by the response rate as well as by the completeness and quality of the reports. It therefore appears crucial to analyse the quality of the injury surveillance system itself and thereby validate the quality of the data. This study aimed to analyse the quality of and compliance with the injury surveillance system implemented during international athletics championships. Prospective, epidemiological study. The national medical teams and the local organising committee physicians daily reported all injuries on a standardised injury report form during 14 international athletics championships from 2007 to 2015. The quality of the injury surveillance system was analysed following the guidelines laid down by the Centre for Disease Control and Prevention. On average 41.7±17.4% (mean±standard deviation) of all registered countries participated in the injury surveillance project, accounting for a coverage of athletes of 79.5±10.2% of all registered athletes. Their medical staff returned 89.2±8.4% of the expected injury report forms (information is missing for one championship). The completeness of injury data provided by medical teams and local organising committee physicians averaged 95.8±6.5%. National medical teams reported 60.6±16.6% of all injuries, and local organising committee physicians 28.7±15.0% whereas 10.6±6.5% of injuries were reported by both. The injury surveillance system used during international athletics championships provided good national medical team participation, coverage of athletes, response rate, and completeness of reports. These parameters should be systematically reported for injury surveillance studies to show the quality of the study. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Evaluation of Multi-Age Team (MAT): Implementation at Crabapple Middle School: Report for 1995-1996.

ERIC Educational Resources Information Center

Elmore, Randy; Wisenbaker, Joseph

In fall 1993, administrators and faculty at the Crabapple Middle School in Roswell, Georgia, implemented the Multi-Age Team (MAT) program, creating multiage teams of sixth-, seventh-, and eighth-grade students. The project's main goal was to enhance self-esteem. Additional goals included implementation of interdisciplinary, thematic instruction;…

Evaluation of Multi-Age Team (MAT) Implementation at Crabapple Middle School: Report for 1994-1995.

ERIC Educational Resources Information Center

Elmore, Randy; Wisenbaker, Joseph

In fall 1993, administrators and faculty at the Crabappple Middle School in Roswell, Georgia, implemented the Multi-Age Team (MAT) program, creating multi-age teams of sixth-, seventh-, and eighth-grade students. The projects' main goal was to enhance self-esteem. Additional goals included implementation of interdisciplinary, thematic instruction;…

The Effects of Team-Based Learning on Social Studies Knowledge Acquisition in High School

ERIC Educational Resources Information Center

Wanzek, Jeanne; Vaughn, Sharon; Kent, Shawn C.; Swanson, Elizabeth A.; Roberts, Greg; Haynes, Martha; Fall, Anna-Mária; Stillman-Spisak, Stephanie J.; Solis, Michael

2014-01-01

This randomized control trial examined the efficacy of team-based learning implemented within 11th-grade social studies classes. A randomized blocked design was implemented with 26 classes randomly assigned to treatment or comparison. In the treatment classes teachers implemented team-based learning practices to support students in engaging in…

Team learning and innovation in nursing, a review of the literature.

PubMed

Timmermans, Olaf; Van Linge, Roland; Van Petegem, Peter; Van Rompaey, Bart; Denekens, Joke

2012-01-01

The capability to learn and innovate has been recognized as a key-factor for nursing teams to deliver high quality performance. Researchers suggest there is a relation between team-learning activities and changes in nursing teams throughout the implementation of novelties. A review of the literature was conducted in regard to the relation between team learning and implementation of innovations in nursing teams and to explore factors that contribute or hinder team learning. The search was limited to studies that were published in English or Dutch between 1998 and 2010. Eight studies were included in the review. The results of this review revealed that research on team learning and innovation in nursing is limited. The included studies showed moderate methodological quality and low levels of evidence. Team learning included processes to gather, process, and store information from different innovations within the nursing team and the prevalence of team-learning activities was contributed or hindered by individual and contextual factors. Further research is needed on the relation between team learning and implementation of innovations in nursing. Copyright © 2011 Elsevier Ltd. All rights reserved.

Development of an Enhanced Recovery After Surgery Guideline and Implementation Strategy Based on the Knowledge-to-action Cycle.

PubMed

McLeod, Robin S; Aarts, Mary-Anne; Chung, Frances; Eskicioglu, Cagla; Forbes, Shawn S; Conn, Lesley Gotlib; McCluskey, Stuart; McKenzie, Marg; Morningstar, Beverly; Nadler, Ashley; Okrainec, Allan; Pearsall, Emily A; Sawyer, Jason; Siddique, Naveed; Wood, Trevor

2015-12-01

Enhanced Recovery After Surgery (ERAS) protocols have been shown to increase recovery, decrease complications, and reduce length of stay. However, they are difficult to implement. To develop and implement an ERAS clinical practice guideline (CPG) at multiple hospitals. A tailored strategy based on the Knowledge-to-action (KTA) cycle was used to develop and implement an ERAS CPG at 15 academic hospitals in Canada. This included an initial audit to identify gaps and interviews to assess barriers and enablers to implementation. Implementation included development of an ERAS guideline by a multidisciplinary group, communities of practice led by multidiscipline champions (surgeons, anesthesiologists, and nurses) both provincially and locally, educational tools, and clinical pathways as well as audit and feedback. The initial audit revealed there was greater than 75% compliance in only 2 of 18 CPG recommendations. Main themes identified by stakeholders were that the CPG must be based on best evidence, there must be increased communication and collaboration among perioperative team members, and patient education is essential. ERAS and Pain Management CPGs were developed by a multidisciplinary team and have been adopted at all hospitals. Preliminary data from more than 1000 patients show that the uptake of recommended interventions varies but despite this, mean length of stay has decreased with low readmission rates and adverse events. On the basis of short-term findings, our results suggest that a tailored implementation strategy based on the KTA cycle can be used to successfully implement an ERAS program at multiple sites.

Implementation of Phased Array Antenna Technology Providing a Wireless Local Area Network to Enhance Port Security and Maritime Interdiction Operations

DTIC Science & Technology

2009-09-01

boarding team, COTS, WLAN, smart antenna, OpenVPN application, wireless base station, OFDM, latency, point-to-point wireless link. 16. PRICE CODE 17...16 c. SSL/TLS .................................17 2. OpenVPN ......................................17 III. EXPERIMENT METHODOLOGY...network frame at Layer 2 has already been secured by encryption at a higher level. 2. OpenVPN OpenVPN is open source software that provides a VPN

Cloud-Based Distributed Control of Unmanned Systems

DTIC Science & Technology

2015-04-01

during mission execution. At best, the data is saved onto hard-drives and is accessible only by the local team. Data history in a form available and...following open source technologies: GeoServer, OpenLayers, PostgreSQL , and PostGIS are chosen to implement the back-end database and server. A brief...geospatial map data. 3. PostgreSQL : An SQL-compliant object-relational database that easily scales to accommodate large amounts of data - upwards to

Land Management Agencies: Restoring Fish Passage Through Culverts on Forest Service and BLM Lands in Oregon and Washington Could Take Decades

DTIC Science & Technology

2001-11-01

provides the foundation for implementing stream and river enhancement projects, timber sales, and road building and decommissioning projects. According...monitoring of project results to ensure they are successful. For example, Oregon’s Rogue River Basin Fish Access Team, composed of local stakeholders...across the Rogue River basin. Potential techniques suggested to determine effectiveness include spawning and snorkeling (underwater observation

Using formative evaluation in an implementation project to increase vaccination rates in high-risk veterans: QUERI Series

PubMed Central

Wallace, Carolyn M; Legro, Marcia W

2008-01-01

Background Implementation of research into practice in health care systems is a challenging and often unsuccessful endeavor. The United States Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) research teams include formative evaluations (FE) in their action-oriented VA implementation projects to identify critical information about the processes of implementation that can guide adjustments to project activities, in order to better meet project goals. This article describes the development and use of FE in an action-oriented implementation research project. Methods This two-year action-oriented implementation research project was conducted at 23 VA Spinal Cord Injury (SCI) Centers, and targeted patients, staff and the system of care, such as administration and information technology. Data for FE were collected by electronic and paper surveys, semi-structured and open-ended interviews, notes during conference calls, and exchange of e-mail messages. Specific questions were developed for each intervention (designed to improve vaccination rates for influenza in veterans with spinal cord injury and disorder); informants were selected for their knowledge of interventions and their use in SCI Centers. Results Data from FE were compiled separately for each intervention to describe barriers to progress and guide adjustments to implementation activities. These data addressed the processes of implementing the interventions, problem-solving activities and the status of interventions at SCI Centers. Conclusion Formative evaluations provided the project team with a broad view of the processes of implementing multi-targeted interventions as well as the evolving status of the related best practice. Using FE was useful, although the challenges of conducting FE for non-field researchers should be addressed. Work is needed to develop methods for conducting FE across multiple sites, as well as acknowledging variations in local contexts that affect implementation of interventions. PMID:18430201

Gathering, strategizing, motivating and celebrating: the team huddle in a teaching general practice.

PubMed

Walsh, Allyn; Moore, Ainsley; Everson, Jennifer; DeCaire, Katharine

2018-03-01

To understand how implementing a daily team huddle affected the function of a complex interprofessional team including learners. A qualitative descriptive study using semi-structured interviews in focus groups. An academic general practice teaching practice. All members of one interprofessional team, including nurses, general practitioners, junior doctors, and support staff. Focus group interviews using semi-structured guidance were transcribed and the results analysed using qualitative content analysis. Four interrelated themes were identified: communication and knowledge sharing; efficiency of care; relationship and team building; and shared responsibility for team function. The implementation of the daily team huddle was seen by participants to enhance the collaboration within the team and to contribute to work life enjoyment. Participants perceived that problems were anticipated and solved quickly. Clinical updates and information about patients benefited the team including learners. Junior doctors quickly understood the scope of practice of other team members, but some felt reluctant to offer clinical opinions. The implementation of a daily team huddle was viewed as worthwhile by this large interprofessional general practice team. The delivery of patient care was more efficient, knowledge was readily distributed, and problem solving was shared across the team, including junior doctors.

Multidisciplinary teams of case managers in the implementation of an innovative integrated services delivery for the elderly in France.

PubMed

de Stampa, Matthieu; Vedel, Isabelle; Trouvé, Hélène; Ankri, Joël; Saint Jean, Olivier; Somme, Dominique

2014-04-07

The case management process is now well defined, and teams of case managers have been implemented in integrated services delivery. However, little is known about the role played by the team of case managers and the value in having multidisciplinary case management teams. The objectives were to develop a fuller understanding of the role played by the case manager team and identify the value of inter-professional collaboration in multidisciplinary teams during the implementation of an innovative integrated service in France. We conducted a qualitative study with focus groups comprising 14 multidisciplinary teams for a total of 59 case managers, six months after their recruitment to the MAIA program (Maison Autonomie Integration Alzheimer). Most of the case managers saw themselves as being part of a team of case managers (91.5%). Case management teams help case managers develop a comprehensive understanding of the integration concept, meet the complex needs of elderly people and change their professional practices. Multidisciplinary case management teams add value by helping case managers move from theory to practice, by encouraging them develop a comprehensive clinical vision, and by initiating the interdisciplinary approach. The multidisciplinary team of case managers is central to the implementation of case management and helps case managers develop their new role and a core inter-professional competency.

Consensus, Dilemmas, and Challenges in Living Donor Liver Transplantation in Latin America.

PubMed

Salvalaggio, Paolo R; Seda Neto, João; Alves, Jefferson Andre; Fonseca, Eduardo A; Carneiro de Albuquerque, Luiz; Andraus, Wellington; Massarollo, Paulo B; Duro Garcia, Valter; Maurette, Rafael J; Ruf, Andrés E; Pacheco-Moreira, Lucio F; Caicedo Rusca, Luis A; Osorio, Veronica Botero; Matamoros, Maria Amalia; Varela-Fascinetto, Gustavo; Jarufe, Nicolas P

2016-06-01

We reviewed the history, volume, outcomes, uniqueness, and challenges of living donor liver transplantation (LDLT) in Latin America. We used the data from the Latin American and Caribbean Transplant Society, local transplant societies, and opinions from local transplant experts. There are more than 160 active liver transplant teams in Latin America, but only 30 centers have used LDLT in the past 2 years. In 2014, 226 LDLTs were done in the region (8.5% of liver transplant activities). Living donor liver transplantation is mainly restricted to pediatric patients. Adult-to-adult LDLT activities decreased after the implementation of the model for end-stage liver disease score and a concomitant increase on the rate of deceased donors per million population. Posttransplant outcome analysis is not mandatory, transparent or regulated in most countries. More experienced teams have outcomes comparable to international expert centers, but donor and recipient morbidity might be underreported. Latin America lags behind in terms of the number of adult LDLT and the rate of living donor utilization in comparison with other continents with similar donation rates. Local alliances and collaborations with major transplant centers in the developed world will contribute to the development of LDLT in Latin America.

EPODE approach for childhood obesity prevention: methods, progress and international development

PubMed Central

Borys, J-M; Le Bodo, Y; Jebb, S A; Seidell, J C; Summerbell, C; Richard, D; De Henauw, S; Moreno, L A; Romon, M; Visscher, T L S; Raffin, S; Swinburn, B

2012-01-01

Summary Childhood obesity is a complex issue and needs multistakeholder involvement at all levels to foster healthier lifestyles in a sustainable way. ‘Ensemble Prévenons l'ObésitéDes Enfants’ (EPODE, Together Let's Prevent Childhood Obesity) is a large-scale, coordinated, capacity-building approach for communities to implement effective and sustainable strategies to prevent childhood obesity. This paper describes EPODE methodology and its objective of preventing childhood obesity. At a central level, a coordination team, using social marketing and organizational techniques, trains and coaches a local project manager nominated in each EPODE community by the local authorities. The local project manager is also provided with tools to mobilize local stakeholders through a local steering committee and local networks. The added value of the methodology is to mobilize stakeholders at all levels across the public and the private sectors. Its critical components include political commitment, sustainable resources, support services and a strong scientific input – drawing on the evidence-base – together with evaluation of the programme. Since 2004, EPODE methodology has been implemented in more than 500 communities in six countries. Community-based interventions are integral to childhood obesity prevention. EPODE provides a valuable model to address this challenge. PMID:22106871

Reducing inequalities in access to health care: developing a toolkit through action research.

PubMed

Goyder, E C; Blank, L; Ellis, E; Furber, A; Peters, J; Sartain, K; Massey, C

2005-10-01

Healthcare organisations are expected both to monitor inequalities in access to health services and also to act to improve access and increase equity in service provision. Locally developed action research projects with an explicit objective of reducing inequalities in access. Eight different health care services in the Yorkshire and Humber region, including community based palliative care, general practice asthma care, hospital based cardiology clinics, and termination of pregnancy services. Changes in service provision, increasing attendance rates in targeted groups. Local teams identified the population concerned and appropriate interventions using both published and grey literature. Where change to service provision was achieved, local data were collected to monitor the impact of service change. A number of evidence based changes to service provision were proposed and implemented with variable success. Service uptake increased in some of the targeted populations. Interventions to improve access must be sensitive to local settings and need both practical and managerial support to succeed. It is particularly difficult to improve access effectively if services are already struggling to meet current demand. Key elements for successful interventions included effective local leadership, identification of an intervention which is both evidence based and locally practicable, and identification of additional resources to support increased activity. A "toolkit" has been developed to support the identification and implementation of appropriate changes.

Implementation of clinical practice guidelines for ventilator-associated pneumonia: a multicenter prospective study.

PubMed

Sinuff, Tasnim; Muscedere, John; Cook, Deborah J; Dodek, Peter M; Anderson, William; Keenan, Sean P; Wood, Gordon; Tan, Richard; Haupt, Marilyn T; Miletin, Michael; Bouali, Redouane; Jiang, Xuran; Day, Andrew G; Overvelde, Janet; Heyland, Daren K

2013-01-01

Ventilator-associated pneumonia is an important cause of morbidity and mortality in critically ill patients. Evidence-based clinical practice guidelines for the prevention, diagnosis, and treatment of ventilator-associated pneumonia may improve outcomes, but optimal methods to ensure implementation of guidelines in the intensive care unit are unclear. Hence, we determined the effect of educational sessions augmented with reminders, and led by local opinion leaders, as strategies to implement evidence-based ventilator-associated pneumonia guidelines on guideline concordance and ventilator-associated pneumonia rates. Two-year prospective, multicenter, time-series study conducted between June 2007 and December 2009. Eleven ICUs (ten in Canada, one in the United States); five academic and six community ICUs. At each site, 30 adult patients mechanically ventilated >48 hrs were enrolled during four data collection periods (baseline, 6, 15, and 24 months). Guideline recommendations for the prevention, diagnosis, and treatment of ventilator-associated pneumonia were implemented using a multifaceted intervention (education, reminders, local opinion leaders, and implementation teams) directed toward the entire multidisciplinary ICU team. Clinician exposure to the intervention was assessed at 6, 15, and 24 months after the introduction of this intervention. The main outcome measure was aggregate concordance with the 14 ventilator-associated pneumonia guideline recommendations. One thousand three hundred twenty patients were enrolled (330 in each study period). Clinician exposure to the multifaceted intervention was high and increased during the study: 86.7%, 93.3%, 95.8%, (p < .001), as did aggregate concordance (mean [SD]): 50.7% (6.1), 54.4% (7.1), 56.2% (5.9), 58.7% (6.7) (p = .007). Over the study period, ventilator-associated pneumonia rates decreased (events/330 patients): 47 (14.2%), 34 (10.3%), 38 (11.5%), 29 (8.8%) (p = .03). A 2-yr multifaceted intervention to enhance ventilator-associated pneumonia guideline uptake was associated with a significant increase in guideline concordance and a reduction in ventilator-associated pneumonia rates.

Evaluating the effect of a web-based quality improvement system with feedback and outreach visits on guideline concordance in the field of cardiac rehabilitation: rationale and study protocol.

PubMed

van Engen-Verheul, Mariëtte M; de Keizer, Nicolette F; van der Veer, Sabine N; Kemps, Hareld M C; Scholte op Reimer, Wilma J M; Jaspers, Monique W M; Peek, Niels

2014-12-31

Implementation of clinical practice guidelines into daily care is hampered by a variety of barriers related to professional knowledge and collaboration in teams and organizations. To improve guideline concordance by changing the clinical decision-making behavior of professionals, computerized decision support (CDS) has been shown to be one of the most effective instruments. However, to address barriers at the organizational level, additional interventions are needed. Continuous monitoring and systematic improvement of quality are increasingly used to achieve change at this level in complex health care systems. The study aims to assess the effectiveness of a web-based quality improvement (QI) system with indicator-based performance feedback and educational outreach visits to overcome organizational barriers for guideline concordance in multidisciplinary teams in the field of cardiac rehabilitation (CR). A multicenter cluster-randomized trial with a balanced incomplete block design will be conducted in 18 Dutch CR clinics using an electronic patient record with CDS at the point of care. The intervention consists of (i) periodic performance feedback on quality indicators for CR and (ii) educational outreach visits to support local multidisciplinary QI teams focussing on systematically improving the care they provide. The intervention is supported by a web-based system which provides an overview of the feedback and facilitates development and monitoring of local QI plans. The primary outcome will be concordance to national CR guidelines with respect to the CR needs assessment and therapy indication procedure. Secondary outcomes are changes in performance of CR clinics as measured by structure, process and outcome indicators, and changes in practice variation on these indicators. We will also conduct a qualitative process evaluation (concept-mapping methodology) to assess experiences from participating CR clinics and to gain insight into factors which influence the implementation of the intervention. To our knowledge, this will be the first study to evaluate the effect of providing performance feedback with a web-based system that incorporates underlying QI concepts. The results may contribute to improving CR in the Netherlands, increasing knowledge on facilitators of guideline implementation in multidisciplinary health care teams and identifying success factors of multifaceted feedback interventions. NTR3251.

Implementation challenges in delivering team-based care ('TEAMcare') for patients with chronic obstructive pulmonary disease in a public hospital setting: a mixed methods approach.

PubMed

Cochrane, Belinda; Foster, Jann; Boyd, Robert; Atlantis, Evan

2016-08-03

Chronic obstructive pulmonary disease (COPD) is considered a multisystem disease, in which comorbidities feature prominently. COPD guidelines recommend holistic assessment and management of relevant comorbid diseases but there is limited information as to how this is best achieved. This pilot study aimed to explore the views of stakeholders, including patients and the healthcare team, on the feasibility, acceptability and barriers to a collaborative, multidisciplinary team-based care intervention ('TEAMcare') to improve health outcomes in COPD patients, within the context of a local hospital outpatient clinic. A mixed methods study design was used. A COPD care algorithm was developed based on the Australasian guidelines, COPDX. COPD participants were consecutively recruited from an outer metropolitan hospital's respiratory clinic. Participants attended for follow up visits at 5 and 10 months to ascertain clinical status, algorithm compliance and to review and revise management recommendations. The intervention was conducted using existing resources, involving collaboration with general practice and the publicly-funded local chronic disease management programme (Medicare Local). Stakeholders provided qualitative feedback about the intervention in terms of feasibility, acceptability and barriers via structured and semi-structured interviews. All interviews were recorded, transcribed verbatim and analysed using qualitative thematic analysis to identify key concepts and themes. The study protocol was abandoned prematurely due to clear lack of feasibility. Of 12 participants, 4 withdrew and none completed pulmonary rehabilitation (PR). The main reasons for non-participation or study withdrawal related to reluctance to attend PR (6 of 16) and the burden of increased appointments (4 of 16). PR conflicted with employment hours, which presented problems for some participants. Similarly, themes that emerged from qualitative data indicate healthcare provider perception of deficiencies in funding (for infrastructure and staffing). Health literacy, motivation, organisation and functional impairment were issues for patients. Available data from this small pilot provided valuable insights to inform future design and implementation strategies. Delivering structured team-based care to COPD patients presents challenges. In addition to enhancing health resources for engaging COPD patients, a focus on health literacy and improving health service access, including colocalisation and access outside business hours, may be required. ACTRN12616000342415 ; 16/03/2016.

Building the dream team: don't make it a nightmare.

PubMed

Nelson, M; Nelson, S

1997-11-01

This article covers the often overlooked area of team management concepts through a discussion of what many companies have done to implement these new concepts successfully. It describes the basics of how to and also explains why people resist the process of implementation. The main topics are (1) team formation, (2) pitfalls to avoid, and (3) team measurement.

Lessons Learned for Improving Spacecraft Ground Operations

NASA Technical Reports Server (NTRS)

Bell, Michael; Henderson, Gena; Stambolian, Damon

2013-01-01

NASA policy requires each Program or Project to develop a plan for how they will address Lessons Learned. Projects have the flexibility to determine how best to promote and implement lessons learned. A large project might budget for a lessons learned position to coordinate elicitation, documentation and archival of the project lessons. The lessons learned process crosses all NASA Centers and includes the contactor community. o The Office of The Chief Engineer at NASA Headquarters in Washington D.C., is the overall process owner, and field locations manage the local implementation. One tool used to transfer knowledge between program and projects is the Lessons Learned Information System (LLIS). Most lessons come from NASA in partnership with support contractors. A search for lessons that might impact a new design is often performed by a contractor team member. Knowledge is not found with only one person, one project team, or one organization. Sometimes, another project team, or person, knows something that can help your project or your task. Knowledge sharing is an everyday activity at the Kennedy Space Center through storytelling, Kennedy Engineering Academy presentations and through searching the Lessons Learned Information system. o Project teams search the lessons repository to ensure the best possible results are delivered. o The ideas from the past are not always directly applicable but usually spark new ideas and innovations. Teams have a great responsibility to collect and disseminate these lessons so that they are shared with future generations of space systems designers. o Leaders should set a goal for themselves to host a set numbers of lesson learned events each year and do more to promote multiple methods of lessons learned activities. o High performing employees are expected to share their lessons, however formal knowledge sharing presentation are not the norm for many employees.

Extra-team connections for knowledge transfer between staff teams

PubMed Central

Ramanadhan, Shoba; Wiecha, Jean L.; Emmons, Karen M.; Gortmaker, Steven L.; Viswanath, Kasisomayajula

2009-01-01

As organizations implement novel health promotion programs across multiple sites, they face great challenges related to knowledge management. Staff social networks may be a useful medium for transferring program-related knowledge in multi-site implementation efforts. To study this potential, we focused on the role of extra-team connections (ties between staff members based in different site teams) as potential channels for knowledge sharing. Data come from a cross-sectional study of afterschool childcare staff implementing a health promotion program at 20 urban sites of the Young Men's Christian Association of Greater Boston. We conducted a sociometric social network analysis and attempted a census of 91 program staff members. We surveyed 80 individuals, and included 73 coordinators and general staff, who lead and support implementation, respectively, in this study. A multiple linear regression model demonstrated a positive relationship between extra-team connections (β = 3.41, P < 0.0001) and skill receipt, a measure of knowledge transfer. We also found that intra-team connections (within-team ties between staff members) were also positively related to skill receipt. Connections between teams appear to support knowledge transfer in this network, but likely require greater active facilitation, perhaps via organizational changes. Further research on extra-team connections and knowledge transfer in low-resource, high turnover environments is needed. PMID:19528313

Improving the implementation of perioperative safety guidelines using a multifaceted intervention approach: protocol of the IMPROVE study, a stepped wedge cluster randomized trial.

PubMed

Emond, Yvette E J J M; Calsbeek, Hiske; Teerenstra, Steven; Bloo, Gerrit J A; Westert, Gert P; Damen, Johan; Wolff, André P; Wollersheim, Hub C

2015-01-08

This study is initiated to evaluate the effects, costs, and feasibility at the hospital and patient level of an evidence-based strategy to improve the use of Dutch perioperative safety guidelines. Based on current knowledge, expert opinions and expertise of the project team, a multifaceted implementation strategy has been developed. This is a stepped wedge cluster randomized trial including nine representative hospitals across The Netherlands. Hospitals are stratified into three groups according to hospital type and geographical location and randomized in terms of the period for receipt of the intervention. All adult surgical patients meeting the inclusion criteria are assessed for patient outcomes. The implementation strategy includes education, audit and feedback, organizational interventions (e.g., local embedding of the guidelines), team-directed interventions (e.g., multi-professional team training), reminders, as well as patient-mediated interventions (e.g., patient safety cards). To tailor the implementation activities, we developed a questionnaire to identify barriers for effective guideline adherence, based on (a) a theoretical framework for classifying barriers and facilitators, (b) an instrument for measuring determinants of innovations, and (c) 19 semi-structured interviews with perioperative key professionals. Primary outcome is guideline adherence measured at the hospital (i.e., cluster) and patient levels by a set of perioperative Patient Safety Indicators (PSIs), which was developed parallel to the perioperative guidelines. Secondary outcomes at the patient level are in-hospital complications, postoperative wound infections and mortality, length of hospital stay, and unscheduled transfer to the intensive care unit, non-elective readmission to the hospital and unplanned reoperation, all within 30 days after the initial surgery. Also, patient safety culture and team climate will be studied as potential determinants. Finally, a process evaluation is conducted to identify the compliance with the implementation strategy, as well as an economic evaluation to assess the costs. Data sources are registered clinical data and surveys. There is no form of blinding. The perioperative setting is an unexplored area with respect to implementation issues. This study is expected to yield important new evidence about the effects of a multifaceted approach on guideline adherence in the perioperative care setting. Dutch trial registry: NTR3568.

Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes.

PubMed

Kohler, Graeme; Sampalli, Tara; Ryer, Ashley; Porter, Judy; Wood, Les; Bedford, Lisa; Higgins-Bowser, Irene; Edwards, Lynn; Christian, Erin; Dunn, Susan; Gibson, Rick; Ryan Carson, Shannon; Vallis, Michael; Zed, Joanna; Tugwell, Barna; Van Zoost, Colin; Canfield, Carolyn; Rivoire, Eleanor

2017-03-06

Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care) perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Implementing interorganizational cooperation in labour market reintegration: a case study.

PubMed

Ståhl, Christian

2012-06-01

To bring people with complex medical, social and vocational needs back to the labour market, interorganizational cooperation is often needed. Yet, studies of processes and strategies for achieving sustainable interorganizational cooperation are sparse. The aim of this study was to analyse the implementation processes of Swedish legislation on financial coordination, with specific focus on different strategies for and perspectives on implementing interorganizational cooperation. A multiple-case study was used, where two local associations for financial coordination were studied in order to elucidate and compare the development of cooperative work in two settings. The material, collected during a 3-year period, consisted of documents, individual interviews with managers, and focus groups with officials. Two different implementation strategies were identified. In case 1, a linear strategy was used to implement cooperative projects, which led to difficulties in maintaining cooperative work forms due to a fragmented and time-limited implementation process. In case 2, an interactive strategy was used, where managers and politicians were continuously involved in developing a central cooperation team that became a central part of a developing structure for interorganizational cooperation. An interactive cooperation strategy with long-term joint financing was here shown to be successful in overcoming organizational barriers to cooperation. It is suggested that a strategy based on adaptation to local conditions, flexibility and constant evaluation is preferred for developing sustainable interorganizational cooperation when implementing policies or legislation affecting interorganizational relationships.

Using a human patient simulator to study the relationship between communication and nursing students' team performance.

PubMed

Hirokawa, Randy Y; Daub, Katharyn; Lovell, Eileen; Smith, Sarah; Davis, Alice; Beck, Christine

2012-11-01

This study examined the relationship between communication and nursing students' team performance by determining whether variations in team performance are related to differences in communication regarding five task-relevant functions: assessment, diagnosis, planning, implementation, and evaluation. The study results indicate a positive relationship between nursing students' team performance and comments focused on the implementation of treatment(s) and the evaluation of treatment options. A negative relationship between nursing students' team performance and miscellaneous comments made by team members was also observed. Copyright 2012, SLACK Incorporated.

77 FR 14350 - North Pacific Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-09

... Pacific Fishery Management Council Individual Fishing Quota (IFQ) Implementation Team. SUMMARY: The North Pacific Fishery Management Council (Council) IFQ Implementation Team will meet March 26, 2012 in Anchorage...-2809. SUPPLEMENTARY INFORMATION: The Team will review the discussion papers on Vessel Monitoring System...

ICU team composition and its association with ABCDE implementation in a quality collaborative.

PubMed

Costa, Deena Kelly; Valley, Thomas S; Miller, Melissa A; Manojlovich, Milisa; Watson, Sam R; McLellan, Phyllis; Pope, Corine; Hyzy, Robert C; Iwashyna, Theodore J

2018-04-01

Awakening, Breathing Coordination, Delirium, and Early Mobility bundle (ABCDE) should involve an interprofessional team, yet no studies describe what team composition supports implementation. We administered a survey at MHA Keystone Center ICU 2015 workshop. We measured team composition by the frequency of nurse, respiratory therapist, physician, physical therapist, nurse practitioner/physician assistant or nursing assistant involvement in 1) spontaneous awakening trials (SATs), 2) spontaneous breathing trials, 3) delirium and 4) early mobility. We assessed ABCDE implementation using a 5-point Likert ("routine part of every patient's care" - "no plans to implement"). We used ordinal logistic regression to examine team composition and ABCDE implementation, adjusting for confounders and clustering. From 293 surveys (75% response rate), we found that frequent nurse [OR 6.1 (1.1-34.9)] and physician involvement [OR 4.2 (1.3-13.4)] in SATs, nurse [OR 4.7 (1.6-13.4)] and nursing assistant's involvement [OR 3.9 (1.2-13.5)] in delirium and nurse [OR 2.8 (1.2-6.7)], physician [OR (3.6 (1.2-10.3)], and nursing assistants' involvement [OR 2.3 (1.1-4.8)] in early mobility were significantly associated with higher odds of routine ABCDE implementation. ABCDE implementation was associated with frequent involvement of team members, suggesting a need for role articulation and coordination. Copyright © 2017 Elsevier Inc. All rights reserved.

The Role of Local Action Teams in School Improvement. Linking R&D with Schools.

ERIC Educational Resources Information Center

Kell, Diane; Louis, Karen Seashore

Intended as a guide for educators in shared decision-making, this report summarizes the structures, procedures, and activities of local action teams in 49 schools involved in the National Institute of Education's Research and Development Utilization (RDU) program. Local action teams in the RDU program consisted of formal groups of teachers and…

The human side of lean teams.

PubMed

Wackerbarth, Sarah B; Strawser-Srinath, Jamie R; Conigliaro, Joseph C

2015-05-01

Organizations use lean principles to increase quality and decrease costs. Lean projects require an understanding of systems-wide processes and utilize interdisciplinary teams. Most lean tools are straightforward, and the biggest barrier to successful implementation is often development of the team aspect of the lean approach. The purpose of this article is to share challenges experienced by a lean team charged with improving a hospital discharge process. Reflection on the experience provides an opportunity to highlight lessons from The Team Handbook by Peter Scholtes and colleagues. To improve the likelihood that process improvement initiatives, including lean projects, will be successful, organizations should consider providing training in organizational change principles and team building. The authors' lean team learned these lessons the hard way. Despite the challenges, the team successfully implemented changes throughout the organization that have had a positive impact. Training to understand the psychology of change might have decreased the resistance faced in implementing these changes. © 2014 by the American College of Medical Quality.

Determinants of treatment plan implementation in multidisciplinary team meetings for patients with chronic diseases: a mixed-methods study

PubMed Central

Raine, Rosalind; Xanthopoulou, Penny; Wallace, Isla; Nic a’ Bháird, Caoimhe; Lanceley, Anne; Clarke, Alex; Livingston, Gill; Prentice, Archie; Ardron, Dave; Harris, Miriam; King, Michael; Michie, Susan; Blazeby, Jane M; Austin-Parsons, Natalie; Gibbs, Simon; Barber, Julie

2014-01-01

Objective Multidisciplinary team (MDT) meetings are assumed to produce better decisions and are extensively used to manage chronic disease in the National Health Service (NHS). However, evidence for their effectiveness is mixed. Our objective was to investigate determinants of MDT effectiveness by examining factors influencing the implementation of MDT treatment plans. This is a proxy measure of effectiveness, because it lies on the pathway to improvements in health, and reflects team decision making which has taken account of clinical and non-clinical information. Additionally, this measure can be compared across MDTs for different conditions. Methods We undertook a prospective mixed-methods study of 12 MDTs in London and North Thames. Data were collected by observation of 370 MDT meetings, interviews with 53 MDT members, and from 2654 patient medical records. We examined the influence of patient-related factors (disease, age, sex, deprivation, whether their preferences and other clinical/health behaviours were mentioned) and MDT features (as measured using the ‘Team Climate Inventory’ and skill mix) on the implementation of MDT treatment plans. Results The adjusted odds (or likelihood) of implementation was reduced by 25% for each additional professional group represented at the MDT meeting. Implementation was more likely in MDTs with clear goals and processes and a good ‘Team Climate’ (adjusted OR 1.96; 95% CI 1.15 to 3.31 for a unit increase in Team Climate Inventory (TCI) score). Implementation varied by disease category, with the lowest adjusted odds of implementation in mental health teams. Implementation was also lower for patients living in more deprived areas (adjusted odds of implementation for patients in the most compared with least deprived areas was 0.60, 95% CI 0.39 to 0.91). Conclusions Greater multidisciplinarity is not necessarily associated with more effective decision making. Explicit goals and procedures are also crucial. Decision implementation should be routinely monitored to ensure the equitable provision of care. PMID:24915539

An approach to verification and validation of a reliable multicasting protocol: Extended Abstract

NASA Technical Reports Server (NTRS)

Callahan, John R.; Montgomery, Todd L.

1995-01-01

This paper describes the process of implementing a complex communications protocol that provides reliable delivery of data in multicast-capable, packet-switching telecommunication networks. The protocol, called the Reliable Multicasting Protocol (RMP), was developed incrementally using a combination of formal and informal techniques in an attempt to ensure the correctness of its implementation. Our development process involved three concurrent activities: (1) the initial construction and incremental enhancement of a formal state model of the protocol machine; (2) the initial coding and incremental enhancement of the implementation; and (3) model-based testing of iterative implementations of the protocol. These activities were carried out by two separate teams: a design team and a V&V team. The design team built the first version of RMP with limited functionality to handle only nominal requirements of data delivery. This initial version did not handle off-nominal cases such as network partitions or site failures. Meanwhile, the V&V team concurrently developed a formal model of the requirements using a variant of SCR-based state tables. Based on these requirements tables, the V&V team developed test cases to exercise the implementation. In a series of iterative steps, the design team added new functionality to the implementation while the V&V team kept the state model in fidelity with the implementation. This was done by generating test cases based on suspected errant or off-nominal behaviors predicted by the current model. If the execution of a test in the model and implementation agreed, then the test either found a potential problem or verified a required behavior. However, if the execution of a test was different in the model and implementation, then the differences helped identify inconsistencies between the model and implementation. In either case, the dialogue between both teams drove the co-evolution of the model and implementation. We have found that this interactive, iterative approach to development allows software designers to focus on delivery of nominal functionality while the V&V team can focus on analysis of off nominal cases. Testing serves as the vehicle for keeping the model and implementation in fidelity with each other. This paper describes (1) our experiences in developing our process model; and (2) three example problems found during the development of RMP. Although RMP has provided our research effort with a rich set of test cases, it also has practical applications within NASA. For example, RMP is being considered for use in the NASA EOSDIS project due to its significant performance benefits in applications that need to replicate large amounts of data to many network sites.

A systematic review of team formulation in clinical psychology practice: Definition, implementation, and outcomes.

PubMed

Geach, Nicole; Moghaddam, Nima G; De Boos, Danielle

2018-06-01

Team formulation is promoted by professional practice guidelines for clinical psychologists. However, it is unclear whether team formulation is understood/implemented in consistent ways - or whether there is outcome evidence to support the promotion of this practice. This systematic review aimed to (1) synthesize how team formulation practice is defined and implemented by practitioner psychologists and (2) analyse the range of team formulation outcomes in the peer-reviewed literature. Seven electronic bibliographic databases were searched in June 2016. Eleven articles met inclusion criteria and were quality assessed. Extracted data were synthesized using content analysis. Descriptions of team formulation revealed three main forms of instantiation: (1) a structured, consultation approach; (2) semi-structured, reflective practice meetings; and (3) unstructured/informal sharing of ideas through routine interactions. Outcome evidence linked team formulation to a range of outcomes for staff teams and service users, including some negative outcomes. Quality appraisal identified significant issues with evaluation methods; such that, overall, outcomes were not well-supported. There is weak evidence to support the claimed beneficial outcomes of team formulation in practice. There is a need for greater specification and standardization of 'team formulation' practices, to enable a clearer understanding of any relationships with outcomes and implications for best-practice implementations. Under the umbrella term of 'team formulation', three types of practice are reported: (1) highly structured consultation; (2) reflective practice meetings; and (3) informal sharing of ideas. Outcomes linked to team formulation, including some negative outcomes, were not well evidenced. Research using robust study designs is required to investigate the process and outcomes of team formulation practice. © 2017 The British Psychological Society.

An interprofessional team approach to tracheostomy care: a mixed-method investigation into the mechanisms explaining tracheostomy team effectiveness.

PubMed

Mitchell, Rebecca; Parker, Vicki; Giles, Michelle

2013-04-01

In an effort to reduce tracheostomy-related complications, many acute care facilities have implemented specialist tracheostomy teams. Some studies, however, generate only mixed support for the connection between tracheostomy teams and patient outcomes. This suggests that the effect of collaborative teamwork in tracheostomy care is still not well understood. The aim of this paper is to investigate the mechanisms through which an interprofessional team approach can improve the management of patients with a tracheostomy. The achievement of this research objective requires the collection of rich empirical data, which indicates the use of a qualitative methodology. A case study approach provided an opportunity to collect a wealth of data on tracheostomy team activities and dynamics. Data were collected on an interprofessional tracheostomy team in a large tertiary referral hospital in Australia. The team was composed of clinical nurse consultants, a physiotherapist, a speech pathologist, a dietician, a social worker and medical officers. Data were collected through a focus group and one-to-one, semi-structured in-depth interviews, and thematic analysis was used to analyse experiences of tracheostomy team members. Qualitative analysis resulted in two main themes: interprofessional protocol development and implementation; and interprofessional decision-making. Our findings suggest that tracheostomy teams enhance consistency of care through the development and implementation of interprofessional protocol. In addition, such team allow more efficient and effective communication and decision-making consequent to the collocation of diverse professionals. These findings provide new insight into the role of tracheostomy teams in successfully implementing complex protocol and the explanatory mechanisms through which interprofessional teams may generate positive outcomes for tracheostomy patients. Copyright © 2012. Published by Elsevier Ltd.

Extra-team Connections for Knowledge Transfer between Staff Teams

ERIC Educational Resources Information Center

Ramanadhan, Shoba; Wiecha, Jean L.; Emmons, Karen M.; Gortmaker, Steven L.; Viswanath, Kasisomayajula

2009-01-01

As organizations implement novel health promotion programs across multiple sites, they face great challenges related to knowledge management. Staff social networks may be a useful medium for transferring program-related knowledge in multi-site implementation efforts. To study this potential, we focused on the role of extra-team connections (ties…

42 CFR 460.106 - Plan of care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Services § 460.106 Plan of care. (a) Basic requirement. The interdisciplinary team must promptly develop a... outcomes to be achieved. (c) Implementation of the plan of care. (1) The team must implement, coordinate...) The team must continuously monitor the participant's health and psychosocial status, as well as the...

42 CFR 460.106 - Plan of care.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Services § 460.106 Plan of care. (a) Basic requirement. The interdisciplinary team must promptly develop a... outcomes to be achieved. (c) Implementation of the plan of care. (1) The team must implement, coordinate...) The team must continuously monitor the participant's health and psychosocial status, as well as the...

Infectious disease and dermatologic conditions in evacuees and rescue workers after Hurricane Katrina--multiple states, August-September, 2005.

PubMed

2005-09-30

On August 29, 2005, Hurricane Katrina struck states along the Gulf Coast of the United States. In the days after the hurricane struck, approximately 750 evacuation centers were established in at least 18 states to accommodate more than 200,000 evacuees. State and local health departments, with assistance from CDC, initiated enhanced infectious disease surveillance and outbreak response activities, implemented by teams of public health and rescue workers, including military personnel. Outbreak monitoring included direct reporting of conditions of public health significance to public health agencies; daily contact between CDC and local public health officials; canvassing of reports from CDC, public health departments, and news media for potential infectious disease outbreaks; and investigation of reports of infectious disease with outbreak potential. This report summarizes infectious disease and dermatologic conditions reported during the first 3 weeks after the hurricane, before effective local surveillance was fully implemented. One outbreak of norovirus was reported among evacuees in Texas; no other outbreaks requiring unusual mobilization of public health resources were reported among evacuees or rescue workers.

A feasibility study of expert patient and community mental health team led bipolar psychoeducation groups: implementing an evidence based practice

PubMed Central

2013-01-01

Background Group psychoeducation is a cost effective intervention which reduces relapse and improves functioning in bipolar disorder but is rarely implemented. The aim of this study was to identify the acceptability and feasibility of a group psychoeducation programme delivered by community mental health teams (CMHTs) and peer specialist (PS) facilitators. Organisational learning was used to identify and address systematically barriers and enablers, at organisational, health professional and patient levels, to its implementation into a routine service. Methods A systematic examination of barriers and enablers to a three day training process informed the delivery of a first treatment group and a similar process informed the delivery of the second treatment group. Triangulation of research methods improved its internal validity: direct observation of training, self-rated surveys of participant experiences, group discussion, and thematically analysed individual participant and facilitator interviews were employed. Results Barriers and enablers were identified at organisational, educational, treatment content, facilitator and patient levels. All barriers under the control of the research team were addressed with subsequent improvements in patient knowledge about the condition and about local service. In addition, self-management, agency and altruism were enhanced. Barriers that could not be addressed required senior clinical and education leadership outside the research team’s control. PS and professional facilitators were successfully trained and worked together to deliver groups which were generally reported as being beneficial. Conclusion Psychoeducation groups involving CMHT and PS facilitators is acceptable and feasible but their sustainment requires senior leadership within and outside the organisation that control finance and education services. PMID:24215655

Implementing Total Quality Management in a University Setting.

ERIC Educational Resources Information Center

Coate, L. Edwin

1991-01-01

Oregon State University implemented Total Quality Management in nine phases: exploration; establishing a pilot study team; defining customer needs; adopting the breakthrough planning process; performing breakthrough planning in divisions; forming daily management teams; initiating cross-functional pilot projects; implementing cross-functional…

Explaining variation in perceived team effectiveness: results from eleven quality improvement collaboratives.

PubMed

Strating, Mathilde M H; Nieboer, Anna P

2013-06-01

Explore effectiveness of 11 collaboratives focusing on 11 different topics, as perceived by local improvement teams and to explore associations with collaborative-, organisational- and team-level factors. Evidence underlying the effectiveness of quality improvement collaboratives is inconclusive and few studies investigated determinants of implementation success. Moreover, most evaluation studies on quality improvement collaboratives are based on one specific topic or quality problem, making it hard to compare across collaboratives addressing different topics. A multiple-case cross-sectional study. Quality improvement teams in 11 quality improvement collaboratives focusing on 11 different topics. Team members received a postal questionnaire at the end of each collaborative. Of the 283 improvement teams, 151 project leaders and 362 team members returned the questionnaire. Analysis of variance revealed that teams varied widely on perceived effectiveness. Especially, members in the Prevention of Malnutrition and Prevention of Medication Errors collaboratives perceived a higher effectiveness than other groups. Multilevel regression analyses showed that educational level of professionals, innovation attributes, organisational support, innovative culture and commitment to change were all significant predictors of perceived effectiveness. In total, 27·9% of the individual-level variance, 57·6% of the team-level variance and 80% of the collaborative-level variance could be explained. The innovation's attributes, organisational support, an innovative team culture and professionals' commitment to change are instrumental to perceived effectiveness. The results support the notion that a layered approach is necessary to achieve improvements in quality of care and provides further insight in the determinants of success of quality improvement collaboratives. Understanding which factors enhance the impact of quality improvement initiatives can help professionals to achieve breakthrough improvement in care delivery to patients on a wide variety of quality problems. © 2012 Blackwell Publishing Ltd.

Strategies for Addressing the Challenges of Patient-Centered Medical Home Implementation: Lessons from Oregon.

PubMed

Gelmon, Sherril; Bouranis, Nicole; Sandberg, Billie; Petchel, Shauna

2018-01-01

Patient-centered medical homes (PCMHs) are at the forefront of the transformation of primary care as part of health systems reform. Despite robust literature describing implementation challenges, few studies describe strategies being used to overcome these challenges. This article addresses this gap through observations of exemplary PCMHs in Oregon, where the Oregon Health Authority supports and recognizes Patient-Centered Primary Care Homes (PCPCH). Twenty exemplary PCPCHs were selected using program scores, with considerations for diversity in clinic characteristics. Between 2015 and 2016, semistructured interviews and focus groups were completed with 85 key informants. Clinics reported similar challenges implementing the PCPCH model, including shifting patterns of care use, fidelity to the PCPCH model, and refining care processes. The following ten implementation strategies emerged: expanding access through care teams, preventing unnecessary emergency department visits through patient outreach, improved communication and referral tracking with outside providers, prioritization of selected program metrics, implementing patient-centered practices, developing continuous improvement capacity through committees and "champions," incorporating preventive services and chronic disease management, standardization of workflows, customizing electronic health records, and integration of mental health. Clinic leaders benefited from understanding the local context in which they were operating. Despite differences in size, ownership, geography, and population, all clinic leaders were observed to be proponents of strategies commonly associated with a "learning organization": systems thinking, personal mastery, mental models, shared vision, and team. Clinics can draw on their own characteristics, use state resources, and look to established PCMHs to build the evidence base for implementation in primary care. © Copyright 2018 by the American Board of Family Medicine.

Putting the MeaT into TeaM Training: Development, Delivery, and Evaluation of a Surgical Team-Training Workshop.

PubMed

Seymour, Neal E; Paige, John T; Arora, Sonal; Fernandez, Gladys L; Aggarwal, Rajesh; Tsuda, Shawn T; Powers, Kinga A; Langlois, Gerard; Stefanidis, Dimitrios

2016-01-01

Despite importance to patient care, team training is infrequently used in surgical education. To address this, a workshop was developed by the Association for Surgical Education Simulation Committee to teach team training using high-fidelity patient simulators and the American College of Surgeons-Association of Program Directors in Surgery team-training curriculum. Workshops were conducted at 3 national meetings. Participants completed preworkshop and postworkshop questionnaires to define experience, confidence in using simulation, intention to implement, as well as workshop content quality. The course consisted of (A) a didactic review of Preparation, Implementation, and Debriefing and (B) facilitated small group simulation sessions followed by debriefings. Of 78 participants, 51 completed the workshops. Overall, 65% indicated that residents at their institutions used patient simulation, but only 33% used the American College of Surgeons-the Association of Program Directors in Surgery team-training modules. The workshop increased confidence to implement simulation team training (3.4 ± 1.3 vs 4.5 ± 0.9). Quality and importance were rated highly (5.4 ± 00.6, highest score = 6). Preparation for simulation-based team training is possible in this workshop setting, although the effect on actual implementation remains to be determined. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Teams communicating through STEPPS.

PubMed

Stead, Karen; Kumar, Saravana; Schultz, Timothy J; Tiver, Sue; Pirone, Christy J; Adams, Robert J; Wareham, Conrad A

2009-06-01

To evaluate the effectiveness of the implementation of a TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) program at an Australian mental health facility. TeamSTEPPS is an evidence-based teamwork training system developed in the United States. Five health care sites in South Australia implemented TeamSTEPPS using a train-the-trainer model over an 8-month intervention period commencing January 2008 and concluding September 2008. A team of senior clinical staff was formed at each site to drive the improvement process. Independent researchers used direct observation and questionnaire surveys to evaluate the effectiveness of the implementation in three outcome areas: observed team behaviours; staff attitudes and opinions; and clinical performance and outcome. The results reported here focus on one site, an inpatient mental health facility. Team knowledge, skills and attitudes; patient safety culture; incident reporting rates; seclusion rates; observation for the frequency of use of TeamSTEPPS tools. Outcomes included restructuring of multidisciplinary meetings and the introduction of structured communication tools. The evaluation of patient safety culture and of staff knowledge, skills and attitudes (KSA) to teamwork and communication indicated a significant improvement in two dimensions of patient safety culture (frequency of event reporting, and organisational learning) and a 6.8% increase in the total KSA score. Clinical outcomes included reduced rates of seclusion. TeamSTEPPS implementation had a substantial impact on patient safety culture, teamwork and communication at an Australian mental health facility. It encouraged a culture of learning from patient safety incidents and making continuous improvements.

Gender Perspectives and Military Effectiveness: Implementing UNSCR 1325 and the National Action Plan on Women, Peace, and Security

DTIC Science & Technology

2016-03-01

20 It is indeed important to stress that there is a difference between sex and gender, and that women are not by definition gender aware, or...effectively as mixed engagement teams can? Does the sex of the interpreter matter when attempting to engage local men and women? All-female engagement...18 Egnell, Hojem, and Berts, Gender, Military Effectiveness, and Organizational Change. 19 Kronsell, Gender, Sex , and the Postnational Defense, 135

Academic-practice collaboration in nursing education: service-learning for injury prevention.

PubMed

Alexander, Gina K; Canclini, Sharon B; Krauser, Debbie L

2014-01-01

Teams of senior-level baccalaureate nursing students at a private, urban university complete a population-focused public health nursing practicum through service-learning partnerships. Recently, students collaborated with local service agencies for Safe Communities America, a program of the National Safety Council in affiliation with the World Health Organization. This article describes the student-led process of community assessment, followed by systematic planning, implementation, and evaluation of evidence-based interventions to advance prescription drug overdose/poisoning prevention efforts in the community.

Building social capital with interprofessional student teams in rural settings: A service-learning model.

PubMed

Craig, Pippa L; Phillips, Christine; Hall, Sally

2016-08-01

To describe outcomes of a model of service learning in interprofessional learning (IPL) aimed at developing a sustainable model of training that also contributed to service strengthening. A total of 57 semi-structured interviews with key informants and document review exploring the impacts of interprofessional student teams engaged in locally relevant IPL activities. Six rural towns in South East New South Wales. Local facilitators, staff of local health and other services, health professionals who supervised the 89 students in 37 IPL teams, and academic and administrative staff. Perceived benefits as a consequence of interprofessional, service-learning interventions in these rural towns. Reported outcomes included increased local awareness of a particular issue addressed by the team; improved communication between different health professions; continued use of the team's product or a changed procedure in response to the teams' work; and evidence of improved use of a particular local health service. Given the limited workforce available in rural areas to supervise clinical IPL placements, a service-learning IPL model that aims to build social capital may be a useful educational model. © 2015 National Rural Health Alliance Inc.

The dependency on central government funding of decentralised health systems: experiences of the challenges and coping strategies in the Kongwa District, Tanzania.

PubMed

Frumence, Gasto; Nyamhanga, Tumaini; Mwangu, Mughwira; Hurtig, Anna-Karin

2014-01-25

Decentralised health systems in Tanzania depend largely on funding from the central government to run health services. Experience has shown that central funding in a decentralised system is not an appropriate approach to ensure the effective and efficient performance of local authorities due to several limitations. One of the limitations is that funds from the central government are not disbursed on a timely basis, which in turn, leads to the serious problem of shortage of financial resources for Council Health Management Teams (CHMT). This paper examines how dependency on central government funding in Tanzania affects health activities in Kongwa district council and the strategies used by the CHMT cope with the situation. The study adopted a qualitative approach and data were collected using semi-structured interviews and focus group discussions. One district in the central region of Tanzania was strategically selected. Ten key informants involved in the management of health service delivery at the district level were interviewed and one focus group discussion was held, which consisted of members of the council health management team. The data generated were analysed for themes and patterns. The results showed that late disbursement of funds interrupts the implementation of health activities in the district health system. This situation delays the implementation of some activities, while a few activities may not be implemented at all. However, based on their prior knowledge of the anticipated delays in financial disbursements, the council health management team has adopted three main strategies to cope with this situation. These include obtaining supplies and other services on credit, borrowing money from other projects in the council, and using money generated from cost sharing. Local government authorities (LGAs) face delays in the disbursement of funds from the central government. This has necessitated introduction of informal coping strategies to deal with the situation. National-level policy and decision makers should minimise the bureaucracy involved in allocating funds to the district health systems to reduce delays.

The dependency on central government funding of decentralised health systems: experiences of the challenges and coping strategies in the Kongwa District, Tanzania

PubMed Central

2014-01-01

Background Decentralised health systems in Tanzania depend largely on funding from the central government to run health services. Experience has shown that central funding in a decentralised system is not an appropriate approach to ensure the effective and efficient performance of local authorities due to several limitations. One of the limitations is that funds from the central government are not disbursed on a timely basis, which in turn, leads to the serious problem of shortage of financial resources for Council Health Management Teams (CHMT). This paper examines how dependency on central government funding in Tanzania affects health activities in Kongwa district council and the strategies used by the CHMT cope with the situation. Methods The study adopted a qualitative approach and data were collected using semi-structured interviews and focus group discussions. One district in the central region of Tanzania was strategically selected. Ten key informants involved in the management of health service delivery at the district level were interviewed and one focus group discussion was held, which consisted of members of the council health management team. The data generated were analysed for themes and patterns. Results The results showed that late disbursement of funds interrupts the implementation of health activities in the district health system. This situation delays the implementation of some activities, while a few activities may not be implemented at all. However, based on their prior knowledge of the anticipated delays in financial disbursements, the council health management team has adopted three main strategies to cope with this situation. These include obtaining supplies and other services on credit, borrowing money from other projects in the council, and using money generated from cost sharing. Conclusion Local government authorities (LGAs) face delays in the disbursement of funds from the central government. This has necessitated introduction of informal coping strategies to deal with the situation. National-level policy and decision makers should minimise the bureaucracy involved in allocating funds to the district health systems to reduce delays. PMID:24460781

Using stakeholder engagement to develop a patient-centered pediatric asthma intervention.

PubMed

Shelef, Deborah Q; Rand, Cynthia; Streisand, Randi; Horn, Ivor B; Yadav, Kabir; Stewart, Lisa; Fousheé, Naja; Waters, Damian; Teach, Stephen J

2016-12-01

Stakeholder engagement has the potential to develop research interventions that are responsive to patient and provider preferences. This approach contrasts with traditional models of clinical research in which researchers determine the study's design. This article describes the effect of stakeholder engagement on the design of a randomized trial of an intervention designed to improve child asthma outcomes by reducing parental stress. The study team developed and implemented a stakeholder engagement process that provided iterative feedback regarding the study design, patient-centered outcomes, and intervention. Stakeholder engagement incorporated the perspectives of parents of children with asthma; local providers of community-based medical, legal, and social services; and national experts in asthma research methodology and implementation. Through a year-long process of multidimensional stakeholder engagement, the research team successfully refined and implemented a patient-centered study protocol. Key stakeholder contributions included selection of patient-centered outcome measures, refinement of intervention content and format, and language framing the study in a culturally appropriate manner. Stakeholder engagement was a useful framework for developing an intervention that was acceptable and relevant to our target population. This approach might have unique benefits in underserved populations, leading to sustainable improvement in health outcomes and reduced disparities. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Monitoring and evaluating transition and sustainability of donor-funded programs: Reflections on the Avahan experience.

PubMed

Bennett, Sara; Ozawa, Sachiko; Rodriguez, Daniela; Paul, Amy; Singh, Kriti; Singh, Suneeta

2015-10-01

In low and middle-income countries, programs funded and implemented by international donors frequently transition to local funding and management, yet such processes are rarely evaluated. We reflect upon experience evaluating the transition of a large scale HIV/AIDS prevention program in India, known as Avahan, in order to draw lessons about transition evaluation approaches and implementation challenges. In terms of conceptualizing the transition theory, the evaluation team identified tensions between the idea of institutionalizing key features of the Avahan program, and ensuring program flexibility to promote sustainability. The transition was planned in three rounds allowing for adaptations to transition intervention and program design during the transition period. The assessment team found it important to track these changes in order to understand which strategies and contextual features supported transition. A mixed methods evaluation was employed, combining semi-structured surveys of transitioning entities (conducted pre and post transition), with longitudinal case studies. Qualitative data helped explain quantitative findings. Measures of transition readiness appeared robust, but we were uncertain of the robustness of institutionalization measures. Finally, challenges to the implementation of such an evaluation are discussed. Given the scarceness of transition evaluations, the lessons from this evaluation may have widespread relevance. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Task shifting and integration of HIV care into primary care in South Africa: The development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention

PubMed Central

2011-01-01

Background Task shifting and the integration of human immunodeficiency virus (HIV) care into primary care services have been identified as possible strategies for improving access to antiretroviral treatment (ART). This paper describes the development and content of an intervention involving these two strategies, as part of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) pragmatic randomised controlled trial. Methods: Developing the intervention The intervention was developed following discussions with senior management, clinicians, and clinic staff. These discussions revealed that the establishment of separate antiretroviral treatment services for HIV had resulted in problems in accessing care due to the large number of patients at ART clinics. The intervention developed therefore combined the shifting from doctors to nurses of prescriptions of antiretrovirals (ARVs) for uncomplicated patients and the stepwise integration of HIV care into primary care services. Results: Components of the intervention The intervention consisted of regulatory changes, training, and guidelines to support nurse ART prescription, local management teams, an implementation toolkit, and a flexible, phased introduction. Nurse supervisors were equipped to train intervention clinic nurses in ART prescription using outreach education and an integrated primary care guideline. Management teams were set up and a STRETCH coordinator was appointed to oversee the implementation process. Discussion Three important processes were used in developing and implementing this intervention: active participation of clinic staff and local and provincial management, educational outreach to train nurses in intervention sites, and an external facilitator to support all stages of the intervention rollout. The STRETCH trial is registered with Current Control Trials ISRCTN46836853. PMID:21810242

Vulnerability assessment in a participatory approach to design and implement community based adaptation to drought in the Peruvian Andes

NASA Astrophysics Data System (ADS)

Lasage, Ralph; Muis, Sanne; Sardella, Carolina; van Drunen, Michiel; Verburg, Peter; Aerts, Jeroen

2015-04-01

The livelihoods of people in the Andes are expected to be affected by climate change due to their dependence on glacier meltwater during the growing season. The observed decrease in glacier volume over the last few decades is likely to accelerate during the current century, which will affect water availability in the region. This paper presents the implementation of an approach for the participatory development of community-based adaptation measures to cope with the projected impacts of climate change, which was implemented jointly by the local community and by a team consisting of an NGO, Peruvian ministry of environment, research organisations and a private sector organisation. It bases participatory design on physical measurements, modelling and a vulnerability analysis. Vulnerability to drought is made operational for households in a catchment of the Ocoña river basin in Peru. On the basis of a household survey we explore how a vulnerability index (impacts divided by the households' perceived adaptive capacity) can be used to assess the distribution of vulnerability over households in a sub catchment. The socio-economic factors water entitlement, area of irrigated land, income and education are all significantly correlate with this vulnerability to drought. The index proved to be appropriate for communicating about vulnerability to climate change and its determining factors with different stakeholders. The water system research showed that the main source of spring water is local rainwater, and that water use efficiency in farming is low. The adaptation measures that were jointly selected by the communities and the project team aimed to increase water availability close to farmland, and increase water use efficiency, and these will help to reduce the communities vulnerability to drought.

A randomized wait-list controlled analysis of the implementation integrity of team-initiated problem solving processes.

PubMed

Newton, J Stephen; Horner, Robert H; Algozzine, Bob; Todd, Anne W; Algozzine, Kate

2012-08-01

Members of Positive Behavior Interventions and Supports (PBIS) teams from 34 elementary schools participated in a Team-Initiated Problem Solving (TIPS) Workshop and follow-up technical assistance. Within the context of a randomized wait-list controlled trial, team members who were the first recipients of the TIPS intervention demonstrated greater implementation integrity in using the problem-solving processes during their team meetings than did members of PBIS Teams in the Wait-List Control group. The success of TIPS at improving implementation integrity of the problem-solving processes is encouraging and suggests the value of conducting additional research focused on determining whether there is a functional relation between use of these problem-solving processes and actual resolution of targeted student academic and social problems. Copyright © 2012 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Implementation of critical care response team.

PubMed

Al Shimemeri, Abdullah

2014-04-01

Analyses of hospital deaths have indicated that a significant proportion of the reported deaths might have been prevented had the patients received intensive level care early enough. Over the past few decades the critical care response team has become an important means of preventing these deaths. As the proactive arm of intensive care delivery, the critical care response team places emphasis on early identification of signs of clinical deterioration, which then prompts the mobilization of intensive care brought right to the patient's bedside. However, the setting up of a critical care response team is a difficult undertaking involving different levels of cooperation between all service stakeholders, and a bringing together of professional expertise and experience in its operations. The implementation of a critical care response team often involves a high-level restructuring of a hospital's service orientation. In the present work, the various factors and different models to be considered in implementing a critical care response team are addressed.

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.

A National Virtual Specimen Database for Early Cancer Detection

NASA Technical Reports Server (NTRS)

Crichton, Daniel; Kincaid, Heather; Kelly, Sean; Thornquist, Mark; Johnsey, Donald; Winget, Marcy

2003-01-01

Access to biospecimens is essential for enabling cancer biomarker discovery. The National Cancer Institute's (NCI) Early Detection Research Network (EDRN) comprises and integrates a large number of laboratories into a network in order to establish a collaborative scientific environment to discover and validate disease markers. The diversity of both the institutions and the collaborative focus has created the need for establishing cross-disciplinary teams focused on integrating expertise in biomedical research, computational and biostatistics, and computer science. Given the collaborative design of the network, the EDRN needed an informatics infrastructure. The Fred Hutchinson Cancer Research Center, the National Cancer Institute,and NASA's Jet Propulsion Laboratory (JPL) teamed up to build an informatics infrastructure creating a collaborative, science-driven research environment despite the geographic and morphology differences of the information systems that existed within the diverse network. EDRN investigators identified the need to share biospecimen data captured across the country managed in disparate databases. As a result, the informatics team initiated an effort to create a virtual tissue database whereby scientists could search and locate details about specimens located at collaborating laboratories. Each database, however, was locally implemented and integrated into collection processes and methods unique to each institution. This meant that efforts to integrate databases needed to be done in a manner that did not require redesign or re-implementation of existing system

Do learning collaboratives strengthen communication? A comparison of organizational team communication networks over time.

PubMed

Bunger, Alicia C; Lengnick-Hall, Rebecca

Collaborative learning models were designed to support quality improvements, such as innovation implementation by promoting communication within organizational teams. Yet the effect of collaborative learning approaches on organizational team communication during implementation is untested. The aim of this study was to explore change in communication patterns within teams from children's mental health organizations during a year-long learning collaborative focused on implementing a new treatment. We adopt a social network perspective to examine intraorganizational communication within each team and assess change in (a) the frequency of communication among team members, (b) communication across organizational hierarchies, and (c) the overall structure of team communication networks. A pretest-posttest design compared communication among 135 participants from 21 organizational teams at the start and end of a learning collaborative. At both time points, participants were asked to list the members of their team and rate the frequency of communication with each along a 7-point Likert scale. Several individual, pair-wise, and team level communication network metrics were calculated and compared over time. At the individual level, participants reported communicating with more team members by the end of the learning collaborative. Cross-hierarchical communication did not change. At the team level, these changes manifested differently depending on team size. In large teams, communication frequency increased, and networks grew denser and slightly less centralized. In small teams, communication frequency declined, growing more sparse and centralized. Results suggest that team communication patterns change minimally but evolve differently depending on size. Learning collaboratives may be more helpful for enhancing communication among larger teams; thus, managers might consider selecting and sending larger staff teams to learning collaboratives. This study highlights key future research directions that can disentangle the relationship between learning collaboratives and team networks.

Preserving Our Homeland: A Collaboration to Connect Science and Traditional Ecological Knowledge for Mashpee Wampanoag Youth

NASA Astrophysics Data System (ADS)

Gutierrez, B.; Fordham, M.; Lopes-Pocknett, R.; Wyman, K.; Stringer, C.; Green, G.; Tobey, Q.; Rassman, J.; Mills, E., Jr.

2014-12-01

Over the past three years, we have developed and implemented a collaborative summer science program for Mashpee Wampanoag youth that engages tribal elders, parents, educators, and local scientists to connect tribal youth with the ecology and geology of their traditional homelands. This collaboration, called Native Youth in Science: Preserving our Homeland (POH), involves the Mashpee Wampanoag Education and Natural Resource Departments, an experienced team of tribal elders and scientists from the U.S. Geological Survey's Woods Hole Coastal and Marine Science Center Waquoit Bay National Estuarine Research Reserve, U.S. Forest Service, and NOAA National Marine Fisheries. The team has developed and implemented a curriculum that stresses the ancestral relationships of Wampanoag people to their land. Through hands-on activities at locations of cultural significance, our efforts focus on presenting topics in environmental science from both western science and Wampanoag perspectives to 5th-8th grade students from the Wampanoag Tribe. Overarching themes focus on local land use history and its impact on traditional food sources such as shellfish and herring. Lessons typically address hydrology, water quality, fish and shellfish biology, botany, and local geology. To present these topics, scientists are paired with Wampanoag Tribe culture keepers to develop lessons that present science topics side-by-side with cultural knowledge. The primary goals of POH are to (a) connect and reinforce science concepts learned in conventional school settings for tribal youth; (b) demonstrate the use of science as a tool for understanding and preserving the ecosystems and homelands of the Mashpee Wampanoag Tribe; and (c) how indigenous traditional ecological knowledge (TEK) and western science complement each other. In the long-term, this program begins to prepare tribal students for more advanced programs supporting their pursuit of higher education.

Using Hourly Time-Outs and a Standardized Tool to Promote Team Communication, Medical Record Documentation, and Patient Satisfaction During Second-Stage Labor.

PubMed

Wood, Jessica; Stevenson, Eleanor

2018-04-12

During labor, effective communication and collaboration among the healthcare team is critical for patient safety; however, there is currently no standard for communication and documentation of the plan of care as agreed upon by healthcare team members and the woman in labor. The goal of this project was to increase consistency in communication and collaboration between clinicians and laboring women during secondstage labor. An hourly "time-out" meeting of all healthcare team members was initiated for all women during second-stage labor. A documentation tool was implemented to ensure regular and clear communication between the clinical team and laboring women. Data were collected via medical review of cases of second-stage labor lasting more than 2 hours (n = 21 in the pre-implementation group; n = 39 for 3 months postimplementation; and n = 468 patients for 2 years post-implementation). Surveys were conducted of the clinical team (n = 40) and patients (n = 28). Following implementation, documented agreement of the plan of care increased from 14.3% before the project to 82.1% 3 months after implementation and remained at 81.6% 2 years after implementation. All nurses who participated in the survey reported a clear understanding of how and when to complete necessary medical record documentation during secondstage labor. The providers viewed the project favorably. Most women (92.9%) reported satisfaction with their experience. This project enhanced collaborative communication between members of the clinical team and laboring women and improved patient satisfaction. The improvements were sustainable over a 2-year period.

Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials.

PubMed

Brookman-Frazee, Lauren; Stahmer, Aubyn C

2018-05-09

The Centers for Disease Control (2018) estimates that 1 in 59 children has autism spectrum disorder, and the annual cost of ASD in the U.S. is estimated to be $236 billion. Evidence-based interventions have been developed and demonstrate effectiveness in improving child outcomes. However, research on generalizable methods to scale up these practices in the multiple service systems caring for these children has been limited and is critical to meet this growing public health need. This project includes two, coordinated studies testing the effectiveness of the Translating Evidence-based Interventions (EBI) for ASD: Multi-Level Implementation Strategy (TEAMS) model. TEAMS focuses on improving implementation leadership, organizational climate, and provider attitudes and motivation in order to improve two key implementation outcomes-provider training completion and intervention fidelity and subsequent child outcomes. The TEAMS Leadership Institute applies implementation leadership strategies and TEAMS Individualized Provider Strategies for training applies motivational interviewing strategies to facilitate provider and organizational behavior change. A cluster randomized implementation/effectiveness Hybrid, type 3, trial with a dismantling design will be used to understand the effectiveness of TEAMS and the mechanisms of change across settings and participants. Study #1 will test the TEAMS model with AIM HI (An Individualized Mental Health Intervention for ASD) in publicly funded mental health services. Study #2 will test TEAMS with CPRT (Classroom Pivotal Response Teaching) in education settings. Thirty-seven mental health programs and 37 school districts will be randomized, stratified by county and study, to one of four groups (Standard Provider Training Only, Standard Provider Training + Leader Training, Enhanced Provider Training, Enhanced Provider Training + Leader Training) to test the effectiveness of combining standard, EBI-specific training with the two TEAMS modules individually and together on multiple implementation outcomes. Implementation outcomes including provider training completion, fidelity (coded by observers blind to group assignment) and child behavior change will be examined for 295 mental health providers, 295 teachers, and 590 children. This implementation intervention has the potential to increase quality of care for ASD in publicly funded settings by improving effectiveness of intervention implementation. The process and modules will be generalizable to multiple service systems, providers, and interventions, providing broad impact in community services. This study is registered with Clinicaltrials.gov ( NCT03380078 ). Registered 20 December 2017, retrospectively registered.

Disaster medical assistance in super typhoon Haiyan: Collaboration with the local medical team that resulted in great synergy.

PubMed

Kim, Hoon; Ahn, Moo Eob; Lee, Kang Hyun; Kim, Yeong Cheol; Hong, Eun Seok

2015-03-01

On 8 November 2013, Typhoon Haiyan made landfalls over the center of the Philippines and devastated the region. Soon aftermath of the disaster, many foreign medical teams (FMTs) headed toward the site, and the Korean team was one of them. This study described the experiences of the team during the initial phase of response, focusing on collaborative efforts with the local medical team. The Korean team was capable of providing primary care, and the Filipino team provided incomplete secondary care which was insufficient for covering the patient load. Not only did the Korean team provide electricity for hospital operation and various materials, but also supplemented medical personnel, who covered the emergency and outpatient departments. Collaborative efforts filled in each other's gap, and resulted in great synergy. Disaster medical relief mission of FMTs should be cooperated with a coordination mechanism. Collaboration with the local resources can be a great opportunity for both parties, and should not be overlooked in any disaster situations.

Hospital management autonomy in Chile: the challenges for human resources in health.

PubMed

Méndez, Claudio A; Torres A, M Cristina

2010-04-01

In Latin America, some health sector reforms have included steps to the implementation of autonomous hospitals. In Chile, the health system is implementing a reform that introduces a network of self-managed institutions. These organizations will be high complexity centers that involve greater technical diversity, cost centers and mechanisms to evaluate users' satisfaction. For human resources in health, the implementation of these centers creates challenges in the planning of service provision and a change from the traditional management style of the teams to one based on networks. These challenges include the estimation of gaps in medical specialists and in other professions in the health sector. In order to be successful with self-management, Chile needs to establish universal and local policies that address training and the organization of health service provisioning in these institutions.

Implementation of the WHO Surgical Safety Checklist in an Ethiopian Referral Hospital

PubMed Central

2014-01-01

Background The WHO Surgical Safety Checklist has a growing evidence base to support its role in improving perioperative safety, although its impact is likely to be directly related to the effectiveness of its implementation. There remains a paucity of documented experience from low-resource settings on Checklist implementation approaches. We report an implementation strategy in a public referral hospital in Addis Ababa, Ethiopia, based on consultation, local leadership, formal introduction, and supported supervision with subsequent audit and feedback. Methods Planning, implementation and assessment took place from December 2011 to December 2012. The planning phase, from December 2011 until April 2012, involved a multidisciplinary consultative approach using local leaders, volunteer clinicians, and staff from non-governmental organisations, to draw up a locally agreed and appropriate Checklist. Implementation in April 2012 involved formal teaching and discussion, simulation sessions and role play, with supportive supervision following implementation. Assessment was performed using completed Checklist analysis and staff satisfaction questionnaires at one month and further Checklist analysis combined with semi-structured interviews in December 2012. Results and discussion Checklist compliance rates were 83% for general anaesthetics at one month after implementation, with an overall compliance rate of 65% at eight months. There was a decrease in Checklist compliance over the period of the study to less than 20% by the end of the study period. The ‘Sign out’ section was reported as being the most difficult section of the Checklist to complete, and was missed completely in 21% of cases. The most commonly missed single item was the team introduction at the start of each case. However, we report high staff satisfaction with the Checklist and enthusiasm for its continued use. Conclusion We report a detailed implementation strategy for introducing the WHO Surgical Safety Checklist to a low-resource setting. We show that this approach can lead to high completion rates and high staff satisfaction, albeit with a drop in completion rates over time. We argue that maximal benefit of the Surgical Safety Checklist is likely to be when it engenders a conversation around patient safety within a department, and when there is local ownership of this process. PMID:24678854

Distributed teaming on JPL projects

NASA Technical Reports Server (NTRS)

Baroff, L. E.

2002-01-01

This paper addresses structures, actions and technologies that contribute to real team development of a distributed team, and the leadership skills and tools that are used to implement that team development.

Circles of Care: Implementation and Evaluation of Support Teams for African Americans with Cancer

ERIC Educational Resources Information Center

Hanson, Laura C.; Green, Melissa A.; Hayes, Michelle; Diehl, Sandra J.; Warnock, Steven; Corbie-Smith, Giselle; Lin, Feng-Chang; Earp, Jo Anne

2014-01-01

Background: Community-based peer support may help meet the practical, emotional, and spiritual needs of African Americans with advanced cancer. Support teams are a unique model of peer support for persons facing serious illness, but research is rare. This study sought to (a) implement new volunteer support teams for African Americans with advanced…

Career Development via Counselor/Teacher Teams; Guide for Implementation.

ERIC Educational Resources Information Center

Royal Oak City School District, MI.

The career development modules of the implementation guide, designed by counselor/teacher teams in Royal Oak, Michigan for junior high students, are intended to be used as a working copy for counselor/teacher teams. Career education concepts of self-awareness, assessment, and decision-making are correlated with the broad questions of: Who am I?…

Primary care emergency team training in situ means learning in real context

PubMed Central

Brandstorp, Helen; Halvorsen, Peder A.; Sterud, Birgitte; Haugland, Bjørgun; Kirkengen, Anna Luise

2016-01-01

Objective The purpose of our study was to explore the local learning processes and to improve in situ team training in the primary care emergency teams with a focus on interaction. Design, setting and subjects As participating observers, we investigated locally organised trainings of teams constituted ad hoc, involving nurses, paramedics and general practitioners, in rural Norway. Subsequently, we facilitated focus discussions with local participants. We investigated what kinds of issues the participants chose to elaborate in these learning situations, why they did so, and whether and how local conditions improved during the course of three and a half years. In addition, we applied learning theories to explore and challenge our own and the local participants’ understanding of team training. Results In situ team training was experienced as challenging, engaging, and enabling. In the training sessions and later focus groups, the participants discussed a wide range of topics constitutive for learning in a sociocultural perspective, and topics constitutive for patient safety culture. The participants expanded the types of training sites, themes and the structures for participation, improved their understanding of communication and developed local procedures. The flexible structure of the model mirrors the complexity of medicine and provides space for the participants’ own sense of responsibility. Conclusion Challenging, monthly in situ team trainings organised by local health personnel facilitate many types of learning. The flexible training model provides space for the participants’ own sense of responsibility and priorities. Outcomes involve social and structural improvements, including a sustainable culture of patient safety. Key Points Challenging, monthly in situ team trainings, organised by local health personnel, facilitate many types of learning.The flexible structure of the training model mirrors the complexity of medicine and the realism of the simulation sessions.Providing room for the participants’ own priorities and sense of responsibility allows for improvement on several levels.The participants demonstrated a consistent, long-term motivation to strengthen safety, both for their patients and for themselves. PMID:27442268

Primary care emergency team training in situ means learning in real context.

PubMed

Brandstorp, Helen; Halvorsen, Peder A; Sterud, Birgitte; Haugland, Bjørgun; Kirkengen, Anna Luise

2016-09-01

The purpose of our study was to explore the local learning processes and to improve in situ team training in the primary care emergency teams with a focus on interaction. As participating observers, we investigated locally organised trainings of teams constituted ad hoc, involving nurses, paramedics and general practitioners, in rural Norway. Subsequently, we facilitated focus discussions with local participants. We investigated what kinds of issues the participants chose to elaborate in these learning situations, why they did so, and whether and how local conditions improved during the course of three and a half years. In addition, we applied learning theories to explore and challenge our own and the local participants' understanding of team training. In situ team training was experienced as challenging, engaging, and enabling. In the training sessions and later focus groups, the participants discussed a wide range of topics constitutive for learning in a sociocultural perspective, and topics constitutive for patient safety culture. The participants expanded the types of training sites, themes and the structures for participation, improved their understanding of communication and developed local procedures. The flexible structure of the model mirrors the complexity of medicine and provides space for the participants' own sense of responsibility. Challenging, monthly in situ team trainings organised by local health personnel facilitate many types of learning. The flexible training model provides space for the participants' own sense of responsibility and priorities. Outcomes involve social and structural improvements, including a sustainable culture of patient safety. KEY POINTS Challenging, monthly in situ team trainings, organised by local health personnel, facilitate many types of learning. The flexible structure of the training model mirrors the complexity of medicine and the realism of the simulation sessions. Providing room for the participants' own priorities and sense of responsibility allows for improvement on several levels. The participants demonstrated a consistent, long-term motivation to strengthen safety, both for their patients and for themselves.

The conduct of Australian Indigenous primary health care research focusing on social and emotional wellbeing: a systematic review.

PubMed

Farnbach, Sara; Eades, Anne-Maree; Gwynn, Josephine D; Glozier, Nick; Hackett, Maree L

2018-06-14

Objectives and importance of study: Values and ethics: guidelines for ethical conduct in Aboriginal and Torres Strait Islander health research (Values and ethics) describes key values that should underpin Aboriginal and Torres Strait Islander (Indigenous)-focused health research. It is unclear how research teams address this document in primary health care research. We systematically review the primary health care literature focusing on Indigenous social and emotional wellbeing (SEWB) to identify how Values and ethics and community preferences for standards of behaviour (local protocols) are addressed during research. Systematic review in accordance with PRISMA Guidelines and MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies. We searched four databases and one Indigenous-specific website for qualitative, quantitative and mixed-method studies published since Values and ethics was implemented (2003). Included studies were conducted in primary health care services, focused on Indigenous SEWB and were conducted by research teams. Using standard data extraction forms, we identified actions taken (reported by authors or identified by us) relating to Values and ethics and local protocols. A total of 25 studies were included. Authors of two studies explicitly mentioned the Values and ethics document, but neither reported how their actions related to the document's values. In more than half the studies, we identified at least three actions relating to the values. Some actions related to multiple values, including use of culturally sensitive research processes and involving Indigenous representatives in the research team. Local protocols were rarely reported. Addressing Values and ethics appears to improve research projects. The academic community should focus on culturally sensitive research processes, relationship building and developing the Indigenous research workforce, to facilitate acceptable research that affects health outcomes. For Values and ethics to achieve its full impact and to improve learning between research teams, authors should be encouraged to report how the principles are addressed during research, including barriers and enablers that are encountered.

Implementation of Local Wellness Policies in Schools: Role of School Systems, School Health Councils, and Health Disparities.

PubMed

Hager, Erin R; Rubio, Diana S; Eidel, G Stewart; Penniston, Erin S; Lopes, Megan; Saksvig, Brit I; Fox, Renee E; Black, Maureen M

2016-10-01

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 having a school-level wellness team/school health council (SHC), with stronger associations among schools without disparity enrollment (majority African-American/Hispanic or low-income students). Online surveys were administered: 24 systems (support), 1349 schools (LWP implementation, perceived system support, SHC). The state provided school demographics. Analyses included multilevel multinomial logistic regression. Response rates were 100% (systems)/55.2% (schools). Among schools, 44.0% had SHCs, 22.6% majority (≥75%) African-American/Hispanic students, and 25.5% majority (≥75%) low-income (receiving free/reduced-price meals). LWP implementation (17-items) categorized as none = 36.3%, low (1-5 items) = 36.3%, high (6+ items) = 27.4%. In adjusted models, greater likelihood of LWP implementation was observed among schools with perceived system support (high versus none relative risk ratio, RRR = 1.63, CI: 1.49, 1.78; low versus none RRR = 1.26, CI: 1.18, 1.36) and SHCs (high versus none RRR = 6.8, CI: 4.07, 11.37; low versus none RRR = 2.24, CI: 1.48, 3.39). Disparity enrollment did not moderate associations (p > .05). Schools with perceived system support and SHCs had greater likelihood of LWP implementation, with no moderating effect of disparity enrollment. SHCs/support may overcome LWP implementation obstacles related to disparities. © 2016, American School Health Association.

An Analysis of Programs and Implementation of Professional Learning Communities in the Red Clay Consolidated School District with Recommendations for Future Implementation

ERIC Educational Resources Information Center

Goodwin, Kenneth L., Jr.

2012-01-01

During the 2010-2011 school year, schools throughout the Red Clay Consolidated School District were expected to implement Professional Learning Communities (PLCs); however, little to no guidance was provided to school-level administrators and teacher teams. Not surprisingly, many schools implemented team meetings that were not aligned with…

Implementing Role-Changing Versus Time-Changing Innovations in Health Care: Differences in Helpfulness of Staff Improvement Teams, Management, and Network for Learning.

PubMed

Nembhard, Ingrid M; Morrow, Christopher T; Bradley, Elizabeth H

2015-12-01

Health care organizations often fail in their effort to implement care-improving innovations. This article differentiates role-changing innovations, altering what workers do, from time-changing innovations, altering when tasks are performed or for how long. We examine our hypothesis that the degree to which access to groups that can alter organizational learning--staff, management, and external network--facilitates implementation depends on innovation type. Our longitudinal study using ordinal logistic regression and survey data on 517 hospitals' implementation of evidence-based practices for treating heart attack confirmed our thesis for factors granting access to each group: improvement team's representativeness (of affected staff), senior management engagement, and network membership. Although team representativeness and network membership were positively associated with implementing role-changing practices, senior management engagement was not. In contrast, senior management engagement was positively associated with implementing time-changing practices, whereas team representativeness was not, and network membership was not unless there was limited management engagement. These findings advance implementation science by explaining mixed results across past studies: Nature of change for workers alters potential facilitators' effects on implementation. © The Author(s) 2015.

Green shoots of recovery: a realist evaluation of a team to support change in general practice.

PubMed

Bartlett, Maggie; Basten, Ruth; McKinley, Robert K

2017-02-08

A multidisciplinary support team for general practice was established in April 2014 by a local National Health Service (NHS) England management team. This work evaluates the team's effectiveness in supporting and promoting change in its first 2 years, using realist methodology. Primary care in one area of England. Semistructured interviews were conducted with staff from 14 practices, 3 key senior NHS England personnel and 5 members of the support team. Sampling of practice staff was purposive to include representatives from relevant professional groups. The team worked with practices to identify areas for change, construct action plans and implement them. While there was no specified timescale for the team's work with practices, it was tailored to each. In realist evaluations, outcomes are contingent on mechanisms acting in contexts, and both an understanding of how an intervention leads to change in a socially constructed system and the resultant changes are outcomes. The principal positive mechanisms leading to change were the support team's expertise and its relationships with practice staff. The 'external view' provided by the team via its corroborative and normalising effects was an important mechanism for increasing morale in some practice contexts. A powerful negative mechanism was related to perceptions of 'being seen as a failing practice' which included expressions of 'shame'. Outcomes for practices as perceived by their staff were better communication, improvements in patients' access to appointments resulting from better clinical and managerial skill mix, and improvements in workload management. The support team promoted change within practices leading to signs of the 'green shoots of recovery' within the time frame of the evaluation. Such interventions need to be tailored and responsive to practices' needs. The team's expertise and relationships between team members and practice staff are central to success. 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/.

Inter-professional in-situ simulated team and resuscitation training for patient safety: Description and impact of a programmatic approach.

PubMed

Zimmermann, Katja; Holzinger, Iris Bachmann; Ganassi, Lorena; Esslinger, Peter; Pilgrim, Sina; Allen, Meredith; Burmester, Margarita; Stocker, Martin

2015-10-29

Inter-professional teamwork is key for patient safety and team training is an effective strategy to improve patient outcome. In-situ simulation is a relatively new strategy with emerging efficacy, but best practices for the design, delivery and implementation have yet to be evaluated. Our aim is to describe and evaluate the implementation of an inter-professional in-situ simulated team and resuscitation training in a teaching hospital with a programmatic approach. We designed and implemented a team and resuscitation training program according to Kern's six steps approach for curriculum development. General and specific needs assessments were conducted as independent cross-sectional surveys. Teamwork, technical skills and detection of latent safety threats were defined as specific objectives. Inter-professional in-situ simulation was used as educational strategy. The training was embedded within the workdays of participants and implemented in our highest acuity wards (emergency department, intensive care unit, intermediate care unit). Self-perceived impact and self-efficacy were sampled with an anonymous evaluation questionnaire after every simulated training session. Assessment of team performance was done with the team-based self-assessment tool TeamMonitor applying Van der Vleuten's conceptual framework of longitudinal evaluation after experienced real events. Latent safety threats were reported during training sessions and after experienced real events. The general and specific needs assessments clearly identified the problems, revealed specific training needs and assisted with stakeholder engagement. Ninety-five interdisciplinary staff members of the Children's Hospital participated in 20 in-situ simulated training sessions within 2 years. Participant feedback showed a high effect and acceptance of training with reference to self-perceived impact and self-efficacy. Thirty-five team members experiencing 8 real critical events assessed team performance with TeamMonitor. Team performance assessment with TeamMonitor was feasible and identified specific areas to target future team training sessions. Training sessions as well as experienced real events revealed important latent safety threats that directed system changes. The programmatic approach of Kern's six steps for curriculum development helped to overcome barriers of design, implementation and assessment of an in-situ team and resuscitation training program. This approach may help improve effectiveness and impact of an in-situ simulated training program.

The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm.

PubMed

Dogba, Maman Joyce; Menear, Matthew; Stacey, Dawn; Brière, Nathalie; Légaré, France

2016-07-19

Healthcare research increasingly focuses on interprofessional collaboration and on shared decision making, but knowledge gaps remain about effective strategies for implementing interprofessional collaboration and shared decision-making together in clinical practice. We used Kuhn's theory of scientific revolutions to reflect on how an integrated interprofessional shared decision-making approach was developed and implemented over time. In 2007, an interdisciplinary team initiated a new research program to promote the implementation of an interprofessional shared decision-making approach in clinical settings. For this reflective case study, two new team members analyzed the team's four projects, six research publications, one unpublished and two published protocols and organized them into recognizable phases according to Kuhn's theory. The merging of two young disciplines led to challenges characteristic of emerging paradigms. Implementation of interprofessional shared-decision making was hindered by a lack of conceptual clarity, a dearth of theories and models, little methodological guidance, and insufficient evaluation instruments. The team developed a new model, identified new tools, and engaged knowledge users in a theory-based approach to implementation. However, several unresolved challenges remain. This reflective case study sheds light on the evolution of interdisciplinary team science. It offers new approaches to implementing emerging knowledge in the clinical context.

Team Training in the Perioperative Arena: A Methodology for Implementation and Auditing Behavior.

PubMed

Rhee, Amanda J; Valentin-Salgado, Yessenia; Eshak, David; Feldman, David; Kischak, Pat; Reich, David L; LoPachin, Vicki; Brodman, Michael

Preventable medical errors in the operating room are most often caused by ineffective communication and suboptimal team dynamics. TeamSTEPPS is a government-funded, evidence-based program that provides tools and education to improve teamwork in medicine. The study hospital implemented TeamSTEPPS in the operating room and merged the program with a surgical safety checklist. Audits were performed to collect both quantitative and qualitative information on time out (brief) and debrief conversations, using a standardized audit tool. A total of 1610 audits over 6 months were performed by live auditors. Performance was sustained at desired levels or improved for all qualitative metrics using χ 2 and linear regression analyses. Additionally, the absolute number of wrong site/side/person surgery and unintentionally retained foreign body counts decreased after TeamSTEPPS implementation.

A new role for the ACNP: the rapid response team leader.

PubMed

Morse, Kate J; Warshawsky, Deborah; Moore, Jacqueline M; Pecora, Denise C

2006-01-01

The implementation of a rapid response team or medical emergency team is 1 of the 6 initiatives of the Institute for Healthcare Improvement's 100,000 Lives Campaign with the goal to reduce the number of cardiopulmonary arrests outside the intensive care unit and inpatient mortality rates. The concept of RRT was pioneered in Australia and is now being implemented in many hospitals across the United States. This article reviews the current literature and describes the implementation of an RRT in a community hospital. The first-quarter data after implementation are described. The unique role of the acute care nurse practitioner in this hospital's model is described.

Complex Instruction and Teaming: The Relationship between School Organization and the Introduction of an Instructional Innovation.

ERIC Educational Resources Information Center

Lee, Ginny; Filby, Nikola

This document presents findings of a study that examined the impact of teacher teaming on the implementation of a comprehensive program of curriculum and instruction. The program, Complex Instruction (CI), was implemented in four middle schools in the Riverdale School District (Arizona), each of which utilized some form of teaming instruction. CI…

Learning Together and Working Apart: Routines for Organizational Learning in Virtual Teams

ERIC Educational Resources Information Center

Dixon, Nancy

2017-01-01

Purpose: Research suggests that teaming routines facilitate learning in teams. This paper identifies and details how specific teaming routines, implemented in a virtual team, support its continual learning. The study's focus was to generate authentic and descriptive accounts of the interviewees' experiences with virtual teaming routines.…

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

PubMed

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

2010-06-01

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

VA's expansion of supportive housing: successes and challenges on the path toward Housing First.

PubMed

Austin, Erika Laine; Pollio, David E; Holmes, Sally; Schumacher, Joseph; White, Bert; Lukas, Carol Vandeusen; Kertesz, Stefan

2014-05-01

The U.S. Department of Veterans Affairs (VA) is transitioning to a Housing First approach to placement of veterans in permanent supportive housing through the use of rental vouchers, an ambitious organizational transformation. This qualitative study examined the experiences of eight VA facilities undertaking this endeavor in 2012. A multidisciplinary team interviewed facility leadership, midlevel managers, and frontline staff (N=95 individuals) at eight VA facilities representing four U.S. regions. The team used a semistructured interview protocol and the constant comparative method to explore how individuals throughout the organizations experienced and responded to the challenges of transitioning to a Housing First approach. Frontline staff faced challenges in rapidly housing homeless veterans because of difficult rental markets, the need to coordinate with local public housing authorities, and a lack of available funds for move-in costs. Staff sought to balance their time spent on housing activities with intensive case management of highly vulnerable veterans. Finding low-demand sheltering options (that is, no expectations regarding sobriety or treatment participation, as in the Housing First model) for veterans waiting for housing presented a significant challenge to implementation of Housing First. Facility leadership supported Housing First implementation through resource allocation, performance monitoring, and reliance on midlevel managers to understand and meet the challenges of implementation. The findings highlight the considerable practical challenges and innovative solutions arising from a large-scale effort to implement Housing First, with particular attention to the experiences of individuals at all levels within an organization.

Brazilian Federal Police drug chemical profiling - the PeQui project.

PubMed

Zacca, Jorge J; Botelho, Elvio Dias; Vieira, Maurício L; Almeida, Fernanda L A; Ferreira, Luciana S; Maldaner, Adriano O

2014-07-01

Over the past six years the Brazilian Federal Police has undertaken major efforts in order to implement and to develop its own drug chemical profiling program. This paper aims to provide a broad perspective regarding the managerial strategies and some examples of subsequent technical issues involved in the implementation of such a project. Close collaboration with local drug enforcement and investigation teams, establishment of proper worldwide partnerships with well recognized institutions in the field of drug analysis and the attainment of suitable funding and human resources are shown to be key success factors. Some preliminary results concerning the chemical profile of cocaine seizures in Brazil during this process are presented. Copyright © 2014 Forensic Science Society. Published by Elsevier Ireland Ltd. All rights reserved.

The “Translators”: Engaging Former Drug Users as Key Research Staff to Design and Implement a Risk Reduction Program for Rural Cocaine Users

PubMed Central

Stewart, Katharine E.; Wright, Patricia B.; Sims, Desi; Tyner, Kathy Russell; Montgomery, Brooke E. E.

2013-01-01

This manuscript describes lessons learned in the development and implementation of a clinical behavioral trial to reduce sexual risk among African-American cocaine users in rural Arkansas, from the perspectives of a multidisciplinary investigative team and community staff members with a history as local drug users who served as “translators.” Recommendations for investigators doing community-based research with active substance users are provided in the following domains: (a) engaging the community during formative research, (b) establishing bidirectional trust, (c) ensuring community voices are heard, and (d) managing conflict. The “translator’s” role is critical to the success of such projects. PMID:22428822

Cost-minimization model of a multidisciplinary antibiotic stewardship team based on a successful implementation on a urology ward of an academic hospital.

PubMed

Dik, Jan-Willem H; Hendrix, Ron; Friedrich, Alex W; Luttjeboer, Jos; Panday, Prashant Nannan; Wilting, Kasper R; Lo-Ten-Foe, Jerome R; Postma, Maarten J; Sinha, Bhanu

2015-01-01

In order to stimulate appropriate antimicrobial use and thereby lower the chances of resistance development, an Antibiotic Stewardship Team (A-Team) has been implemented at the University Medical Center Groningen, the Netherlands. Focus of the A-Team was a pro-active day 2 case-audit, which was financially evaluated here to calculate the return on investment from a hospital perspective. Effects were evaluated by comparing audited patients with a historic cohort with the same diagnosis-related groups. Based upon this evaluation a cost-minimization model was created that can be used to predict the financial effects of a day 2 case-audit. Sensitivity analyses were performed to deal with uncertainties. Finally, the model was used to financially evaluate the A-Team. One whole year including 114 patients was evaluated. Implementation costs were calculated to be €17,732, which represent total costs spent to implement this A-Team. For this specific patient group admitted to a urology ward and consulted on day 2 by the A-Team, the model estimated total savings of €60,306 after one year for this single department, leading to a return on investment of 5.9. The implemented multi-disciplinary A-Team performing a day 2 case-audit in the hospital had a positive return on investment caused by a reduced length of stay due to a more appropriate antibiotic therapy. Based on the extensive data analysis, a model of this intervention could be constructed. This model could be used by other institutions, using their own data to estimate the effects of a day 2 case-audit in their hospital.

Teleconsultation and Training of VHA Providers on Transgender Care: Implementation of a Multisite Hub System.

PubMed

Kauth, Michael R; Shipherd, Jillian C; Lindsay, Jan A; Kirsh, Susan; Knapp, Herschel; Matza, Lexi

2015-12-01

The Veterans Health Administration (VHA) is piloting a national program providing teleconsultation and training to clinicians to increase knowledge and comfort with treating transgender veterans and to expand clinical capacity. This program is based on Project ECHO and uses specialist expertise to train and educate front-line clinicians. Over time, the front-line clinicians increase knowledge and skills, enabling them to provide care locally and obviate need for patient travel. This program is innovative in its national scope, interdisciplinary team model, and multihub structure. This article describes development of the program and initial results for the first cohort of learners. Five interdisciplinary clinical teams participated in the 14-session, 7-month program. Most teams had some experience treating transgender veterans prior to participation. The teams completed at least 12 of 14 sessions. Thirteen of 33 participants completed an evaluation. In general, respondents found the teleconsultation program very helpful and credited the experience with improving their team functioning. Furthermore, respondents reported a significant increase in confidence to treat transgender veterans by the end of the program (59% versus 83%). We explored whether it is possible to recruit VHA clinical teams to participate in lengthy training on a low prevalence but complex condition. Early results support the feasibility and effectiveness of this national VHA teleconsultation and training program for transgender care. Lessons learned from the first group of learners have been applied to two concurrent groups with positive results.

Advancing Perspectives of Sustainability and Large-Scale Implementation of Design Teams in Ghana's Polytechnics: Issues and Opportunities

ERIC Educational Resources Information Center

Bakah, Marie Afua Baah; Voogt, Joke M.; Pieters, Jules M.

2012-01-01

Polytechnic staff perspectives are sought on the sustainability and large-scale implementation of design teams (DT), as a means for collaborative curriculum design and teacher professional development in Ghana's polytechnics, months after implementation. Data indicates that teachers still collaborate in DTs for curriculum design and professional…

Deliberation Makes a Difference: Preparation Strategies for TeamSTEPPS Implementation in Small and Rural Hospitals

PubMed Central

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

2016-01-01

Small and rural hospitals face special challenges to implement and sustain organization-wide quality improvement (QI) initiatives due to limited resources and infrastructures. We studied the implementation of TeamSTEPPS, a national QI initiative, in 14 critical access hospitals. Drawing on QI and organization development theories, we propose five strategic preparation steps for TeamSTEPPS: assess needs, reflect on the context, set goals, develop a shared understanding, and select change agents. We explore how hospitals’ practices correspond to suggested best practices by analyzing qualitative data collected through quarterly interviews with key informants. We find that the level of deliberation was a key factor that differentiated hospitals’ practices. Hospitals that were more deliberate in preparing for the five strategic steps were more likely to experience engagement, perceive efficacy, foresee and manage barriers, and achieve progress during implementation. We discuss potential steps that hospitals may take to better prepare for TeamSTEPPS implementation. PMID:26429835

Impacts of dairy diagnostic teams on herd performance.

PubMed

Weinand, D; Conlin, B J

2003-05-01

This study evaluated impacts of educational diagnostic teams of consultants used to transfer technology to dairy farms. Herd management performance changes were measured by comparing Dairy Herd Improvement data from 38 project farms to data from herds that were geographical contemporaries. The value of focused goals for effecting change was also assessed. Interviews provided producers' perception of project outcomes and insight on organization and conduct of dairy diagnostic teams. Changes observed in project herds were small compared with controls with tendencies for increased herd size and improved milk production per cow. Focused goals had greater impacts on increasing herd size, milk per cow, first lactation peak milk, reducing age at first calving, and percentages of cows with subclinical mastitis. Time, money, facility limitations, labor, and alternative priorities were the most cited constraints to implementing changes. Satisfaction scores of producers were significantly related to the degree that team recommendations were followed. Improved attitudes, quality of life, and financial well-being were benefits listed by a majority of producers from participation in the project. If similar projects were to be offered, 83% said they would participate again, and 69% indicated they would pay at least some of the costs. Project farms served as demonstration farms for 1930 other producers in their respective locales, resulting in a multiplier effect of original advice given by consultant teams. Suggestions by farmer participants for improvements in dairy diagnostic teams included needs for at least some unbiased team members, more frequent meetings, more follow-up on recommendations, and consistency of recommendations with family goals.

Evaluation of a model training program for respiratory-protection preparedness at local health departments.

PubMed

Alfano-Sobsey, Edie; Kennedy, Bobby; Beck, Frank; Combs, Brian; Kady, Wendy; Ramsey, Steven; Stockweather, Allison; Service, Will

2006-04-01

Respiratory-protection programs have had limited application in local health departments and have mostly focused on protecting employees against exposure to tuberculosis (TB). The need to provide the public health workforce with effective respiratory protection has, however, been underscored by recent concerns about emerging infectious diseases, bioterrorism attacks, drug-resistant microbes, and environmental exposures to microbial allergens (as in recent hurricane flood waters). Furthermore, OSHA has revoked the TB standard traditionally followed by local health departments, replacing it with a more stringent regulation. The additional OSHA requirements may place increased burdens on health departments with limited resources and time. For these reasons, the North Carolina Office of Public Health Preparedness and Response and industrial hygienists of the Public Health Regional Surveillance Teams have developed a training program to facilitate implementation of respiratory protection programs at local health departments. To date, more than 1,400 North Carolina health department employees have been properly fit-tested for respirator use and have received training in all aspects of respiratory protection. This article gives an overview of the development and evaluation of the program. The training approach presented here can serve as a model that other health departments and organizations can use in implementing similar respiratory-protection programs.

Generating evidence for health policy in challenging settings: lessons learned from four prevention of mother-to-child transmission of HIV implementation research studies in Nigeria.

PubMed

Sam-Agudu, Nadia A; Aliyu, Muktar H; Adeyemi, Olusegun A; Oronsaye, Frank; Oyeledun, Bolanle; Ogidi, Amaka G; Ezeanolue, Echezona E

2018-04-17

Implementation research (IR) facilitates health systems strengthening and optimal patient outcomes by generating evidence for scale-up of efficacious strategies in context. Thus, difficulties in generating IR evidence, particularly in limited-resource settings with wide disease prevention and treatment gaps, need to be anticipated and addressed. Nigeria is a priority country for the prevention of mother-to-child transmission of HIV (PMTCT). This paper analyses the experiences of four PMTCT IR studies in Nigeria, and proffers solutions to major challenges encountered during implementation. Multicentre PMTCT IR studies conducted in Nigeria during the Global Plan's assessment period (2011 to 2015) were included. Four studies were identified, namely The Baby Shower Trial, Optimizing PMTCT, MoMent and Lafiyan Jikin Mata. Major common challenges encountered were categorised as 'External' (beyond the control of study teams) and 'Internal' (amenable to rectification by study teams). External challenges included healthcare worker strikes and turnover, acts and threats of ethnic and political violence and terrorism, and multiplicity of required local ethical reviews. Internal challenges included limited research capacity among study staff, research staff turnover and travel restrictions hindering study site visits. Deliberate research capacity-building was provided to study staff through multiple opportunities before and during study implementation. Post-study employment opportunities and pathways for further research career-building are suggested as incentives for study staff retention. Engagement of study community-resident personnel minimised research staff turnover in violence-prone areas. The IR environment in Nigeria is extremely diverse and challenging, yet, with local experience and anticipatory planning, innovative solutions can be implemented to modulate internal challenges. Issues still remain with healthcare worker strikes and often unpredictable insecurity. There is a dire need for cooperation between institutional review boards across Nigeria in order to minimise the multiplicity of reviews for multicentre studies. External challenges need to be addressed by high-level stakeholders, given Nigeria's crucial regional and global position in the fight against the HIV epidemic.

Expectations and requests regarding team training interventions to promote interdisciplinary collaboration in medical rehabilitation--A qualitative study.

PubMed

Müller, C; Plewnia, A; Becker, S; Rundel, M; Zimmermann, L; Körner, M

2015-08-19

Interdisciplinary teamwork and team interventions are highly valued in the rehabilitation sector because they can improve outcomes of care for persons with complex health problems. However, little is known about expectations and requests regarding team interventions, especially in medical rehabilitation. This study aimed to explore how clinical managers and health professionals within multidisciplinary rehabilitation teams describe their expectations and requests regarding team-training interventions in the field of medical rehabilitation. Considering the methodology of qualitative research, data were collected using semi-structured interviews and focus groups at five rehabilitation clinics in Germany. We conducted face-to-face interviews with 5 clinical managers and 13 department heads of health care teams as well as five focus groups with a total of 35 members of interdisciplinary rehabilitation teams. Afterwards, the data were analyzed through qualitative content analysis encompassing data coding and using inductive thematic analysis. The exploration of team members' and clinical managers' descriptions showed that, to them, interdisciplinary team training programs should include a wide array of training contents. Seven common core themes emerged from the interviews, including participation of employees, leadership, communication, team meetings, team composition, coordination, and equal esteem. Additionally, 13 themes were identified by either managers or team members. The body of expectations regarding team training content in healthcare spans the continuum of changes on the team and organizational levels. On the organizational level, a number of structural factors were mentioned (e.g. improving the general conditions for team meetings, organized workshops to exchange interdisciplinary experiences, and leadership training), and on the team level, changes in procedural factors were listed (e.g. optimizing the consecutive planning and coordination of patient treatments, clarity with regard to roles and responsibilities of team members, and mutual esteem and appreciation between different professions). The synthesis underscores that there is meaningful heterogeneity in team training needs; training interventions should be locally adapted for each clinic in terms of training content and training strategies. Tailored team interventions are important for rehabilitation clinics. Future work should evaluate employed team training concepts over time as well as training contents, implementation strategies, and learning outcomes. This includes using robust study designs and evaluating team-training effects.

Consensus statement on the anticipation and prevention of acute postoperative pain: multidisciplinary RADAR approach.

PubMed

Vickers, A; Bali, S; Baxter, A; Bruce, G; England, J; Heafield, R; Langford, R; Makin, R; Power, I; Trim, J

2009-10-01

There has been considerable investment in efforts to improve postoperative pain management, including the introduction of acute pain teams. There have also been a number of guidelines published on postoperative pain management and there is widespread agreement on how pain should be practically managed. Despite these advances, there is no apparent improvement in the number of patients experiencing moderately severe or extreme pain after surgery. This highlights significant scope for improvement in acute postoperative pain management. In January 2009, a multidisciplinary UK expert panel met to define and agree a practical framework to encourage implementation of the numerous guidelines and fundamentals of pain management at a local level. The panel recognised that to do this, there was a need to organise the information and guidelines into a simplified, accessible and easy-to-implement system based on their practical clinical experience. Given the volume of literature in this area, the Chair recommended that key international guidelines from professional bodies should be distributed and then reviewed during the meeting to form the basis of the framework. Consensus was reached by unanimous agreement of all ten participants. This report provides a framework for the key themes, including consensus recommendations based upon practical experience agreed during the meeting, with the aim of consolidating the key guidelines to provide a fundamental framework which is simple to teach and implement in all areas. Key priorities that emerged were: Responsibility, Anticipation, Discussion, Assessment and Response. This formed the basis of RADAR, a novel framework to help pain specialists educate the wider care team on understanding and prioritising the management of acute pain. Acute postoperative pain can be more effectively managed if it is prioritised and anticipated by a well-informed care team who are educated with regard to appropriate analgesic options and understand what the long-term benefits of pain relief are. The principles of RADAR provide structure to help with training and implementation of good practice, to achieve effective postoperative pain management.

Teaming for Speech and Auditory Training.

ERIC Educational Resources Information Center

Nussbaum, Debra B.; Waddy-Smith, Bettie

1985-01-01

The article suggests three strategies for the audiologist and speech/communication specialist to use in assisting the preschool teacher to implement student's individualized education program: (1) demonstration teaming, (2) dual teaming; and (3) rotation teaming. (CL)

Republished: Building a culture of safety through team training and engagement.

PubMed

Thomas, Lily; Galla, Catherine

2013-07-01

Medical errors continue to occur despite multiple strategies devised for their prevention. Although many safety initiatives lead to improvement, they are often short lived and unsustainable. Our goal was to build a culture of patient safety within a structure that optimised teamwork and ongoing engagement of the healthcare team. Teamwork impacts the effectiveness of care, patient safety and clinical outcomes, and team training has been identified as a strategy for enhancing teamwork, reducing medical errors and building a culture of safety in healthcare. Therefore, we implemented Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), an evidence-based framework which was used for team training to create transformational and/or incremental changes; facilitating transformation of organisational culture, or solving specific problems. To date, TeamSTEPPS (TS) has been implemented in 14 hospitals, two Long Term Care Facilities, and outpatient areas across the North Shore LIJ Health System. 32 150 members of the healthcare team have been trained. TeamSTEPPS was piloted at a community hospital within the framework of the health system's organisational care delivery model, the Collaborative Care Model to facilitate sustainment. AHRQ's Hospital Survey on Patient Safety Culture, (HSOPSC), was administered before and after implementation of TeamSTEPPS, comparing the perception of patient safety by the heathcare team. Pilot hospital results of HSOPSC show significant improvement from 2007 (pre-TeamSTEPPS) to 2010. System-wide results of HSOPSC show similar trends to those seen in the pilot hospital. Valuable lessons for organisational success from the pilot hospital enabled rapid spread of TeamSTEPPS across the rest of the health system.

Building a culture of safety through team training and engagement.

PubMed

Thomas, Lily; Galla, Catherine

2013-05-01

Medical errors continue to occur despite multiple strategies devised for their prevention. Although many safety initiatives lead to improvement, they are often short lived and unsustainable. Our goal was to build a culture of patient safety within a structure that optimised teamwork and ongoing engagement of the healthcare team. Teamwork impacts the effectiveness of care, patient safety and clinical outcomes, and team training has been identified as a strategy for enhancing teamwork, reducing medical errors and building a culture of safety in healthcare. Therefore, we implemented Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), an evidence-based framework which was used for team training to create transformational and/or incremental changes; facilitating transformation of organisational culture, or solving specific problems. To date, TeamSTEPPS (TS) has been implemented in 14 hospitals, two Long Term Care Facilities, and outpatient areas across the North Shore LIJ Health System. 32 150 members of the healthcare team have been trained. TeamSTEPPS was piloted at a community hospital within the framework of the health system's organisational care delivery model, the Collaborative Care Model to facilitate sustainment. AHRQ's Hospital Survey on Patient Safety Culture, (HSOPSC), was administered before and after implementation of TeamSTEPPS, comparing the perception of patient safety by the heathcare team. Pilot hospital results of HSOPSC show significant improvement from 2007 (pre-TeamSTEPPS) to 2010. System-wide results of HSOPSC show similar trends to those seen in the pilot hospital. Valuable lessons for organisational success from the pilot hospital enabled rapid spread of TeamSTEPPS across the rest of the health system.

Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda.

PubMed

Kananura, Rornald Muhumuza; Ekirapa-Kiracho, Elizabeth; Paina, Ligia; Bumba, Ahmed; Mulekwa, Godfrey; Nakiganda-Busiku, Dinah; Oo, Htet Nay Lin; Kiwanuka, Suzanne Namusoke; George, Asha; Peters, David H

2017-12-28

The use of participatory monitoring and evaluation (M&E) approaches is important for guiding local decision-making, promoting the implementation of effective interventions and addressing emerging issues in the course of implementation. In this article, we explore how participatory M&E approaches helped to identify key design and implementation issues and how they influenced stakeholders' decision-making in eastern Uganda. The data for this paper is drawn from a retrospective reflection of various M&E approaches used in a maternal and newborn health project that was implemented in three districts in eastern Uganda. The methods included qualitative and quantitative M&E techniques such as  key informant interviews, formal surveys and supportive supervision, as well as participatory approaches, notably participatory impact pathway analysis. At the design stage, the M&E approaches were useful for identifying key local problems and feasible local solutions and informing the activities that were subsequently implemented. During the implementation phase, the M&E approaches provided evidence that informed decision-making and helped identify emerging issues, such as weak implementation by some village health teams, health facility constraints such as poor use of standard guidelines, lack of placenta disposal pits, inadequate fuel for the ambulance at some facilities, and poor care for low birth weight infants. Sharing this information with key stakeholders prompted them to take appropriate actions. For example, the sub-county leadership constructed placenta disposal pits, the district health officer provided fuel for ambulances, and health workers received refresher training and mentorship on how to care for newborns. Diverse sources of information and perspectives can help researchers and decision-makers understand and adapt evidence to contexts for more effective interventions. Supporting districts to have crosscutting, routine information generating and sharing platforms that bring together stakeholders from different sectors is therefore crucial for the successful implementation of complex development interventions.

Turning education into action: Impact of a collective social education approach to improve nurses' ability to recognize and accurately assess delirium in hospitalized older patients.

PubMed

Travers, Catherine; Henderson, Amanda; Graham, Fred; Beattie, Elizabeth

2018-03-01

Although cognitive impairment including dementia and delirium is common in older hospital patients, it is not well recognized or managed by hospital staff, potentially resulting in adverse events. This paper describes, and reports on the impact of a collective social education approach to improving both nurses' knowledge of, and screening for delirium. Thirty-four experienced nurses from six hospital wards, became Cognition Champions (CogChamps) to lead their wards in a collective social education process about cognitive impairment and the assessment of delirium. At the outset, the CogChamps were provided with comprehensive education about dementia and delirium from a multidisciplinary team of clinicians. Their knowledge was assessed to ascertain they had the requisite understanding to engage in education as a collective social process, namely, with each other and their local teams. Following this, they developed ward specific Action Plans in collaboration with their teams aimed at educating and evaluating ward nurses' ability to accurately assess and care for patients for delirium. The plans were implemented over five months. The broader nursing teams' knowledge was assessed, together with their ability to accurately assess patients for delirium. Each ward implemented their Action Plan to varying degrees and key achievements included the education of a majority of ward nurses about delirium and the certification of the majority as competent to assess patients for delirium using the Confusion Assessment Method. Two wards collected pre-and post-audit data that demonstrated a substantial improvement in delirium screening rates. The education process led by CogChamps and supported by educators and clinical experts provides an example of successfully educating nurses about delirium and improving screening rates of patients for delirium. ACTRN 12617000563369. Copyright © 2018 Elsevier Ltd. All rights reserved.

Implementing healthy lifestyle promotion in primary care: a quasi-experimental cross-sectional study evaluating a team initiative.

PubMed

Thomas, Kristin; Krevers, Barbro; Bendtsen, Preben

2015-01-22

Non-communicable diseases are a leading cause of death and can largely be prevented by healthy lifestyles. Health care organizations are encouraged to integrate healthy lifestyle promotion in routine care. This study evaluates the impact of a team initiative on healthy lifestyle promotion in primary care. A quasi-experimental, cross-sectional design compared three intervention centres that had implemented lifestyle teams with three control centres that used a traditional model of care. Outcomes were defined using the RE-AIM framework: reach, the proportion of patients receiving lifestyle promotion; effectiveness, self-reported attitudes and competency among staff; adoption, proportion of staff reporting regular practice of lifestyle promotion; implementation, fidelity to the original lifestyle team protocol. Data collection methods included a patient questionnaire (n = 888), a staff questionnaire (n = 120) and structured interviews with all practice managers and, where applicable, team managers (n = 8). The chi square test and problem-driven content analysis was used to analyse the questionnaire and interview data, respectively. Reach: patients at control centres (48%, n = 211) received lifestyle promotion significantly more often compared with patients at intervention centres (41%, n = 169). Effectiveness: intervention staff was significantly more positive towards the effectiveness of lifestyle promotion, shared competency and how lifestyle promotion was prioritized at their centre. Adoption: 47% of staff at intervention centres and 58% at control centres reported that they asked patients about their lifestyle on a daily basis. all intervention centres had implemented multi-professional teams and team managers and held regular meetings but struggled to implement in-house referral structures for lifestyle promotion, which was used consistently among staff. Intervention centres did not show higher rates than control centres on reach of patients or adoption among staff at this stage. All intervention centres struggled to implement working referral structures for lifestyle promotion. Intervention centres were more positive on effectiveness outcomes, attitudes and competency among staff, however. Thus, lifestyle teams may facilitate lifestyle promotion practice in terms of increased responsiveness among staff, illustrated by positive attitudes and perceptions of shared competency. More research is needed on lifestyle promotion referral structures in primary care regarding their configuration and implementation.

Realistic evaluation of an emergency department-based mental health nurse practitioner outpatient service in Australia.

PubMed

Wand, Timothy; White, Kathryn; Patching, Joanna

2011-06-01

Evaluation of new models of care requires consideration of the complexity inherent within health care programs and their sensitivity to local contextual factors as well as broader community, social and political influences. Evaluation frameworks that are flexible and responsive while maintaining research rigor are therefore required. Realistic evaluation was adopted as the methodology for the implementation and evaluation of an emergency department-based mental health nurse practitioner outpatient service in Sydney, Australia. The aim of realistic evaluation is to generate, test and refine theories of how programs work within a given context. This paper represents the final methodological step from the completed evaluation. A summary of quantitative and qualitative findings from the mixed-methods evaluation is presented, which is transformed into a set of overarching statements or "middle range theories". Middle range theory statements seek to explain the success of a program and provide transferable lessons for practitioners wishing to implement similar programs elsewhere. For example, the research team consider that early consultation with key local stakeholders and emergency department ownership of the project was pivotal to the implementation process. © 2011 Blackwell Publishing Asia Pty Ltd.

Preoperative tumour staging with multidisciplinary team assessment improves the outcome in locally advanced primary rectal cancer.

PubMed

Palmer, G; Martling, A; Cedermark, B; Holm, T

2011-12-01

Multidisciplinary team meetings have been introduced as a result of developments in preoperative radiological tumour staging and neoadjuvant treatment. Multidisciplinary team recommendations will influence treatment decisions but their effect on patient outcome is unknown. The aim of this study was to assess outcome in relation to preoperative local and distant staging, with or without multidisciplinary team assessment. A population-based registry of all patients with rectal cancer, treated in the Stockholm region from 1995 to 2004, identified 303 patients with locally advanced primary rectal cancer. The patients were classified into three groups: group 1, preoperative local and distant radiological tumour staging with discussion at a multidisciplinary team meeting; group 2, preoperative staging but no multidisciplinary team assessment; and group 3, no proper preoperative radiological staging. Neoadjuvant treatment was more prevalent in groups 1 and 2 than in group 3. The incidence of R0 resection differed significantly between the groups (52% in group 1, 43% in group 2 and 21% in group 3; P < 0.001). Local tumour control was achieved in 57%, 36%, and 19% of patients in groups 1, 2 and 3, respectively (P < 0.001). The estimated overall 5-year survival of patients was 30%, 28% and 12% in groups 1, 2 and 3, respectively. Preoperative radiological tumour staging in patients with locally advanced primary rectal cancer and discussion at a multidisciplinary team meeting increases the proportion of patients receiving neoadjuvant treatment and cancer-specific end-points. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

Effects of a Brief Team Training Program on Surgical Teams' Nontechnical Skills: An Interrupted Time-Series Study.

PubMed

Gillespie, Brigid M; Harbeck, Emma; Kang, Evelyn; Steel, Catherine; Fairweather, Nicole; Panuwatwanich, Kriengsak; Chaboyer, Wendy

2017-04-27

Up to 60% of adverse events in surgery are the result of poor communication and teamwork. Nontechnical skills in surgery (NOTSS) are critical to the success of surgery and patient safety. The study aim was to evaluate the effect of a brief team training intervention on teams' observed NOTSS. Pretest-posttest interrupted time-series design with statistical process control analysis was used to detect longitudinal changes in teams' NOTSS. We evaluated NOTSS using the revised NOTECHS weekly for 20 to 25 weeks before and after implementation of a team training program. We observed 179 surgical procedures with cardiac, vascular, upper gastrointestinal, and hepatobiliary teams. Mean posttest NOTECHS scores increased across teams, showing special cause variation. There were also significant before and after improvements in NOTECHS scores in respect to professional role and in the use of the Surgical Safety Checklist. Our results suggest associated improvements in teams' NOTSS after implementation of the team training program.

Training the Workforce: Description of a Longitudinal Interdisciplinary Education and Mentoring Program in Palliative Care.

PubMed

Levine, Stacie; O'Mahony, Sean; Baron, Aliza; Ansari, Aziz; Deamant, Catherine; Frader, Joel; Leyva, Ileana; Marschke, Michael; Preodor, Michael

2017-04-01

The rapid increase in demand for palliative care (PC) services has led to concerns regarding workforce shortages and threats to the resiliency of PC teams. To describe the development, implementation, and evaluation of a regional interdisciplinary training program in PC. Thirty nurse and physician fellows representing 22 health systems across the Chicago region participated in a two-year PC training program. The curriculum was delivered through multiple conferences, self-directed e-learning, and individualized mentoring by expert local faculty (mentors). Fellows shadowed mentors' clinical practices and received guidance on designing, implementing, and evaluating a practice improvement project to address gaps in PC at their institutions. Enduring, interdisciplinary relationships were built at all levels across health care organizations. Fellows made significant increases in knowledge and self-reported confidence in adult and pediatric PC and program development skills and frequency performing these skills. Fellows and mentors reported high satisfaction with the educational program. This interdisciplinary PC training model addressed local workforce issues by increasing the number of clinicians capable of providing PC. Unique features include individualized longitudinal mentoring, interdisciplinary education, on-site project implementation, and local network building. Future research will address the impact of the addition of social work and chaplain trainees to the program. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

What Makes Teacher Teams in a Vocational Education Context Effective?: A Qualitative Study of Managers' View on Team Working

ERIC Educational Resources Information Center

Truijen, K. J. P.; Sleegers, P. J. C.; Meelissen, M. R. M.; Nieuwenhuis, A. F. M.

2013-01-01

Purpose: At a time when secondary vocational education is implementing competence-based education (CBE) on a large scale, to adapt to the needs of students and of the labour market in a modern society, many vocational schools have recognised that interdisciplinary teacher teams are an important condition for this implementation. In order to…

Implementation of a Mobile Clinical Decision Support Application to Augment Local Antimicrobial Stewardship.

PubMed

Hoff, Brian M; Ford, Diana C; Ince, Dilek; Ernst, Erika J; Livorsi, Daniel J; Heintz, Brett H; Masse, Vincent; Brownlee, Michael J; Ford, Bradley A

2018-01-01

Medical applications for mobile devices allow clinicians to leverage microbiological data and standardized guidelines to treat patients with infectious diseases. We report the implementation of a mobile clinical decision support (CDS) application to augment local antimicrobial stewardship. We detail the implementation of our mobile CDS application over 20 months. Application utilization data were collected and evaluated using descriptive statistics to quantify the impact of our implementation. Project initiation focused on engaging key stakeholders, developing a business case, and selecting a mobile platform. The preimplementation phase included content development, creation of a pathway for content approval within the hospital committee structure, engaging clinical leaders, and formatting the first version of the guide. Implementation involved a media campaign, staff education, and integration within the electronic medical record and hospital mobile devices. The postimplementation phase required ongoing quality improvement, revision of outdated content, and repeated staff education. The evaluation phase included a guide utilization analysis, reporting to hospital leadership, and sustainability and innovation planning. The mobile application was downloaded 3056 times and accessed 9259 times during the study period. The companion web viewer was accessed 8214 times. Successful implementation of a customizable mobile CDS tool enabled our team to expand beyond microbiological data to clinical diagnosis, treatment, and antimicrobial stewardship, broadening our influence on antimicrobial prescribing and incorporating utilization data to inspire new quality and safety initiatives. Further studies are needed to assess the impact on antimicrobial utilization, infection control measures, and patient care outcomes.

Are they ready? Organizational readiness for change among clinical teaching teams

PubMed Central

Bank, Lindsay; Jippes, Mariëlle; Leppink, Jimmie; Scherpbier, Albert JJA; den Rooyen, Corry; van Luijk, Scheltus J; Scheele, Fedde

2017-01-01

Introduction Curriculum change and innovation are inevitable parts of progress in postgraduate medical education (PGME). Although implementing change is known to be challenging, change management principles are rarely looked at for support. Change experts contend that organizational readiness for change (ORC) is a critical precursor for the successful implementation of change initiatives. Therefore, this study explores whether assessing ORC in clinical teaching teams could help to understand how curriculum change takes place in PGME. Methods Clinical teaching teams in hospitals in the Netherlands were requested to complete the Specialty Training’s Organizational Readiness for curriculum Change, a questionnaire to measure ORC in clinical teaching teams. In addition, change-related behavior was measured by using the “behavioral support-for-change” measure. A two-way analysis of variance was performed for all response variables of interest. Results In total, 836 clinical teaching team members were included in this study: 288 (34.4%) trainees, 307 (36.7%) clinical staff members, and 241 (28.8%) program directors. Overall, items regarding whether the program director has the authority to lead scored higher compared with the other items. At the other end, the subscales “management support and leadership,” “project resources,” and “implementation plan” had the lowest scores in all groups. Discussion The study brought to light that program directors are clearly in the lead when it comes to the implementation of educational innovation. Clinical teaching teams tend to work together as a team, sharing responsibilities in the implementation process. However, the results also reinforce the need for change management support in change processes in PGME. PMID:29276424

Are they ready? Organizational readiness for change among clinical teaching teams.

PubMed

Bank, Lindsay; Jippes, Mariëlle; Leppink, Jimmie; Scherpbier, Albert Jja; den Rooyen, Corry; van Luijk, Scheltus J; Scheele, Fedde

2017-01-01

Curriculum change and innovation are inevitable parts of progress in postgraduate medical education (PGME). Although implementing change is known to be challenging, change management principles are rarely looked at for support. Change experts contend that organizational readiness for change (ORC) is a critical precursor for the successful implementation of change initiatives. Therefore, this study explores whether assessing ORC in clinical teaching teams could help to understand how curriculum change takes place in PGME. Clinical teaching teams in hospitals in the Netherlands were requested to complete the Specialty Training's Organizational Readiness for curriculum Change, a questionnaire to measure ORC in clinical teaching teams. In addition, change-related behavior was measured by using the "behavioral support-for-change" measure. A two-way analysis of variance was performed for all response variables of interest. In total, 836 clinical teaching team members were included in this study: 288 (34.4%) trainees, 307 (36.7%) clinical staff members, and 241 (28.8%) program directors. Overall, items regarding whether the program director has the authority to lead scored higher compared with the other items. At the other end, the subscales "management support and leadership," "project resources," and "implementation plan" had the lowest scores in all groups. The study brought to light that program directors are clearly in the lead when it comes to the implementation of educational innovation. Clinical teaching teams tend to work together as a team, sharing responsibilities in the implementation process. However, the results also reinforce the need for change management support in change processes in PGME.

Stress Analysis and Testing at the Marshall Space Flight Center to Study Cause and Corrective Action of Space Shuttle External Tank Stringer Failures

NASA Technical Reports Server (NTRS)

Wingate, Robert J.

2012-01-01

After the launch scrub of Space Shuttle mission STS-133 on November 5, 2010, large cracks were discovered in two of the External Tank intertank stringers. The NASA Marshall Space Flight Center, as managing center for the External Tank Project, coordinated the ensuing failure investigation and repair activities with several organizations, including the manufacturer, Lockheed Martin. To support the investigation, the Marshall Space Flight Center formed an ad-hoc stress analysis team to complement the efforts of Lockheed Martin. The team undertook six major efforts to analyze or test the structural behavior of the stringers. Extensive finite element modeling was performed to characterize the local stresses in the stringers near the region of failure. Data from a full-scale tanking test and from several subcomponent static load tests were used to confirm the analytical conclusions. The analysis and test activities of the team are summarized. The root cause of the stringer failures and the flight readiness rationale for the repairs that were implemented are discussed.

Networking 2.0: Expanding your collaboration circles through the Interagency Arctic Research Policy Committee (IARPC)

NASA Astrophysics Data System (ADS)

Rohde, J. A.; Bowden, S.; Stephenson, S. N.; Starkweather, S.

2015-12-01

The Interagency Arctic Research Policy Committee (IARPC) envisions a prosperous, sustainable, and healthy Arctic understood through innovative and collaborative research coordinated among Federal agencies and domestic and international partners. IARPC's approach is to harnesses the talent of the scientific and stakeholder community through Federally-run but broadly open collaboration teams, and an innovative website that expands the frontiers of collaborative research. The Obama Administration released the five-year Arctic Research Plan: FY2013-2017 in February 2013. The Plan focuses on advancing knowledge and sustainability of the Arctic by improving collaboration in seven priority research areas: sea ice and marine ecosystems, terrestrial ice and ecosystems, atmospheric studies, observing systems, regional climate models, human health studies, and adaptation tools for communities. From these seven research areas, 12 collaboration teams were formed to respond to the 145 milestones laid out in the Plan. The collaboration teams are charged with enhancing inter-institutional and interdisciplinary implementation of scientific research on local, regional, and circumpolar environmental and societal issues in the Arctic. The collaboration teams are co-chaired by Federal program managers, and, in some cases, external partners and are open to research and stakeholder communities. They meet on a regular basis by web- or teleconference to inform one another about ongoing and planned programs and new research results, as well as to inventory existing programs, identify gaps in knowledge and research, and address and implement the Plan's milestones. In-between meetings, team members communicate via our innovative, user-driven, collaboration website. Members share information about their research activities by posting updates, uploading documents, and including events on our calendar, and entering into dialogue about their research activities. Conversations taking place on the website are open to any other member, enabling new talent to enter into conversations and collaborations to form.

An Open Source Tool to Test Interoperability

NASA Astrophysics Data System (ADS)

Bermudez, L. E.

2012-12-01

Scientists interact with information at various levels from gathering of the raw observed data to accessing portrayed processed quality control data. Geoinformatics tools help scientist on the acquisition, storage, processing, dissemination and presentation of geospatial information. Most of the interactions occur in a distributed environment between software components that take the role of either client or server. The communication between components includes protocols, encodings of messages and managing of errors. Testing of these communication components is important to guarantee proper implementation of standards. The communication between clients and servers can be adhoc or follow standards. By following standards interoperability between components increase while reducing the time of developing new software. The Open Geospatial Consortium (OGC), not only coordinates the development of standards but also, within the Compliance Testing Program (CITE), provides a testing infrastructure to test clients and servers. The OGC Web-based Test Engine Facility, based on TEAM Engine, allows developers to test Web services and clients for correct implementation of OGC standards. TEAM Engine is a JAVA open source facility, available at Sourceforge that can be run via command line, deployed in a web servlet container or integrated in developer's environment via MAVEN. The TEAM Engine uses the Compliance Test Language (CTL) and TestNG to test HTTP requests, SOAP services and XML instances against Schemas and Schematron based assertions of any type of web service, not only OGC services. For example, the OGC Web Feature Service (WFS) 1.0.0 test has more than 400 test assertions. Some of these assertions includes conformance of HTTP responses, conformance of GML-encoded data; proper values for elements and attributes in the XML; and, correct error responses. This presentation will provide an overview of TEAM Engine, introduction of how to test via the OGC Testing web site and description of performing local tests. It will also provide information about how to participate in the open source code development of TEAM Engine.

Effects of implementation of a team model on physician and staff perceptions of a clinic's organizational and learning environments.

PubMed

Roth, Linda M; Markova, Tsveti; Monsur, Joseph C; Severson, Richard K

2009-06-01

Although teamwork is widely promoted by the Institute of Medicine, the American Academy of Family Physicians, and the Future of Family Medicine project, the health care literature does not provide clear direction on how to create or maintain high-functioning teams in ambulatory residency education. In 2004, we reorganized the clinical operation of our family medicine residency clinic into teams, each consisting of faculty, residents, and nursing and administrative staff. We hypothesized that operating within teams would have a positive effect on employees' job satisfaction and perceptions of our clinic's organizational and learning environments. We administered a confidential survey to faculty, residents, and staff annually over 5 years (2002-2006). Using questionnaire data from 2002-2003 as a baseline and data from 2004-2006 as a post-intervention measurement, we performed Mann-Whitney tests to assess the effect of the implementation of teams on employees' ratings of job satisfaction, individual autonomy, organizational commitment, goal attainment, physical characteristics and personnel arrangements within the clinic, learning opportunities for residents, teaching behaviors of faculty, roles of staff, and learning organization characteristics. After the implementation of teams, there was an improvement in ratings of learning opportunities and quality of teaching, job satisfaction, employee autonomy, staff roles, and staff attitudes toward residents. Implementing a team approach in a residency clinic can improve measures of physician and staff satisfaction and organizational function.

Implementing team huddles in small rural hospitals: How does the Kotter model of change apply?

PubMed

Baloh, Jure; Zhu, Xi; Ward, Marcia M

2017-12-17

To examine how the process of change prescribed in Kotter's change model applies in implementing team huddles, and to assess the impact of the execution of early change phases on change success in later phases. Kotter's model can help to guide hospital leaders to implement change and potentially to improve success rates. However, the model is under studied, particularly in health care. We followed eight hospitals implementing team huddles for 2 years, interviewing the change teams quarterly to inquire about implementation progress. We assessed how the hospitals performed in the three overarching phases of the Kotter model, and examined whether performance in the initial phase influenced subsequent performance. In half of the hospitals, change processes were congruent with Kotter's model, where performance in the initial phase influenced their success in subsequent phases. In other hospitals, change processes were incongruent with the model, and their success depended on implementation scope and the strategies employed. We found mixed support for the Kotter model. It better fits implementation that aims to spread to multiple hospital units. When the scope is limited, changes can be successful even when steps are skipped. Kotter's model can be a useful guide for nurse managers implementing changes. © 2017 John Wiley & Sons Ltd.

Implementing OpenMRS for patient monitoring in an HIV/AIDS care and treatment program in rural Mozambique.

PubMed

Manders, Eric-Jan; José, Eurico; Solis, Manuel; Burlison, Janeen; Nhampossa, José Leopoldo; Moon, Troy

2010-01-01

We have adopted the Open Medical Record System (OpenMRS) framework to implement an electronic patient monitoring system for an HIV care and treatment program in Mozambique. The program provides technical assistance to the Ministry of Health supporting the scale up of integrated HIV care and support services in health facilities in rural resource limited settings. The implementation is in use for adult and pediatric programs, with ongoing roll-out to cover all supported sites. We describe early experiences in adapting the system to the program needs, addressing infrastructure challenges, creating a regional support team, training data entry staff, migrating a legacy database, deployment, and current use. We find that OpenMRS offers excellent prospects for in-country development of health information systems, even in severely resource limited settings. However, it also requires considerable organizational infrastructure investment and technical capacity building to ensure continued local support.

The Implementation and Maintenance of a Behavioral Safety Process in a Petroleum Refinery

ERIC Educational Resources Information Center

Myers, Wanda V.; McSween, Terry E.; Medina, Rixio E.; Rost, Kristen; Alvero, Alicia M.

2010-01-01

A values-centered and team-based behavioral safety process was implemented in a petroleum oil refinery. Employee teams defined the refinery's safety values and related practices, which were used to guide the process design and implementation. The process included (a) a safety assessment; (b) the clarification of safety-related values and related…

Emergency Manuals: How Quality Improvement and Implementation Science Can Enable Better Perioperative Management During Crises.

PubMed

Goldhaber-Fiebert, Sara N; Macrae, Carl

2018-03-01

How can teams manage critical events more effectively? There are commonly gaps in performance during perioperative crises, and emergency manuals are recently available tools that can improve team performance under stress, via multiple mechanisms. This article examines how the principles of implementation science and quality improvement were applied by multiple teams in the development, testing, and systematic implementations of emergency manuals in perioperative care. The core principles of implementation have relevance for future patient safety innovations perioperatively and beyond, and the concepts of emergency manuals and interprofessional teamwork are applicable for diverse fields throughout health care. Copyright © 2017 Sara N. Goldhaber-Fiebert, Carl Macrae. Published by Elsevier Inc. All rights reserved.

Putting the "Team" in the Fine Arts Team: An Application of Business Management Team Concepts

ERIC Educational Resources Information Center

Fisher, Ryan

2007-01-01

In this article, the author discusses current challenges to the idea of teamwork in fine arts teams, redefines the terms team and collaboration using a business management perspective, discusses the success of effective teams in the business world and the characteristics of those teams, and proposes the implementation of the business model of…

Electronic Help for the Harried Team Chair.

ERIC Educational Resources Information Center

Polis, A. Richard

This paper describes one accreditation team leader's experience with coordinating the entire team accreditation review process on personal computer and offers 14 suggestions for future implementation. The leaders of the accreditation team describes pre-accreditation visit arrangements to facilitate the use of computers. He polled team members on…

For the Common Good. A Guide for Developing Local Interagency Linkage Teams.

ERIC Educational Resources Information Center

Imel, Susan

Developed from the Ohio At-Risk Linkage Team experiences, this guide assists local communities in organizing and strengthening effective collaborative interagency linkage teams for at-risk youth and adults. The guide proposes a series of steps, poses a number of questions relating to each step, and provides information about additional resources.…

Do primary care professionals agree about progress with implementation of primary care teams: results from a cross sectional study.

PubMed

Tierney, E; O'Sullivan, M; Hickey, L; Hannigan, A; May, C; Cullen, W; Kennedy, N; Kineen, L; MacFarlane, A

2016-11-22

Primary care is the cornerstone of healthcare reform with policies across jurisdictions promoting interdisciplinary team working. The effective implementation of such health policies requires understanding the perspectives of all actors. However, there is a lack of research about health professionals' views of this process. This study compares Primary Healthcare Professionals' perceptions of the effectiveness of the Primary Care Strategy and Primary Care Team (PCT) implementation in Ireland. Design and Setting: e-survey of (1) General Practitioners (GPs) associated with a Graduate Medical School (N = 100) and (2) Primary Care Professionals in 3 of 4 Health Service Executive (HSE) regions (N = 2309). After piloting, snowball sampling was used to administer the survey. Descriptive analysis was carried out using SPSS. Ratings across groups were compared using non-parametric tests. There were 569 responses. Response rates varied across disciplines (71 % for GPs, 22 % for other Primary Healthcare Professionals (PCPs). Respondents across all disciplines viewed interdisciplinary working as important. Respondents agreed on lack of progress of implementation of formal PCTs (median rating of 2, where 1 is no progress at all and 5 is complete implementation). GPs were more negative about the effectiveness of the Strategy to promote different disciplines to work together (median rating of 2 compared to 3 for clinical therapists and 3.5 for nurses, P = 0.001). Respondents identified resources and GP participation as most important for effective team working. Protected time for meetings and capacity to manage workload for meetings were rated as very important factors for effective team working by GPs, clinical therapists and nurses. A building for co-location of teams was rated as an important factor by nurses and clinical therapists though GPs rated it as less important. Payment to attend meetings and contractual arrangements were considered important factors by GPs but not by nurses or clinical therapists. PCPs and GPs agree there is limited PCT implementation. GPs are most negative about this implementation. There is some disagreement about which resources are most important for effective PCT working. These findings provide valuable data for clinicians and policy makers about implementation of interdisciplinary teams in primary care.

Using Local Climate Science to Educate "Key Influentials" and their Communities in the San Diego Region

NASA Astrophysics Data System (ADS)

Boudrias, M. A.; Estrada, M.; Anders, S.; Silva-Send, N. J.; Yin, Z.; Schultz, P.; Young, E.

2012-12-01

The San Diego Regional Climate Education Partnership has formed an innovative and collaborative team whose mission is to implement a research-based climate science education and communications program to increase knowledge about climate science among highly-influential leaders and their communities and foster informed decision making based on climate science and impacts. The team includes climate scientists, behavioral psychologists, formal and informal educators and communication specialists. The Partnership's strategic plan has three major goals: (1) raise public understanding of the causes and consequences of climate change; (2) identify the most effective educational methods to educate non-traditional audiences (Key Influentials) about the causes and consequences of climate change; and (3) develop and implement a replicable model for regional climate change education. To implement this strategic plan, we have anchored our project on three major pillars: (1) Local climate science (causes, impacts and long-term consequences); (2) theoretical, research-based evaluation framework (TIMSI); and (3) Key! Influentials (KI) as primary audience for messages (working w! ith and through them). During CCEP-I, the Partnership formed and convened an advisory board of Key Influentials, completed interviews with a sample of Key Influentials, conducted a public opinion survey, developed a website (www.sandiego.edu/climate) , compiled inventories on literature of climate science education resources and climate change community groups and local activities, hosted stakeholder forums, and completed the first phase of on an experiment to test the effects of different messengers delivering the same local climate change message via video. Results of 38 KI Interviews provided evidence of local climate knowledge, strong concern about climate change, and deeply held values related to climate change education and regional leadership. The most intriguing result was that while 90% of Key Influentials described themselves as concerned about climate change, they believed only 10% of their peers were equally concerned. Results from a public opinion survey of 1001 San Diego residents exhibited two clear trends: San Diegans were consistently more attuned and concerned about climate change and its impacts than nationwide average; and similar to the KI findings, they do not believe others are as concerned as they are. Further, mediation analysis of results supported TIMSI, showing that climate change education that promotes efficacy, identity and values endorsed by a concerned community are most likely to result in engagement in mitigation and adaptive behaviors. All CCEP-I activities informed and directed the design of our Phase II Strategic plan and will provide baseline data for assessing changes that occur as we implement the educational plan. Implementation strategies for the next Phase will emphasize (1) presenting local climate science and unique climate impacts, (2) working with Key Influentials in diverse ways, including educational both formal and informal dialogues for this non-traditional audience, developing climate education messages to be delivered by KIs to their peers and their communities, and engaging certain KIs to be the portal to their constituents; and (3) using social media to connect educators and their audiences.

The role and structure of the multidisciplinary team in the management of advanced Parkinson’s disease with a focus on the use of levodopa–carbidopa intestinal gel

PubMed Central

Pedersen, Stephen W; Suedmeyer, Martin; Liu, Louis W C; Domagk, Dirk; Forbes, Alison; Bergmann, Lars; Onuk, Koray; Yegin, Ashley; van Laar, Teus

2017-01-01

A multidisciplinary team (MDT) approach is increasingly recommended in Parkinson’s disease (PD) treatment guidelines, but no standard of care exists for such an approach, and the guidelines do not provide clarification on how it should be implemented. This paper reviews evidence of MDT interventions in people with PD and provides expert clinical perspectives for an MDT approach, with a focus on advanced PD and levodopa–carbidopa intestinal gel (carbidopa–levodopa enteral suspension in the USA). The key recommendations are to enable the best possible treatment of people with PD locally by facilitating a close structured collaboration of different health care professionals working in a fixed network structure; to refer people with PD to established MDT centers in a timely manner; to establish regular meetings for the MDT enabling interdisciplinary exchange and learning; to optimize individual treatment and carefully evaluate available treatment options; to ensure treatment decisions are agreed jointly between people with PD, their caregivers, family, and health care professional; and to include specialists outside of neurology from adjuvant medical departments as necessary when implementing advanced therapies. PMID:28115853

Design and field test of collaborative tools in the service of an innovative organization

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

De Beler, N.; Parfouru, S.

2012-07-01

This paper presents the design process of collaborative tools, based on ICT, aiming at supporting the tasks of the team that manages an outage of an energy production plant for maintenance activities. The design process follows an iterative and multidisciplinary approach, based on a collective tasks modeling of the outage management team in the light of Socio Organizational and Human (SOH) field studies, and on the state of the art of ICT. Field test of the collaborative tools designed plays a great place in this approach, allowing taking into account the operational world but involves also some risks which mustmore » be managed. To implement tools on all the production plants, we build an 'operational concept' with a level of description which authorizes the evolution of tools and allows some local adaptations. The field tests provide lessons on the ICT topics. For examples: the status of the remote access tools, the potential of use of a given information input by an actor for several individual and collective purposes, the actors perception of the tools meaning, and the requirements for supporting the implementation of change. (authors)« less

Prime movers: Advanced practice professionals in the role of stroke coordinator.

PubMed

Rattray, Nicholas A; Damush, Teresa M; Luckhurst, Cherie; Bauer-Martinez, Catherine J; Homoya, Barbara J; Miech, Edward J

2017-07-01

Following a stroke quality improvement clustered randomized trial and a national acute ischemic stroke (AIS) directive in the Veterans Health Administration in 2011, this comparative case study examined the role of advanced practice professionals (APPs) in quality improvement activities among stroke teams. Semistructured interviews were conducted at 11 Veterans Affairs medical centers annually over a 3-year period. A multidisciplinary team analyzed interviews from clinical providers through a mixed-methods, data matrix approach linking APPs (nurse practitioners and physician assistants) with Consolidated Framework for Implementation Research constructs and a group organization measure. Five of 11 facilities independently chose to staff stroke coordinator positions with APPs. Analysis indicated that APPs emerged as boundary spanners across services and disciplines who played an important role in coordinating evidence-based, facility-level approaches to AIS care. The presence of APPs was related to engaging in group-based evaluation of performance data, implementing stroke protocols, monitoring care through data audit, convening interprofessional meetings involving planning activities, and providing direct care. The presence of APPs appears to be an influential feature of local context crucial in developing an advanced, facility-wide approach to stroke care because of their boundary spanning capabilities. ©2017 American Association of Nurse Practitioners.

Design and implementation of a patient navigation system in rural Nepal: Improving patient experience in resource-constrained settings.

PubMed

Raut, Anant; Thapa, Poshan; Citrin, David; Schwarz, Ryan; Gauchan, Bikash; Bista, Deepak; Tamrakar, Bibhu; Halliday, Scott; Maru, Duncan; Schwarz, Dan

2015-12-01

Patient navigation programs have shown to be effective across multiple settings in guiding patients through the care delivery process. Limited experience and literature exist, however, for such programs in rural and resource-constrained environments. Patients living in such settings frequently have low health literacy and substantially lower social status than their providers. They typically have limited experiences interfacing with formalized healthcare systems, and, when they do, their experience can be unpleasant and confusing. At a district hospital in rural far-western Nepal, we designed and implemented a patient navigation system that aimed to improve patients' subjective care experience. First, we hired and trained a team of patient navigators who we recruited from the local area. Their responsibility is exclusively to demonstrate compassion and to guide patients through their care process. Second, we designed visual cues throughout our hospital complex to assist in navigating patients through the buildings. Third, we incorporated the patient navigators within the management and communications systems of the hospital care team, and established standard operating procedures. We describe here our experiences and challenges in designing and implementing a patient navigator program. Such patient-centered systems may be relevant at other facilities in Nepal and globally where patient health literacy is low, patients come from backgrounds of substantial marginalization and disempowerment, and patient experience with healthcare facilities is limited. Copyright © 2015 Elsevier Inc. All rights reserved.

Implementing a Complex Intervention to Support Personal Recovery: A Qualitative Study Nested within a Cluster Randomised Controlled Trial

PubMed Central

Leamy, Mary; Clarke, Eleanor; Le Boutillier, Clair; Bird, Victoria; Janosik, Monika; Sabas, Kai; Riley, Genevieve; Williams, Julie; Slade, Mike

2014-01-01

Objective To investigate staff and trainer perspectives on the barriers and facilitators to implementing a complex intervention to help staff support the recovery of service users with a primary diagnosis of psychosis in community mental health teams. Design Process evaluation nested within a cluster randomised controlled trial (RCT). Participants 28 interviews with mental health care staff, 3 interviews with trainers, 4 focus groups with intervention teams and 28 written trainer reports. Setting 14 community-based mental health teams in two UK sites (one urban, one semi-rural) who received the intervention. Results The factors influencing the implementation of the intervention can be organised under two over-arching themes: Organisational readiness for change and Training effectiveness. Organisational readiness for change comprised three sub-themes: NHS Trust readiness; Team readiness; and Practitioner readiness. Training effectiveness comprised three sub-themes: Engagement strategies; Delivery style and Modelling recovery principles. Conclusions Three findings can inform future implementation and evaluation of complex interventions. First, the underlying intervention model predicted that three areas would be important for changing practice: staff skill development; intention to implement; and actual implementation behaviour. This study highlighted the importance of targeting the transition from practitioners' intent to implement to actual implementation behaviour, using experiential learning and target setting. Second, practitioners make inferences about organisational commitment by observing the allocation of resources, Knowledge Performance Indicators and service evaluation outcome measures. These need to be aligned with recovery values, principles and practice. Finally, we recommend the use of organisational readiness tools as an inclusion criteria for selecting both organisations and teams in cluster RCTs. We believe this would maximise the likelihood of adequate implementation and hence reduce waste in research expenditure. Trial Registration Controlled-Trials.com ISRCTN02507940 PMID:24875748

Implementing a complex intervention to support personal recovery: a qualitative study nested within a cluster randomised controlled trial.

PubMed

Leamy, Mary; Clarke, Eleanor; Le Boutillier, Clair; Bird, Victoria; Janosik, Monika; Sabas, Kai; Riley, Genevieve; Williams, Julie; Slade, Mike

2014-01-01

To investigate staff and trainer perspectives on the barriers and facilitators to implementing a complex intervention to help staff support the recovery of service users with a primary diagnosis of psychosis in community mental health teams. Process evaluation nested within a cluster randomised controlled trial (RCT). 28 interviews with mental health care staff, 3 interviews with trainers, 4 focus groups with intervention teams and 28 written trainer reports. 14 community-based mental health teams in two UK sites (one urban, one semi-rural) who received the intervention. The factors influencing the implementation of the intervention can be organised under two over-arching themes: Organisational readiness for change and Training effectiveness. Organisational readiness for change comprised three sub-themes: NHS Trust readiness; Team readiness; and Practitioner readiness. Training effectiveness comprised three sub-themes: Engagement strategies; Delivery style and Modelling recovery principles. Three findings can inform future implementation and evaluation of complex interventions. First, the underlying intervention model predicted that three areas would be important for changing practice: staff skill development; intention to implement; and actual implementation behaviour. This study highlighted the importance of targeting the transition from practitioners' intent to implement to actual implementation behaviour, using experiential learning and target setting. Second, practitioners make inferences about organisational commitment by observing the allocation of resources, Knowledge Performance Indicators and service evaluation outcome measures. These need to be aligned with recovery values, principles and practice. Finally, we recommend the use of organisational readiness tools as an inclusion criteria for selecting both organisations and teams in cluster RCTs. We believe this would maximise the likelihood of adequate implementation and hence reduce waste in research expenditure. Controlled-Trials.com ISRCTN02507940.

Integration of leprosy services into the General Health Service in Sri Lanka: overcoming challenges to implementation in a remote district.

PubMed

Wijesinghe, Thushanthi S; Wijesinghe, Pushpa Ranjan

2013-01-01

Sri Lanka took a policy decision to integrate leprosy services into the general health services (GHS) in 1999. This paper aims to summarize the emergence of new, specific challenges and how they were overcome during the integration of leprosy services to the GHS in a remote, leprosy endemic district in Sri Lanka. In this article, the regional epidemiologist as the team leader describes the principles used for transition to an effective integrated model of leprosy services from a centralized leprosy control model in the district. In addition, rationale for integration is viewed from the epidemiological and operational perspectives. National and district leprosy epidemiological data from secondary sources are also reviewed for corroborating the effectiveness of integration. Challenges surfaced were mainly related to the transfer of ownership of the programme, selection of appropriate service providing institutions easily accessible to clients, sustainability of leprosy services at the GHS, ensuring participation of all stakeholders in capacity building programmes and co-ordination of patient care in the absence of a dermatologist in the district. An empowered district team leader with specified roles and responsibilities, his sound technical and managerial know how and ability to translate 'team work' concept to practice were found to be essential for successful implementation of integration. Decision-making powers at the district level and flexibility to introduce new, area-specific changes to the centrally prepared core activities of integration were also vital to overcome locally surfaced challenges.

Strategic conservation planning for the Eastern North Carolina/Southeastern Virginia Strategic Habitat Conservation Team

USGS Publications Warehouse

Alexander-Vaughn, Louise B.; Collazo, Jaime A.; Drew, C. Ashton

2014-01-01

The Eastern North Carolina/Southeastern Virginia Strategic Habitat Conservation Team (ENCSEVA) is a partnership among local federal agencies and programs with a mission to apply Strategic Habitat Conservation to accomplish priority landscape-level conservation within its geographic region. ENCSEVA seeks to further landscape-scale conservation through collaboration with local partners. To accomplish this mission, ENCSEVA is developing a comprehensive Strategic Habitat Conservation Plan (Plan) to provide guidance for its members, partners, and collaborators by establishing mutual conservation goals, objectives, strategies, and metrics to gauge the success of conservation efforts. Identifying common goals allows the ENCSEVA team to develop strategies that leverage joint resources and are more likely to achieve desired impacts across the landscape. The Plan will also provide an approach for ENCSEVA to meet applied research needs (identify knowledge gaps), foster adaptive management principles, identify conservation priorities, prioritize threats (including potential impacts of climate change), and identify the required capacity to implement strategies to create more resilient landscapes. ENCSEVA seeks to support the overarching goals of the South Atlantic Landscape Conservation Cooperative (SALCC) and to provide scientific and technical support for conservation at landscape scales as well as inform the management of natural resources in response to shifts in climate, habitat fragmentation and loss, and other landscape-level challenges (South Atlantic LCC 2012). The ENCSEVA ecoregion encompasses the northern third of the SALCC geography and offers a unique opportunity to apply landscape conservation at multiple scales through the guidance of local conservation and natural resource management efforts and by reporting metrics that reflect the effectiveness of those efforts (Figure 1). The Environmental Decision Analysis Team, housed within the North Carolina Cooperative Fish and Wildlife Research Unit at North Carolina State University, is assisting the ENCSEVA team in developing a scientifically sound basis for the Plan though the elicitation of expert knowledge and the organization of that knowledge using the Open Standards for the Practice of Conservation. The Open Standards for the Practice of Conservation is a framework that is well suited to incorporating decision-making tools such as Structured Decision Making and provides a multi-step process to conceptually organize conservation projects in a manner that enhances the rigor and transparency of expert and knowledge-based plans. It helps define explicit pathways from 2 planned conservation activities and ultimate impact, as well as indicators to measure success (Stem et al. 2005). Specifically, the framework identifies conservation targets, key ecological attributes, threats, and associated indicators to monitor responses given the implementation of a conservation action (Conservation Measures Partnership 2007). This report serves to provide a scientific foundation for the Plan by summarizing the expert opinion of wildlife biologists, ecologists, hydrologists, researchers, natural resource managers, and conservation practitioners regarding five environments (wetlands, riverine systems, estuaries, uplands, and barrier islands) within the ENCSEVA geography. Specifically, this report describes (1) the approach to elicit expert knowledge meant to support the strategic plan, (2) how this knowledge can inform collaborative conservation planning, and (3) a summary of opportunities available for the ENCSEVA team to address threats and impacts associated with climate change within the ecoregion.

Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature.

PubMed

Soukup, Tayana; Lamb, Benjamin W; Arora, Sonal; Darzi, Ara; Sevdalis, Nick; Green, James Sa

2018-01-01

In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs). A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs - including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos) and practices to avoid (Don'ts) when setting up MDT-driven cancer care.

Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature

PubMed Central

Soukup, Tayana; Lamb, Benjamin W; Arora, Sonal; Darzi, Ara; Sevdalis, Nick; Green, James SA

2018-01-01

In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs). A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs – including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos) and practices to avoid (Don’ts) when setting up MDT-driven cancer care. PMID:29403284

Spreading improvements for advanced COPD care through a Canadian Collaborative.

PubMed

Rocker, Graeme M; Amar, Claudia; Laframboise, Wendy L; Burns, Jane; Verma, Jennifer Y

2017-01-01

A year-long pan-Canadian quality improvement collaborative (QIC) led by the Canadian Foundation for Healthcare Improvement (CFHI) supported the spread of the successful Halifax, Nova Scotia-based INSPIRED COPD Outreach Program™ to 19 teams in the 10 Canadian provinces. We describe QIC results, addressing two main questions: 1) Can the results of the Nova Scotia INSPIRED model be replicated elsewhere in Canada? 2) How did the teams implement and evaluate their versions of the INSPIRED program? Collaborative faculty selected measures that were evidence-based, relatively simple to collect, and relevant to local context. Chosen process and outcome measures are related to four quality domains: 1) patient- and family-centeredness, 2) coordination, 3) efficiency, and 4) appropriateness. Evaluation of a complex intervention followed a mixed-methods approach. Most participants were nurse managers and/or COPD educators. Only 8% were physicians. Fifteen teams incorporated all core INSPIRED interventions. All teams carried out evaluation. Thirteen teams actively involved patients and families in customized, direct care planning, eg, asking them to complete evaluative surveys and/or conducting interviews. Patients consistently reported greater self-confidence in symptom management, a return to daily activities, and improvements to quality of life. Twelve teams collected data on care transitions using the validated three-item Care Transitions Measure (CTM-3). Twelve teams used the Lung Information Needs Questionnaire (LINQ). Admissions, emergency room visits, and patient-related costs fell substantially for two teams described in detail (combined enrollment 208 patients). Most teams reported gaining deeper knowledge around complexities of COPD care, optimizing patient care through action plans, self-management support, psychosocial support, advance care planning, and coordinating community partnerships. Quality-of-care gains are achievable in the short term among different teams across diverse geographical and social contexts. A well-designed, adequately funded public-private partnership can deliver widespread beneficial outcomes for the health care system and for those living with advanced COPD.

Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: a qualitative participatory European study.

PubMed

Teunissen, E; Gravenhorst, K; Dowrick, C; Van Weel-Baumgarten, E; Van den Driessen Mareeuw, F; de Brún, T; Burns, N; Lionis, C; Mair, F S; O'Donnell, C; O'Reilly-de Brún, M; Papadakaki, M; Saridaki, A; Spiegel, W; Van Weel, C; Van den Muijsenbergh, M; MacFarlane, A

2017-02-10

Cross-cultural communication in primary care is often difficult, leading to unsatisfactory, substandard care. Supportive evidence-based guidelines and training initiatives (G/TIs) exist to enhance cross cultural communication but their use in practice is sporadic. The objective of this paper is to elucidate how migrants and other stakeholders can adapt, introduce and evaluate such G/TIs in daily clinical practice. We undertook linked qualitative case studies to implement G/TIs focused on enhancing cross cultural communication in primary care, in five European countries. We combined Normalisation Process Theory (NPT) as an analytical framework, with Participatory Learning and Action (PLA) as the research method to engage migrants, primary healthcare providers and other stakeholders. Across all five sites, 66 stakeholders participated in 62 PLA-style focus groups over a 19 month period, and took part in activities to adapt, introduce, and evaluate the G/TIs. Data, including transcripts of group meetings and researchers' fieldwork reports, were coded and thematically analysed by each team using NPT. In all settings, engaging migrants and other stakeholders was challenging but feasible. Stakeholders made significant adaptations to the G/TIs to fit their local context, for example, changing the focus of a G/TI from palliative care to mental health; or altering the target audience from General Practitioners (GPs) to the wider multidisciplinary team. They also progressed plans to deliver them in routine practice, for example liaising with GP practices regarding timing and location of training sessions and to evaluate their impact. All stakeholders reported benefits of the implemented G/TIs in daily practice. Training primary care teams (clinicians and administrators) resulted in a more tolerant attitude and more effective communication, with better focus on migrants' needs. Implementation of interpreter services was difficult mainly because of financial and other resource constraints. However, when used, migrants were more likely to trust the GP's diagnoses and GPs reported a clearer understanding of migrants' symptoms. Migrants, primary care providers and other key stakeholders can work effectively together to adapt and implement G/TIs to improve communication in cross-cultural consultations, and enhance understanding and trust between GPs and migrant patients.

Chicago-St. Louis high speed rail plan

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

Stead, M.E.

1994-12-31

The Illinois Department of Transportation (IDOT), in cooperation with Amtrak, undertook the Chicago-St. Louis High Speed Rail Financial and Implementation Plan study in order to develop a realistic and achievable blueprint for implementation of high speed rail in the Chicago-St. Louis corridor. This report presents a summary of the Price Waterhouse Project Team`s analysis and the Financial and Implementation Plan for implementing high speed rail service in the Chicago-St. Louis corridor.

Implementing a lessons learned process at Sandia National Laboratories

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

Fosshage, Erik D.; Drewien, Celeste A.; Eras, Kenneth

2016-01-01

The Lessons Learned Process Improvement Team was tasked to gain an understanding of the existing lessons learned environment within the major programs at Sandia National Laboratories, identify opportunities for improvement in that environment as compared to desired attributes, propose alternative implementations to address existing inefficiencies, perform qualitative evaluations of alternative implementations, and recommend one or more near-term activities for prototyping and/or implementation. This report documents the work and findings of the team.

Team-based learning in therapeutics workshop sessions.

PubMed

Beatty, Stuart J; Kelley, Katherine A; Metzger, Anne H; Bellebaum, Katherine L; McAuley, James W

2009-10-01

To implement team-based learning in the workshop portion of a pathophysiology and therapeutics sequence of courses to promote integration of concepts across the pharmacy curriculum, provide a consistent problem-solving approach to patient care, and determine the impact on student perceptions of professionalism and teamwork. Team-based learning was incorporated into the workshop portion of 3 of 6 pathophysiology and therapeutics courses. Assignments that promoted team-building and application of key concepts were created. Readiness assurance tests were used to assess individual and team understanding of course materials. Students consistently scored 20% higher on team assessments compared with individual assessments. Mean professionalism and teamwork scores were significantly higher after implementation of team-based learning; however, this improvement was not considered educationally significant. Approximately 91% of students felt team-based learning improved understanding of course materials and 93% of students felt teamwork should continue in workshops. Team-based learning is an effective teaching method to ensure a consistent approach to problem-solving and curriculum integration in workshop sessions for a pathophysiology and therapeutics course sequence.

Team deliberate practice in medicine and related domains: a consideration of the issues.

PubMed

Harris, Kevin R; Eccles, David W; Shatzer, John H

2017-03-01

A better understanding of the factors influencing medical team performance and accounting for expert medical team performance should benefit medical practice. Therefore, the aim here is to highlight key issues with using deliberate practice to improve medical team performance, especially given the success of deliberate practice for developing individual expert performance in medicine and other domains. Highlighting these issues will inform the development of training for medical teams. The authors first describe team coordination and its critical role in medical teams. Presented next are the cognitive mechanisms that allow expert performers to accurately interpret the current situation via the creation of an accurate mental "model" of the current situation, known as a situation model. Following this, the authors propose that effective team performance depends at least in part on team members having similar models of the situation, known as a shared situation model. The authors then propose guiding principles for implementing team deliberate practice in medicine and describe how team deliberate practice can be used in an attempt to reduce barriers inherent in medical teams to the development of shared situation models. The paper concludes with considerations of limitations, and future research directions, concerning the implementation of team deliberate practice within medicine.

Why do certain primary health care teams respond better to intimate partner violence than others? A multiple case study.

PubMed

Goicolea, Isabel; Marchal, Bruno; Hurtig, Anna-Karin; Vives-Cases, Carmen; Briones-Vozmediano, Erica; San Sebastián, Miguel

2017-12-09

To analyse how team level conditions influenced health care professionals' responses to intimate partner violence. We used a multiple embedded case study. The cases were four primary health care teams located in a southern region of Spain; two of them considered "good" and two s "average". The two teams considered good had scored highest in practice issues for intimate partner violence, measured via a questionnaire (PREMIS - Physicians Readiness to Respond to Intimate Partner Violence Survey) applied to professionals working in the four primary health care teams. In each case quantitative and qualitative data were collected using a social network questionnaire, interviews and observations. The two "good" cases showed dynamics and structures that promoted team working and team learning on intimate partner violence, had committed social workers and an enabling environment for their work, and had put into practice explicit strategies to implement a women-centred approach. Better individual responses to intimate partner violence were implemented in the teams which: 1) had social workers who were knowledgeable and motivated to engage with others; 2) sustained a structure of regular meetings during which issues of violence were discussed; 3) encouraged a friendly team climate; and 4) implemented concrete actions towards women-centred care. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Disaster Research Team Building: A Case Study of a Web-based Disaster Research Training Program.

PubMed

Beaton, Randal D; Johnson, L Clark; Maida, Carl A; Houston, J Brian; Pfefferbaum, Betty

2012-11-19

This case study describes the process and outcomes of the Northwest Center for Public Health Practice Child and Family Disaster Research Training (UWDRT) Program housed at the University of Washington, which used web-based distance learning technology. The purposes of this program were to provide training and to establish a regional cadre of researchers and clinicians; to increase disaster mental health research capacity and collaboration; and to improve the scientific rigor of research investigations of disaster mental health in children and families. Despite a number of obstacles encountered in development and implementation, outcomes of this program included increased team member awareness and knowledge of child and family disaster mental health issues; improved disaster and public health instruction and training independent of the UWDRT program; informed local and state disaster response preparedness and response; and contributions to the child and family disaster mental health research literature.

Disaster management and mitigation: the telecommunications infrastructure.

PubMed

Patricelli, Frédéric; Beakley, James E; Carnevale, Angelo; Tarabochia, Marcello; von Lubitz, Dag K J E

2009-03-01

Among the most typical consequences of disasters is the near or complete collapse of terrestrial telecommunications infrastructures (especially the distribution network--the 'last mile') and their concomitant unavailability to the rescuers and the higher echelons of mitigation teams. Even when such damage does not take place, the communications overload/congestion resulting from significantly elevated traffic generated by affected residents can be highly disturbing. The paper proposes innovative remedies to the telecommunications difficulties in disaster struck regions. The offered solutions are network-centric operations-cap able, and can be employed in management of disasters of any magnitude (local to national or international). Their implementation provide ground rescue teams (such as law enforcement, firemen, healthcare personnel, civilian authorities) with tactical connectivity among themselves, and, through the Next Generation Network backbone, ensure the essential bidirectional free flow of information and distribution of Actionable Knowledge among ground units, command/control centres, and civilian and military agencies participating in the rescue effort.

Clinician Perspectives on Challenges to Patient Centered Care at the End of Life.

PubMed

Bardach, Shoshana H; Dunn, Edward J; Stein, J Christopher

2017-04-01

Discussions regarding patient preferences for resuscitation are often delayed and preferences may be neglected, leading to the receipt of unwanted medical care. To better understand barriers to the expression and realization of patients' end of life wishes, a preventive ethics team in one Veterans Affairs Medical Center conducted a survey of physicians, nurses, social workers, and respiratory therapists. Surveys were analyzed through qualitative analysis, using sorting methodologies to identify themes. Analysis revealed barriers to patient wishes being identified and followed, including discomfort conducting end-of-life discussions, difficulty locating patients' preferences in medical records, challenges with expiring do not resuscitate (DNR) orders, and confusion over terminology. Based on these findings, the preventive ethics team proposed new terminology for code status preferences, elimination of the local policy for expiration of DNR orders, and enhanced systems for storing and retrieving patients' end-of-life preferences. Educational efforts were initiated to facilitate implementation of the proposed changes.

Lewis Information Network (LINK): Background and overview

NASA Technical Reports Server (NTRS)

Schulte, Roger R.

1987-01-01

The NASA Lewis Research Center supports many research facilities with many isolated buildings, including wind tunnels, test cells, and research laboratories. These facilities are all located on a 350 acre campus adjacent to the Cleveland Hopkins Airport. The function of NASA-Lewis is to do basic and applied research in all areas of aeronautics, fluid mechanics, materials and structures, space propulsion, and energy systems. These functions require a great variety of remote high speed, high volume data communications for computing and interactive graphic capabilities. In addition, new requirements for local distribution of intercenter video teleconferencing and data communications via satellite have developed. To address these and future communications requirements for the next 15 yrs, a project team was organized to design and implement a new high speed communication system that would handle both data and video information in a common lab-wide Local Area Network. The project team selected cable television broadband coaxial cable technology as the communications medium and first installation of in-ground cable began in the summer of 1980. The Lewis Information Network (LINK) became operational in August 1982 and has become the backbone of all data communications and video.

The health educator as a team leader in primary health care.

PubMed

Brieger, W R; Ramakrishna, J

1986-01-01

Health teams naturally vary in size and composition according to their goals and objectives. Leadership of these teams should also be based on these goals. The goals of community-based primary health care, local involvement, cultural relevance, effective use of local resources, imply an important leadership role for health educators. The experience in the Ibarapa Local Government Area in Nigeria shows that health educators can be effective leaders in guiding a primary health care work group through various stages of program development. The use of a flexible, contractual model of team formation fits in well with the health educator's abilities to coordinate various program inputs and serve as mediator between professionals and the communities they serve. The ultimate mark of the health educator's leadership skills is the incorporation of community members into the health team.

From guidelines to local realities: evaluation of oral rehydration therapy and zinc supplementation in Guatemala.

PubMed

Hall-Clifford, Rachel; Amerson, Roxanne

2017-04-20

Diarrhea remains a leading cause of morbidity and mortality for children in low- and middle-income countries throughout the Americas. The World Health Organization (WHO) has developed guidelines on incorporating zinc supplementation (ZS) with traditional oral rehydration therapy (ORT) in order to shorten the duration of diarrheal episodes and to reduce poor health outcomes. Guatemala adopted these guidelines in 2011, but they have not yet been fully implemented at the community level. The objectives of this study were: (1) to co-design an ORT/ZS training program for community members with local health promoters that is appropriate to the local context and (2) to understand how attitudes and behaviors of community members changed after receiving training from the study promoters. In an observational study, community health promoters in rural Guatemala were trained according to WHO guidelines, and they worked collaboratively with the study team to develop a training curriculum to implement in their community. Community-based surveys, interviews, and focus group discussions were used to assess acceptability, accessibility, and availability of oral rehydration therapy and zinc supplementation. Use of ORT increased from 63% to 95% among community members following training by local health promoters. Satisfaction with the service offered by health promoters increased from 63% to 90% amongst community members trained by the study promoters. However, knowledge and use of zinc supplementation remained low, which was attributable to unavailability of zinc in the study community. Use of trained community health promoters is an effective way to translate WHO guidelines to local contexts and overcome sociocultural barriers to care. However, the health system's structure must support availability of essential medicines in order to effectively implement those guidelines.

Development of a technical assistance framework for building organizational capacity of health programs in resource-limited settings.

PubMed

Reyes, E Michael; Sharma, Anjali; Thomas, Kate K; Kuehn, Chuck; Morales, José Rafael

2014-09-17

Little information exists on the technical assistance needs of local indigenous organizations charged with managing HIV care and treatment programs funded by the US President's Emergency Plan for AIDS Relief (PEPFAR). This paper describes the methods used to adapt the Primary Care Assessment Tool (PCAT) framework, which has successfully strengthened HIV primary care services in the US, into one that could strengthen the capacity of local partners to deliver priority health programs in resource-constrained settings by identifying their specific technical assistance needs. Qualitative methods and inductive reasoning approaches were used to conceptualize and adapt the new Clinical Assessment for Systems Strengthening (ClASS) framework. Stakeholder interviews, comparisons of existing assessment tools, and a pilot test helped determine the overall ClASS framework for use in low-resource settings. The framework was further refined one year post-ClASS implementation. Stakeholder interviews, assessment of existing tools, a pilot process and the one-year post- implementation assessment informed the adaptation of the ClASS framework for assessing and strengthening technical and managerial capacities of health programs at three levels: international partner, local indigenous partner, and local partner treatment facility. The PCAT focus on organizational strengths and systems strengthening was retained and implemented in the ClASS framework and approach. A modular format was chosen to allow the use of administrative, fiscal and clinical modules in any combination and to insert new modules as needed by programs. The pilot led to refined pre-visit planning, informed review team composition, increased visit duration, and restructured modules. A web-based toolkit was developed to capture three years of experiential learning; this kit can also be used for independent implementation of the ClASS framework. A systematic adaptation process has produced a qualitative framework that can inform implementation strategies in support of country led HIV care and treatment programs. The framework, as a well-received iterative process focused on technical assistance, may have broader utility in other global programs.

A Case Analysis of an Elementary School's Implementation of Response to Intervention

ERIC Educational Resources Information Center

White, Richard B.; Polly, Drew; Audette, Robert H.

2012-01-01

The study provides an illustration of an elementary school's implementation of a model of Response to Intervention (RTI). The school was selected to be the pilot for RTI implementation within the district. The study employed interviews of all members of the school RTI Leadership Team and select members of the district-level RTI Leadership Team. An…

The Implementation Process of Two Multigrade/Multiyear Teams in Two Middle Schools in South Florida: A Cross-Site Case Study.

ERIC Educational Resources Information Center

Heeney, Margaret R.

Multigrade grouping is the practice of intentionally grouping two or more grade levels in the same classroom to enhance learning. It is becoming a much discussed and implemented alternative grouping practice in middle level education. This paper describes the implementation process of two multigrade "teams" in two Florida middle schools,…

Team Teaching among Mixed Messages: Implementing Two-Way Dual Language Bilingual Education at Third Grade in Texas

ERIC Educational Resources Information Center

Palmer, Deborah; Henderson, Kathryn; Wall, Dorothy; Zúñiga, Christian E.; Berthelsen, Stefan

2016-01-01

This article documents and interrogates top-down district-wide implementation of a two-way dual language bilingual education (DLBE) program in a large urban district. We carried out a language policy ethnography to explore the way two schools' teams of third grade teachers worked together to negotiate the intersection of DLBE implementation and…

Virtual Breakthrough Series, Part 2: Improving Fall Prevention Practices in the Veterans Health Administration.

PubMed

Zubkoff, Lisa; Neily, Julia; Quigley, Pat; Soncrant, Christina; Young-Xu, Yinong; Boar, Shoshana; Mills, Peter D

2016-11-01

The Veterans Health Administration (VHA) implemented a Virtual Breakthrough Series (VBTS) collaborative to help prevent falls and fall-related injuries. This project enabled teams to expand program infrastructure, redesign improvement strategies, and enhance program evaluation. A VBTS collaborative involves prework, action, and continuous improvement. Actions included educational calls, monthly reports, coaching, and feedback. Evaluation included assessment of interventions, team capacity and infrastructure changes, and rates of falls and fall-related major injuries. Fifty-nine teams completed the project. The majority submitted monthly reports. The average number of interventions per team was 6.66 (range, 1-12; mode = 6). The most frequently implemented changes were staff education; post-fall huddles; data tracking; and classifying falls, handoff communication, and intentional rounding. On a program questionnaire aggregated average summary scores improved from 136.54 (baseline) to 58.26 (follow-up; range, 0-189; p < 0.0001). The mean aggregated fall-related major injury rate for participants decreased from 6.8 to 4.8 per 100,000 bed-days of care (p = 0.02), or 5 major injuries avoided per month. No statistically significant changes occurred for nonparticipants. The mean aggregated fall rate did not change significantly from baseline to follow-up for participants (p = 0.42) or nonparticipants (p = 0.21). Teams submitted reports and implemented changes resulting in decreased major injuries related to falls for participating units. Teams also made changes in their fall prevention programs such as classifying how they analyze falls and implementing injury reduction strategies. The approaches used show promise for reducing fall-related harm for inpatients, as well as assisting teams in implementing changes. Copyright 2016 The Joint Commission.

A critical friend: monitoring and evaluation systems, development cooperation and local government. The case of Tuscany.

PubMed

Rossignoli, Serena; Coticchia, Fabrizio; Mezzasalma, Annarosa

2015-06-01

The role of monitoring and evaluation (M&E) systems in the field of development cooperation has globally increased in last decades. International and regional organizations, as well as states, local governments and NGOs have largely adopted the tools provided by M&E in order to enhance transparency, effectiveness and efficiency. The paper aims at verifying how and to what extent the implementation of M&E systems has affected the overall quality of international cooperation projects financed by a local government. After a literature review on M&E in development cooperation, the research analyzes the wide range of activities (evaluation ex-ante, mid-term, final, monitoring, consultancy) carried out by the Evaluation Team of the XY in the last eight years in behalf of an Italian local government: the Region of Tuscany. The paper reveals the strategic significance of adopting M&E systems in the medium-long term. Copyright © 2015 Elsevier Ltd. All rights reserved.

Regional approach to building operational level capacity for disaster planning: the case of the Eastern Africa region.

PubMed

Bazeyo, W; Mayega, R W; Orach, G C; Kiguli, J; Mamuya, S; Tabu, J S; Sena, L; Rugigana, E; Mapatano, M; Lewy, D; Mock, N; Burnham, G; Keim, M; Killewo, J

2013-06-01

The Eastern Africa region is regularly affected by a variety of disasters ranging from drought, to human conflict and population displacement. The magnitude of emergencies and response capacities is similar across the region. In order to strengthen public health disaster management capacities at the operational level in six countries of the Eastern Africa region, the USAID-funded leadership project worked through the HEALTH Alliance, a network of seven schools of public health from six countries in the region to train district-level teams. To develop a sustainable regional approach to building operational level capacity for disaster planning. This project was implemented through a higher education leadership initiative. Project activities were spear-headed by a network of Deans and Directors of public health schools within local universities in the Eastern Africa region. The leadership team envisioned a district-oriented systems change strategy. Pre-service and in-service curricula were developed regionally and district teams were formed to attend short training courses. Project activities began with a situational analysis of the disaster management capacity at national and operational levels. The next steps were chronologically the formation of country training teams and training of trainers, the development of a regional disaster management training curriculum and training materials, the cascading of training activities in the region, and the incorporation of emerging issues into the training curriculum. An evaluation model included the analysis of preparedness impact of the training program. The output from the district teams was the creation of individual district-level disaster plans and their implementation. This 4-year project focused on building operational level public health emergency response capacity, which had not previously been part of any national program. Use of the all-hazard approach rather than a scenario-based contingency planning led to the development of a standardized curriculum for training both in-service and pre-service personnel. Materials developed during the implementation phases of the project have been incorporated into public health graduate curricula in the seven schools. This systems-based strategy resulted in demonstrable outcomes related to district preparedness and university engagement in disaster management. University partnerships are an effective method to build district-level disaster planning capacity. Use of a regional network created a standardized approach across six countries.

What is the Cost of Free Cleft Surgery in the Middle East?

PubMed

Sheriff, Samar; Zawahrah, Hassan J; Chang, Lenisa V; Beyatli, Sonay; Elhadi Babiker, Haithem M; Roach, Ashton L; Biskup, Natalyia; van Aalst, John A

2018-05-01

This project explores the costs of cleft lip and/or palate surgeries in Palestine and Sudan, two low- and middle-income countries (LMIC), in the Middle East. Our purpose is to examine the veracity of advertisements from international cleft organizations claiming that "250 US dollars (USD) covers the cost of a single cleft surgery." We hypothesize that the actual cost of surgery is greater than 250 USD. Costs for each cleft surgery were organized broadly into 5 categories: hospital charges, personnel (time and money spent for health professionals to travel to LMIC, including lost wages), tests, consumables, and reusables. Each item was priced at market value during the time of data collection. Following itemization of actual costs, we compared the costs per cleft surgery among four surgical practice models: (1) visiting international surgical teams, (2) visiting international surgeon working with local teams, (3) local teams working at government hospitals, and (4) local teams working at private hospitals. Our results suggest that 250 USD is an underestimate of actual costs per cleft surgery in all models. The most expensive model in both Palestine and Sudan was the first model, visiting international teams performing all team functions; the cheapest surgical model in both countries was a local team working at government hospitals. The largest cost for any of these models is travel and lost wages for international team members. Eliminating this single cost (travel) decreases overall cost tremendously, but still does not approach the advertised cost of 250 USD. We conclude that 250 USD underestimates the actual costs to perform a single cleft surgery in Palestine and Sudan. If international cleft organizations are genuinely committed to creating sustainable international cleft programs, they should focus exclusively on training local professionals to perform surgery in hospitals of their own choosing.

Equity and service innovation: the implementation of a bibliotherapy scheme in Wales.

PubMed

Porter, Alison; Peconi, Julie; Evans, Angela; Snooks, Helen; Lloyd, Keith; Russell, Ian

2008-04-01

Book Prescription Wales (BPW) is a pilot bibiliotherapy scheme launched in July 2005 as a primary care treatment option for people with mild to moderate mental health problems. In an innovative model, patients are prescribed self-help books from a list, to borrow from local libraries. Our objective was to evaluate its implementation, focusing on the issue of equity of service delivery. Data were gathered from Welsh Assembly Government concerning project set-up and borrowing rates. Mailed questionnaires were completed by 21/22 (95.4%) Local Health Boards and 44/64 (68.8%) Community Mental Health Teams. In addition, 327 out of 497 (66%) primary care practices were surveyed by telephone, 20 prescribers took part in in-depth telephone interviews and three focus groups were conducted with library staff. From July 2005-March 2006, books were borrowed 15,236 times. There was a 10-fold variation in borrowing rates across local authorities (1.07 to 10.18 loans/1000 people). The priority which Local Health Board staff reported giving to the scheme varied. Uptake among prescribers was mixed: in 35% of general practices (n = 116) no-one participated. Prescribers reported different ways of using the bibliotherapy scheme. Library staff reported issues of patchy uptake. Variation in usage of bibliotherapy raises questions about equity; it is unlikely to reflect the distribution of people who could potentially benefit. Factors influencing variation existed all along the implementation chain. It is not always possibly to separate demand-side and supply-side factors when considering equity and service innovation in health care.

Self-reliance in health among village women.

PubMed

Wong, M L; Chen, P C

1991-01-01

A project in a remote region in Sarawak, Malaysia, in which village women were mobilized to plan and implement a kindergarten and child feeding program, illustrates the potential of carefully conceptualized community participation. Permission was obtained from village elders to train 18 mothers (all of whom has at least 4 years of education) to conduct a community needs survey. III health among children emerged as the problem of greatest concern to villagers and a health committee was formed to plan an intervention. Although a team of outside professionals was available for technical support, the emphasis from he onset was on developing self-reliance and community involvement in all decisions. To build confidence and develop leadership, a month-long participatory training course in promotive health care was organized by village health volunteers. Preparation for the project included conversion of an unused hut into a kindergarten and construction of furniture by village men, registration of preschool children, preparation of educational materials, and organization of a kitchen and duty roster for the feeding program. Project funding came from local bake sales and kindergarten subscriptions. Monitoring during the initial phase identified several problems, such as food shortages brought about by drought, some parents' inability to pay for kindergarten services, and a lack of trust in the teacher's abilities. These problems were corrected by the field team, but subsequent supervisory visits focused on teaching problem-solving skills to the local women. An evaluation conducted 1 year after program implementation revealed dramatic increases in the proportion of households producing fruits and vegetables, a higher percentage of breastfeeding mothers, and improvements in weight-for-age among kindergartners.

Solar Technical Assistance Team Webinars | State, Local, and Tribal

Science.gov Websites

Governments | NREL Solar Technical Assistance Team Webinars Solar Technical Assistance Team Webinars NREL's Solar Technical Assistance Team (STAT), with support from the U.S. Department of Energy

Enhanced Recovery After Surgery: A Review.

PubMed

Ljungqvist, Olle; Scott, Michael; Fearon, Kenneth C

2017-03-01

Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care, resulting in substantial improvements in clinical outcomes and cost savings. Enhanced Recovery After Surgery is a multimodal, multidisciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient. The care protocol is based on published evidence. The ERAS Society, an international nonprofit professional society that promotes, develops, and implements ERAS programs, publishes updated guidelines for many operations, such as evidence-based modern care changes from overnight fasting to carbohydrate drinks 2 hours before surgery, minimally invasive approaches instead of large incisions, management of fluids to seek balance rather than large volumes of intravenous fluids, avoidance of or early removal of drains and tubes, early mobilization, and serving of drinks and food the day of the operation. Enhanced Recovery After Surgery protocols have resulted in shorter length of hospital stay by 30% to 50% and similar reductions in complications, while readmissions and costs are reduced. The elements of the protocol reduce the stress of the operation to retain anabolic homeostasis. The ERAS Society conducts structured implementation programs that are currently in use in more than 20 countries. Local ERAS teams from hospitals are trained to implement ERAS processes. Audit of process compliance and patient outcomes are important features. Enhanced Recovery After Surgery started mainly with colorectal surgery but has been shown to improve outcomes in almost all major surgical specialties. Enhanced Recovery After Surgery is an evidence-based care improvement process for surgical patients. Implementation of ERAS programs results in major improvements in clinical outcomes and cost, making ERAS an important example of value-based care applied to surgery.

Speeding Up Team Learning.

ERIC Educational Resources Information Center

Edmondson, Amy; Bohmer, Richard; Pisano, Gary

2001-01-01

A study of 16 cardiac surgery teams looked at how the teams adapted to new ways of working. The challenge of team management is to implement new processes as quickly as possible. Steps for creating a learning team include selecting a mix of skills and expertise, framing the challenge, and creating an environment of psychological safety. (JOW)

Pennsylvania School Improvement Program. Linkage Case Study. Intermediate Unit A.

ERIC Educational Resources Information Center

Barnette, J. Jackson

The Pennsylvania School Improvement Program (PSIP) was created to assist local schools and school districts in the development of curriculum improvement strategies. The process involves the use of "linkers," curriculum specialists who work with teams from the local level to ascertain needs, then connect the local teams with the research…

What is needed to implement a web-based audit and feedback intervention with outreach visits to improve care quality: A concept mapping study among cardiac rehabilitation teams.

PubMed

van Engen-Verheul, Mariëtte M; Peek, Niels; Haafkens, Joke A; Joukes, Erik; Vromen, Tom; Jaspers, Monique W M; de Keizer, Nicolette F

2017-01-01

Evidence on successful quality improvement (QI) in health care requires quantitative information from randomized clinical trials (RCTs) on the effectiveness of QI interventions, but also qualitative information from professionals to understand factors influencing QI implementation. Using a structured qualitative approach, concept mapping, this study determines factors identified by cardiac rehabilitation (CR) teams on what is needed to successfully implement a web-based audit and feedback (A&F) intervention with outreach visits to improve the quality of CR care. Participants included 49 CR professionals from 18 Dutch CR centres who had worked with the A&F system during a RCT. In three focus group sessions participants formulated statements on factors needed to implement QI successfully. Subsequently, participants rated all statements for importance and feasibility and grouped them thematically. Multi dimensional scaling was used to produce a final concept map. Forty-two unique statements were formulated and grouped into five thematic clusters in the concept map. The cluster with the highest importance was QI team commitment, followed by organisational readiness, presence of an adequate A&F system, access to an external quality assessor, and future use and functionalities of the A&F system. Concept mapping appeared efficient and useful to understand contextual factors influencing QI implementation as perceived by healthcare teams. While presence of a web-based A&F system and external quality assessor were seen as instrumental for gaining insight into performance and formulating QI actions, QI team commitment and organisational readiness were perceived as essential to actually implement and carry out these actions. These two sociotechnical factors should be taken into account when implementing and evaluating the success of QI implementations in future research. Copyright © 2016. Published by Elsevier Ireland Ltd.

Reframing implementation as an organisational behaviour problem.

PubMed

Clay-Williams, Robyn; Braithwaite, Jeffrey

2015-01-01

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

Implementing Distributed Operations: A Comparison of Two Deep Space Missions

NASA Technical Reports Server (NTRS)

Mishkin, Andrew; Larsen, Barbara

2006-01-01

Two very different deep space exploration missions--Mars Exploration Rover and Cassini--have made use of distributed operations for their science teams. In the case of MER, the distributed operations capability was implemented only after the prime mission was completed, as the rovers continued to operate well in excess of their expected mission lifetimes; Cassini, designed for a mission of more than ten years, had planned for distributed operations from its inception. The rapid command turnaround timeline of MER, as well as many of the operations features implemented to support it, have proven to be conducive to distributed operations. These features include: a single science team leader during the tactical operations timeline, highly integrated science and engineering teams, processes and file structures designed to permit multiple team members to work in parallel to deliver sequencing products, web-based spacecraft status and planning reports for team-wide access, and near-elimination of paper products from the operations process. Additionally, MER has benefited from the initial co-location of its entire operations team, and from having a single Principal Investigator, while Cassini operations have had to reconcile multiple science teams distributed from before launch. Cassini has faced greater challenges in implementing effective distributed operations. Because extensive early planning is required to capture science opportunities on its tour and because sequence development takes significantly longer than sequence execution, multiple teams are contributing to multiple sequences concurrently. The complexity of integrating inputs from multiple teams is exacerbated by spacecraft operability issues and resource contention among the teams, each of which has their own Principal Investigator. Finally, much of the technology that MER has exploited to facilitate distributed operations was not available when the Cassini ground system was designed, although later adoption of web-based and telecommunication tools has been critical to the success of Cassini operations.

Prosthesis Prescription Protocol of the Arm (PPP-Arm): The implementation of a national prosthesis prescription protocol.

PubMed

Wijdenes, Paula; Brouwers, Michael; van der Sluis, Corry K

2018-02-01

In order to create more uniformity in the prescription of upper limb prostheses by Dutch rehabilitation teams, the development and implementation of a Prosthesis Prescription Protocol of the upper limb (PPP-Arm) was initiated. The aim was to create a national digital protocol to structure, underpin, and evaluate the prescription of upper limb prostheses for clients with acquired or congenital arm defects. Prosthesis Prescription Protocol of the Arm (PPP-Arm) was developed on the basis of the International Classification of Functioning and consisted of several layers. All stakeholders (rehabilitation teams, orthopedic workshops, patients, and insurance companies) were involved in development and implementation. A national project coordinator and knowledge brokers in each team were essential for the project. PPP-Arm was successfully developed and implemented in nine Dutch rehabilitation teams. The protocol improved team collaboration, structure, and completeness of prosthesis prescriptions and treatment uniformity and might be interesting for other countries as well. Clinical relevance A national protocol to prescribe upper limb prostheses can be helpful to create uniformity in treatment of patients with upper limb defects. Such a protocol improves quality of care for all patients in the country.

Implementation of Water Safety Plans (WSPs): A Case Study in the Coastal Area in Semarang City, Indonesia

NASA Astrophysics Data System (ADS)

Budiyono; Ginandjar, P.; Saraswati, L. D.; Pangestuti, D. R.; Martini; Jati, S. P.

2018-02-01

An area of 508.28 hectares in North Semarang is flooded by tidal inundation, including Bandarharjo village, which could affect water quality in the area. People in Bandarharjo use safe water from deep groundwater, without disinfection process. More than 90% of water samples in the Bandaharjo village had poor bacteriological quality. The aimed of the research was to describe the implementation of Water Safety Plans (WSPs) program in Bandarharjo village. This was a descriptive study with steps for implementations adopted the guidelines and tools of the World Health Organization. The steps consist of introducing WSPs program, team building, training the team, examination of water safety before risk assessment, risk assessment, minor repair I, examination of water safety risk, minor repair II (after monitoring). Data were analyzed using descriptive methods. WSPs program has been introduced and formed WSPs team, and the training of the team has been conducted. The team was able to conduct risks assessment, planned the activities, examined water quality, conduct minor repair and monitoring at the source, distribution, and households connection. The WSPs program could be implemented in the coastal area in Semarang, however regularly supervision and some adjustment are needed.

Using practice development methodology to develop children's centre teams: ideas for the future.

PubMed

Hemingway, Ann; Cowdell, Fiona

2009-09-01

The Children's Centre Programme is a recent development in the UK and brings together multi-agency teams to work with disadvantaged families. Practice development methods enable teams to work together in new ways. Although the term practice development remains relatively poorly defined, its key properties suggest that it embraces engagement, empowerment, evaluation and evolution. This paper introduces the Children's Centre Programme and practice development methods and aims to discuss the relevance of using this method to develop teams in children's centres through considering the findings from an evaluation of a two-year project to develop inter-agency public health teams. The evaluation showed that practice development methods can enable successful team development and showed that through effective facilitation, teams can change their practice to focus on areas of local need. The team came up with their own process to develop a strategy for their locality.

Transplant professionals' proposals for the implementation of an altruistic unbalanced paired kidney exchange program.

PubMed

Durand, Céline; Duplantie, Andrée; Fortin, Marie-Chantal

2014-10-15

Kidney recipients in the O blood group are at a disadvantage in kidney exchange programs (KEPs) because they can only receive an organ from O blood group donors. A way to remedy this unfair situation is through altruistic unbalanced paired kidney exchange (AUPKE) where a compatible pair (CP) consisting of an O donor and a non-O recipient is invited to participate in a KEP. There is no established AUPKE program in Canada. The aim of this study was to gather transplant professionals' views on the conditions necessary for the implementation of an AUPKE program. Nineteen Canadian transplant professionals took part in semistructured interviews. The content of these interviews was analyzed using a qualitative data analysis method. Respondents' recommendations focused on the following: (i) the logistics of AUPKE (e.g., not delaying the transplantation for the CP, retrieving organs locally, providing a good quality organ to the CP, and maintaining anonymity); (ii) the transplantation teams (e.g., establishing a consensus among members and ensuring sufficient resources); (iii) information provided to CPs; and (iv) research (e.g., looking into all transplant options for O recipients, studying all potential impacts of KEPs and AUPKE). The respondents in our study made the following recommendations for the implementation of an AUPKE program: (i) CPs should not be disadvantaged, (ii) measures should be taken to ensure that all transplant team members agree to participate and that there are sufficient resources for implementation, (iii) comprehensive information should be provided to the CP, and (iv) further research is needed on AUPKE.

Testing the Feasibility of a Passive and Active Case Ascertainment System for Multiple Rare Conditions Simultaneously: The Experience in Three US States

PubMed Central

McDermott, Suzanne; Ruttenber, Margaret; Mann, Joshua; Smith, Michael G; Royer, Julie; Valdez, Rodolfo

2016-01-01

Background Owing to their low prevalence, single rare conditions are difficult to monitor through current state passive and active case ascertainment systems. However, such monitoring is important because, as a group, rare conditions have great impact on the health of affected individuals and the well-being of their caregivers. A viable approach could be to conduct passive and active case ascertainment of several rare conditions simultaneously. This is a report about the feasibility of such an approach. Objective To test the feasibility of a case ascertainment system with passive and active components aimed at monitoring 3 rare conditions simultaneously in 3 states of the United States (Colorado, Kansas, and South Carolina). The 3 conditions are spina bifida, muscular dystrophy, and fragile X syndrome. Methods Teams from each state evaluated the possibility of using current or modified versions of their local passive and active case ascertainment systems and datasets to monitor the 3 conditions. Together, these teams established the case definitions and selected the variables and the abstraction tools for the active case ascertainment approach. After testing the ability of their local passive and active case ascertainment system to capture all 3 conditions, the next steps were to report the number of cases detected actively and passively for each condition, to list the local barriers against the combined passive and active case ascertainment system, and to describe the experiences in trying to overcome these barriers. Results During the test period, the team from South Carolina was able to collect data on all 3 conditions simultaneously for all ages. The Colorado team was also able to collect data on all 3 conditions but, because of age restrictions in its passive and active case ascertainment system, it was able to report few cases of fragile X syndrome. The team from Kansas was able to collect data only on spina bifida. For all states, the implementation of an active component of the ascertainment system was problematic. The passive component appears viable with minor modifications. Conclusions Despite evident barriers, the joint passive and active case ascertainment of rare disorders using modified existing surveillance systems and datasets seems feasible, especially for systems that rely on passive case ascertainment. PMID:27574026

Introduction of a quality improvement program in a children's hospital in Tehran: design, implementation, evaluation and lessons learned.

PubMed

Mohammadi, S Mehrdad; Mohammadi, S Farzad; Hedges, Jerris R; Zohrabi, Morteza; Ameli, Omid

2007-08-01

Reports addressing continuous quality improvement (CQI) methods in developing countries are scant and there are questions about the applicability of quality improvement methods in such settings. The structure and output of a formal quality improvement program implemented in a teaching hospital affiliated with the Tehran University of Medical Sciences is presented. OBJECTIVE METHOD: During a nine-month period, a multi-stage quality improvement program was implemented. It comprised: (i) training workshops; (ii) a steering committee; (iii) weekly consultation and facilitation of improvement projects; and (iv) a day-long demonstration and recognition meeting. Four cycles of workshops were held in which 132 employees were trained in the basics of CQI. Thirty improvement projects were initiated. Twenty-five of the projects were completed. In an evaluation survey more than 70% of respondents assessed a 'positive impact' on organizational culture, work efficiency and quality of services. More than 90% believed that the changes were sustained, and more than 60% reported that they have implemented additional improvement projects. Our quality improvement package supported rapid implementation of multiple projects. The underlying 'change structure' comprised the improvement teams, top management and the university's quality improvement office; it integrated project management, support and facilitation functions by the respective participant. Organization-wide change was more limited than anticipated. To institutionalize the program and ensure sustainability, a local structure for change should be organized, management coaching should be sustained, local facilitators should be developed, incentives should be established and physician involvement should be emphasized.

Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review.

PubMed

Wheeler, Claire; Lloyd-Evans, Brynmor; Churchard, Alasdair; Fitzgerald, Caroline; Fullarton, Kate; Mosse, Liberty; Paterson, Bethan; Zugaro, Clementina Galli; Johnson, Sonia

2015-04-08

Crisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital. CRTs were implemented nationally in England following the NHS Plan of 2000. Single centre studies suggest CRTs can reduce hospital admissions and increase service users' satisfaction: however, there is also evidence that model implementation and outcomes vary considerably. Evidence on crucial characteristics of effective CRTs is needed to allow team functioning to be optimised. This review aims to establish what evidence, if any, is available regarding the characteristics of effective and acceptable CRTs. A systematic review was conducted. MEDLINE, Embase, PsycINFO, CINAHL and Web of Science were searched to November 2013. A further web-based search was conducted for government and expert guidelines on CRTs. We analysed studies separately as: comparing CRTs to Treatment as Usual; comparing two or more CRT models; national or regional surveys of CRT services; qualitative studies of stakeholders' views regarding best practice in CRTs; and guidelines from government and expert organisations regarding CRT service delivery. Quality assessment and narrative synthesis were conducted. Statistical meta-analysis was not feasible due to the variety of design of retrieved studies. Sixty-nine studies were included. Studies varied in quality and in the composition and activities of the clinical services studied. Quantitative studies suggested that longer opening hours and the presence of a psychiatrist in the team may increase CRTs' ability to prevent hospital admissions. Stakeholders emphasised communication and integration with other local mental health services; provision of treatment at home; and limiting the number of different staff members visiting a service user. Existing guidelines prioritised 24-hour, seven-day-a-week CRT service provision (including psychiatrist and medical prescriber); and high quality of staff training. We cannot draw confident conclusions about the critical components of CRTs from available quantitative evidence. Clearer definition of the CRT model is required, informed by stakeholders' views and guidelines. Future studies examining the relationship of overall CRT model fidelity to outcomes, or evaluating the impact of key aspects of the CRT model, are desirable. Prospero CRD42013006415 .

Implementing and Evaluating a Peer-Led Team Learning Approach in Undergraduate Anatomy and Physiology

ERIC Educational Resources Information Center

Finn, Kevin; Campisi, Jay

2015-01-01

This article describes how a Peer-Led Team Learning (PLTL) program was implemented in a first-year, undergraduate Anatomy and Physiology course sequence to examine the student perceptions of the program and determine the effects of PLTL on student performance.

Tracking Team Dynamic Strategy Implemented in Sly Fox Mission 22

DTIC Science & Technology

communication between team members and track the overall status of the team social dynamic. This paper provides a detailed account of the need, methodology , results, benefits, and limitations of this strategy.

Can hospital audit teams identify case management problems, analyse their causes, identify and implement improvements? A cross-sectional process evaluation of obstetric near-miss case reviews in Benin.

PubMed

Borchert, Matthias; Goufodji, Sourou; Alihonou, Eusèbe; Delvaux, Thérèse; Saizonou, Jacques; Kanhonou, Lydie; Filippi, Véronique

2012-10-11

Obstetric near-miss case reviews are being promoted as a quality assurance intervention suitable for hospitals in low income countries. We introduced such reviews in five district, regional and national hospitals in Benin, West Africa. In a cross-sectional study we analysed the extent to which the hospital audit teams were able to identify case management problems (CMPs), analyse their causes, agree on solutions and put these solutions into practice. We analysed case summaries, women's interview transcripts and audit minutes produced by the audit teams for 67 meetings concerning one woman with near-miss complications each. We compared the proportion of CMPs identified by an external assessment team to the number found by the audit teams. For the latter, we described the CMP causes identified, solutions proposed and implemented by the audit teams. Audit meetings were conducted regularly and were well attended. Audit teams identified half of the 714 CMPs; they were more likely to find managerial ones (71%) than the ones relating to treatment (30%). Most identified CMPs were valid. Almost all causes of CMPs were plausible, but often too superficial to be of great value for directing remedial action. Audit teams suggested solutions, most of them promising ones, for 38% of the CMPs they had identified, but recorded their implementation only for a minority (8.5%). The importance of following-up and documenting the implementation of solutions should be stressed in future audit interventions. Tools facilitating the follow-up should be made available. Near-miss case reviews hold promise, but their effectiveness to improve the quality of care sustainably and on a large scale still needs to be established.

Can hospital audit teams identify case management problems, analyse their causes, identify and implement improvements? A cross-sectional process evaluation of obstetric near-miss case reviews in Benin

PubMed Central

2012-01-01

Background Obstetric near-miss case reviews are being promoted as a quality assurance intervention suitable for hospitals in low income countries. We introduced such reviews in five district, regional and national hospitals in Benin, West Africa. In a cross-sectional study we analysed the extent to which the hospital audit teams were able to identify case management problems (CMPs), analyse their causes, agree on solutions and put these solutions into practice. Methods We analysed case summaries, women’s interview transcripts and audit minutes produced by the audit teams for 67 meetings concerning one woman with near-miss complications each. We compared the proportion of CMPs identified by an external assessment team to the number found by the audit teams. For the latter, we described the CMP causes identified, solutions proposed and implemented by the audit teams. Results Audit meetings were conducted regularly and were well attended. Audit teams identified half of the 714 CMPs; they were more likely to find managerial ones (71%) than the ones relating to treatment (30%). Most identified CMPs were valid. Almost all causes of CMPs were plausible, but often too superficial to be of great value for directing remedial action. Audit teams suggested solutions, most of them promising ones, for 38% of the CMPs they had identified, but recorded their implementation only for a minority (8.5%). Conclusions The importance of following-up and documenting the implementation of solutions should be stressed in future audit interventions. Tools facilitating the follow-up should be made available. Near-miss case reviews hold promise, but their effectiveness to improve the quality of care sustainably and on a large scale still needs to be established. PMID:23057707

Enhanced clarity and holism: the outcome of implementing the ICF with an acute stroke multidisciplinary team in England

PubMed Central

Harries, Priscilla; Kilbride, Cherry; De Souza, Lorraine

2013-01-01

Purpose: Although it is recommended that the ICF (International Classification of Functioning, Disability and Health) should be implemented to aid communication within multidisciplinary stroke services, there is no empirical evidence to demonstrate the outcomes of such implementation. Working with one stroke service, this project aimed to address this gap and sought to evaluate the outcomes of implementing an ICF-based clinical tool into practice. Method: Using an action research framework with mixed methods, data were collected from individual interviews, a focus group, questionnaires, email communications, minutes from relevant meetings and field notes. Thematic analysis was undertaken, using immersion and crystallisation, to define overall themes. Descriptive statistics were used to analyse quantitative data. Data from both sources were combined to create key findings. Results: Three findings were determined from the data analysis. The ICF (1) fosters communication within and beyond the multidisciplinary stroke team; (2) promotes holistic thinking; and (3) helps to clarify team roles. Conclusions: The ICF enhanced clarity of communication and team roles within the acute stroke multidisciplinary team as well as with other clinicians, patients and their relatives. In addition, the ICF challenged stroke clinicians to think holistically, thereby appropriately extending their domain of concern beyond their traditional remit. Implications for Rehabilitation The ICF is a globally accepted framework to describe functioning and is in use in a variety of clinical settings. Yet, the outcomes of using it in clinical practice have yet to be fully explored. This study found that the ICF enhanced clarity of communication and team roles within an acute stroke multidisciplinary team and to others beyond the team, including clinicians, patients and their relatives. Using the ICF also challenged clinicians to think holistically about patient needs following a stroke. PMID:23530624

Enhanced clarity and holism: the outcome of implementing the ICF with an acute stroke multidisciplinary team in England.

PubMed

Tempest, Stephanie; Harries, Priscilla; Kilbride, Cherry; De Souza, Lorraine

2013-01-01

Although it is recommended that the ICF (International Classification of Functioning, Disability and Health) should be implemented to aid communication within multidisciplinary stroke services, there is no empirical evidence to demonstrate the outcomes of such implementation. Working with one stroke service, this project aimed to address this gap and sought to evaluate the outcomes of implementing an ICF-based clinical tool into practice. Using an action research framework with mixed methods, data were collected from individual interviews, a focus group, questionnaires, email communications, minutes from relevant meetings and field notes. Thematic analysis was undertaken, using immersion and crystallisation, to define overall themes. Descriptive statistics were used to analyse quantitative data. Data from both sources were combined to create key findings. Three findings were determined from the data analysis. The ICF (1) fosters communication within and beyond the multidisciplinary stroke team; (2) promotes holistic thinking; and (3) helps to clarify team roles. The ICF enhanced clarity of communication and team roles within the acute stroke multidisciplinary team as well as with other clinicians, patients and their relatives. In addition, the ICF challenged stroke clinicians to think holistically, thereby appropriately extending their domain of concern beyond their traditional remit. The ICF is a globally accepted framework to describe functioning and is in use in a variety of clinical settings. Yet, the outcomes of using it in clinical practice have yet to be fully explored. This study found that the ICF enhanced clarity of communication and team roles within an acute stroke multidisciplinary team and to others beyond the team, including clinicians, patients and their relatives. Using the ICF also challenged clinicians to think holistically about patient needs following a stroke.

Innovating team-based outpatient mental health care in the Veterans Health Administration: Staff-perceived benefits and challenges to pilot implementation of the Behavioral Health Interdisciplinary Program (BHIP).

PubMed

Barry, Catherine N; Abraham, Kristen M; Weaver, Kendra R; Bowersox, Nicholas W

2016-05-01

In the past decade, the demand for Veterans Health Administration (VHA) mental health care has increased rapidly. In response to the increased demand, the VHA developed the Behavioral Health Interdisciplinary Program (BHIP) team model as an innovative approach to transform VHA general outpatient mental health delivery. The present formative evaluation gathered information about pilot implementation of BHIP to understand the struggles and successes that staff experienced during facility transitions to the BHIP model. Using a purposive, nonrandom sampling approach, we conducted 1-on-1, semistructured interviews with 37 licensed and nonlicensed clinical providers and 13 clerical support staff assigned to BHIP teams in 21 facilities across the VHA. Interviews revealed that having actively involved facility mental health leaders, obtaining adequate staffing for teams to meet the requirements of the BHIP model, creating clear descriptions and expectations for team member roles within the BHIP framework, and allocating designated time for BHIP team meetings challenged many VHA sites but are crucial for successful BHIP implementation. Despite the challenges, staff reported that the transition to BHIP improved team work and improved patient care. Staff specifically highlighted the potential for the BHIP model to improve staff working relationships and enhance communication, collaboration, morale, and veteran treatment consistency. Future evaluations of the BHIP implementation process and BHIP team functioning focusing on patient outcomes, organizational outcomes, and staff functioning are recommended for fully understanding effects of transitioning to the BHIP model within VHA general mental health clinics and to identify best practices and areas for improvement. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Performance of district disaster management teams after undergoing an operational level planners' training in Uganda.

PubMed

Orach, Christopher Garimol; Mayega, Roy William; Woboya, Vincent; William, Bazeyo

2013-06-01

Uganda is vulnerable to several natural, man-made and a hybrid of disasters including drought, famine, floods, warfare, and disease outbreaks. We assessed the district disaster team's performance, roles and experiences following the training. The disasters most commonly experienced by the district teams were epidemics of diseases in humans (7 of 12), animals (epizoonotics) (3 of 12) and crops (3 of 12); hailstorms and floods (3 of 12). The capabilities viewed most useful for management of disasters were provision of health care services (9/12) and response management (8 of 12). The capability domains most often consulted during the disasters were general response management (31%), health services (29%) and water and sanitation (17%). The skills areas perceived to be vital following the training were response to epidemics 10/12, disaster management planning 8/12, hazards and vulnerability analysis 7/12 and principles of disaster planning 7/12 respectively. Main challenges mentioned by district teams were inadequacy of finance and logistics, lack of commitment by key partners towards disaster preparedness and response. The most common disaster experienced disasters related to outbreaks of diseases in man, animals and crops. The most frequently applied capabilities were response management and provision of emergency health services. The activities most frequently implemented following disaster management teams training were conducting planning meetings, refinement of plans and dissemination of skills gained. The main challenges were related to limited budget allocations and legal frameworks for disaster management that should be addressed by both central and local governments.

Translation and cross-cultural adaptation of a family booklet on comfort care in dementia: sensitive topics revised before implementation.

PubMed

van der Steen, Jenny T; Hertogh, Cees M P M; de Graas, Tjomme; Nakanishi, Miharu; Toscani, Franco; Arcand, Marcel

2013-02-01

Families of patients with dementia may need support in difficult end-of-life decision making. Such guidance may be culturally sensitive. To support families in Canada, a booklet was developed to aid decision making on palliative care issues. For reasons of cost effectiveness and promising effects, we prepared for its implementation in Italy, the Netherlands and Japan. Local teams translated and adapted the booklet to local ethical, legal and medical standards where needed, retaining guidance on palliative care. Using qualitative content analyses, we grouped and compared adaptations to understand culturally sensitive aspects. Three themes emerged: (1) relationships among patient, physician and other professionals-the authority of the physician was more explicit in adapted versions; (2) patient rights and family position-adding detail about local regulations; and (3) typology of treatments and decisions. Considerations underlying palliative care decisions were detailed (Dutch and Italian versions), and the Japanese version frequently referred to professional and legal standards, and life-prolongation was a competing goal. Text on artificial feeding or fluids and euthanasia was revised extensively. Providing artificial feeding and fluids and discussing euthanasia may be particularly sensitive topics, and guidance on these subjects needs careful consideration of ethical aspects and possible adaptations to local standards and practice. The findings may promote cross-national debate on sensitive, core issues regarding end-of-life care in dementia.

Multidisciplinary cancer care in Australia: a national audit highlights gaps in care and medico-legal risk for clinicians.

PubMed

Wilcoxon, Heidi; Luxford, Karen; Saunders, Christobel; Peterson, Janice; Zorbas, Helen

2011-03-01

Multidisciplinary care (MDC) is accepted as best practice in cancer treatment planning and care. Despite recognition of the importance of a team approach, limited data are available about the extent to which MDC has been implemented in Australia. The aim of the audit was to investigate the implementation of MDC for five main cancer types across Australia in line with best practice. A sample of 155 hospitals was surveyed to investigate the status of MDC for cancer treatment planning in Australia across five cancer types (breast, gynecological, lung, prostate and colorectal). The survey investigated team structure, meetings, patient consent, documentation of team recommendations and communication with the patient. Two-thirds of hospitals surveyed did not have a multidisciplinary team. Of those with such a team; in one-third patients were not informed their case would be discussed by the team, in half patient consent was not sought for all cases discussed by the team, in one-quarter the team's recommended treatment plan was not noted in the patient record. Less than 1% of teams reported routine attendance by the tumour-specific minimum core team. MDC is not being implemented in line with best practice or applied consistently across Australia. This audit has highlighted gaps in care delivery, despite national recommendations about MDC. Areas being neglected can affect the quality of care provided and may put clinicians at medico-legal risk. Recommendations to improve uptake and effectiveness of MDC are provided. © 2011 Blackwell Publishing Asia Pty Ltd.

Special Education Teachers' Attitudes and Perceptions of Teamwork

ERIC Educational Resources Information Center

Malone, D. Michael; Gallagher, Peggy A.

2010-01-01

One hundred and eighty-four special education teachers serving school-based intervention teams completed the "Attitudes About Teamwork Survey", the "Team Characteristics Survey", and the "Team Process Perception Survey". Respondents' regard for the team process in planning and implementing supports for children with disabilities was generally…

Team-based Learning in Therapeutics Workshop Sessions

PubMed Central

Kelley, Katherine A.; Metzger, Anne H.; Bellebaum, Katherine L.; McAuley, James W.

2009-01-01

Objectives To implement team-based learning in the workshop portion of a pathophysiology and therapeutics sequence of courses to promote integration of concepts across the pharmacy curriculum, provide a consistent problem-solving approach to patient care, and determine the impact on student perceptions of professionalism and teamwork. Design Team-based learning was incorporated into the workshop portion of 3 of 6 pathophysiology and therapeutics courses. Assignments that promoted team-building and application of key concepts were created. Assessment Readiness assurance tests were used to assess individual and team understanding of course materials. Students consistently scored 20% higher on team assessments compared with individual assessments. Mean professionalism and teamwork scores were significantly higher after implementation of team-based learning; however, this improvement was not considered educationally significant. Approximately 91% of students felt team-based learning improved understanding of course materials and 93% of students felt teamwork should continue in workshops. Conclusion Team-based learning is an effective teaching method to ensure a consistent approach to problem-solving and curriculum integration in workshop sessions for a pathophysiology and therapeutics course sequence. PMID:19885069

Creating and Supporting a Mixed Methods Health Services Research Team

PubMed Central

Bowers, Barbara; Cohen, Lauren W; Elliot, Amy E; Grabowski, David C; Fishman, Nancy W; Sharkey, Siobhan S; Zimmerman, Sheryl; Horn, Susan D; Kemper, Peter

2013-01-01

Objective. To use the experience from a health services research evaluation to provide guidance in team development for mixed methods research. Methods. The Research Initiative Valuing Eldercare (THRIVE) team was organized by the Robert Wood Johnson Foundation to evaluate The Green House nursing home culture change program. This article describes the development of the research team and provides insights into how funders might engage with mixed methods research teams to maximize the value of the team. Results. Like many mixed methods collaborations, the THRIVE team consisted of researchers from diverse disciplines, embracing diverse methodologies, and operating under a framework of nonhierarchical, shared leadership that required new collaborations, engagement, and commitment in the context of finite resources. Strategies to overcome these potential obstacles and achieve success included implementation of a Coordinating Center, dedicated time for planning and collaborating across researchers and methodologies, funded support for in-person meetings, and creative optimization of resources. Conclusions. Challenges are inevitably present in the formation and operation of effective mixed methods research teams. However, funders and research teams can implement strategies to promote success. PMID:24138774

Creating and supporting a mixed methods health services research team.

PubMed

Bowers, Barbara; Cohen, Lauren W; Elliot, Amy E; Grabowski, David C; Fishman, Nancy W; Sharkey, Siobhan S; Zimmerman, Sheryl; Horn, Susan D; Kemper, Peter

2013-12-01

To use the experience from a health services research evaluation to provide guidance in team development for mixed methods research. The Research Initiative Valuing Eldercare (THRIVE) team was organized by the Robert Wood Johnson Foundation to evaluate The Green House nursing home culture change program. This article describes the development of the research team and provides insights into how funders might engage with mixed methods research teams to maximize the value of the team. Like many mixed methods collaborations, the THRIVE team consisted of researchers from diverse disciplines, embracing diverse methodologies, and operating under a framework of nonhierarchical, shared leadership that required new collaborations, engagement, and commitment in the context of finite resources. Strategies to overcome these potential obstacles and achieve success included implementation of a Coordinating Center, dedicated time for planning and collaborating across researchers and methodologies, funded support for in-person meetings, and creative optimization of resources. Challenges are inevitably present in the formation and operation of effective mixed methods research teams. However, funders and research teams can implement strategies to promote success. © Health Research and Educational Trust.

Team functioning as a predictor of patient outcomes in early medical home implementation.

PubMed

Wu, Frances M; Rubenstein, Lisa V; Yoon, Jean

New models of patient-centered primary care such as the patient-centered medical home (PCMH) depend on high levels of interdisciplinary primary care team functioning to achieve improved outcomes. A few studies have qualitatively assessed barriers and facilitators to optimal team functioning; however, we know of no prior study that assesses PCMH team functioning in relationship to patient health outcomes. The aim of the study was to assess the relationships between primary care team functioning, patients' use of acute care, and mortality. Retrospective longitudinal cohort analysis of patient outcomes measured at two time points (2012 and 2013) after PCMH implementation began in Veterans Health Administration practices. Multilevel models examined practice-level measures of team functioning in relationship to patient outcomes (all-cause and ambulatory care-sensitive condition-related hospitalizations, emergency department visits, and mortality). We controlled for practice-level factors likely to affect team functioning, including leadership support, provider and staff burnout, and staffing sufficiency, as well as for individual patient characteristics. We also tested the model among a subgroup of vulnerable patients (homeless, mentally ill, or with dementia). In adjusted analyses, higher team functioning was associated with lower mortality (OR = 0.92, p = .04) among all patients and with fewer all-cause admissions (incidence rate ratio [IRR] = 0.90, p < 0.01), ambulatory care-sensitive condition-related admissions (IRR = 0.91, p = .04), and emergency department visits (IRR = 0.91, p = .03) in the vulnerable patient subgroup. These early findings give support for the importance of team functioning within PCMH models for achieving improved patient outcomes. A focus on team functioning is important especially in the early implementation of team-based primary care models.

Primary health-care teams as adaptive organizations: exploring and explaining work variation using case studies in rural and urban Scotland.

PubMed

Farmer, Jane; West, Christina; Whyte, Bruce; Maclean, Margaret

2005-08-01

It is acknowledged, internationally, that health-care practitioners' work differs between and urban areas. While several factors affect individual teams' activities, there is little understanding about how patterns of work evolve. Consideration of work in relation to local circumstances is important for training, devising contracts and redesigning services. Six case studies centred on Scottish rural and urban general practices were used to examine, in-depth, the activity of primary health-care teams. Quantitative workload data about patient contacts were collected over 24 months. Interviews and diaries revealed insightful qualitative data. Findings revealed that rural general practitioners and district nurses tended to conduct more consultations per practice patient compared with their urban counterparts. Conditions seen and work tasks varied between case study teams. Qualitative data suggested that the key reasons for variation were: local needs and circumstances; choices made about deployment of available time, team composition and the extent of access to other services. Primary care teams might be viewed as adaptive organization, with co-evolution of services produced by health professionals and local people. The study highlights limitations in the application of workload data and suggests that understanding the nature of work in relation to local circumstances is important in service redesign.

The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm

PubMed Central

Menear, Matthew; Stacey, Dawn; Brière, Nathalie; Légaré, France

2016-01-01

Introduction: Healthcare research increasingly focuses on interprofessional collaboration and on shared decision making, but knowledge gaps remain about effective strategies for implementing interprofessional collaboration and shared decision-making together in clinical practice. We used Kuhn’s theory of scientific revolutions to reflect on how an integrated interprofessional shared decision-making approach was developed and implemented over time. Methods: In 2007, an interdisciplinary team initiated a new research program to promote the implementation of an interprofessional shared decision-making approach in clinical settings. For this reflective case study, two new team members analyzed the team’s four projects, six research publications, one unpublished and two published protocols and organized them into recognizable phases according to Kuhn’s theory. Results: The merging of two young disciplines led to challenges characteristic of emerging paradigms. Implementation of interprofessional shared-decision making was hindered by a lack of conceptual clarity, a dearth of theories and models, little methodological guidance, and insufficient evaluation instruments. The team developed a new model, identified new tools, and engaged knowledge users in a theory-based approach to implementation. However, several unresolved challenges remain. Discussion: This reflective case study sheds light on the evolution of interdisciplinary team science. It offers new approaches to implementing emerging knowledge in the clinical context. PMID:28435417

Design and Implementation of an Interdisciplinary Marketing/Management Course on Technology and Innovation Management

ERIC Educational Resources Information Center

Athaide, Gerard A.; Desai, Harsha B.

2005-01-01

Given increasing industry demand for integrative learning, marketing curricula need to emphasize interdisciplinary approaches to teaching. Although team teaching is a useful method for achieving cross-functional integration, there are very few frameworks for effectively implementing team teaching. Consequently, marketing educators seeking to offer…

Self-Directed Workplace Learning.

ERIC Educational Resources Information Center

1998

This document contains four papers from a symposium on self-directed workplace learning. "Self-Directed Work Teams: Implementation and Performance" (Marcel van der Klink, Hilde ter Horst) discusses the results of a study examining the implementation and effects of self-directed work teams in a land register office and the role of the…

The Effects of Self-Directed Teams in an Automotive Manufacturing Environment

ERIC Educational Resources Information Center

Shall, David W.

2010-01-01

This study compares self-directed work structures to more traditional supervised work structures in order to determine if the expenditures and efforts required to implement self-directed work teams are warranted. Multiple internal performance metrics are examined in comparing plant work structures in various degrees of implementation between…

Professional Development in Educational Technology through Teacher Support Teams

ERIC Educational Resources Information Center

Alvarado, Guillermo

2017-01-01

Since the turn of the 21st century, the implementation of instructional technologies in the secondary classroom has increased exponentially. As a result, teacher support in its implementation has become paramount. Using a qualitative case study design, this research explored teachers' and administrators' perceptions of teacher support teams that…

Collaborative Team Model: Design for Successful Special Education

ERIC Educational Resources Information Center

Bishop, Ellis Norman

2016-01-01

This study examined the academic impact in reading and mathematics when Collaborative, Co-Teaching Team Model of high incidence special education student service delivery implemented in a suburban school district. This study hypothesized that the implementation of an inclusive collaborative co-teaching model of service delivery could possibly…

The relationship between baseline Organizational Readiness to Change Assessment subscale scores and implementation of hepatitis prevention services in substance use disorders treatment clinics: a case study

PubMed Central

2010-01-01

Background The Organizational Readiness to Change Assessment (ORCA) is a measure of organizational readiness for implementing practice change in healthcare settings that is organized based on the core elements and sub-elements of the Promoting Action on Research Implementation in Health Services (PARIHS) framework. General support for the reliability and factor structure of the ORCA has been reported. However, no published study has examined the utility of the ORCA in a clinical setting. The purpose of the current study was to examine the relationship between baseline ORCA scores and implementation of hepatitis prevention services in substance use disorders (SUD) clinics. Methods Nine clinic teams from Veterans Health Administration SUD clinics across the United States participated in a six-month training program to promote evidence-based practices for hepatitis prevention. A representative from each team completed the ORCA evidence and context subscales at baseline. Results Eight of nine clinics reported implementation of at least one new hepatitis prevention practice after completing the six-month training program. Clinic teams were categorized by level of implementation-high (n = 4) versus low (n = 5)-based on how many hepatitis prevention practices were integrated into their clinics after completing the training program. High implementation teams had significantly higher scores on the patient experience and leadership culture subscales of the ORCA compared to low implementation teams. While not reaching significance in this small sample, high implementation clinics also had higher scores on the research, clinical experience, staff culture, leadership behavior, and measurement subscales as compared to low implementation clinics. Conclusions The results of this study suggest that the ORCA was able to measure differences in organizational factors at baseline between clinics that reported high and low implementation of practice recommendations at follow-up. This supports the use of the ORCA to describe factors related to implementing practice recommendations in clinical settings. Future research utilizing larger sample sizes will be essential to support these preliminary findings. PMID:20546584

ARTIST (Asian regional tobacco industry scientist team): Philip Morris' attempt to exert a scientific and regulatory agenda on Asia

PubMed Central

Tong, E; Glantz, S

2004-01-01

Objective: To describe how the transnational tobacco industry has collaborated with local Asian tobacco monopolies and companies to promote a scientific and regulatory agenda. Methods: Analysis of previously secret tobacco industry documents. Results: Transnational tobacco companies began aggressively entering the Asia market in the 1980s, and the current tobacco industry in Asia is a mix of transnational and local monopolies or private companies. Tobacco industry documents demonstrate that, in 1996, Philip Morris led an organisation of scientific representatives from different tobacco companies called the Asian Regional Tobacco Industry Science Team (ARTIST), whose membership grew to include monopolies from Korea, China, Thailand, and Taiwan and a company from Indonesia. ARTIST was initially a vehicle for PM's strategies against anticipated calls for global smoke-free areas from a World Health Organization secondhand smoke study. ARTIST evolved through 2001 into a forum to present scientific and regulatory issues faced primarily by Philip Morris and other transnational tobacco companies. Philip Morris' goal for the organisation became to reach the external scientific and public health community and regulators in Asia. Conclusion: The Asian tobacco industry has changed from an environment of invasion by transnational tobacco companies to an environment of participation with Philip Morris' initiated activities. With this participation, tobacco control efforts in Asia face new challenges as Philip Morris promotes and integrates its scientific and regulatory agenda into the local Asian tobacco industry. As the local Asian tobacco monopolies and companies can have direct links with their governments, future implementation of effective tobacco control may be at odds with national priorities. PMID:15564214

ARTIST (Asian regional tobacco industry scientist team): Philip Morris' attempt to exert a scientific and regulatory agenda on Asia.

PubMed

Tong, E K; Glantz, S A

2004-12-01

To describe how the transnational tobacco industry has collaborated with local Asian tobacco monopolies and companies to promote a scientific and regulatory agenda. Analysis of previously secret tobacco industry documents. Transnational tobacco companies began aggressively entering the Asia market in the 1980s, and the current tobacco industry in Asia is a mix of transnational and local monopolies or private companies. Tobacco industry documents demonstrate that, in 1996, Philip Morris led an organisation of scientific representatives from different tobacco companies called the Asian Regional Tobacco Industry Science Team (ARTIST), whose membership grew to include monopolies from Korea, China, Thailand, and Taiwan and a company from Indonesia. ARTIST was initially a vehicle for PM's strategies against anticipated calls for global smoke-free areas from a World Health Organization secondhand smoke study. ARTIST evolved through 2001 into a forum to present scientific and regulatory issues faced primarily by Philip Morris and other transnational tobacco companies. Philip Morris' goal for the organisation became to reach the external scientific and public health community and regulators in Asia. The Asian tobacco industry has changed from an environment of invasion by transnational tobacco companies to an environment of participation with Philip Morris' initiated activities. With this participation, tobacco control efforts in Asia face new challenges as Philip Morris promotes and integrates its scientific and regulatory agenda into the local Asian tobacco industry. As the local Asian tobacco monopolies and companies can have direct links with their governments, future implementation of effective tobacco control may be at odds with national priorities.

The turn team: a novel strategy for reducing pressure ulcers in the surgical intensive care unit.

PubMed

Still, Mary D; Cross, Linda C; Dunlap, Martha; Rencher, Rugenia; Larkins, Elizabeth R; Carpenter, David L; Buchman, Timothy G; Coopersmith, Craig M

2013-03-01

Pressure ulcers cause significant morbidity and mortality in the surgical intensive care unit (SICU). The purpose of this study was to determine if a dedicated team tasked with turning and repositioning all hemodynamically stable SICU patients could decrease the formation of pressure ulcers. A total of 507 patients in a 20-bed SICU in a university hospital were assessed for pressure ulcers using a point prevalence strategy, between December 2008 and September 2010, before and after implementation of a team tasked with turning and repositioning all hemodynamically stable patients every 2 hours around the clock. At baseline, when frequent turning was encouraged but not required, a total of 42 pressure ulcers were identified in 278 patients. After implementation of the turn team, a total of 12 pressure ulcers were identified in 229 patients (p < 0.0001). The preintervention group included 34 stage I and II ulcers and 8 higher stage ulcers. After implementation of the turn team, there were 7 stage I and II ulcers and 5 higher stage ulcers. The average Braden score was 16.5 in the preintervention group and 13.4 in the postintervention group (p = 0.04), suggesting that pressure ulcers were occurring in higher risk patients after implementation of the turn team. A team dedicated to turning SICU patients every 2 hours dramatically decreased the incidence of pressure ulcers. The majority of stage I and stage II ulcers appear to be preventable with an aggressive intervention aimed at pressure ulcer prevention. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Work in Progress: The Seven Rs of Team Building

ERIC Educational Resources Information Center

Brunelli, Jean; Schneider, Elaine Fogel

2004-01-01

This article argues that supportive teams--including professionals, paraprofessionals, and parents--can teach staff members how to identify and implement best practices in early intervention settings. The authors describe "the seven Rs of team building" distilled from their many years of team building and maintenance: 1) Reading cues; 2) Regular…

Trainees as Teachers in Team-Based Learning

ERIC Educational Resources Information Center

Ravindranath, Divy; Gay, Tamara L.; Riba, Michelle B.

2010-01-01

Objective: Team-based learning is an active learning modality that is gaining popularity in medical education. The authors studied the effect of using trainees as facilitators of team-based learning sessions. Methods: Team-based learning modules were developed and implemented by faculty members and trainees for the third-year medical student…

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

PubMed

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

2014-01-01

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

Experiences from implementing value-based healthcare at a Swedish University Hospital - an longitudinal interview study.

PubMed

Nilsson, Kerstin; Bååthe, Fredrik; Andersson, Annette Erichsen; Wikström, Ewa; Sandoff, Mette

2017-02-28

Implementing the value-based healthcare concept (VBHC) is a growing management trend in Swedish healthcare organizations. The aim of this study is to explore how representatives of four pilot project teams experienced implementing VBHC in a large Swedish University Hospital over a period of 2 years. The project teams started their work in October 2013. An explorative and qualitative design was used, with interviews as the data collection method. All the participants in the four pilot project teams were individually interviewed three times, with interviews starting in March 2014 and ending in November 2015. All the interviews were transcribed and analyzed using qualitative analysis. Value for the patients was experienced as the fundamental drive for implementing VBHC. However, multiple understandings of what value for patients' means existed in parallel. The teams received guidance from consultants during the first 3 months. There were pros and cons to the consultant's guidance. This period included intensive work identifying outcome measurements based on patients' and professionals' perspectives, with less interest devoted to measuring costs. The implementation process, which both gave and took energy, developed over time and included interventions. In due course it provided insights to the teams about the complexity of healthcare. The necessity of coordination, cooperation and working together inter-departmentally was critical. Healthcare organizations implementing VBHC will benefit from emphasizing value for patients, in line with the intrinsic drive in healthcare, as well as managing the process of implementation on the basis of understanding the complexities of healthcare. Paying attention to the patients' voice is a most important concern and is also a key towards increased engagement from physicians and care providers for improvement work.

"RAPID" team triage: one hospital's approach to patient-centered team triage.

PubMed

Shea, Sheila Sanning; Hoyt, K Sue

2012-01-01

Patients who present to the emergency department want definitive care by a health care provider who can perform an initial assessment, initiate treatment, and implement a disposition plan. The traditional "nurse triage" model often creates barriers to the process of rapidly evaluating patients. Therefore, innovative strategies must be explored to improve the time of patient arrival to the time seen by a qualified provider in order to complete a thorough medical screening examination. One such approach is a rapid team triage system that provides a patient-centered process. This article describes the implementation of a rapid team triage model in an urban community hospital.

Leader Humility and Team Innovation: Investigating the Substituting Role of Task Interdependence and the Mediating Role of Team Voice Climate

PubMed Central

Liu, Wenxing; Mao, Jianghua; Chen, Xiao

2017-01-01

Leadership has been found to be linked with team innovation. Based on social information processing theory and substitutes for leadership theory, this paper examines the influence of leader humility on team innovation. Results from 90 teams showed that leader humility will enhance team innovation by fostering team voice climate. Further, task interdependence substitutes the effect of leader humility on team innovation through an indirect way via team voice climate. This study discussed the theoretical and practical implementations of these observations. PMID:28713316

Leader Humility and Team Innovation: Investigating the Substituting Role of Task Interdependence and the Mediating Role of Team Voice Climate.

PubMed

Liu, Wenxing; Mao, Jianghua; Chen, Xiao

2017-01-01

Leadership has been found to be linked with team innovation. Based on social information processing theory and substitutes for leadership theory, this paper examines the influence of leader humility on team innovation. Results from 90 teams showed that leader humility will enhance team innovation by fostering team voice climate. Further, task interdependence substitutes the effect of leader humility on team innovation through an indirect way via team voice climate. This study discussed the theoretical and practical implementations of these observations.

Experiences from a pilot study on how to conduct a qualitative multi-country research project regarding use of antibiotics in Southeast Europe.

PubMed

Kaae, Susanne; Sporrong, Sofia Kälvemark; Traulsen, Janine Morgall; Wallach Kildemoes, Helle; Nørgaard, Lotte Stig; Jakupi, Arianit; Raka, Denis; Gürpinar, Emre Umut; Alkan, Ali; Hoxha, Iris; Malaj, Admir; Cantarero, Lourdes Arevalo

2016-01-01

In 2014, a qualitative multi-country research project was launched to study the reasons behind the high use of antibiotics in regions of Southeast Europe by using previously untrained national interviewers (who were engaged in other antibiotic microbial resistance-related investigations) to conduct qualitative interviews with local patients, physicians and pharmacists. Little knowledge exists about how to implement qualitative multi-country research collaborations involving previously untrained local data collectors. The aim of this paper was therefore to contribute to the knowledge regarding how to conduct these types of research projects by evaluating a pilot study of the project. Local data collectors conducted the study according to a developed protocol and evaluated the study with the responsible researcher-team from University of Copenhagen. The pilot study focused on 'local ownership', 'research quality' and 'feasibility' with regard to successful implementation and evaluation. The evaluation was achieved by interpreting 'Skype' and 'face to face' meetings and email correspondence by applying 'critical common sense'. Local data collectors achieved a sense of joint ownership. Overall, the protocol worked well. Several minor challenges pertaining to research quality and feasibility were identified, in particular obtaining narratives when conducting interviews and recruiting patients for the study. Furthermore, local data collectors found it difficult to allocate sufficient time to the project. Solutions were discussed and added to the protocol. Despite the challenges, it was possible to achieve an acceptable scientific level of research when conducting qualitative multi-country research collaboration under the given circumstances. Specific recommendations to achieve this are provided by the authors.

Team Nutrition School Activity Planner. A How-To Guide for Team Nutrition Schools and Supporters.

ERIC Educational Resources Information Center

Food and Consumer Service (USDA), Washington, DC.

This "how-to" guide for Team Nutrition fairs and tasting activities helps Team Nutrition supporters and schools understand how to work together to improve the health and education of children. Team Nutrition is the implementation tool for the U.S. Department of Agriculture's School Meals Initiative for Healthy Children. Section 1 of the guide…

Climate change science education across schools, campuses, and centers: strategies and successes

NASA Astrophysics Data System (ADS)

Merrill, J.; Harcourt, P.; Rogers, M.; Buttram, J.; Petrone, C.; Veron, D. E.; Sezen-Barrie, A.; Stylinski, C.; Ozbay, G.

2016-02-01

With established partnerships in higher education, K-12, and informal science education communities across Delaware and Maryland, the NSF-funded MADE CLEAR project (Maryland Delaware Climate Change Education, Assessment, and Research) has instituted a suite of professional development strategies to bring climate change science into science education methods courses, K-12 classrooms, university lecture halls, and public park facilities. MADE CLEAR partners have provided consistent climate literacy topics (mechanisms, human contributions, local and global impacts, mitigation and adaptation) while meeting the unique needs of each professional community. In-person topical lectures, hands-on work with classroom materials, seed funding for development of new education kits, and on-line live and recorded sessions are some of the tools employed by the team to meet those needs and build enduring capacity for climate change science education. The scope of expertise of the MADE CLEAR team, with climate scientists, educators, learning scientists, and managers has provided not only PD tailored for each education audience, but has also created, fostered, and strengthened relationships across those audiences for long-term sustainability of the newly-built capacity. Specific examples include new climate change programs planned for implementation across Delaware State Parks that will be consistent with middle school curriculum; integration of climate change topics into science methods classes for pre-service teachers at four universities; and active K-12 and informal science education teams working to cooperatively develop lessons that apply informal science education techniques and formal education pedagogy. Evaluations by participants highlight the utility of personal connections, access to experts, mentoring and models for developing implementation plans.

[Team Development in Medical Rehabilitation: Concept and Evaluation of a Team Intervention].

PubMed

Körner, M; Luzay, L; Becker, S; Rundel, M; Müller, C; Zimmermann, L

2016-04-01

Interprofessional collaboration is a main precondition of successful treatment in rehabilitation. In order to improve interprofessional collaboration, a clinic-specific, goal- and solution-oriented and systemic team development approach was designed. The aim of the study is the evaluation of this approach. A multi-centre cluster-randomized controlled study with staff questionnaires. The team development could be implemented successfully in 4 of 5 clinics and led to significant improvements in team organisation, willingness to accept responsibility and knowledge integration. The effects are small and are caused by the opposed development of intervention and control group. The team development approach can be recommended for rehabilitation practice. A train-the-trainer approach will be developed and further studies are planned in order to disseminate the approach and to investigate the conditions of implementation. © Georg Thieme Verlag KG Stuttgart · New York.

Practical Team-Based Learning from Planning to Implementation

PubMed Central

Bell, Edward; Eng, Marty; Fuentes, David G.; Helms, Kristen L.; Maki, Erik D.; Vyas, Deepti

2015-01-01

Team-based learning (TBL) helps instructors develop an active teaching approach for the classroom through group work. The TBL infrastructure engages students in the learning process through the Readiness Assessment Process, problem-solving through team discussions, and peer feedback to ensure accountability. This manuscript describes the benefits and barriers of TBL, and the tools necessary for developing, implementing, and critically evaluating the technique within coursework in a user-friendly method. Specifically, the manuscript describes the processes underpinning effective TBL development, preparation, implementation, assessment, and evaluation, as well as practical techniques and advice from authors’ classroom experiences. The paper also highlights published articles in the area of TBL in education, with a focus on pharmacy education. PMID:26889061

The challenge of promoting integration: conceptualization, implementation, and assessment of a pilot care delivery model for patients with type 2 diabetes.

PubMed

Nasmith, Louise; Coté, Brigitte; Cox, Joseph; Inkell, Diane; Rubenstein, Heather; Jimenez, Vania; Rodriguez, Rosario; Larouche, Danielle; Contandriopoulos, Andre-Pierre

2004-01-01

The Côte-des-Neiges diabetes pilot project strove to conceptualize, implement, and assess an integrated health care system for Type 2 diabetes. Using a disease management and population-based approach, a multidisciplinary team sought to (1). organize health care in an integrative framework, (2). promote behavior changes in patients to foster self-care, (3). introduce tools to allow family physicians to modify their practices, and (4). encourage local community action to support patients and providers. Information from a needs assessment helped guide the development of the care model, which was implemented over a 1-year period. A preliminary assessment was undertaken using qualitative methods. Data were collected through in-depth interviews, focus groups, participant observation, and document analysis. (1). Physicians and patients appreciated having access to a multidisciplinary team and related services, and personalized communication was preferred to computerized links. (2). Patients also perceived the benefit of individualized assessment and self-care educational sessions allowing them to participate in their illness management. (3). A diabetes care flow sheet altered the management strategies of physicians. (4). Limited time prevented full development of networking efforts to promote community mobilization. Approaches to chronic diseases such as diabetes require integrative health care strategies to support patients and providers in their community. In spite of time constraints, patients perceived the value of education with increasing involvement in their illness, physicians reported changes in their practice, and steps were initiated to mobilize community resources.

Implementing Extreme Programming in Distributed Software Project Teams: Strategies and Challenges

NASA Astrophysics Data System (ADS)

Maruping, Likoebe M.

Agile software development methods and distributed forms of organizing teamwork are two team process innovations that are gaining prominence in today's demanding software development environment. Individually, each of these innovations has yielded gains in the practice of software development. Agile methods have enabled software project teams to meet the challenges of an ever turbulent business environment through enhanced flexibility and responsiveness to emergent customer needs. Distributed software project teams have enabled organizations to access highly specialized expertise across geographic locations. Although much progress has been made in understanding how to more effectively manage agile development teams and how to manage distributed software development teams, managers have little guidance on how to leverage these two potent innovations in combination. In this chapter, I outline some of the strategies and challenges associated with implementing agile methods in distributed software project teams. These are discussed in the context of a study of a large-scale software project in the United States that lasted four months.

Consequences of team charter quality: Teamwork mental model similarity and team viability in engineering design student teams

NASA Astrophysics Data System (ADS)

Conway Hughston, Veronica

Since 1996 ABET has mandated that undergraduate engineering degree granting institutions focus on learning outcomes such as professional skills (i.e. solving unstructured problems and working in teams). As a result, engineering curricula were restructured to include team based learning---including team charters. Team charters were diffused into engineering education as one of many instructional activities to meet the ABET accreditation mandates. However, the implementation and execution of team charters into engineering team based classes has been inconsistent and accepted without empirical evidence of the consequences. The purpose of the current study was to investigate team effectiveness, operationalized as team viability, as an outcome of team charter implementation in an undergraduate engineering team based design course. Two research questions were the focus of the study: a) What is the relationship between team charter quality and viability in engineering student teams, and b) What is the relationship among team charter quality, teamwork mental model similarity, and viability in engineering student teams? Thirty-eight intact teams, 23 treatment and 15 comparison, participated in the investigation. Treatment teams attended a team charter lecture, and completed a team charter homework assignment. Each team charter was assessed and assigned a quality score. Comparison teams did not join the lecture, and were not asked to create a team charter. All teams completed each data collection phase: a) similarity rating pretest; b) similarity posttest; and c) team viability survey. Findings indicate that team viability was higher in teams that attended the lecture and completed the charter assignment. Teams with higher quality team charter scores reported higher levels of team viability than teams with lower quality charter scores. Lastly, no evidence was found to support teamwork mental model similarity as a partial mediator of the team charter quality on team viability relationship. Foci for future research opportunities include using: a) online data collection methods to improve participant adherence to similarity rating instructions; b) story or narratives during pre- and posttest similarity rating data collection to create common levels of contextual perception; and c) support to ensure charters are integrated into the full project life cycle, not just a pre-project one time isolated activity. Twenty five sections, on average, of EDSGN 100 are taught each spring and fall semester. Consistent instructor expectations are set for the technical aspects of the course. However, ideas to foster team effectiveness are often left to the discretion of the individual instructor. Implementing empirically tested team effectiveness instructional activities would bring consistency to EDGSN 100 curriculum. Other instructional activities that would be of benefit to engineering educators include qualitative inquiry---asking intrateam process questions (at the mid-point of the project) and in-class reflection---dedicated time, post project, to discuss what went well/not well within the team.

Implementation of Process Oriented Guided Inquiry Learning (POGIL) in Engineering

ERIC Educational Resources Information Center

Douglas, Elliot P.; Chiu, Chu-Chuan

2013-01-01

This paper describes implementation and testing of an active learning, team-based pedagogical approach to instruction in engineering. This pedagogy has been termed Process Oriented Guided Inquiry Learning (POGIL), and is based upon the learning cycle model. Rather than sitting in traditional lectures, students work in teams to complete worksheets…

Fidelity of Problem Solving in Everyday Practice: Typical Training May Miss the Mark

ERIC Educational Resources Information Center

Ruby, Susan F.; Crosby-Cooper, Tricia; Vanderwood, Michael L.

2011-01-01

With national attention on scaling up the implementation of Response to Intervention, problem solving teams remain one of the central components for development, implementation, and monitoring of school-based interventions. Studies have shown that problem solving teams evidence a sound theoretical base and demonstrated efficacy; however, limited…

Engaging with Faculty to Develop, Implement, and Pilot Electronic Performance Assessments of Student Teachers Using Mobile Devices

ERIC Educational Resources Information Center

Haughton, Noela A.; Keil, Virginia L.

2009-01-01

This article discusses the development and implementation of a technology-supported student teacher performance assessment that supports integration with a larger electronic assessment system. The authors spearheaded a multidisciplinary team to develop a comprehensive performance assessment based on the Pathwise framework. The team collaborated…

An Exploratory Case Study of PBIS Implementation Using Social Network Analysis

ERIC Educational Resources Information Center

Whitcomb, Sara A.; Woodland, Rebecca H.; Barry, Shannon K.

2017-01-01

An exploratory case study is presented in which social network analysis (SNA) was used to explore how school teaming structures influence the implementation of School-Wide Positive Behavioral Interventions and Supports (PBIS). The authors theorized that PBIS leadership teams that include members with connections to all other information-sharing…

Perceptions of Contextual Features Related to Implementation and Sustainability of School-Wide Positive Behavior Support

ERIC Educational Resources Information Center

McIntosh, Kent; Predy, Larissa K.; Upreti, Gita; Hume, Amanda E.; Turri, Mary G.; Mathews, Susanna

2014-01-01

The purpose of this study was to assess the perceived importance of specific contextual variables for initial implementation and sustainability of School-Wide Positive Behavior Support (SWPBS). A large, national sample of 257 school team members completed the "School-Wide Universal Behavior Sustainability Index: School Teams", a…

Implementing Team-Based Learning in Middle School Social Studies Classes

ERIC Educational Resources Information Center

Wanzek, Jeanne; Kent, Shawn C.; Vaughn, Sharon; Swanson, Elizabeth A.; Roberts, Greg; Haynes, Martha

2015-01-01

The authors examined the effects of team-based learning (TBL) implemented in Grade 8 social studies classes on student content acquisition. Twenty-four classes were randomly assigned to treatment or comparison blocking on teacher. In the treatment classes teachers integrated TBL practices in the content instruction. The authors examined teacher…

High quality diabetes care: testing the effectiveness of strategies of regional implementation teams.

PubMed

Drach-Zahavy, Anat; Shadmi, Efrat; Freund, Anat; Goldfracht, Margalit

2009-01-01

The purpose of this article is to identify and test the effectiveness of work strategies employed by regional implementation teams to attain high quality care for diabetes patients. The study was conducted in a major health maintenance organization (HMO) that provides care for 70 per cent of Israel's diabetes patients. A sequential mixed model design, combining qualitative and quantitative methods was employed. In-depth interviews were conducted with members of six regional implementation teams, each responsible for the care of 25,000-34,000 diabetic patients. Content analysis of the interviews revealed that teams employed four key strategies: task-interdependence, goal-interdependence, reliance on top-down standardised processes and team-learning. These strategies were used to predict the mean percentage performance of eight evidence-based indicators of diabetes care: percentage of patients with HbA1c < 7 per cent, blood pressure < or = 130/80 and cholesterol < or = 100; and performance of: HbA1c tests, LDL cholesterol tests, blood pressure measurements, urine protein tests, and ophthalmic examinations. Teams were found to vary in their use of the four strategies. Mixed linear models analysis indicated that type of indicator (simple process, compound process, and outcome) and goal interdependence were significantly linked to team effectiveness. For simple-process indicators, reliance on top-down standardised processes led to team effectiveness, but for outcome measures this strategy was ineffective, and even counter-effective. For outcome measures, team-learning was more beneficial. The findings have implications for the management of chronic diseases. The advantage of allowing team members flexibility in the choice of the best work strategy to attain high quality diabetes care is attested.

A protocol for the development of Mediterranean climate services based on the experiences of the CLIM-RUN case studies

NASA Astrophysics Data System (ADS)

Goodess, Clare; Ruti, Paolo; Rousset, Nathalie

2014-05-01

During the closing stages of the CLIM-RUN EU FP7 project on Climate Local Information in the Mediterranean region Responding to User Needs, the real-world experiences encountered by the case-study teams are being assessed and synthesised to identify examples of good practice and, in particular, to produce the CLIM-RUN protocol for the development of Mediterranean climate services. The specific case studies have focused on renewable energy (Morocco, Spain, Croatia, Cyprus), tourism (Savoie, Tunisia, Croatia, Cyprus) and wild fires (Greece) as well as one cross-cutting case study (Veneto region). They have been implemented following a common programme of local workshops, questionnaires and interviews, with Climate Expert Team and Stakeholder Expert Team members collaborating to identify and translate user needs and subsequently develop climate products and information. Feedback from stakeholders has been essential in assessing and refining these products. The protocol covers the following issues: the overall process and methodological key stages; identification and selection of stakeholders; communication with stakeholders; identification of user needs; translation of needs; producing products; assessing and refining products; methodologies for evaluating the economic value of climate services; and beyond CLIM-RUN - the lessons learnt. Particular emphasis is given to stakeholder analysis in the context of the participatory, bottom-up approach promoted by CLIM-RUN and to the iterative approach taken in the development of climate products. Recommendations are also made for an envisioned three-tier business model for the development of climate services involving climate, intermediary and stakeholder tiers.

OUTCOME OF IMPLEMENTATION OF A MULTIDISCIPLINARY TEAM APPROACH TO THE CARE OF PATIENTS AFTER TRANSSPHENOIDAL SURGERY.

PubMed

Carminucci, Arthur S; Ausiello, John C; Page-Wilson, Gabrielle; Lee, Michelle; Good, Laura; Bruce, Jeffrey N; Freda, Pamela U

2016-01-01

Transsphenoidal surgery (TS) for sellar lesions is an established and safe procedure, but complications can occur, particularly involving the neuroendocrine system. We hypothesized that postoperative care of TS patients would be optimized when performed by a coordinated team including a pituitary neurosurgeon, endocrinologists, and a specialty nurse. We implemented a formalized, multidisciplinary team approach and standardized postoperative protocols for the care of adult patients undergoing TS by a single surgeon (J.N.B.) at our institution beginning in July 2009. We retrospectively compared the outcomes of 214 consecutive TS-treated cases: 113 cases prior to and 101 following the initiation of the team approach and protocol implementation. Outcomes assessed included the incidence of neurosurgical and endocrine complications, length of stay (LOS), and rates of hospital readmission and unscheduled clinical visits. The median LOS decreased from 3 days preteam to 2 days postteam (P<.01). Discharge occurred on postoperative day 2 in 46% of the preteam group patients compared to 69% of the postteam group (P<.01). Rates of early postoperative diabetes insipidus (DI) and readmissions within 30 days for syndrome of inappropriate antidiuretic hormone (SIADH) or other complications did not differ between groups. Implementation of a multidisciplinary team approach was associated with a reduction of LOS. Despite earlier discharge, postoperative outcomes were not compromised. The endocrinologist is central to the success of this team approach, which could be successfully applied to care of patients undergoing TS, as well as other types of endocrine surgery at other centers.

Enhancing Treatment Team Process through Mindfulness-Based Mentoring in an Inpatient Psychiatric Hospital

ERIC Educational Resources Information Center

Singh, Nirbhay N.; Singh, Subhashni D.; Sabaawi, Mohamed; Myers, Rachel E.; Wahler, Robert G.

2006-01-01

The authors investigated changes in treatment team functioning in an adult inpatient psychiatric hospital after the implementation of a mindfulness-based mentoring intervention. Using a multiple baseline across treatment teams design, the authors assessed levels of functioning of three treatment teams using a 50-item rating scale and then…

An Implementation of Active Learning: Assessing the Effectiveness of the Team Infomercial Assignment

ERIC Educational Resources Information Center

Matveev, Alexei V.; Milter, Richard G.

2010-01-01

This article examines the effectiveness of the team infomercial assignment as an active learning tool in undergraduate courses. The structure and three phases of the team infomercial assignment, as well as student evaluations and feedback, are presented. We investigated student experiences working on the team infomercial assignment, the common…

Beyond Interdisciplinary Teaming: Findings and Implications of the NASSP National Middle Level Study.

ERIC Educational Resources Information Center

Hackmann, Donald G.; Petzko, Vicki N.; Valentine, Jerry W.; Clark, Donald C.; Nori, John R.; Lucas, Stephen E.

2002-01-01

Reports trends and implications of interdisciplinary teaming practices in middle schools, based on findings from a national survey. Noting that nearly 80 percent of schools currently implement teaming, challenges principals and teachers to move beyond simple formation of teams to the creation of an infrastructure that supports high-performing…

Report on Progress toward Security and Stability in Afghanistan

DTIC Science & Technology

2009-10-01

teams from Germany, two teams from Poland , two teams from the Netherlands, and one team from Canada. The Mol and CSTC-A are implementing a modified...Development Bank sponsored construction of a rail line from the Uzbek border to Mazer e Sharif. Kazakhstan has also provided $50 million to educate more than

Development of the Community Healthy Living Index: a tool to foster healthy environments for the prevention of obesity and chronic disease.

PubMed

Kim, Soowon; Adamson, Katie Clarke; Balfanz, Deborah R; Brownson, Ross C; Wiecha, Jean L; Shepard, Dennis; Alles, Wesley F

2010-01-01

This paper presents a new, comprehensive tool for communities to assess opportunities for active living and healthy eating and to mobilize all sectors of society to conquer obesity and chronic disease. Relevant existing tools and input from an expert panel were considered to draft the Community Healthy Living Index (CHLI). CHLI covers five major sectors where people live, work, learn, and play: schools, afterschools, work sites, neighborhoods, and the community-at-large. CHLI and the accompanying procedures enable community teams to assess programs, the physical environment, and policies related to healthy living and to plan improvement strategies. In 2008, with local YMCAs acting as conveners, community assessment teams from six US communities pilot-tested CHLI for cognitive response testing, inter-rater reliability, and implementation feasibility. CHLI was revised to reflect the test results. Pilot analyses demonstrated that the process was feasible, with most questions being interpreted as intended and showing substantial to almost perfect agreement between raters. The final CHLI is being disseminated nationally. Preliminary data illustrate CHLI obtains reliable results and is feasible to implement. CHLI is a promising tool for community-based prevention efforts to draw attention to opportunities for healthy living and create impetus for community changes.

Developing a nurse-led clinic using transformational leadership.

PubMed

Gousy, Mamood; Green, Kim

2015-03-25

Nurses are at the forefront of implementing and managing change, given constantly changing healthcare services and the increase in demand for health care. Therefore, it is important to identify the best style of leadership to engage nurses in implementing service-led improvements. This article explores the effects of transformational leadership in bringing about service-led improvements in health care, using the example of setting up a nurse-led acupuncture clinic to optimise the care of patients with chronic pain. Transformational leadership was used throughout the project - from the initial local planning, training and development, through to liaising with the appropriate staff and deciding on an evaluation strategy. Transformational leadership proved to be an effective way to engage and empower nurses and other members of the chronic pain team to enable them to achieve the project aims.

The accountability for reasonableness approach to guide priority setting in health systems within limited resources--findings from action research at district level in Kenya, Tanzania, and Zambia.

PubMed

Byskov, Jens; Marchal, Bruno; Maluka, Stephen; Zulu, Joseph M; Bukachi, Salome A; Hurtig, Anna-Karin; Blystad, Astrid; Kamuzora, Peter; Michelo, Charles; Nyandieka, Lillian N; Ndawi, Benedict; Bloch, Paul; Olsen, Oystein E

2014-08-20

Priority-setting decisions are based on an important, but not sufficient set of values and thus lead to disagreement on priorities. Accountability for Reasonableness (AFR) is an ethics-based approach to a legitimate and fair priority-setting process that builds upon four conditions: relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This paper focuses on the assessment of AFR within the project REsponse to ACcountable priority setting for Trust in health systems (REACT). This intervention study applied an action research methodology to assess implementation of AFR in one district in Kenya, Tanzania, and Zambia, respectively. The assessments focused on selected disease, program, and managerial areas. An implementing action research team of core health team members and supporting researchers was formed to implement, and continually assess and improve the application of the four conditions. Researchers evaluated the intervention using qualitative and quantitative data collection and analysis methods. The values underlying the AFR approach were in all three districts well-aligned with general values expressed by both service providers and community representatives. There was some variation in the interpretations and actual use of the AFR in the decision-making processes in the three districts, and its effect ranged from an increase in awareness of the importance of fairness to a broadened engagement of health team members and other stakeholders in priority setting and other decision-making processes. District stakeholders were able to take greater charge of closing the gap between nationally set planning and the local realities and demands of the served communities within the limited resources at hand. This study thus indicates that the operationalization of the four broadly defined and linked conditions is both possible and seems to be responding to an actual demand. This provides arguments for the continued application and further assessment of the potential of AFR in supporting priority-setting and other decision-making processes in health systems to achieve better agreed and more sustainable health improvements linked to a mutual democratic learning with potential wider implications.

The accountability for reasonableness approach to guide priority setting in health systems within limited resources – findings from action research at district level in Kenya, Tanzania, and Zambia

PubMed Central

2014-01-01

Background Priority-setting decisions are based on an important, but not sufficient set of values and thus lead to disagreement on priorities. Accountability for Reasonableness (AFR) is an ethics-based approach to a legitimate and fair priority-setting process that builds upon four conditions: relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This paper focuses on the assessment of AFR within the project REsponse to ACcountable priority setting for Trust in health systems (REACT). Methods This intervention study applied an action research methodology to assess implementation of AFR in one district in Kenya, Tanzania, and Zambia, respectively. The assessments focused on selected disease, program, and managerial areas. An implementing action research team of core health team members and supporting researchers was formed to implement, and continually assess and improve the application of the four conditions. Researchers evaluated the intervention using qualitative and quantitative data collection and analysis methods. Results The values underlying the AFR approach were in all three districts well-aligned with general values expressed by both service providers and community representatives. There was some variation in the interpretations and actual use of the AFR in the decision-making processes in the three districts, and its effect ranged from an increase in awareness of the importance of fairness to a broadened engagement of health team members and other stakeholders in priority setting and other decision-making processes. Conclusions District stakeholders were able to take greater charge of closing the gap between nationally set planning and the local realities and demands of the served communities within the limited resources at hand. This study thus indicates that the operationalization of the four broadly defined and linked conditions is both possible and seems to be responding to an actual demand. This provides arguments for the continued application and further assessment of the potential of AFR in supporting priority-setting and other decision-making processes in health systems to achieve better agreed and more sustainable health improvements linked to a mutual democratic learning with potential wider implications. PMID:25142148

Advantages of Brahms for Specifying and Implementing a Multiagent Human-Robotic Exploration System

NASA Technical Reports Server (NTRS)

Clancey, William J.; Sierhuis, Maarten; Kaskiris, Charis; vanHoof, Ron

2003-01-01

We have developed a model-based, distributed architecture that integrates diverse components in a system designed for lunar and planetary surface operations: an astronaut's space suit, cameras, all-terrain vehicles, robotic assistant, crew in a local habitat, and mission support team. Software processes ('agents') implemented in the Brahms language, run on multiple, mobile platforms. These mobile agents interpret and transform available data to help people and robotic systems coordinate their actions to make operations more safe and efficient. The Brahms-based mobile agent architecture (MAA) uses a novel combination of agent types so the software agents may understand and facilitate communications between people and between system components. A state-of-the-art spoken dialogue interface is integrated with Brahms models, supporting a speech-driven field observation record and rover command system. An important aspect of the methodology involves first simulating the entire system in Brahms, then configuring the agents into a runtime system Thus, Brahms provides a language, engine, and system builder's toolkit for specifying and implementing multiagent systems.

Modelling the effect of perceived interdependence among mental healthcare professionals on their work role performance.

PubMed

Markon, Marie-Pierre; Chiocchio, François; Fleury, Marie-Josée

2017-07-01

The purpose of mental healthcare system reform was to enhance service efficiency by strengthening primary mental healthcare and increasing service integration in communities. Reinforcing interprofessional teamwork also intended to address the extensive and multidimensional needs of patients with mental disorders by bringing together a broader array of expertise. In this context, mental healthcare professionals (MHCPs) from various health and social care professions are more interdependent in many aspects of their work (tasks, resources, and goals). We wanted to examine the effect of perceived interdependence among MHCPs on their work role performance in the context of mental healthcare. For this purpose, we developed and tested a model coherent with the Input-Mediator-Outcome-Input (IMOI) framework of team effectiveness. Data from questionnaires administered to 315 MHCPs from four local health service networks in Quebec, Canada were analysed through structural equation modelling and mediation analysis. The structural equation model provided a good fit for the data and explained 51% of the variance of work role performance. Perceived collaboration, confidence in the advantages of interprofessional collaboration, involvement in the decision process, knowledge sharing, and satisfaction with the nature of the work partially mediated the effect of perceived interdependence among team members on work role performance. Therefore, perceived interdependence among team members had a positive impact on the work role performance of MHCPs mostly through its effect on favourable team functioning features. This implies, in practice, that increased interdependence of MHCPs would be more likely to truly enhance work role performance if team-based interventions to promote collaborative work and interprofessional teaching and training programs to support work within interprofessional teams were jointly implemented. Participation in the decision process and knowledge sharing should also be fostered, for instance, by adopting knowledge management best practices.

Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration

PubMed Central

Sullivan, Jennifer L.; Adjognon, Omonyêlé L.; Engle, Ryann L.; Shin, Marlena H.; Afable, Melissa K.; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen

2018-01-01

Background: From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. Purpose: The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Methodology: Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. Results: The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. Discussion: This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Implications: Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges. PMID:28125459

Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration.

PubMed

Sullivan, Jennifer L; Adjognon, Omonyêlé L; Engle, Ryann L; Shin, Marlena H; Afable, Melissa K; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen

From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges.

Staff turnover in statewide implementation of ACT: relationship with ACT fidelity and other team characteristics

PubMed Central

Rollins, Angela L.; Salyers, Michelle P.; Tsai, Jack; Lydick, Jennifer M.

2010-01-01

Staff turnover on assertive community treatment (ACT) teams is a poorly understood phenomenon. This study examined annual turnover and fidelity data collected in a statewide implementation of ACT over a 5-year period. Mean annual staff turnover across all observations was 30.0%. Turnover was negatively correlated with overall fidelity at Year 1 and 3. The team approach fidelity item was negatively correlated with staff turnover at Year 3. For 13 teams with 3 years of follow-up data, turnover rates did not change over time. Most ACT staff turnover rates were comparable or better than other turnover rates reported in the mental health and substance abuse literature. PMID:20012481

Staff turnover in statewide implementation of ACT: relationship with ACT fidelity and other team characteristics.

PubMed

Rollins, Angela L; Salyers, Michelle P; Tsai, Jack; Lydick, Jennifer M

2010-09-01

Staff turnover on assertive community treatment (ACT) teams is a poorly understood phenomenon. This study examined annual turnover and fidelity data collected in a statewide implementation of ACT over a 5-year period. Mean annual staff turnover across all observations was 30.0%. Turnover was negatively correlated with overall fidelity at Year 1 and 3. The team approach fidelity item was negatively correlated with staff turnover at Year 3. For 13 teams with 3 years of follow-up data, turnover rates did not change over time. Most ACT staff turnover rates were comparable or better than other turnover rates reported in the mental health and substance abuse literature.

Use of an action-selection framework for human-carnivore conflict in the Bangladesh Sundarbans.

PubMed

Barlow, Adam C D; Greenwood, Christina J; Ahmad, Ishtiaq U; Smith, James L D

2010-10-01

Human-carnivore conflict is manifested in the death of humans, livestock, and carnivores. The resulting negative local attitudes and retribution killings imperil the future of many endangered carnivores. We tailored existing management tools to create a framework to facilitate the selection of actions to alleviate human-carnivore conflict and applied the framework to the human-tiger conflict in the Bangladesh Sundarbans. We identified potential actions that consider previous management efforts, local knowledge, cost-effectiveness, fieldwork experience of authors and project staff, previous research on tiger ecology by the authors, and recommendations from human-carnivore conflict studies in other countries. Our framework includes creation of a profile to improve understanding of the nature of the conflict and its underlying causality. Identified actions include deterrents, education, direct tiger management, and response teams. We ranked actions by their potential to reduce conflict and the monetary cost of their implementation. We ranked tiger-response teams and monitoring problem tigers as the two best actions because both had relatively high impact and cost-effectiveness. We believe this framework could be used under a wide range of human-wildlife conflict situations because it provides a structured approach to selection of mitigating actions. © 2010 Society for Conservation Biology.

Pan-European management of coastal lagoons: A science-policy-stakeholder interface perspective

NASA Astrophysics Data System (ADS)

Lillebø, Ana I.; Stålnacke, Per; Gooch, Geoffrey D.; Krysanova, Valentina; Bielecka, Małgorzata

2017-11-01

The main objective of the work carried out in the scope of a three years collaborative research project was to develop science-based strategies and a decision support framework for the integrated management of coastal lagoons and their catchments and, in this context, to enhance connectivity between research and policymaking. In this paper our main objective is to share the lessons learned from the innovative methodology used throughout the project. To achieve the proposed objectives, the multidisciplinary scientific knowledge in the project team was combined and integrated with the knowledge and views of local stakeholders of four selected European coastal lagoons, using a three step participatory approach. With this innovative approach, which included the usage of eco-hydrological and water quality-modelling tools, the team developed and analyzed integrated scenarios of possible economic development and environmental impacts in four European lagoons and their catchments. These scenarios were presented and discussed with stakeholders, giving rise to management recommendations for each case study lagoon. Results show that some management options might be transferrable to other European lagoons having similar climatic, geophysical and socio-economic settings. In management terms, the project output provides a set of policy guidelines derived from the different analyses conducted and proposes initiatives concerning management implementation in a local-regional-national-European setting.

Working towards integrated community care for older people: empowering organisational features from a professional perspective.

PubMed

Janssen, Bienke M; Snoeren, Miranda W C; Van Regenmortel, Tine; Abma, Tineke A

2015-01-01

Although multi-disciplinary cooperation between professionals is a prerequisite to provide integrated care in the community, this seems hard to realise in practice. Yet, little is known about the experiences of professionals who implement it nor about the organisational features professionals identify as empowering during this cooperation process. Therefore, a case study of a multi-disciplinary geriatric team was performed. The data-collection included observations of meetings, in-depth interviews and focus groups with professionals (N = 12). Data were analysed inductively and related to the three organisational levels within the model of organisational empowerment of Peterson and Zimmerman. Signs of empowering organisational features on the intraorganisational level were mutual trust and clear working routines. On the interorganisational level important features included improved linkages between participating organisations and increased insight into each other's tasks. Tensions occurred relating to the inter- and the extraorganisational level. Professionals felt that the commitment of the management of involved organisations should be improved just as the capacity of the team to influence (local) policy. It is recommended that policymakers should not determine the nature of professional cooperation in advance, but to leave that to the local context as well as to the judgement of involved professionals. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The Tiger Team Process in the Rebaselining of the Plutonium Finishing Plant (PFP)

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

BAILEY, R.W.

2000-02-01

This paper will describe the integrated, teaming approach and planning process utilized by the Tiger Team in the development of the IPMP. This paper will also serve to document the benefits derived from this implementation process.

Solar Technical Assistance Team Success Stories Video - Text Version |

Science.gov Websites

State, Local, and Tribal Governments | NREL Solar Technical Assistance Team Success Stories Video - Text Version Solar Technical Assistance Team Success Stories Video - Text Version Below is the text version for the Solar Technical Assistance Team Success Stories video. My name is Christopher

36 CFR 13.460 - Use of snowmobiles, motorboats, dog teams, and other means of surface transportation...

Code of Federal Regulations, 2010 CFR

2010-07-01

..., motorboats, dog teams, and other means of surface transportation traditionally employed by local rural... of snowmobiles, motorboats, dog teams, and other means of surface transportation traditionally... this chapter, the use of snowmobiles, motorboats, dog teams, and other means of surface transportation...

36 CFR 13.460 - Use of snowmobiles, motorboats, dog teams, and other means of surface transportation...

Code of Federal Regulations, 2012 CFR

2012-07-01

..., motorboats, dog teams, and other means of surface transportation traditionally employed by local rural... of snowmobiles, motorboats, dog teams, and other means of surface transportation traditionally... this chapter, the use of snowmobiles, motorboats, dog teams, and other means of surface transportation...

36 CFR 13.460 - Use of snowmobiles, motorboats, dog teams, and other means of surface transportation...

Code of Federal Regulations, 2014 CFR

2014-07-01

..., motorboats, dog teams, and other means of surface transportation traditionally employed by local rural... of snowmobiles, motorboats, dog teams, and other means of surface transportation traditionally... this chapter, the use of snowmobiles, motorboats, dog teams, and other means of surface transportation...

36 CFR 13.460 - Use of snowmobiles, motorboats, dog teams, and other means of surface transportation...

Code of Federal Regulations, 2011 CFR

2011-07-01

..., motorboats, dog teams, and other means of surface transportation traditionally employed by local rural... of snowmobiles, motorboats, dog teams, and other means of surface transportation traditionally... this chapter, the use of snowmobiles, motorboats, dog teams, and other means of surface transportation...

36 CFR 13.460 - Use of snowmobiles, motorboats, dog teams, and other means of surface transportation...

Code of Federal Regulations, 2013 CFR

2013-07-01

..., motorboats, dog teams, and other means of surface transportation traditionally employed by local rural... of snowmobiles, motorboats, dog teams, and other means of surface transportation traditionally... this chapter, the use of snowmobiles, motorboats, dog teams, and other means of surface transportation...

Team-Based Learning Reduces Attrition in a First-Semester General Chemistry Course

ERIC Educational Resources Information Center

Comeford, Lorrie

2016-01-01

Team-based learning (TBL) is an instructional method that has been shown to reduce attrition and increase student learning in a number of disciplines. TBL was implemented in a first-semester general chemistry course, and its effect on attrition was assessed. Attrition from sections before implementing TBL (fall 2008 to fall 2009) was compared with…

How Do Staff Perceive Schoolwide Positive Behavior Supports? Implications for Teams in Planning and Implementing Schools

ERIC Educational Resources Information Center

Feuerborn, Laura L.; Tyre, Ashli D.

2016-01-01

Schoolwide Positive Behavior Support (SWPBS) offers an alternative to reactive and exclusionary school discipline practices. However, the shift to SWPBS requires substantial change in the practices of staff, and many leadership teams struggle to rally staff support for implementation. With a more thorough understanding of staff perceptions, level…

Variable implementation of good practice recommendations for the assessment and management of UK children with neurodisability.

PubMed

Gray, L; Gibbs, J; Jolleff, N; Williams, J; McConachie, H; Parr, J R

2015-11-01

The aims of this study were to determine whether UK child development teams (CDTs) have implemented good practice recommendations for the co-ordinated assessment and support of children with neurodisability and to explore some of the factors associated with variations in good practice implementation. Surveys were sent to every UK CDT in 2009/2010. Responses about CDT provision and ways of working were compared with good practice recommendations from national policy documents and professional organizations. The extent to which CDTs in England and Wales met 11 selected good practice recommendations was scored; teams in Scotland and Northern Ireland were given a score out of 9 to reflect the optional use of the common assessment framework and early support materials in these countries. Responses were received from 225/240 (94%) UK CDTs. Thirty-seven per cent of CDTs in England and Wales had implemented nine or more of the 11 recommendations. Fifty-nine per cent of teams in Scotland and 78% of teams in Northern Ireland met between six and nine recommendations of good working practice. Higher levels of implementation of recommendations were found when the CDT had a Child Development Centre base and for teams who had received increased funding in the 5 years preceding the survey. There was considerable variability in the degree to which CDTs implemented good practice recommendations for the diagnosis and management of children with neurodisability. Evidence about child and parent satisfaction, and the effectiveness of CDT practices and provision, is required, so policymakers, healthcare commissioners and clinicians can provide the most appropriate services to children with neurodisability and their families. © 2015 John Wiley & Sons Ltd.

Implementation of Task-Tracking Software for Clinical IT Management.

PubMed

Purohit, Anne-Maria; Brutscheck, Clemens; Prokosch, Hans-Ulrich; Ganslandt, Thomas; Schneider, Martin

2017-01-01

Often in clinical IT departments, many different methods and IT systems are used for task-tracking and project organization. Based on managers' personal preferences and knowledge about project management methods, tools differ from team to team and even from employee to employee. This causes communication problems, especially when tasks need to be done in cooperation with different teams. Monitoring tasks and resources becomes impossible: there are no defined deliverables, which prevents reliable deadlines. Because of these problems, we implemented task-tracking software which is now in use across all seven teams at the University Hospital Erlangen. Over a period of seven months, a working group defined types of tasks (project, routine task, etc.), workflows, and views to monitor the tasks of the 7 divisions, 20 teams and 340 different IT services. The software has been in use since December 2016.

Implementing a Trauma-Informed Model of Care in a Community Acute Mental Health Team.

PubMed

Moloney, Bill; Cameron, Ian; Baker, Ashley; Feeney, Johanna; Korner, Anthony; Kornhaber, Rachel; Cleary, Michelle; McLean, Loyola

2018-04-12

In this paper, we demonstrate the value of implementing a Trauma-Informed Model of Care in a Community Acute Mental Health Team by providing brief intensive treatment (comprising risk interventions, brief counselling, collaborative formulation and pharmacological treatment). The team utilised the Conversational Model (CM), a psychotherapeutic approach for complex trauma. Key features of the CM are described in this paper using a clinical case study. The addition of the Conversational Model approach to practice has enabled better understandings of consumers' capacities and ways to then engage, converse, and intervene. The implementation of this intervention has led to a greater sense of self-efficacy amongst clinicians, who can now articulate a clear counselling model of care.

Facilitating the implementation of the American College of Surgeons/Association of Program Directors in Surgery phase III skills curriculum: training faculty in the assessment of team skills.

PubMed

Hull, Louise; Arora, Sonal; Stefanidis, Dimitrios; Sevdalis, Nick

2015-11-01

Effective teamwork is critical to safety in the operating room; however, implementation of phase III of the American College of Surgeons (ACS) and Association of Program Directors in Surgery (APDS) Curriculum that focuses on team-based skills remains worryingly low. Training and assessing the complexities of teamwork is challenging. The objective of this study was to establish guidelines and recommendations for training faculty in assessing/debriefing team skills. A multistage survey-based consensus study was completed by 108 experts responsible for training and assessing surgical residents from the ACS Accredited Educational Institutes. Experts agreed that a program to teach faculty to assess team-based skills should include training in the recognition of teamwork skills, practice rating these skills, and training in the provision of feedback/debriefing. Agreement was reached that faculty responsible for conducting team-based skills assessment should be revalidated every 2 years and stringent proficiency criteria should be met. Faculty development is critical to ensure high-quality, standardized training and assessment. Training faculty to assess team-based skills has the potential to facilitate the effective implementation of phase III of the ACS and APDS Curriculum. Copyright © 2015 Elsevier Inc. All rights reserved.

The BRIGHTEN Program: Implementation and Evaluation of a Program to Bridge Resources of an Interdisciplinary Geriatric Health Team via Electronic Networking

ERIC Educational Resources Information Center

Emery, Erin E.; Lapidos, Stan; Eisenstein, Amy R.; Ivan, Iulia I.; Golden, Robyn L.

2012-01-01

Purpose: To demonstrate the feasibility of the BRIGHTEN Program (Bridging Resources of an Interdisciplinary Geriatric Health Team via Electronic Networking), an interdisciplinary team intervention for assessing and treating older adults for depression in outpatient primary and specialty medical clinics. The BRIGHTEN team collaborates "virtually"…

Using a Dual Role Assignment to Improve Group Dynamics and Performance: The Effects of Facilitating Social Capital in Teams

ERIC Educational Resources Information Center

Aquino, Karl; Serva, Mark A.

2005-01-01

This article describes a project that simulates the interplay between management and development project teams in a business environment. Each student team was assigned a management role supervising one project and a development role implementing another project. Results indicate that teams that communicate regularly and interact socially outside…

A Case Study of Team-Initiated Problem Solving Addressing Student Behavior in One Elementary School

ERIC Educational Resources Information Center

Todd, Anne W.; Horner, Robert H.; Berry, Dorothy; Sanders, Carol; Bugni, Michelle; Currier, Allison; Potts, Nicky; Newton, J. Stephen; Algozzine, Bob; Algozzine, Kate

2012-01-01

Team-Initiated Problem Solving (TIPS) is an approach for organizing school team meetings to improve identification of targeted problems, use of data in the development of solutions, and development of implemented action plans. TIPS has been demonstrated in single-case and randomized controlled trial studies to improve the effectiveness of teams to…

Development of an Integrated Team Training Design and Assessment Architecture to Support Adaptability in Healthcare Teams

DTIC Science & Technology

2016-10-01

and implementation of embedded, adaptive feedback and performance assessment. The investigators also initiated work designing a Bayesian Belief ...training; Teamwork; Adaptive performance; Leadership; Simulation; Modeling; Bayesian belief networks (BBN) 16. SECURITY CLASSIFICATION OF: 17. LIMITATION...Trauma teams Team training Teamwork Adaptability Adaptive performance Leadership Simulation Modeling Bayesian belief networks (BBN) 6

Teachers' Perceptions of a Four-Teacher Team Model in the Middle School

ERIC Educational Resources Information Center

Chavarria, George A.

2010-01-01

One middle school recently adopted a team teaching model as a result of principal directive in order to improve staff communication and better serve students. Because seventh and eighth grade teachers had never been teamed in this particular middle school, research was needed to investigate how teaming was implemented and how these teachers…

A Systematic Review of Developing Team Competencies in Information Systems Education

ERIC Educational Resources Information Center

Figl, Kathrin

2010-01-01

The ability to work effectively in teams has been a key competence for information systems engineers for a long time. Gradually, more attention is being paid to developing this generic competence as part of academic curricula, resulting in two questions: how to best promote team competencies and how to implement team projects successfully. These…

Robotics and local fusion

NASA Astrophysics Data System (ADS)

Emmerman, Philip J.

2005-05-01

Teams of robots or mixed teams of warfighters and robots on reconnaissance and other missions can benefit greatly from a local fusion station. A local fusion station is defined here as a small mobile processor with interfaces to enable the ingestion of multiple heterogeneous sensor data and information streams, including blue force tracking data. These data streams are fused and integrated with contextual information (terrain features, weather, maps, dynamic background features, etc.), and displayed or processed to provide real time situational awareness to the robot controller or to the robots themselves. These blue and red force fusion applications remove redundancies, lessen ambiguities, correlate, aggregate, and integrate sensor information with context such as high resolution terrain. Applications such as safety, team behavior, asset control, training, pattern analysis, etc. can be generated or enhanced by these fusion stations. This local fusion station should also enable the interaction between these local units and a global information world.

Measurement invariance of an instrument assessing sustainability of school-based universal behavior practices.

PubMed

Mercer, Sterett H; McIntosh, Kent; Strickland-Cohen, M Kathleen; Horner, Robert H

2014-06-01

The purpose of the study was to examine the extent to which the School-Wide Universal Behavior Sustainability Index: School Teams (SUBSIST; McIntosh, Doolittle, Vincent, Horner, & Ervin, 2009), a measure of school and district contextual factors that promote the sustainability of school practices, demonstrated measurement invariance across groups of schools that differed in length of time implementing school-wide Positive Behavioral Interventions and Supports (PBIS; Sugai & Horner, 2009), student ethnic composition, and student socioeconomic status (SES). School PBIS team members and district coaches representing 860 schools in 14 U.S. states completed the SUBSIST. Findings supported strong measurement invariance, for all items except 1, of a model with two school-level factors (School Priority and Team Use of Data) and 2 district-level factors (District Priority and Capacity Building) across groups of schools at initial implementation, institutionalization, and sustainability phases of PBIS implementation. Schools in the sustainability phase were rated significantly higher on School Priority and Team Use of Data than schools in initial implementation. Strong measurement invariance held across groups of schools that differed in student ethnicity and SES. The findings regarding measurement invariance are important for future longitudinal investigations of factors that may promote the sustained implementation of school practices. PsycINFO Database Record (c) 2014 APA, all rights reserved.

A prospective analysis of implementation of multi-disciplinary team decisions in breast cancer.

PubMed

English, Rachel; Metcalfe, Chris; Day, James; Rayter, Zenon; Blazeby, Jane M

2012-09-01

Multi-disciplinary teams (MDTs) management of patients with cancer is mandatory in the United Kingdom, and auditing team decision-making by examining rates of decision implementation and reasons for nonimplementation may inform this practice. Consecutive breast cancer MDT decisions, subsequent decision implementation, and reasons for nonimplementation were prospectively recorded. Factors associated with nonimplementation of the MDT decision were analyzed with logistic regression. Of 289 consecutive MDT decisions involving 210 women, 20 (6.9%, 95% CIs 4.3%-10.5%) were not implemented. Most changed MDT decisions did so because of patient preferences (n = 13, 65%), with the discovery of new clinical information (n = 3) and individual doctor's views (n = 4) also leading to decision nonimplementation. MDT decisions were significantly less likely to be adhered to in patients with confirmed malignant disease compared to those with benign or 'unknown' disease categories (p < 0.001) and MDT decisions in older patients were significantly more likely not to be implemented than in younger patients (p = 0.002). Auditing nonimplementation of MDT recommendations and examining reasons for changed decisions is a useful process to monitor team performance and to identify factors that need more attention during the MDT meeting to ensure that the process makes optimal patient centered decisions. © 2012 Wiley Periodicals, Inc.

Standardized patient walkthroughs in the National Drug Abuse Treatment Clinical Trials Network: common challenges to protocol implementation.

PubMed

Fussell, Holly E; Kunkel, Lynn E; McCarty, Dennis; Lewy, Colleen S

2011-09-01

Training research staff to implement clinical trials occurring in community-based addiction treatment programs presents unique challenges. Standardized patient walkthroughs of study procedures may enhance training and protocol implementation. Examine and discuss cross-site and cross-study challenges of participant screening and data collection procedures identified during standardized patient walkthroughs of multi-site clinical trials. Actors portrayed clients and "walked through" study procedures with protocol research staff. The study completed 57 walkthroughs during implementation of 4 clinical trials. Observers and walkthrough participants identified three areas of concern (consent procedures, screening and assessment processes, and protocol implementation) and made suggestions for resolving the concerns. Standardized patient walkthroughs capture issues with study procedures previously unidentified with didactic training or unscripted rehearsals. Clinical trials within the National Drug Abuse Treatment Clinical Trials Network are conducted in addiction treatment centers that vary on multiple dimensions. Based on walkthrough observations, the national protocol team and local site leadership modify standardized operating procedures and resolve cross-site problems prior to recruiting study participants. The standardized patient walkthrough improves consistency across study sites and reduces potential site variation in study outcomes.

Critical Review of Technical Questions Facing Low Impact Development and Green Infrastructure: A Perspective from the Great Plains.

PubMed

Vogel, Jason R; Moore, Trisha L; Coffman, Reid R; Rodie, Steven N; Hutchinson, Stacy L; McDonough, Kelsey R; McLemore, Alex J; McMaine, John T

2015-09-01

Since its inception, Low Impact Development (LID) has become part of urban stormwater management across the United States, marking progress in the gradual transition from centralized to distributed runoff management infrastructure. The ultimate goal of LID is full, cost-effective implementation to maximize watershed-scale ecosystem services and enhance resilience. To reach that goal in the Great Plains, the multi-disciplinary author team presents this critical review based on thirteen technical questions within the context of regional climate and socioeconomics across increasing complexities in scale and function. Although some progress has been made, much remains to be done including continued basic and applied research, development of local LID design specifications, local demonstrations, and identifying funding mechanisms for these solutions. Within the Great Plains and beyond, by addressing these technical questions within a local context, the goal of widespread acceptance of LID can be achieved, resulting in more effective and resilient stormwater management.

Primary Care Integration of Psychiatric and Behavioral Health Services: A Primer for Providers and Case Report of Local Implementation.

PubMed

Guerrero, Anthony Ps; Takesue, Cori L; Medeiros, Jared Hn; Duran, Aileen A; Humphry, Joseph W; Lunsford, Ryan M; Shaw, Diana V; Fukuda, Michael H; Hishinuma, Earl S

2017-06-01

Mental health conditions are common, disabling, potentially life-threatening, and costly; however, they are mostly treatable with early detection and intervention. Unfortunately, mental healthcare is in significantly short supply both nationally and locally, and particularly in small, rural, and relatively isolated communities. This article provides physicians and other health practitioners with a primer on the basic rationale and principles of integrating behavioral healthcare - particularly psychiatric specialty care - in primary care settings, including effective use of teleconferencing. Referring to a local-based example, this paper describes the programmatic components (universal screening, telephone availability, mutually educational team rounds, as-needed consultations, etc) that operationalize and facilitate successful primary care integration, and illustrates how these elements are applied to population segments with differing needs for behavioral healthcare involvement. Lastly, the article discusses the potential value of primary care integration in promoting quality, accessibility, and provider retention; discusses how new developments in healthcare financing could enhance the sustainability of primary care integration models; and summarizes lessons learned.

A comparative analysis of dynamic grids vs. virtual grids using the A3pviGrid framework.

PubMed

Shankaranarayanan, Avinas; Amaldas, Christine

2010-11-01

With the proliferation of Quad/Multi-core micro-processors in mainstream platforms such as desktops and workstations; a large number of unused CPU cycles can be utilized for running virtual machines (VMs) as dynamic nodes in distributed environments. Grid services and its service oriented business broker now termed cloud computing could deploy image based virtualization platforms enabling agent based resource management and dynamic fault management. In this paper we present an efficient way of utilizing heterogeneous virtual machines on idle desktops as an environment for consumption of high performance grid services. Spurious and exponential increases in the size of the datasets are constant concerns in medical and pharmaceutical industries due to the constant discovery and publication of large sequence databases. Traditional algorithms are not modeled at handing large data sizes under sudden and dynamic changes in the execution environment as previously discussed. This research was undertaken to compare our previous results with running the same test dataset with that of a virtual Grid platform using virtual machines (Virtualization). The implemented architecture, A3pviGrid utilizes game theoretic optimization and agent based team formation (Coalition) algorithms to improve upon scalability with respect to team formation. Due to the dynamic nature of distributed systems (as discussed in our previous work) all interactions were made local within a team transparently. This paper is a proof of concept of an experimental mini-Grid test-bed compared to running the platform on local virtual machines on a local test cluster. This was done to give every agent its own execution platform enabling anonymity and better control of the dynamic environmental parameters. We also analyze performance and scalability of Blast in a multiple virtual node setup and present our findings. This paper is an extension of our previous research on improving the BLAST application framework using dynamic Grids on virtualization platforms such as the virtual box.

Dynamics behind the scale up of evidence-based obesity prevention: protocol for a multi-site case study of an electronic implementation monitoring system in health promotion practice.

PubMed

Conte, Kathleen P; Groen, Sisse; Loblay, Victoria; Green, Amanda; Milat, Andrew; Persson, Lina; Innes-Hughes, Christine; Mitchell, Jo; Thackway, Sarah; Williams, Mandy; Hawe, Penelope

2017-12-06

The effectiveness of many interventions to promote health and prevent disease has been well established. The imperative has therefore shifted from amassing evidence about efficacy to scale-up to maximise population-level health gains. Electronic implementation monitoring, or 'e-monitoring', systems have been designed to assist and track the delivery of preventive policies and programs. However, there is little evidence on whether e-monitoring systems improve the dissemination, adoption, and ongoing delivery of evidence-based preventive programs. Also, given considerable difficulties with e-monitoring systems in the clinical sector, scholars have called for a more sophisticated re-examination of e-monitoring's role in enhancing implementation. In the state of New South Wales (NSW), Australia, the Population Health Information Management System (PHIMS) was created to support the dissemination of obesity prevention programs to 6000 childcare centres and elementary schools across all 15 local health districts. We have established a three-way university-policymaker-practice research partnership to investigate the impact of PHIMS on practice, how PHIMS is used, and how achievement of key performance indicators of program adoption may be associated with local contextual factors. Our methods encompass ethnographic observation, key informant interviews and participatory workshops for data interpretation at a state and local level. We use an on-line social network analysis of the collaborative relationships across local health district health promotion teams to explore the relationship between PHIMS use and the organisational structure of practice. Insights will be sensitised by institutional theory, practice theory and complex adaptive system thinking, among other theories which make sense of socio-technical action. Our working hypothesis is that the science of getting evidence-based programs into practice rests on an in-depth understanding of the role they play in the on-going system of local relationships and multiple accountabilities. Data will be synthesised to produce a typology to characterise local context, PHIMS use and key performance indicator achievement (of program implementation) across the 15 local health districts. Results could be used to continuously align e-monitoring technologies within quality improvement processes to ensure that such technologies enhance practice and innovation. A partnership approach to knowledge production increases the likelihood that findings will be put into practice.

9/11 Ten Years After: Command, Control, Communications Remain an Issue

DTIC Science & Technology

2012-02-09

must respond, manage forces, and provide critical support as a cohesive team. These organizations span the gamut of local, tribal, state, and federal...and provide critical support as a cohesive team. These organizations span the gamut of local, tribal, state, and federal levels of government and of

MVERT: common solutions for technological disasters--a study on cooperation

NASA Astrophysics Data System (ADS)

Roberts, Walter O.; Allred, William D.

1999-01-01

Most Idaho communities are not prepared to handle a hazardous materials incident and must rely on resources outside of their jurisdiction for assistance. Idaho has established four Regional Response Teams (RRT) to help the communities. The teams are located in the northern, north-central, south-western and south-eastern parts of the state. The south-central area is served by a team from Boise or Pocatello. Response from either team requires nearly four hours of travel time. After analyzing the problems of time and distance, six counties from south-central Idaho have agreed to provide a team to function as an RRT during the initial phases of an incident. This organization is unprecedented because it consists of members from law enforcement, local fire protection organizations, emergency medical personnel, and local government agencies who will share personnel, equipment, resources, and training. The Magic Valley Emergency Response Team (MVERT) is locally funded and self- governed. MVERT has received support from the Idaho Bureau of Hazardous Materials, State Bureau of Disaster Services, Idaho Division of Environmental Quality, Idaho Emergency Services Training and Idaho State Police. MVERT is not limited to hazardous materials incidents and can respond to any emergency requiring specialized training and equipment.

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

PubMed

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

2016-12-01

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

Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review.

PubMed

O'Reilly, Pauline; Lee, Siew Hwa; O'Sullivan, Madeleine; Cullen, Walter; Kennedy, Catriona; MacFarlane, Anne

2017-01-01

Interdisciplinary team working is of paramount importance in the reform of primary care in order to provide cost-effective and comprehensive care. However, international research shows that it is not routine practice in many healthcare jurisdictions. It is imperative to understand levers and barriers to the implementation process. This review examines interdisciplinary team working in practice, in primary care, from the perspective of service providers and analyses 1 barriers and facilitators to implementation of interdisciplinary teams in primary care and 2 the main research gaps. An integrative review following the PRISMA guidelines was conducted. Following a search of 10 international databases, 8,827 titles were screened for relevance and 49 met the criteria. Quality of evidence was appraised using predetermined criteria. Data were analysed following the principles of framework analysis using Normalisation Process Theory (NPT), which has four constructs: sense making, enrolment, enactment, and appraisal. The literature is dominated by a focus on interdisciplinary working between physicians and nurses. There is a dearth of evidence about all NPT constructs apart from enactment. Physicians play a key role in encouraging the enrolment of others in primary care team working and in enabling effective divisions of labour in the team. The experience of interdisciplinary working emerged as a lever for its implementation, particularly where communication and respect were strong between professionals. A key lever for interdisciplinary team working in primary care is to get professionals working together and to learn from each other in practice. However, the evidence base is limited as it does not reflect the experiences of all primary care professionals and it is primarily about the enactment of team working. We need to know much more about the experiences of the full network of primary care professionals regarding all aspects of implementation work. International Prospective Register of Systematic Reviews PROSPERO 2015: CRD42015019362.

Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review

PubMed Central

O’Reilly, Pauline; Lee, Siew Hwa; O’Sullivan, Madeleine; Cullen, Walter; Kennedy, Catriona; MacFarlane, Anne

2017-01-01

Background Interdisciplinary team working is of paramount importance in the reform of primary care in order to provide cost-effective and comprehensive care. However, international research shows that it is not routine practice in many healthcare jurisdictions. It is imperative to understand levers and barriers to the implementation process. This review examines interdisciplinary team working in practice, in primary care, from the perspective of service providers and analyses 1 barriers and facilitators to implementation of interdisciplinary teams in primary care and 2 the main research gaps. Methods and findings An integrative review following the PRISMA guidelines was conducted. Following a search of 10 international databases, 8,827 titles were screened for relevance and 49 met the criteria. Quality of evidence was appraised using predetermined criteria. Data were analysed following the principles of framework analysis using Normalisation Process Theory (NPT), which has four constructs: sense making, enrolment, enactment, and appraisal. The literature is dominated by a focus on interdisciplinary working between physicians and nurses. There is a dearth of evidence about all NPT constructs apart from enactment. Physicians play a key role in encouraging the enrolment of others in primary care team working and in enabling effective divisions of labour in the team. The experience of interdisciplinary working emerged as a lever for its implementation, particularly where communication and respect were strong between professionals. Conclusion A key lever for interdisciplinary team working in primary care is to get professionals working together and to learn from each other in practice. However, the evidence base is limited as it does not reflect the experiences of all primary care professionals and it is primarily about the enactment of team working. We need to know much more about the experiences of the full network of primary care professionals regarding all aspects of implementation work. Systematic review registration International Prospective Register of Systematic Reviews PROSPERO 2015: CRD42015019362. PMID:28545038

Developing and Implementing "Waupaca Eating Smart": A Restaurant and Supermarket Intervention to Promote Healthy Eating Through Changes in the Food Environment.

PubMed

Escaron, Anne L; Martinez-Donate, Ana P; Riggall, Ann Josie; Meinen, Amy; Hall, Beverly; Nieto, F Javier; Nitzke, Susan

2016-03-01

Restaurants and food stores are suitable settings for healthy eating interventions. A community-academic partnership developed and implemented "Waupaca Eating Smart" (WES), a healthy eating program in restaurants and supermarkets of a rural, Midwest community. Previous interventions targeted either restaurants or small food stores nearly all in urban areas. Intervention design and implementation is rarely documented, making replication difficult for interested researchers and communities. In this article, we report the activities we undertook to develop and implement WES. Working with a local nutrition and activity coalition, we used evidence-based strategies guided by the social ecological model and social marketing principles to inform the content of WES. Formative assessment included a review of the literature, statewide key informant interviews and focus groups with restaurant and food store operators and patrons, a local community survey, and interviews with prospective WES businesses. WES was implemented in seven restaurants and two supermarkets and evaluated for feasibility and acceptance using surveys and direct observation of WES implementation. Prior to this intervention, only one of seven restaurants had three or more meals that met WES nutrition criteria. By the end of the program, 38 meals were labeled and promoted to restaurant customers, and the team had staffed four side salad taste tests for supermarket customers. Four and 10 months after intervention launch, the majority of the program's strategies were observed in participating outlets, suggesting that these program's strategies are feasible and can be sustained. Operators reported strong satisfaction overall. A combined restaurant- and supermarket-based healthy eating intervention is feasible and positively valued in rural communities. Further research is needed to better understand how to foster sustainability of these interventions and their impact on customer food choices. © 2015 Society for Public Health Education.

Journal of Special Operations Medicine. Volume 10, Edition 3, Summer 2010

DTIC Science & Technology

2010-01-01

team from Bagram to help. This spe- cial team of healthcare providers was utilized by him and the SF medics in other parts of Afghanistan, as well...Give the local doc a set of basic dental tools, not an $8,000 state-of-the-art chair that is not sustainable.” LTC Harrington said he utilized a unique...produced. Furthermore, the SF teams utilize DoD CERP (Commander’s Emergency Response Program) funding for the local purchases, but this tends to take

Resolving the psychiatric bed crisis: a critical analysis of policy.

PubMed

Loader, Katie

The National Service Framework (NSF) for Mental Health in 1999 was central to the modernisation of mental health services under the New Labour government of 1997. It placed an emphasis on universal clinical standards and set out a vision for service developments over the next 10 years. One such proposal was the development of crisis resolution teams, aimed at reducing the psychiatric admissions rate by providing care at home. This article provides a critical analysis of policies relating to the provision of 24-hour access to mental health services, focusing on the specifications for creating crisis resolution teams, as laid out in the NSF for Mental Health and the NHS Plan. First, it looks at the historical context surrounding the policy, examining the content of the NSF and NHS plan and how policy was disseminated and implemented nationally and locally. Then it examines the effects and changes this policy brought about and, specifically, whether it has achieved its aims of reducing the nationwide acute psychiatric inpatient admission rate.

Team-training in healthcare: a narrative synthesis of the literature.

PubMed

Weaver, Sallie J; Dy, Sydney M; Rosen, Michael A

2014-05-01

Patients are safer and receive higher quality care when providers work as a highly effective team. Investment in optimising healthcare teamwork has swelled in the last 10 years. Consequently, evidence regarding the effectiveness for these interventions has also grown rapidly. We provide an updated review concerning the current state of team-training science and practice in acute care settings. A PubMed search for review articles examining team-training interventions in acute care settings published between 2000 and 2012 was conducted. Following identification of relevant reviews with searches terminating in 2008 and 2010, PubMed and PSNet were searched for additional primary studies published in 2011 and 2012. Primary outcomes included patient outcomes and quality indices. Secondary outcomes included teamwork behaviours, knowledge and attitudes. Both simulation and classroom-based team-training interventions can improve teamwork processes (eg, communication, coordination and cooperation), and implementation has been associated with improvements in patient safety outcomes. Thirteen studies published between 2011 and 2012 reported statistically significant changes in teamwork behaviours, processes or emergent states and 10 reported significant improvement in clinical care processes or patient outcomes, including mortality and morbidity. Effects were reported across a range of clinical contexts. Larger effect sizes were reported for bundled team-training interventions that included tools and organisational changes to support sustainment and transfer of teamwork competencies into daily practice. Overall, moderate-to-high-quality evidence suggests team-training can positively impact healthcare team processes and patient outcomes. Additionally, toolkits are available to support intervention development and implementation. Evidence suggests bundled team-training interventions and implementation strategies that embed effective teamwork as a foundation for other improvement efforts may offer greatest impact on patient outcomes.

Team-training in healthcare: a narrative synthesis of the literature

PubMed Central

Weaver, Sallie J; Dy, Sydney M; Rosen, Michael A

2014-01-01

Background Patients are safer and receive higher quality care when providers work as a highly effective team. Investment in optimising healthcare teamwork has swelled in the last 10 years. Consequently, evidence regarding the effectiveness for these interventions has also grown rapidly. We provide an updated review concerning the current state of team-training science and practice in acute care settings. Methods A PubMed search for review articles examining team-training interventions in acute care settings published between 2000 and 2012 was conducted. Following identification of relevant reviews with searches terminating in 2008 and 2010, PubMed and PSNet were searched for additional primary studies published in 2011 and 2012. Primary outcomes included patient outcomes and quality indices. Secondary outcomes included teamwork behaviours, knowledge and attitudes. Results Both simulation and classroom-based team-training interventions can improve teamwork processes (eg, communication, coordination and cooperation), and implementation has been associated with improvements in patient safety outcomes. Thirteen studies published between 2011 and 2012 reported statistically significant changes in teamwork behaviours, processes or emergent states and 10 reported significant improvement in clinical care processes or patient outcomes, including mortality and morbidity. Effects were reported across a range of clinical contexts. Larger effect sizes were reported for bundled team-training interventions that included tools and organisational changes to support sustainment and transfer of teamwork competencies into daily practice. Conclusions Overall, moderate-to-high-quality evidence suggests team-training can positively impact healthcare team processes and patient outcomes. Additionally, toolkits are available to support intervention development and implementation. Evidence suggests bundled team-training interventions and implementation strategies that embed effective teamwork as a foundation for other improvement efforts may offer greatest impact on patient outcomes. PMID:24501181

Geophysics field school: A team-based learning experience for students and faculty

NASA Astrophysics Data System (ADS)

Karchewski, B.; Innanen, K. A.; Lauer, R. M.; Pidlisecky, A.

2016-12-01

The core challenge facing a modern science educator is to deliver a curriculum that reaches broadly and deeply into the technical domain, while also helping students to develop fundamental scientific skills such as inquiry, critical thinking and technical communication. That is, our aim is for students to achieve significant learning at all levels summarized by Bloom's Taxonomy of Educational Objectives. It is not always clear how to achieve the full spectrum of goals, with much debate over which component is more important in a science education. Team-based and experiential learning are research-supported approaches that aim to reach across the spectrum by placing students in a setting where they solve practical problems in teams of peers. This learning mode modifies the role of the instructor to a guide or facilitator, and students take a leadership role in their own education. We present a case study of our team's implementation of team-based learning in a geophysics field school, an inherently experiential learning environment. The core philosophies behind our implementation are to present clearly defined learning outcomes, to recognize that students differ in their learning modalities and to strive to engage students through a range of evidence-based learning experiences. We discuss the techniques employed to create functional teams, the key learning activities involved in a typical day of field school and data demonstrating the learning activities that showed the strongest correlation to overall performance in the course. In the process, we also realized that our team-based approach to course design and implementation also enhanced our skillsets as educators, and our institution recently recognized our efforts with a team teaching award. Therefore, we conclude with some of our observations of best practices for team teaching in a field setting to initiate discussions with colleagues engaged in similar activities.

The relationship between vertical teaming in science and student achievement as reported in the Academic Excellence Indicator System (AEIS) at selected public schools in Bexar County, Texas

NASA Astrophysics Data System (ADS)

Arteaga, Veronica Hernandez

The purpose of this study was to examine the relationship between vertical teaming in science and student achievement. This study compared student achievement of campuses implementing vertical teaming with schools that do not practice vertical teaming. In addition, this study explored the relationship between selected demographic variables and vertical teaming using Grade 5 Science TAKS results in the Academic Excellence Indicator System (AEIS). Campus demographic variables such as economically disadvantaged, minority students, English language learners, student mobility, and experienced teachers were researched. A call-out yielded 168 responses. With the exclusion of the 12 campuses, a total of 156 participating campuses from 18 traditional school districts remained. Campuses employing vertical teaming were self-identified on the basis of having implemented the process for two or more years. The gain in percent mastered for Science TAKS scores from 2004 to 2007 was used as the Science TAKS score variable. Results indicated that there was no significant difference in student achievement in science for campuses practicing vertical teaming and campuses that did not. The two-way ANOVA was used to measure the relationship between the independent variables (vertical teaming and campus demographic variables) on the dependent variable (student achievement on Science TAKS). The results suggested that campuses having low percentages of economically disadvantaged students statistically gained more on the Science TAKS than campuses that have high percentages of economically disadvantaged students irrespective of vertical teaming practices. In addition, campuses that have low percentages of minority students statistically gained more on the Science TAKS than campuses that have high percentages of minority students despite vertical teaming participation. Recommendations include districts, state, and federal agencies providing campuses with a high percent of economically disadvantaged students with more resources and more flexibility in using those resources. Recommendations for further study included a replication of the study that takes into account the degree of implementation of vertical teaming.

Analysis, Design and Implementation of a Networking Proof-of-Concept Prototype to Support Maritime Visit, Board, Search and Seizure Teams

DTIC Science & Technology

2014-03-01

M. Callaghan ( AKR -1001). Retrieved from http://www.navsource.org/archives/09/54/541001.htm Nguyen, H., & Baker, M. (2012). Characteristics of a ...AND IMPLEMENTATION OF A NETWORKING PROOF-OF-CONCEPT PROTOTYPE TO SUPPORT MARITIME VISIT, BOARD, SEARCH AND SEIZURE TEAMS by Van E. Stewart...2. REPORT DATE March 2014 3. REPORT TYPE AND DATES COVERED Master’s Thesis 4. TITLE AND SUBTITLE ANALYSIS, DESIGN AND IMPLEMENTATION OF A

Adoption, implementation and prioritization of specialist outreach policy in Australia: a national perspective.

PubMed

O'Sullivan, Belinda G; Joyce, Catherine M; McGrail, Matthew R

2014-07-01

The World Health Organization has endorsed the use of outreach to promote: efficient redeployment of the health-care workforce; continuity of care at the local level; and professional support for local, rural, health-care workers. Australia is the only country that has had, since 2000, a sustained national policy on outreach for subsidizing medical specialist outreach to rural areas. This paper describes the adoption, implementation and prioritization of a national specialist outreach policy in Australia. Adoption of the national policy followed a long history of successful outreach, largely driven by the professional interest and personal commitment of the workforce. Initially the policy supported only new outreach services but concerns about the sustainability of existing services resulted in eligibility for funding being extended to all specialist services. The costs of travel, travel time, accommodation, professional support, staff relief at specialists' primary practices and equipment hire were subsidized. Over time, a national political commitment to the equitable treatment of indigenous people resulted in more targeted support for outreach in remote areas. Current priorities are: (i) establishing team-based outreach services; (ii) improving local staff's skills; (iii) achieving local coordination; and (iv) conducting a nationally consistent needs assessment. The absence of subsidies for specialists' clinical work can discourage private specialists from providing services in remote areas where clinical throughput is low. To be successful, outreach policy must harmonize with the interests of the workforce and support professional autonomy. Internationally, the development of outreach policy must take account of the local pay and practice conditions of health workers.

Adoption, implementation and prioritization of specialist outreach policy in Australia: a national perspective

PubMed Central

Joyce, Catherine M; McGrail, Matthew R

2014-01-01

Abstract The World Health Organization has endorsed the use of outreach to promote: efficient redeployment of the health-care workforce; continuity of care at the local level; and professional support for local, rural, health-care workers. Australia is the only country that has had, since 2000, a sustained national policy on outreach for subsidizing medical specialist outreach to rural areas. This paper describes the adoption, implementation and prioritization of a national specialist outreach policy in Australia. Adoption of the national policy followed a long history of successful outreach, largely driven by the professional interest and personal commitment of the workforce. Initially the policy supported only new outreach services but concerns about the sustainability of existing services resulted in eligibility for funding being extended to all specialist services. The costs of travel, travel time, accommodation, professional support, staff relief at specialists’ primary practices and equipment hire were subsidized. Over time, a national political commitment to the equitable treatment of indigenous people resulted in more targeted support for outreach in remote areas. Current priorities are: (i) establishing team-based outreach services; (ii) improving local staff’s skills; (iii) achieving local coordination; and (iv) conducting a nationally consistent needs assessment. The absence of subsidies for specialists’ clinical work can discourage private specialists from providing services in remote areas where clinical throughput is low. To be successful, outreach policy must harmonize with the interests of the workforce and support professional autonomy. Internationally, the development of outreach policy must take account of the local pay and practice conditions of health workers. PMID:25110376

Implementing an Antibiotic Stewardship Information System to Improve Hospital Infection Control: A Co-Design Process.

PubMed

Maia, Mélanie R; Simões, Alexandra; Lapão, Luís V

2018-01-01

HAITooL information system design and implementation was based on Design Science Research Methodology, ensuring full participation, in close collaboration, of researchers and a multidisciplinary team of healthcare professionals. HAITooL enables effective monitoring of antibiotic resistance, antibiotic use and provides an antibiotic prescription decision-supporting system by clinicians, strengthening the patient safety procedures. The design, development and implementation process reveals benefits in organizational and behavior change with significant success. Leadership commitment multidisciplinary team and mainly informaticians engagement was crucial to the implementation process. Participants' motivation and the final product delivery and evolution depends on that.

Communication and relationship skills for rapid response teams at hamilton health sciences.

PubMed

Cziraki, Karen; Lucas, Janie; Rogers, Toni; Page, Laura; Zimmerman, Rosanne; Hauer, Lois Ann; Daniels, Charlotte; Gregoroff, Susan

2008-01-01

Rapid response teams (RRT) are an important safety strategy in the prevention of deaths in patients who are progressively failing outside of the intensive care unit. The goal is to intervene before a critical event occurs. Effective teamwork and communication skills are frequently cited as critical success factors in the implementation of these teams. However, there is very little literature that clearly provides an education strategy for the development of these skills. Training in simulation labs offers an opportunity to assess and build on current team skills; however, this approach does not address how to meet the gaps in team communication and relationship skill management. At Hamilton Health Sciences (HHS) a two-day program was developed in collaboration with the RRT Team Leads, Organizational Effectiveness and Patient Safety Leaders. Participants reflected on their conflict management styles and considered how their personality traits may contribute to team function. Communication and relationship theories were reviewed and applied in simulated sessions in the relative safety of off-site team sessions. The overwhelming positive response to this training has been demonstrated in the incredible success of these teams from the perspective of the satisfaction surveys of the care units that call the team, and in the multi-phased team evaluation of their application to practice. These sessions offer a useful approach to the development of the soft skills required for successful RRT implementation.

Teamwork and Electronic Health Record Implementation: A Case Study of Preserving Effective Communication and Mutual Trust in a Changing Environment.

PubMed

Gross, Anne H; Leib, Ryan K; Tonachel, Anne; Tonachel, Richard; Bowers, Danielle M; Burnard, Rachel A; Rhinehart, Catherine A; Valentim, Rahila; Bunnell, Craig A

2016-11-01

This article describes how trust among team members and in the technology supporting them was eroded during implementation of an electronic health record (EHR) in an adult outpatient oncology practice at a comprehensive cancer center. Delays in care of a 38-year-old woman with high-risk breast cancer occurred because of ineffective team communication and are illustrated in a case study. The case explores how the patient's trust and mutual trust between team members were disrupted because of inaccurate assumptions about the functionality of the EHR's communication tool, resultant miscommunications between team members and the patient, and the eventual recognition that care was not being effectively coordinated, as it had been previously. Despite a well-established, team-based culture and significant preparation for the EHR implementation, the challenges that occurred point to underlying human and system failures from which other organizations going through a similar process may learn. Through an analysis and evaluation of events that transpired before and during the EHR rollout, suggested interventions for preventing this experience are offered, which include: a thorough crosswalk between old and new communication mechanisms before implementation; understanding and mitigation of gaps in the communication tool's functionality; more robust training for staff, clinicians, and patients; greater consideration given to the pace of change expected of individuals; and development of models of collaboration between EHR users and vendors in developing products that support high-quality, team-based care in the oncology setting. These interventions are transferable to any organizational or system change that threatens mutual trust and effective communication.

Mr. Traore introduces team supervision. Case scenarios for training and group discussion.

PubMed

1993-01-01

This supplement to "The Family Planning Manager" presents a case example and five case discussion questions to illustrate the concept of team supervision. In contrast to traditional supervision, where an emphasis is placed on inspection and the uncovering of deficiencies, team supervision uses a facilitative, advocacy-oriented approach. Problem-solving and decision-making responsibilities are assumed by the clinic staff, who identify and analyze problems in group meetings. Thus, the focus shifts from assessing individual performance to evaluating how well they meet clinic objectives as a team. In the team meetings, the visiting supervisor asks the team as a whole to analyze clinic problems and ensures that all staff members are aware of the significance of their contributions. The supervisor also clarifies the division of labor required for implementing solutions and performance standards. Staff are asked if they have concerns they would like communicated to the next organizational level. The supervisory report of the visit can serve as a guide for implementing the recommendations. This approach may require that supervisors and clinic managers receive training in problem solving, motivating staff, team building, and providing constructive feedback.

Designing a critical care nurse-led rapid response team using only available resources: 6 years later.

PubMed

Mitchell, Anne; Schatz, Marilyn; Francis, Heather

2014-06-01

Rapid response teams have been introduced to intervene in the care of patients whose condition deteriorates unexpectedly by bringing clinical experts quickly to the patient's bedside. Evidence supporting the need to overcome failure to deliver optimal care in hospitals is robust; whether rapid response teams demonstrate benefit by improving patient safety and reducing the occurrence of adverse events remains controversial. Despite inconsistent evidence regarding the effectiveness of rapid response teams, concerns regarding care and costly consequences of unaddressed deterioration in patients' condition have prompted many hospitals to implement rapid response teams as a patient safety strategy. A cost-neutral structure for a rapid response team led by a nurse from the intensive care unit was implemented with the goal of reducing cardiopulmonary arrests occurring outside the intensive care unit. The results of 6 years' experience indicate that a sustainable and effective rapid response team response can be put into practice without increasing costs or adding positions and can decrease the percentage of cardiopulmonary arrests occurring outside the intensive care unit. ©2014 American Association of Critical-Care Nurses.

Human Simulators and Standardized Patients to Teach Difficult Conversations to Interprofessional Health Care Teams

PubMed Central

Zimmerman, Christine; Kennedy, Christopher; Schremmer, Robert; Smith, Katharine V.

2010-01-01

Objective To design and implement a demonstration project to teach interprofessional teams how to recognize and engage in difficult conversations with patients. Design Interdisciplinary teams consisting of pharmacy students and residents, student nurses, and medical residents responded to preliminary questions regarding difficult conversations, listened to a brief discussion on difficult conversations; formed ad hoc teams and interacted with a standardized patient (mother) and a human simulator (child), discussing the infant's health issues, intimate partner violence, and suicidal thinking; and underwent debriefing. Assessment Participants evaluated the learning methods positively and a majority demonstrated knowledge gains. The project team also learned lessons that will help better design future programs, including an emphasis on simulations over lecture and the importance of debriefing on student learning. Drawbacks included the major time commitment for design and implementation, sustainability, and the lack of resources to replicate the program for all students. Conclusion Simulation is an effective technique to teach interprofessional teams how to engage in difficult conversations with patients. PMID:21088725

Flight Test Implementation of a Second Generation Intelligent Flight Control System

NASA Technical Reports Server (NTRS)

Williams-Hayes, Peggy S.

2005-01-01

The NASA F-15 Intelligent Flight Control System project team has developed a series of flight control concepts designed to demonstrate the benefits of a neural network-based adaptive controller. The objective of the team was to develop and flight-test control systems that use neural network technology, to optimize the performance of the aircraft under nominal conditions, and to stabilize the aircraft under failure conditions. Failure conditions include locked or failed control surfaces as well as unforeseen damage that might occur to the aircraft in flight. The Intelligent Flight Control System team is currently in the process of implementing a second generation control scheme, collectively known as Generation 2 or Gen 2, for flight testing on the NASA F-15 aircraft. This report describes the Gen 2 system as implemented by the team for flight test evaluation. Simulation results are shown which describe the experiment to be performed in flight and highlight the ways in which the Gen 2 system meets the defined objectives.

Practice development: implementing a change of practice as a team.

PubMed

Covill, Carl; Hope, Angela

2012-08-01

Practice development (PD), as a framework for multiprofessional working, has immense potential, specifically within change management and the clinical governance agenda. It has been acknowledged as a vehicle for 'continuous improvement'. This article discusses PD through collaborative working using the example of a case study on change of practice in falls reduction within a localised community setting. The process is underpinned by a PD framework and facilitated by leaders of PD within a university setting. The article identifies that PD frameworks are conducive to developing leadership and management roles within a democratic process. The article discusses the potential for multiprofessional PD within the locality and further afield.

Youth Action Teams: An Approach to Student Involvement. Technical Assistance Bulletin 33.

ERIC Educational Resources Information Center

National School Resource Network, Washington, DC.

Youth Action Teams have been implemented in over 14 sites across the country in the past few years. Such teams are made up of a diverse group of youth working together on a project through the school, a youth service organization, a community organization, or the government. The team decides its focus, and what projects its members wish to…

Student Teachers' Team Teaching: How Do Learners in the Classroom Experience Team-Taught Lessons by Student Teachers?

ERIC Educational Resources Information Center

Baeten, Marlies; Simons, Mathea

2016-01-01

This study focuses on student teachers' team teaching. Two team teaching models (sequential and parallel teaching) were applied by 14 student teachers in a quasi-experimental design. When implementing new teaching models, it is important to take into account the perspectives of all actors involved. Although learners are key actors in the teaching…

Developing a Multidisciplinary Team for Disorders of Sex Development: Planning, Implementation, and Operation Tools for Care Providers

PubMed Central

Moran, Mary Elizabeth; Karkazis, Katrina

2012-01-01

In the treatment of patients with disorders of sex development (DSD), multidisciplinary teams (MDTs) represent a new standard of care. While DSDs are too complex for care to be delivered effectively without specialized team management, these conditions are often considered to be too rare for their medical management to be a hospital priority. Many specialists involved in DSD care want to create a clinic or team, but there is no available guidance that bridges the gap between a group of like-minded DSD providers who want to improve care and the formation of a functional MDT. This is an important dilemma, and one with serious implications for the future of DSD care. If a network of multidisciplinary DSD teams is to be a reality, those directly involved in DSD care must be given the necessary program planning and team implementation tools. This paper offers a protocol and set of tools to meet this need. We present a 6-step process to team formation, and a sample set of tools that can be used to guide, develop, and evaluate a team throughout the course of its operation. PMID:22792098

Teacher Design Teams (TDTs)--Building Capacity for Innovation, Learning and Curriculum Implementation in the Continuing Professional Development of In-Career Teachers

ERIC Educational Resources Information Center

Simmie, Geraldine Mooney

2007-01-01

From October to December 2005, six biology associates were employed to progress the connection between curriculum implementation and the continuing professional development of teachers at regional level. The associates worked with one hundred biology teachers in Teacher Design Teams (TDTs) and together they produced eighteen innovative classroom…

Nutrient and Sediment Reductions from Algal Flow-Way Technologies: Recommendations to the Chesapeake Bay Program's Water Quality Goal Implementation Team from the Algal Flow-Way Technologies BMP Expert Panel

USDA-ARS?s Scientific Manuscript database

The Chesapeake Stormwater Network hosted a workshop on July, 2012 to discuss the potential nutrient reductions from emerging stormwater technologies including algal flow-way technologies (AFTs). Workshop participants recommended the Chesapeake Bay Program’s Water Quality Goal Implementation Team(WQ...

Identifying the challenges and facilitators of implementing a COPD care bundle

PubMed Central

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

2014-01-01

Background Care bundles have been shown to improve outcomes, reduce hospital readmissions and reduce length of hospital stay; therefore increasing the speed of uptake and delivery of care bundles should be a priority in order to deliver more timely improvements and consistent high-quality care. Previous studies have detailed the difficulties of obtaining full compliance to bundle elements but few have described the underlying reasons for this. In order to improve future implementation this paper investigates the challenges encountered by clinical teams implementing a chronic obstructive pulmonary disease (COPD) care bundle and describes actions taken to overcome these challenges. Methods An initial retrospective documentary analysis of data from seven clinical implementation teams was undertaken to review the challenges faced by the clinical teams. Three focus groups with healthcare professionals and managers explored solutions to these challenges developed during the project. Results Documentary analysis identified 28 challenges which directly impacted implementation of the COPD care bundle within five themes; staffing, infrastructure, process, use of improvement methodology and patient and public involvement. Focus groups revealed that the five most significant challenges for all groups were: staff too busy, staff shortages, lack of staff engagement, added workload of the bundle and patient coding issues. The participants shared facilitating factors used to overcome issues including: shifting perceptions to improve engagement, further education sessions to increase staff participation and gaining buy-in from managers through payment frameworks. Conclusions Maximising the impact of a care bundle relies on its successful and timely implementation. Teams implementing the COPD care bundle encountered challenges that were common to all teams and sites. Understanding and learning from the challenges faced by previous endeavours and identifying the facilitators to overcoming these barriers provides an opportunity to mitigate issues that waste time and resources, and ensures that training can be tailored to the anticipated challenges. PMID:25478183

System Issues Related to Implementing on the Internet

NASA Technical Reports Server (NTRS)

Mackey, William; Bagg, Thomas C., III

1999-01-01

Implementing capabilities on the World Wide Web should never be taken lightly. A good systems engineer is able to examine such implementations from all points of view, including political, legal, security, access, technical deployment, and quality. The evacuation discussed in this paper was conducted to ensure that the National Aeronautics and Space Administration (NASA) was proceeding in a correct direction by implementing RECALL a Lessons Learned System on the Web and, subsequently, did so successfully. The systems approach extended well beyond technical implementation to several issue that are not often addressed by an implementation team. The resulting evaluation increased the team's sensitivity to such issues and, in fact, the authors believe that the evaluation provided as much benefit as the system itself.

Integrating TeamSTEPPS® into ambulatory reproductive health care: Early successes and lessons learned.

PubMed

Paul, Maureen E; Dodge, Laura E; Intondi, Evelyn; Ozcelik, Guzey; Plitt, Ken; Hacker, Michele R

2017-04-01

Most medical teamwork improvement interventions have occurred in hospitals, and more efforts are needed to integrate them into ambulatory care settings. In 2014, Affiliates Risk Management Services, Inc. (ARMS), the risk management services organization for a large network of reproductive health care organizations in the United States, launched a voluntary 5-year initiative to implement a medical teamwork system in this network using the TeamSTEPPS model. This article describes the ARMS initiative and progress made during the first 2 years, including lessons learned. The ARMS TeamSTEPPS program consists of the following components: preparation of participating organizations, TeamSTEPPS master training, implementation of teamwork improvement programs, and evaluation. We used self-administered questionnaires to assess satisfaction with the ARMS program and with the master training course. In the first 2 years, 20 organizations enrolled. Participants found the preparation phase valuable and were highly satisfied with the master training course. Although most attendees felt that the course imparted the knowledge and tools critical for TeamSTEPPS implementation, they identified time restraints and competing initiatives as potential barriers. The project team has learned valuable lessons about obtaining buy-in, consolidating the change teams, making the curriculum relevant, and evaluation. Ambulatory care settings require innovative approaches to integration of teamwork improvement systems. Evaluating and sharing lessons learned will help to hone best practices as we navigate this new frontier in the field of patient safety. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

Assessing the effectiveness of policy interventions to reduce the use of agency or temporary social workers in England.

PubMed

Cornes, Michelle; Manthorpe, Jill; Moriarty, Jo; Blendi-Mahota, Saidah; Hussein, Shereen

2013-05-01

There has been growing concern that English local authorities are over reliant on temporary staff to meet the shortage of social workers. This has been criticised as inefficient and costly while leading to problems of continuity and consistency for people using social work services. Focussing on recent policy and the implementation of new administrative procedures for the procurement and management of temporary or agency staff, this article explores progress being made towards achieving the previous government's policy goal that by 2020 local authorities will no longer need to rely on agency workers to carry out tasks that would normally be carried out by a permanent social worker. The article draws on the findings of an exploratory study (2007-2010) commissioned by the Department of Health which comprised of the following: a survey of local councils in England with adult social services responsibilities; case studies in three different localities; and qualitative interviews with stakeholders (n = 93). The findings suggest that while local authorities have reduced the costs of employing temporary staff through the setting up of intermediary control mechanisms, agency social workers continue to play important roles in teams and services. © 2013 Blackwell Publishing Ltd.

The effect of transforming care at the bedside initiative on healthcare teams' work environments.

PubMed

Lavoie-Tremblay, Mélanie; O'Conner, Patricia; Harripaul, Anastasia; Biron, Alain; Ritchie, Judith; Lavigne, Genevieve L; Baillargeon, Sophie; Ringer, Justin; Macgibbon, Brenda; Taylor-Ducharme, Sharon; Sourdif, Jacynthe

2014-02-01

Different initiatives have been implemented in healthcare organizations to improve efficiency, such as transforming care at the bedside (TCAB). However, there are important gaps in understanding the effect of TCAB on healthcare teams' work environments. The specific aim of the study is to describe findings regarding the TCAB initiative effects on healthcare teams' work environments. A pretest and posttest study design was used for this study. The TCAB initiative was implemented in fall 2010 in a university health center in Montreal, Canada. The sample consisted of healthcare workers from four different care units. Statistically significant improvement was observed with the communicating specific information subscale from the measure of processes of care variable, and a significant difference was found between the support from colleagues variable, which was higher at baseline than postprogram. The differences for psychological demand, decisional latitude, and effort-reward were not significant. TCAB is an intervention that allows healthcare teams to implement change to improve patients' and families' outcomes. Ongoing energy should focus on how to improve communication among all members of the team and ensure their support. © 2013 Sigma Theta Tau International.

Intensified Local Resource Mobilization for the Polio Eradication Initiative: The Experience of World Health Organization in Nigeria During 2008–2015

PubMed Central

Yehualashet, Yared G.; Horton, Janet; Mkanda, Pascal; Vaz, Rui G.; Afolabi, Oluwole; Gashu, Sisay G.; Banda, Richard; O'Malley, Helena; Nsubuga, Peter

2016-01-01

Background. Since the World Health Assembly (WHA) resolved in 1988 to eradicate poliovirus, several rounds of immunization campaigns have been conducted by member states. By 2000, with the support of the Global Polio Eradication Initiative (GPEI) partners, the number of polio cases decreased by 99%. Eradicating the remaining 1% proved to be more challenging. Although the GPEI, being the largest public health project, required >$9 billion between 1988 and 2012, economic analysis showed the estimated incremental net benefits of $40 billion–$50 billion between 1988 and 2035. In 2012, the WHA declared that the completion of poliovirus eradication is a programmatic emergency for global public health. Nigeria, as one of 3 remaining polio-endemic countries, developed an emergency plan to interrupt the transmission of poliovirus. The plan included the introduction or scale-up of various new innovations and strategies, which had substantial financial implication. Methods. This is a retrospective study to document the intensified resource mobilization efforts made by the World Health Organization (WHO) in Nigeria to meet the increased financial requirements and bridge the remaining gap in funding. In addition to the established coordination platforms, the WHO Nigeria Country Office team directly engaged with national authorities, donors, and partners throughout the process of resource requirement analysis, project appraisals, proposal development, and implementation of activities, joint monitoring, and evaluation exercises. The office strengthened its capacity for direct funds disbursement and systematic implementation of a rigorous accountability framework. Results. Between 2008 and May 2015, $538 million was mobilized locally, of which 82% was mobilized since 2012. The percentage of the total funding requirements that were locally mobilized averaged 31% between 2008 and 2011 and increased to 70% between 2012 and May 2015. During the same period, the WHO Nigeria Country Office team produced and submitted 102 grant reports and facilitated >20 joint project assessment exercises. Discussion. The polio program in Nigeria has achieved unprecedented gains, despite prevailing security and operational challenges, with no case of wild poliovirus infection since July 2014. Through rigorous, transparent, and accountable funds management practice, the WHO country office in Nigeria gained donors' confidence. The locally mobilized funds have made a remarkable contribution to the successful implementation of the strategies set out in the polio emergency plan. We face the challenges of a narrow donor-base, donor fatigue, and competition among other emerging agencies joining the polio eradication initiative efforts over the last few years. We actively engage the national authorities and partners for effective coordination of the polio eradication initiative program and harmonization of resources, using the existing platforms at national, state, and local levels. We recommend strengthening the local resource mobilization machinery and broadening the donor base, to support the polio endgame strategy. Such efforts should also be adopted to support routine immunization, introduction of new vaccines, and strengthening of health systems in the country as part of polio legacy planning. PMID:26912380

Intensified Local Resource Mobilization for the Polio Eradication Initiative: The Experience of World Health Organization in Nigeria During 2008-2015.

PubMed

Yehualashet, Yared G; Horton, Janet; Mkanda, Pascal; Vaz, Rui G; Afolabi, Oluwole; Gashu, Sisay G; Banda, Richard; O'Malley, Helena; Nsubuga, Peter

2016-05-01

Since the World Health Assembly (WHA) resolved in 1988 to eradicate poliovirus, several rounds of immunization campaigns have been conducted by member states. By 2000, with the support of the Global Polio Eradication Initiative (GPEI) partners, the number of polio cases decreased by 99%. Eradicating the remaining 1% proved to be more challenging. Although the GPEI, being the largest public health project, required >$9 billion between 1988 and 2012, economic analysis showed the estimated incremental net benefits of $40 billion-$50 billion between 1988 and 2035. In 2012, the WHA declared that the completion of poliovirus eradication is a programmatic emergency for global public health. Nigeria, as one of 3 remaining polio-endemic countries, developed an emergency plan to interrupt the transmission of poliovirus. The plan included the introduction or scale-up of various new innovations and strategies, which had substantial financial implication. This is a retrospective study to document the intensified resource mobilization efforts made by the World Health Organization (WHO) in Nigeria to meet the increased financial requirements and bridge the remaining gap in funding. In addition to the established coordination platforms, the WHO Nigeria Country Office team directly engaged with national authorities, donors, and partners throughout the process of resource requirement analysis, project appraisals, proposal development, and implementation of activities, joint monitoring, and evaluation exercises. The office strengthened its capacity for direct funds disbursement and systematic implementation of a rigorous accountability framework. Between 2008 and May 2015, $538 million was mobilized locally, of which 82% was mobilized since 2012. The percentage of the total funding requirements that were locally mobilized averaged 31% between 2008 and 2011 and increased to 70% between 2012 and May 2015. During the same period, the WHO Nigeria Country Office team produced and submitted 102 grant reports and facilitated >20 joint project assessment exercises. The polio program in Nigeria has achieved unprecedented gains, despite prevailing security and operational challenges, with no case of wild poliovirus infection since July 2014. Through rigorous, transparent, and accountable funds management practice, the WHO country office in Nigeria gained donors' confidence. The locally mobilized funds have made a remarkable contribution to the successful implementation of the strategies set out in the polio emergency plan. We face the challenges of a narrow donor-base, donor fatigue, and competition among other emerging agencies joining the polio eradication initiative efforts over the last few years. We actively engage the national authorities and partners for effective coordination of the polio eradication initiative program and harmonization of resources, using the existing platforms at national, state, and local levels. We recommend strengthening the local resource mobilization machinery and broadening the donor base, to support the polio endgame strategy. Such efforts should also be adopted to support routine immunization, introduction of new vaccines, and strengthening of health systems in the country as part of polio legacy planning. © 2016 World Health Organization; licensee Oxford Journals.

Implementation of the Arsenic Biosand Filter in Nepal

NASA Astrophysics Data System (ADS)

Murcott, S.; Ngai, T.; Shrestha, R.; Pokharel, K.; Walewijk, S.

2004-05-01

A low-cost, household-scale drinking water filter, the Arsenic Biosand Filter (ABF), appropriate for rural Nepal, was developed by researchers at Massachusetts Institute of Technology and two local partners (ENPHO and RWSSSP) to simultaneously remove arsenic and pathogens from tubewell water. The project implementation site is the Terai region of southern Nepal, where about 90% of people receive water from tubewells and where about 25+% and 40+% of tubewells are contaminated with arsenic (naturally-occurring) and coliforms (from human and animal sources) respectively, causing severe health consequences such as cancers and gastrointestinal illnesses. Despite growing recognition of the immediacy of the arsenic crisis in this region, many previous arsenic technology projects have failed. This is because many of the available technologies have serious drawbacks, including complex production methods, high maintenance, high costs, insufficient filtration rate, and/or reliance on materials unavailable in remote villages. In addition, most technologies treat arsenic and pathogens independently, resulting in complicated treatment operations. Implementation deficiencies including ineffective technology transfer, confusing NGO responsibilities, organizational non-sustainability, lack of user education and contribution, and inadequate long-term maintenance and monitoring capacity are other major problems. The ABF design is optimized based on the socio-economic conditions of rural Terai and is constructed using locally available labor and materials. It was the only arsenic remediation technology to win the prestigious World Bank Development Marketplace Competition in 2003. Funding from this prize will provide start-up capital to pilot a technology transfer network. In 2004, the team has established an in-country technology dissemination and implementation center and is building local capacity in arsenic-affected villages towards long-term, self-reliant, user-participatory safe water provision, involving training of local women, entrepreneurs, trainers, teachers, and local authorities. A laboratory and three month pilot study conducted in Nepal from September 2002 to January 2003 found that the ABF removed arsenic (range = 87 to 96%, mean = 93%), total coliform (range = 0 to 99%, mean = 58%), E. Coli (range = 0 to >99%, mean = 64%), and iron (range = >90 to >97 %, mean = >93%). This presentation will report on the results of the 2004 ABF implementation program in 25 villages in Nepal, targeting an overall population of 10,000 people and will discuss the ABF technology in the context of other similar low-cost household scale approaches to remediation of arsenic-contaminated groundwater.

Reported implementation lessons from a national quality improvement initiative; Productive Ward: Releasing Time to Care™. A qualitative, ward-based team perspective.

PubMed

White, Mark; Butterworth, Tony; Wells, John S G

2017-10-01

To explore the experiences of participants involved in the implementation of the Productive Ward: Releasing Time to Care™ initiative in Ireland, identifying key implementation lessons. A large-scale quality improvement programme Productive Ward: Releasing Time to Care™ was introduced nationwide into Ireland in 2011. We captured accounts from ward-based teams in an implementation phase during 2013-14 to explore their experiences. Semi-structured, in-depth interviews with a purposive sample of 24 members of ward-based teams from nine sites involved in the second national phase of the initiative were conducted. Interviews were analysed and coded under themes, using a seven-stage iterative process. The predominant theme identified was associated with the implementation and management of the initiative and included: project management; training; preparation; information and communication; and participant's negative experiences. The most prominent challenge reported related to other competing clinical priorities. Despite the structured approach of Productive Ward: Releasing Time to Care™, it appears that overstretched and busy clinical environments struggle to provide the right climate and context for ward-based teams to engage and interact actively with quality improvement tools, methods and activities. Findings highlight five key aspects of implementation and management that will help facilitate successful adoption of large-scale, ward-based quality improvement programmes such as Productive Ward: Releasing Time to Care™. Utilising pre-existing implementation or quality frameworks to assess each ward/unit for 'readiness' prior to commencing a quality improvement intervention such as Productive Ward: Releasing Time to Care™ should be considered. © 2017 John Wiley & Sons Ltd.

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

PubMed

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

2015-12-01

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

Team climate and attitudes toward information and communication technology among nurses on acute psychiatric wards.

PubMed

Koivunen, Marita; Anttila, Minna; Kuosmanen, Lauri; Katajisto, Jouko; Välimäki, Maritta

2015-01-01

Objectives: To describe the association of team climate with attitudes toward information and communication technology among nursing staff working on acute psychiatric wards. Background: Implementation of ICT applications in nursing practice brings new operating models to work environments, which may affect experienced team climate on hospital wards. Method: Descriptive survey was used as a study design. Team climate was measured by the Finnish modification of the Team Climate Inventory, and attitudes toward ICT by Burkes' questionnaire. The nursing staff (N = 181, n = 146) on nine acute psychiatric wards participated in the study. Results: It is not self-evident that experienced team climate associates with attitudes toward ICT, but there are some positive relationships between perceived team climate and ICT attitudes. The study showed that nurses' motivation to use ICT had statistically significant connections with experienced team climate, participative safety (p = 0.021), support for innovation (p = 0.042) and task orientation (p = 0.042). Conclusion: The results suggest that asserting team climate and supporting innovative operations may lead to more positive attitudes toward ICT. It is, in particular, possible to influence nurses' motivation to use ICT. More attention should be paid to psychosocial factors such as group education and co-operation at work when ICT applications are implemented in nursing.

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.

Adapting evidence-based clinical practice guidelines at university teaching hospitals: A model for the Eastern Mediterranean Region.

PubMed

Amer, Yasser S; Wahabi, Hayfaa A; Abou Elkheir, Manal M; Bawazeer, Ghada A; Iqbal, Shaikh M; Titi, Maher A; Ekhzaimy, Aishah; Alswat, Khalid A; Alzeidan, Rasmieh A; Al-Ansary, Lubna A

2018-04-24

Clinical practice guidelines (CPGs) are significant tools for evidence-based health care quality improvement. The CPG program at King Saud University was launched as a quality improvement program to fulfil the international accreditation standards. This program was a collaboration between the Research Chair for Evidence-Based Healthcare and Knowledge Translation and the Quality Management Department. This study aims to develop a fast-track method for adaptation of evidence-based CPGs and describe results of the program. Twenty-two clinical departments participated in the program. Following a CPGs awareness week directed to all health care professionals (HCPs), 22 teams were trained to set priorities, search, screen, assess, select, and customize the best available CPGs. The teams were technically supported by the program's CPG advisors. To address the local health care context, a modified version of the ADAPTE was used where recommendations were either accepted or rejected but not changed. A strict peer-review process for clinical content and methodology was employed. In addition to raising awareness and building capacity, 35 CPGs were approved for implementation by March 2018. These CPGs were integrated with other existing projects such as accreditation, electronic medical records, performance management, and training and education. Preliminary implementation audits suggest a positive impact on patient outcomes. Leadership commitment was a strength, but the high turnover of the team members required frequent and extensive training for HCPs. This model for CPG adaptation represents a quick, practical, economical method with a sense of ownership by staff. Using this modified version can be replicated in other countries to assess its validity. © 2018 John Wiley & Sons, Ltd.

SeaWiFS Technical Report Series. Volume 41; Case Studies for SeaWiFS Calibration and Validation

NASA Technical Reports Server (NTRS)

Yeh, Eueng-nan; Barnes, Robert A.; Darzi, Michael; Kumar, Lakshmi; Early, Edward A.; Johnson, B. Carol; Mueller, James L.; Trees, Charles C.

1997-01-01

This document provides brief reports, or case studies, on a number of investigations sponsored by the Calibration and Validation Team (CVT) within the Sea-viewing Wide Field-of-view Sensor (SeaWiFS) Project. Chapter I describes the calibration and characterization of the GSFC sphere, which was used in the recent recalibration of the SeaWiFS instrument. Chapter 2 presents a revision of the diffuse attenuation coefficient, K(490), algorithm based on the SeaWiFS wavelengths. Chapter 3 provides an implementation scheme for an algorithm to remove out-of-band radiance when using a sensor calibration based on a finite width (truncated) spectral response function, e.g., between the 1% transmission points. Chapter 4 describes the implementation schemes for the stray light quality flag (local area coverage [LAC] and global area coverage [GAC]) and the LAC stray light correction.

Engaging with clinicians to implement and evaluate the ICF in neurorehabilitation practice.

PubMed

Tempest, Stephanie; Jefferson, Richard

2015-01-01

Although deemed a globally accepted framework, there remains scare evidence on the process and outcome of implementing the International Classification of Functioning, Disability and Health (ICF) within neurorehabilitation. This review briefly explores the existing, broader literature and then reports on two action research projects, undertaken in England, specifically within stroke and neurorehabilitation. Working with participants, including clinicians from in-patient and community settings, there are now 35 different ways identified for the use of the ICF. The outcome of the first project highlights that using the ICF enhances communication within and beyond the acute stroke service, fosters holistic thinking and clarifies team roles. To adopt it into clinical practice, the ICF must be adapted to meet local service needs. The use of action research has facilitated the knowledge translation process which has enabled the ICF to become a clinical reality in neurorehabilitation, with clinicians identifying a range of potential uses.

Implementation of an interactive database interface utilizing HTML, PHP, JavaScript, and MySQL in support of water quality assessments in the Northeastern North Carolina Pasquotank Watershed

NASA Astrophysics Data System (ADS)

Guion, A., Jr.; Hodgkins, H.

2015-12-01

The Center of Excellence in Remote Sensing Education and Research (CERSER) has implemented three research projects during the summer Research Experience for Undergraduates (REU) program gathering water quality data for local waterways. The data has been compiled manually utilizing pen and paper and then entered into a spreadsheet. With the spread of electronic devices capable of interacting with databases, the development of an electronic method of entering and manipulating the water quality data was pursued during this project. This project focused on the development of an interactive database to gather, display, and analyze data collected from local waterways. The database and entry form was built in MySQL on a PHP server allowing participants to enter data from anywhere Internet access is available. This project then researched applying this data to the Google Maps site to provide labeling and information to users. The NIA server at http://nia.ecsu.edu is used to host the application for download and for storage of the databases. Water Quality Database Team members included the authors plus Derek Morris Jr., Kathryne Burton and Mr. Jeff Wood as mentor.

The Pediatric Obesity Initiative: development, implementation, and evaluation.

PubMed

Sample, Denise A; Carroll, Heather L; Barksdale, Debra J; Jessup, Ann

2013-09-01

Pediatric obesity rates have nearly tripled over the past three decades contributing to increased morbidity and mortality in the United States and around the world. Pediatric obesity is most prevalent in developed countries and affects all races, ethnicities, cultures, and age groups. To combat this epidemic locally, a team of dedicated providers developed a comprehensive evidenced-based toolkit and training program for clinical practices providing primary care services to children in a North Carolina county. The toolkit and training program were developed using the most current treatment guidelines for pediatric obesity and included resources developed by Healthy Carolinians. One unique feature of the training was a demonstration of motivational interviewing with additional resources included in the toolkit. Staff and providers in three pediatric practices and the local Health Department received the training. In a 3 months follow-up survey after the training, the providers indicated that the toolkit and training program were useful but that they still did not consistently use the guidelines or tools. Ensuring the use of available guidelines and resources by providers remains a challenge. Further study is needed on how to improve implementation of guidelines in primary care settings. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

Thetford plastics fire, October 1991: the role of a preventive medical team in chemical incidents.

PubMed Central

Baxter, P J; Heap, B J; Rowland, M G; Murray, V S

1995-01-01

OBJECTIVES--To review the role of a medical team in the emergency management of a major polyvinyl chloride (PVC) fire in an urban area. METHODS--The district health authority's consultant in communicable disease control (CCDC) was requested to advise on the health impacts of a fire that consumed some 1000 tonnes of plastic, mainly PVC, over 72 hours and which emitted a large smoke plume that threatened the health of local residents and emergency workers alike, constituting one of the largest incidents the local emergency services had dealt with in recent years. A medical team was formed comprising the CCDC, a regional epidemiologist, an occupational physician, and a medical toxicologist. This paper is an account of this team's experience of advising on the medical management of the emergency without having any formally established role or previous training for the task. RESULTS--The main issues requiring the input of the medical team included: the possible products of combustion and their effects on health; the clinical management of those exposed; the alerting of local hospitals to the type of casualties to expect; the special health risks posed to emergency workers, especially the firemen; the need for evacuation of local residents; the risks of contamination of soil, water, and crops; the potential health impact of the plume; and the provision of expert and authoritative advice on the short and long term health implications to the public. Active surveillance systems, which included the local general practitioners and hospitals, were established and air monitoring instigated. The 46 casualties were restricted to emergency personnel who had inadvertently received exposure to the fire smoke: all recovered within 48 hours. Local residents were unharmed. CONCLUSION--The incident showed the need for preventive medical teams trained to fill a formal advisory and investigative role for chemical releases and fires, and which can play an integral part in emergency management. PMID:7489061

Thetford plastics fire, October 1991: the role of a preventive medical team in chemical incidents.

PubMed

Baxter, P J; Heap, B J; Rowland, M G; Murray, V S

1995-10-01

To review the role of a medical team in the emergency management of a major polyvinyl chloride (PVC) fire in an urban area. The district health authority's consultant in communicable disease control (CCDC) was requested to advise on the health impacts of a fire that consumed some 1000 tonnes of plastic, mainly PVC, over 72 hours and which emitted a large smoke plume that threatened the health of local residents and emergency workers alike, constituting one of the largest incidents the local emergency services had dealt with in recent years. A medical team was formed comprising the CCDC, a regional epidemiologist, an occupational physician, and a medical toxicologist. This paper is an account of this team's experience of advising on the medical management of the emergency without having any formally established role or previous training for the task. The main issues requiring the input of the medical team included: the possible products of combustion and their effects on health; the clinical management of those exposed; the alerting of local hospitals to the type of casualties to expect; the special health risks posed to emergency workers, especially the firemen; the need for evacuation of local residents; the risks of contamination of soil, water, and crops; the potential health impact of the plume; and the provision of expert and authoritative advice on the short and long term health implications to the public. Active surveillance systems, which included the local general practitioners and hospitals, were established and air monitoring instigated. The 46 casualties were restricted to emergency personnel who had inadvertently received exposure to the fire smoke: all recovered within 48 hours. Local residents were unharmed. The incident showed the need for preventive medical teams trained to fill a formal advisory and investigative role for chemical releases and fires, and which can play an integral part in emergency management.

Using adapted quality-improvement approaches to strengthen community-based health systems and improve care in high HIV-burden sub-Saharan African countries.

PubMed

Horwood, Christiane M; Youngleson, Michele S; Moses, Edward; Stern, Amy F; Barker, Pierre M

2015-07-01

Achieving long-term retention in HIV care is an important challenge for HIV management and achieving elimination of mother-to-child transmission. Sustainable, affordable strategies are required to achieve this, including strengthening of community-based interventions. Deployment of community-based health workers (CHWs) can improve health outcomes but there is a need to identify systems to support and maintain high-quality performance. Quality-improvement strategies have been successfully implemented to improve quality and coverage of healthcare in facilities and could provide a framework to support community-based interventions. Four community-based quality-improvement projects from South Africa, Malawi and Mozambique are described. Community-based improvement teams linked to the facility-based health system participated in learning networks (modified Breakthrough Series), and used quality-improvement methods to improve process performance. Teams were guided by trained quality mentors who used local data to help nurses and CHWs identify gaps in service provision and test solutions. Learning network participants gathered at intervals to share progress and identify successful strategies for improvement. CHWs demonstrated understanding of quality-improvement concepts, tools and methods, and implemented quality-improvement projects successfully. Challenges of using quality-improvement approaches in community settings included adapting processes, particularly data reporting, to the education level and first language of community members. Quality-improvement techniques can be implemented by CHWs to improve outcomes in community settings but these approaches require adaptation and additional mentoring support to be successful. More research is required to establish the effectiveness of this approach on processes and outcomes of care.

Teamwork and delegation in medical homes: primary care staff perspectives in the Veterans Health Administration.

PubMed

True, Gala; Stewart, Greg L; Lampman, Michelle; Pelak, Mary; Solimeo, Samantha L

2014-07-01

The patient-centered medical home (PCMH) relies on a team approach to patient care. For organizations engaged in transitioning to a PCMH model, identifying and providing the resources needed to promote team functioning is essential. To describe team-level resources required to support PCMH team functioning within the Veterans Health Administration (VHA), and provide insight into how the presence or absence of these resources facilitates or impedes within-team delegation. Semi-structured interviews with members of pilot teams engaged in PCMH implementation in 77 primary care clinics serving over 300,000 patients across two VHA regions covering the Mid-Atlantic and Midwest United States. A purposive sample of 101 core members of pilot teams, including 32 primary care providers, 42 registered nurse care managers, 15 clinical associates, and 12 clerical associates. Investigators from two evaluation sites interviewed frontline primary care staff separately, and then collaborated on joint analysis of parallel data to develop a broad, comprehensive understanding of global themes impacting team functioning and within-team delegation. We describe four themes key to understanding how resources at the team level supported ability of primary care staff to work as effective, engaged teams. Team-based task delegation was facilitated by demarcated boundaries and collective identity; shared goals and sense of purpose; mature and open communication characterized by psychological safety; and ongoing, intentional role negotiation. Our findings provide a framework for organizations to identify assets already in place to support team functioning, as well as areas in need of improvement. For teams struggling to make practice changes, our results indicate key areas where they may benefit from future support. In addition, this research sheds light on how variation in medical home implementation and outcomes may be associated with variation in team-based task delegation.

Reducing Teenage Binge Drinking and Drunk Driving on the Reservation: The Pikanii Action Team

ERIC Educational Resources Information Center

Still Smoking, Dorothy; Bull Shoe, Debbie Whitegrass

2012-01-01

The Pikanii Action Team project addressed the issues of teenage drinking and drunk driving on the Blackfeet Reservation. Basing their actions on locally-generated research, the Pikanii Action Team conducted a series of activities and initiatives to promote public awareness and action related to high-risk activities related to drinking. The team's…

30 CFR 49.60 - Requirements for a local mine rescue contest.

Code of Federal Regulations, 2010 CFR

2010-07-01

... EDUCATION AND TRAINING MINE RESCUE TEAMS Mine Rescue Teams for Underground Coal Mines § 49.60 Requirements... United States; (2) Uses MSHA-recognized rules; (3) Has a minimum of three mine rescue teams competing; (4) Has one or more problems conducted on one or more days with a determined winner; (5) Includes team...

30 CFR 49.60 - Requirements for a local mine rescue contest.

Code of Federal Regulations, 2013 CFR

2013-07-01

... EDUCATION AND TRAINING MINE RESCUE TEAMS Mine Rescue Teams for Underground Coal Mines § 49.60 Requirements... United States; (2) Uses MSHA-recognized rules; (3) Has a minimum of three mine rescue teams competing; (4) Has one or more problems conducted on one or more days with a determined winner; (5) Includes team...

30 CFR 49.60 - Requirements for a local mine rescue contest.

Code of Federal Regulations, 2012 CFR

2012-07-01

... EDUCATION AND TRAINING MINE RESCUE TEAMS Mine Rescue Teams for Underground Coal Mines § 49.60 Requirements... United States; (2) Uses MSHA-recognized rules; (3) Has a minimum of three mine rescue teams competing; (4) Has one or more problems conducted on one or more days with a determined winner; (5) Includes team...

30 CFR 49.60 - Requirements for a local mine rescue contest.

Code of Federal Regulations, 2011 CFR

2011-07-01

... EDUCATION AND TRAINING MINE RESCUE TEAMS Mine Rescue Teams for Underground Coal Mines § 49.60 Requirements... United States; (2) Uses MSHA-recognized rules; (3) Has a minimum of three mine rescue teams competing; (4) Has one or more problems conducted on one or more days with a determined winner; (5) Includes team...

30 CFR 49.60 - Requirements for a local mine rescue contest.

Code of Federal Regulations, 2014 CFR

2014-07-01

... EDUCATION AND TRAINING MINE RESCUE TEAMS Mine Rescue Teams for Underground Coal Mines § 49.60 Requirements... United States; (2) Uses MSHA-recognized rules; (3) Has a minimum of three mine rescue teams competing; (4) Has one or more problems conducted on one or more days with a determined winner; (5) Includes team...

Interdisciplinary Team Teaching: An Effective Method to Transform Student Attitudes

ERIC Educational Resources Information Center

Little, Amanda; Hoel, Anne

2011-01-01

In order to maximize student development in an interdisciplinary context, we implemented and evaluated a business-biology team teaching approach. The class project involved teams of environmental science and business students analyzing an industry stakeholder interested in participating in the development of a community composting network. We…

The Virtual Intercultural Team Tool

ERIC Educational Resources Information Center

Rus, Calin

2010-01-01

This article describes the Virtual Intercultural Team Tool (VITT) and discusses its processes and benefits. VIIT is a virtual platform designed with the aim of assisting European project teams to improve intercultural communication and build on their cultural diversity for effective implementation of their projects. It is a process-focused tool,…

Development and Determination of Reliability and Validity of Professional Learning Community Collaborative Team Survey (CTS)

ERIC Educational Resources Information Center

Colvin, Joshua A.

2013-01-01

The study of transformative learning within collaborative teams was conducted to gain new applicable knowledge used to influence overall school improvement and implementation of professional learning communities. To obtain this new knowledge, the Professional Learning Community Collaborative Team Survey (CTS) was developed and psychometrically…

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

ERIC Educational Resources Information Center

Northeast Regional Exchange, Inc., Chelmsford, MA.

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

School Technology Leadership: Artifacts in Systems of Practice

ERIC Educational Resources Information Center

Dexter, Sara

2011-01-01

A cross-case analysis of five case studies of team-based technology leadership in middle schools with laptop programs identifies systems of practice that organize teams' distributed leadership. These cases suggest that successfully implementing a complex improvement effort warrants a team-based leadership approach, especially for an improvement…

From Iron Cages to Webs on Wind: Three Theses on Themes and Learning at Work.

ERIC Educational Resources Information Center

Engestrom, Yrjo

1999-01-01

Examines three theses: (1) work teams should be analyzed as object-oriented activity systems; (2) the nature of teams depends on the type of production in which they are implemented; and (3) fluid forms of collaborative work organization are displacing stable teams. (SK)

Understanding the Everyday Practice of Individualized Education Program Team Members

ERIC Educational Resources Information Center

Hartmann, Elizabeth S.

2016-01-01

The Individuals with Disabilities Education Improvement Act of 2004 states that individualized education program (IEP) teams are composed of members with distinct identities, roles, expertise, and histories. Although team members must work together to implement educational and related services for learners with special needs, little is known about…

Backstepping-based cooperative and adaptive tracking control design for a group of underactuated AUVs in horizontal plan

NASA Astrophysics Data System (ADS)

Ghommam, Jawhar; Saad, Maarouf

2014-05-01

In this paper, we investigate new implementable cooperative adaptive backstepping controllers for a group of underactuated autonomous vehicles that are communicating with their local neighbours to track a time-varying virtual leader of which the relative position may only be available to a portion of the team members. At the kinematic cooperative control level of the autonomous underwater vehicle, the virtual cooperative controller is basically designed on a proportional and derivative consensus algorithm presented in Ren (2010), which involves velocity information from local neighbours. In this paper, we propose a new design algorithm based on singular perturbation theory that precludes the use of the neighbours' velocity information in the cooperative design. At the dynamic cooperative control level, calculation of the partial derivatives of some stabilising functions which in turn will contain velocity information from the local neighbours is required. To facilitate the implementation of the cooperative controllers, we propose a command filter approach technique to avoid analytic differentiation of the virtual cooperative control laws. We show how Lyapunov-based techniques and graph theory can be combined together to yield a robust cooperative controller where the uncertain dynamics of the cooperating vehicles and the constraints on the communication topology which contains a directed spanning tree are explicitly taken into account. Simulation results with a dynamic model of underactuated autonomous underwater vehicles moving on the horizontal plane are presented and discussed.

Team Software Process (TSP) Coach Mentoring Program Guidebook

DTIC Science & Technology

2009-08-01

SEI TSP Initiative Team. • All training was conducted in English only, and observations were limited to English- speaking coaches and teams. The...Certified TSP Mentor Coach programs also enable the expansion of TSP implementation to non-English- speaking teams and organizations. This pro- gram also...Communication Needs Significant Improvement Could Benefit from Development Capable and Effective Role Model 1. I listen before speaking . 2. I

As good as it gets? Managing risks of cardiovascular disease in California's top-performing physician organizations.

PubMed

Rodriguez, Hector P; Ivey, Susan L; Raffetto, Brian J; Vaughn, Jennifer; Knox, Margae; Hanley, Hattie Rees; Mangione, Carol M; Shortell, Stephen M

2014-04-01

The California Right Care Initiative (RCI) accelerates the adoption of evidence-based guidelines and improved care management practices for conditions for which the gap between science and practice is significant, resulting in preventable disability and death. Medical directors and quality improvement leaders from 11 of the 12 physician organizations that met the 2010 national 90th percentile performance benchmarks for control of hyperlipidemia and glycated hemoglobin in 2011 were interviewed in 2012. Interviews, as well as surveys, assessed performance reporting and feedback to individual physicians; medication management protocols; team-based care management; primary care team huddles; coordination of care between primary care clinicians and specialists; implementation of shared medical appointments; and telephone visits for high-risk patients. All but 1 of 11 organizations implemented electronic health records. Electronic information exchange between primary care physicians and specialists, however, was uncommon. Few organizations routinely used interdisciplinary team approaches, shared medical appointments, or telephonic strategies for managing cardiovascular risks among patients. Implementation barriers included physicians' resistance to change, limited resources and reimbursement for team approaches, and limited organizational capacity for change. Implementation facilitators included routine use of reliable data to guide improvement, leadership facilitation of change, physician buy-in, health information technology use, and financial incentives. To accelerate improvements in managing cardiovascular risks, physician organizations may need to implement strategies involving extensive practice reorganization and work flow redesign.

[Tobacco control: an intersectorial experience in Tunja (Colombia)].

PubMed

Panader-Torres, Adriana; Agudelo-Cely, Nancy Aurora; Bolívar-Suárez, Yolima; Cárdenas-Cárdenas, Luz Mery

2014-01-01

Tobacco control in Colombia is regulated by Law 1335 of 2009. The implementation and monitoring of the provisions of this law require strengthening of intersectorial work at the local level. This field note presents an intersectorial work experience that was carried out in the municipality of Tunja (Colombia) to improve tobacco control. The Respirarte Group was established. This group consists of an intersectorial team composed of 15 institutions. The Respirarte Group achieved the following political and community actions: signing of an agreement on tobacco control by government actors, expedition of a local decree to comply with Law 1335 in the municipality, provision of information and communication, and social mobilization and monitoring. This experience serves as a national and international reference and its lessons could be used in the approach to other public health problems. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

Academic Leadership: Management of Groups or Leadership of Teams? A Multiple-Case Study on Designing and Implementing a Team-Based Development Programme for Academic Leadership

ERIC Educational Resources Information Center

Söderhjelm, Teresa; Björklund, Christina; Sandahl, Christer; Bolander-Laksov, Klara

2018-01-01

Demands on academic leadership are increasing, which raises the need for leadership training. This article describes development and implementation of a group training intervention in academic leadership at a departmental level. Little systematic research has addressed the question of what forms of leadership training are associated with…

The Contribution of the Self-Efficacy of Curriculum Development Team and Curriculum Document Quality to the Implementation of Diversified Curriculum in Indonesia

ERIC Educational Resources Information Center

Susilana, Rudi; Asra; Herlina

2014-01-01

The aim of this study is to describe how the self-efficacy of curriculum development team (CDT) and curriculum document quality contributed to the implementation of diversified curriculum in elementary schools. This research is a survey study using descriptive method. Schools were the unit of analysis while respondents selected from the schools…

Measuring unmet obstetric need at district level: how an epidemiological tool can affect health service organization and delivery.

PubMed

Guindo, Gabriel; Dubourg, Dominique; Marchal, Bruno; Blaise, Pierre; De Brouwere, Vincent

2004-10-01

A national retrospective survey on the unmet need for major obstetric surgery using the Unmet Obstetric Need Approach was carried out in Mali in 1999. In Koutiala, the district health team decided to carry on the monitoring of the met need for several years in order to assess their progress over time. The first prospective study, for 1999, estimated that more than 100 women in need of obstetric care never reached the hospital and probably died as a consequence. This surprising result shocked the district health team and the resulting increased awareness of service deficits triggered operational measures to tackle the problem. The Unmet Obstetric Need study in Koutiala district was implemented without financial support and only limited external technical back-up. The appropriation of the study by the district team for solving local problems of access to obstetric care may have contributed to the success of the experience. Used as a health service management tool, the study and its results started a dialogue between the hospital staff and both health centre staff and community representatives. This had not only the effect of triggering consideration of coverage, but also of quality of obstetric care. Copyright 2004 Oxford University Press

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.

Integrating team resource management program into staff training improves staff's perception and patient safety in organ procurement and transplantation: the experience in a university-affiliated medical center in Taiwan.

PubMed

Hsu, Ya-Chi; Jerng, Jih-Shuin; Chang, Ching-Wen; Chen, Li-Chin; Hsieh, Ming-Yuan; Huang, Szu-Fen; Liu, Yueh-Ping; Hung, Kuan-Yu

2014-08-11

The process involved in organ procurement and transplantation is very complex that requires multidisciplinary coordination and teamwork. To prevent error during the processes, teamwork education and training might play an important role. We wished to evaluate the efficacy of implementing a Team Resource Management (TRM) program on patient safety and the behaviors of the team members involving in the process. We implemented a TRM training program for the organ procurement and transplantation team members of the National Taiwan University Hospital (NTUH), a teaching medical center in Taiwan. This 15-month intervention included TRM education and training courses for the healthcare workers, focused group skill training for the procurement and transplantation team members, video demonstration and training, and case reviews with feedbacks. Teamwork culture was evaluated and all procurement and transplantation cases were reviewed to evaluate the application of TRM skills during the actual processes. During the intervention period, a total of 34 staff members participated the program, and 67 cases of transplantations were performed. Teamwork framework concept was the most prominent dimension that showed improvement from the participants for training. The team members showed a variety of teamwork behaviors during the process of procurement and transplantation during the intervention period. Of note, there were two potential donors with a positive HIV result, for which the procurement processed was timely and successfully terminated by the team. None of the recipients was transplanted with an infected organ. No error in communication or patient identification was noted during review of the case records. Implementation of a Team Resource Management program improves the teamwork culture as well as patient safety in organ procurement and transplantation.

Integrating team resource management program into staff training improves staff’s perception and patient safety in organ procurement and transplantation: the experience in a university-affiliated medical center in Taiwan

PubMed Central

2014-01-01

Background The process involved in organ procurement and transplantation is very complex that requires multidisciplinary coordination and teamwork. To prevent error during the processes, teamwork education and training might play an important role. We wished to evaluate the efficacy of implementing a Team Resource Management (TRM) program on patient safety and the behaviors of the team members involving in the process. Methods We implemented a TRM training program for the organ procurement and transplantation team members of the National Taiwan University Hospital (NTUH), a teaching medical center in Taiwan. This 15-month intervention included TRM education and training courses for the healthcare workers, focused group skill training for the procurement and transplantation team members, video demonstration and training, and case reviews with feedbacks. Teamwork culture was evaluated and all procurement and transplantation cases were reviewed to evaluate the application of TRM skills during the actual processes. Results During the intervention period, a total of 34 staff members participated the program, and 67 cases of transplantations were performed. Teamwork framework concept was the most prominent dimension that showed improvement from the participants for training. The team members showed a variety of teamwork behaviors during the process of procurement and transplantation during the intervention period. Of note, there were two potential donors with a positive HIV result, for which the procurement processed was timely and successfully terminated by the team. None of the recipients was transplanted with an infected organ. No error in communication or patient identification was noted during review of the case records. Conclusion Implementation of a Team Resource Management program improves the teamwork culture as well as patient safety in organ procurement and transplantation. PMID:25115403

Ecology of Greater Sage-Grouse in the Bi-State Planning Area Final Report, September 2007

USGS Publications Warehouse

Casazza, Michael L.; Overton, Cory T.; Farinha, Melissa A.; Torregrosa, Alicia; Fleskes, Joseph P.; Miller, Michael R.; Sedinger, James S.; Kolada, Eric J.

2009-01-01

Conservation efforts for greater sage-grouse (Centrocercus urophasianus), hereafter sage-grouse, are underway across the range of this species. Over 70 local working groups have been established and are implementing on-the-ground sage-grouse oriented conservation projects. Early on in this process, the California Department of Fish and Game (CDFG) recognized the need to join in these efforts and received funding from the U.S. Fish and Wildlife Service (USFWS) under the Candidate Species Conservation Program to help develop a species conservation plan for sage-grouse in the Mono County area. This conservation plan covers portions of Alpine, Mono, and Inyo counties in California and Douglas, Esmeralda, Lyon, and Mineral counties in Nevada. A concurrent effort underway through the Nevada Governor's Sage-grouse Conservation Team established Local Area Working Groups across Nevada and eastern California. The Mono County populations of sage-grouse were encompassed by the Bi-State Local Planning Area, which was comprised of six population management units (PMUs). The state agencies from California (CDFG) and Nevada (Nevada Department of Wildlife; NDOW) responsible for the management of sage-grouse agreed to utilize the process that had begun with the Nevada Governor's Team in order to develop local plans for conservation planning and implementation. Resources from the USFWS were applied to several objectives in support of the development of the Bi-State Local Area Sage-grouse Conservation Plan through a grant to the U.S. Geological Survey (USGS). Objectives included: (1) participate in the development of the Bi-State Conservation Plan, (2) compile and synthesize existing sage-grouse data, (3) document seasonal movements of sage-grouse, (4) identify habitats critical to sage-grouse, (5) determine survival rates and identify causal factors of mortality, (6) determine nest success and brood success of sage-grouse, and (7) identify sage-grouse lek sites. Progress reports completed in 2004 and 2005 addressed each of the specific objectives and this final report focuses on the biological information gathered in support of local conservation efforts. Participation in the development of the Bi-State Local Area Conservation Plan was accomplished on multiple scales. Beginning in the fall of 2002, USGS personnel began participating in meetings of local stakeholders involved in the development of a sage-grouse conservation plan for the Bi-State planning area. This included attendance at numerous local PMU group meetings and field trips as well as participating on the technical advisory committee (TAC) for the Bi-State group. Whenever appropriate, ongoing results and findings regarding sage-grouse ecology in the local area were incorporated into these working group meetings. In addition, the USGS partnered with CDFG to help reorganize one of the local PMU groups (South Mono) and edited that portion of the Bi-State plan. The USGS also worked closely with CDFG to draft a description of the state of knowledge for sage-grouse genetic information for inclusion in the Bi-State Conservation Plan. The first edition of the Bi-State Conservation Plan for Greater Sage-Grouse was completed in June 2004 (Bi-State Sage-grouse Conservation Team 2004). This report is organized primarily by PMU to facilitate the incorporation of these research findings into the individual PMU plans that compose the Bi-State plan. Information presented in this report was derived from over 7,000 radio-telemetry locations obtained on 145 individual sage-grouse during a three year period (2003-2005). In addition, we collected detailed vegetation measurements at over 590 habitat sampling plots within the study area including canopy cover, shrubs, forbs, and grasses diversity. Vegetation data collection focused on sage-grouse nests, and brood-use areas. Additionally we collected data at random sites to examine sage-grouse habitat relationships within the study area. The majori

Developing a targeted, theory-informed implementation intervention using two theoretical frameworks to address health professional and organisational factors: a case study to improve the management of mild traumatic brain injury in the emergency department.

PubMed

Tavender, Emma J; Bosch, Marije; Gruen, Russell L; Green, Sally E; Michie, Susan; Brennan, Sue E; Francis, Jill J; Ponsford, Jennie L; Knott, Jonathan C; Meares, Sue; Smyth, Tracy; O'Connor, Denise A

2015-05-25

Despite the availability of evidence-based guidelines for the management of mild traumatic brain injury in the emergency department (ED), variations in practice exist. Interventions designed to implement recommended behaviours can reduce this variation. Using theory to inform intervention development is advocated; however, there is no consensus on how to select or apply theory. Integrative theoretical frameworks, based on syntheses of theories and theoretical constructs relevant to implementation, have the potential to assist in the intervention development process. This paper describes the process of applying two theoretical frameworks to investigate the factors influencing recommended behaviours and the choice of behaviour change techniques and modes of delivery for an implementation intervention. A stepped approach was followed: (i) identification of locally applicable and actionable evidence-based recommendations as targets for change, (ii) selection and use of two theoretical frameworks for identifying barriers to and enablers of change (Theoretical Domains Framework and Model of Diffusion of Innovations in Service Organisations) and (iii) identification and operationalisation of intervention components (behaviour change techniques and modes of delivery) to address the barriers and enhance the enablers, informed by theory, evidence and feasibility/acceptability considerations. We illustrate this process in relation to one recommendation, prospective assessment of post-traumatic amnesia (PTA) by ED staff using a validated tool. Four recommendations for managing mild traumatic brain injury were targeted with the intervention. The intervention targeting the PTA recommendation consisted of 14 behaviour change techniques and addressed 6 theoretical domains and 5 organisational domains. The mode of delivery was informed by six Cochrane reviews. It was delivered via five intervention components : (i) local stakeholder meetings, (ii) identification of local opinion leader teams, (iii) a train-the-trainer workshop for appointed local opinion leaders, (iv) local training workshops for delivery by trained local opinion leaders and (v) provision of tools and materials to prompt recommended behaviours. Two theoretical frameworks were used in a complementary manner to inform intervention development in managing mild traumatic brain injury in the ED. The effectiveness and cost-effectiveness of the developed intervention is being evaluated in a cluster randomised trial, part of the Neurotrauma Evidence Translation (NET) program.

Information Issues and Contexts that Impair Team Based Communication Workflow: A Palliative Sedation Case Study.

PubMed

Cornett, Alex; Kuziemsky, Craig

2015-01-01

Implementing team based workflows can be complex because of the scope of providers involved and the extent of information exchange and communication that needs to occur. While a workflow may represent the ideal structure of communication that needs to occur, information issues and contextual factors may impact how the workflow is implemented in practice. Understanding these issues will help us better design systems to support team based workflows. In this paper we use a case study of palliative sedation therapy (PST) to model a PST workflow and then use it to identify purposes of communication, information issues and contextual factors that impact them. We then suggest how our findings could inform health information technology (HIT) design to support team based communication workflows.

Stress Prevention@Work: a study protocol for the evaluation of a multifaceted integral stress prevention strategy to prevent employee stress in a healthcare organization: a cluster controlled trial.

PubMed

Hoek, Rianne J A; Havermans, Bo M; Houtman, Irene L D; Brouwers, Evelien P M; Heerkens, Yvonne F; Zijlstra-Vlasveld, Moniek C; Anema, Johannes R; van der Beek, Allard J; Boot, Cécile R L

2017-07-17

Adequate implementation of work-related stress management interventions can reduce or prevent work-related stress and sick leave in organizations. We developed a multifaceted integral stress-prevention strategy for organizations from several sectors that includes a digital platform and collaborative learning network. The digital platform contains a stepwise protocol to implement work-related stress-management interventions. It includes stress screeners, interventions and intervention providers to facilitate access to and the selection of matching work-related stress-management interventions. The collaborative learning network, including stakeholders from various organizations, plans meetings focussing on an exchange of experiences and good practices among organizations for the implementation of stress prevention measures. This paper describes the design of an integral stress-prevention strategy, Stress Prevention@Work, and the protocol for the evaluation of: 1) the effects of the strategy on perceived stress and work-related outcomes, and 2) the barriers and facilitators for implementation of the strategy. The effectiveness of Stress Prevention@Work will be evaluated in a cluster controlled trial, in a large healthcare organization in the Netherlands, at six and 12 months. An independent researcher will match teams on working conditions and size and allocate the teams to the intervention or control group. Teams in the intervention group will be offered Stress Prevention@Work. For each intervention team, one employee is responsible for applying the strategy within his/her team using the digital platform and visiting the collaborative learning network. Using a waiting list design, the control group will be given access to the strategy after 12 months. The primary outcome is the employees' perceived stress measured by the stress subscale of the Depression, Anxiety, and Stress Scale (DASS-21). Secondary outcome measures are job demands, job resources and the number of preventive stress measures implemented at the team level. Alongside the trial, a process evaluation, including barriers and facilitators of the implementation of Stress Prevention@Work, will be conducted in one healthcare organisation. If Stress Prevention@Work is found to be effective in one healthcare organisation, further implementation on a broader scale might lead to increased productivity and decreased stress and sick leave in other organizations. Results are expected in 2018. NTR5527 . Registered 7 Dec 2015.

Acute Care for Elders (ACE) Tracker and e-Geriatrician: Methods to Disseminate ACE Concepts to Hospitals with No Geriatricians on Staff

PubMed Central

Malone, Michael L.; Vollbrecht, Marsha; Stephenson, Jeff; Burke, Laura; Pagel, Patti; Goodwin, James S.

2014-01-01

This article describes an innovative method to disseminate the Acute Care for Elders (ACE) model of care for hospitalized older patients implemented at 11 community hospitals in Wisconsin. The ACE Tracker is a computer-generated checklist of all older patients in a facility that takes information from multiple areas of the electronic medical record to identify the older patients’ risk factors for functional decline and poor outcomes. The ACE Tracker report was validated against in-person observation of the older patients and found to be accurate. Interdisciplinary teams on medical–surgical units use this summary report to review each patient’s plan of care and to efficiently assess the patients who are vulnerable to poor hospital outcomes. The ACE Tracker is also used during regular consultation provided through teleconferencing between an off-site geriatrician (e-Geriatrician) and the local ACE team. The effect of the ACE Tracker and e-Geriatrician models was assessed by measuring use of urinary catheters, physical restraints, high-risk medications, and social service evaluation at a single hospital for the 6 months before and after implementation of the models. There were significant improvements in urinary catheter and physical therapy referrals but no significant changes in the other outcomes. There was no change in the length of stay or in the rate of hospital readmission within 30 days. PMID:20122048

The new clinical leadership role of senior charge nurses: a mixed methods study of their views and experience.

PubMed

Stoddart, Kathleen; Bugge, Carol; Shepherd, Ashley; Farquharson, Barbara

2014-01-01

To investigate the experience and views of senior charge nurses in relation to the implementation of a national clinical leadership policy. The role of the senior charge nurse in providing clinical leadership is evolving. However, recent evidence suggests that research is needed to inform the development of leadership and quality improvement and to connect them. Data were collected using an electronic survey to all senior charge nurses in one locality and semi-structured interviews with a subsample of respondents. Fifty (54%) senior charge nurses responded to the survey and nine were interviewed. Senior charge nurses reported mainly positive perceptions of clinical leadership, clinical team performance and improvement of care delivery for patients following the leadership programme implementation. Themes related to confidence, quality improvement and team performance were generated. 'Leading Better Care' was reported to enhance senior charge nurse clinical leadership, with some development needed to link the details of change management with the wider strategic direction. Nurse managers may wish to ensure that their clinical leaders have clarity of role in order to inspire confidence. Some challenges were noted in achieving improvement in quality and it is possible that if improvement in quality is the cornerstone of patient-centred care then it needs to be placed centrally in workload considerations. © 2012 John Wiley & Sons Ltd.

Moving Beyond Motive-based categories of Targeted Violence

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

Weine, Stevan; Cohen, John; Brannegan, David

Today’s categories for responding to targeted violence are motive-based and tend to drive policies, practices, training, media coverage, and research. These categories are based on the assumption that there are significant differences between ideological and non-ideological actors and between domestic and international actors. We question the reliance on these categories and offer an alternative way to frame the response to multiple forms of targeted violence. We propose adopting a community-based multidisciplinary approach to assess risk and provide interventions that are focused on the pre-criminal space. We describe four capabilities that should be implemented locally by establishing and maintaining multidisciplinary responsemore » teams that combine community and law-enforcement components: (1) community members are educated, making them better able to identify and report patterns associated with elevated risk for violence; (2) community-based professionals are trained to assess the risks for violent behavior posed by individuals; (3) community-based professionals learn to implement strategies that directly intervene in causal factors for those individuals who are at elevated risk; and (4) community-based professionals learn to monitor and assess an individual’s risk for violent behaviors on an ongoing basis. Community-based multidisciplinary response teams have the potential to identify and help persons in the pre-criminal space and to reduce barriers that have traditionally impeded community/law-enforcement collaboration.« less

The Process of Creating Integrated Home Care in Lithuania: from Idea to Reality

PubMed Central

Jurkuvienė, Ramunė; Butkevičienė, Rūta; Gajdosikienė, Indrė

2016-01-01

Background: The article presents an analysis of the formulation and implementation of a social innovation: integrated home care (IHC) in post-soviet Lithuania. From 1998 a series of top-down orders to implement IHC were issued, however, home nursing did not start. In 2011 the Ministry of Social Security and Labour began a process to develop integrated home care using new, collaborative processes. The result was 21 pilot projects with well-conceptualized IHC services. Method: Using data from focus groups, interviews, and recorded observations, the research team systematically documented the innovation process, including themes and deviations, employing Smale’s Innovation Trinity framework to organize the larger picture. Results: In the Lithuanian post-totalitarian context, top-down communication was found to be prevalent. Not only IHC, but also openness to change and dialogue at high levels were innovations. Patient-centered practice at local levels could only occur when a new attitude of mind was reached through dialogue with officials at higher levels and between peers. Conclusions: The enactment, rather than the mask of dialogue, participatory program development were critical in the success of IHC innovation. This is difficult to achieve in the light of antiquated public bureaucracies, but in this case, the Ministry team, rather than avoiding the expectation of top-down communication, made it into an asset through promotion of collaboration. PMID:28435419

Building Statewide Infrastructure for the Academic Support of Students With Mild Traumatic Brain Injury.

PubMed

Gioia, Gerard A; Glang, Ann E; Hooper, Stephen R; Brown, Brenda Eagan

To focus attention on building statewide capacity to support students with mild traumatic brain injury (mTBI)/concussion. Consensus-building process with a multidisciplinary group of clinicians, researchers, policy makers, and state Department of Education personnel. The white paper presents the group's consensus on the essential components of a statewide educational infrastructure to support the management of students with mTBI. The nature and recovery process of mTBI are briefly described specifically with respect to its effects on school learning and performance. State and local policy considerations are then emphasized to promote implementation of a consistent process. Five key components to building a statewide infrastructure for students with mTBI are described including (1) definition and training of the interdisciplinary school team, (2) professional development of the school and medical communities, (3) identification, assessment, and progress monitoring protocols, (4) a flexible set of intervention strategies to accommodate students' recovery needs, and (5) systematized protocols for active communication among medical, school, and family team members. The need for a research to guide effective program implementation is stressed. This guiding framework strives to assist the development of support structures for recovering students with mTBI to optimize academic outcomes. Until more evidence is available on academic accommodations and other school-based supports, educational systems should follow current best practice guidelines.

Process evaluation of two participatory approaches: Implementing total worker health® interventions in a correctional workforce.

PubMed

Dugan, Alicia G; Farr, Dana A; Namazi, Sara; Henning, Robert A; Wallace, Kelly N; El Ghaziri, Mazen; Punnett, Laura; Dussetschleger, Jeffrey L; Cherniack, Martin G

2016-10-01

Correctional Officers (COs) have among the highest injury rates and poorest health of all the public safety occupations. The HITEC-2 (Health Improvement Through Employee Control-2) study uses Participatory Action Research (PAR) to design and implement interventions to improve health and safety of COs. HITEC-2 compared two different types of participatory program, a CO-only "Design Team" (DT) and "Kaizen Event Teams" (KET) of COs and supervisors, to determine differences in implementation process and outcomes. The Program Evaluation Rating Sheet (PERS) was developed to document and evaluate program implementation. Both programs yielded successful and unsuccessful interventions, dependent upon team-, facility-, organizational, state-, facilitator-, and intervention-level factors. PAR in corrections, and possibly other sectors, depends upon factors including participation, leadership, continuity and timing, resilience, and financial circumstances. The new PERS instrument may be useful in other sectors to assist in assessing intervention success. Am. J. Ind. Med. 59:897-918, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Harnessing Protocolized Adaptation in Dissemination: Successful Implementation and Sustainment of the Veterans Affairs Coordinated-Transitional Care Program in a Non-Veterans Affairs Hospital.

PubMed

Kind, Amy J H; Brenny-Fitzpatrick, Maria; Leahy-Gross, Kris; Mirr, Jacquelyn; Chapman, Elizabeth; Frey, Brooke; Houlahan, Beth

2016-02-01

The Department of Veterans Affairs (VA) Coordinated-Transitional Care (C-TraC) program is a low-cost transitional care program that uses hospital-based nurse case managers, inpatient team integration, and in-depth posthospital telephone contacts to support high-risk patients and their caregivers as they transition from hospital to community. The low-cost, primarily telephone-based C-TraC program reduced 30-day rehospitalizations by one-third, leading to significant cost savings at one VA hospital. Non-VA hospitals have expressed interest in launching C-TraC, but non-VA hospitals differ in important ways from VA hospitals, particularly in terms of context, culture, and resources. The objective of this project was to adapt C-TraC to the specific context of one non-VA setting using a modified Replicating Effective Programs (REP) implementation theory model and to test the feasibility of this protocolized implementation approach. The modified REP model uses a mentored phased-based implementation with intensive preimplementation activities and harnesses key local stakeholders to adapt processes and goals to local context. Using this protocolized implementation approach, an adapted C-TraC protocol was created and launched at the non-VA hospital in July 2013. In its first 16 months, C-TraC successfully enrolled 1,247 individuals with 3.2 full-time nurse case managers, achieving good fidelity for core protocol steps. C-TraC participants experienced a 30-day rehospitalization rate of 10.8%, compared with 16.6% for a contemporary comparison group of similar individuals for whom C-TraC was not available (n = 1,307) (P < .001). The new C-TraC program continues in operation. Use of a modified REP model to guide protocolized adaptation to local context resulted in a C-TraC program that was feasible and sustained in a real-world non-VA setting. A modified REP implementation framework may be an appropriate foundational step for other clinical programs seeking to harness protocolized adaptation in mentored dissemination activities. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Outcomes of an Innovative Evidence-Based Practice Project: Building a Difficult-Access Team in the Emergency Department.

PubMed

Whalen, Madeleine; Maliszewski, Barbara; Sheinfeld, Rebecca; Gardner, Heather; Baptiste, Diana

2018-04-25

Difficult venous access is a common problem in health care-especially in the emergency setting-that relies on quick diagnostics to differentiate patient acuities and administer critical medications. The creation of a dedicated team to address difficult venous access (DVA) is a possible solution to the problems of delayed venous access, yet no studies have been published on implementing such a team in the emergency department. This was a quasi-experimental study in an urban emergency department. Researchers performed chart audits of staff-identified patients with DVA to gather baseline data. A DVA team was subsequently implemented 16 hours a day, 7 days a week. Data were recorded on patients referred to the team and included time, number of IV attempts, and patient characteristics. Baseline data were collected on 53 patients, and postintervention data included 135 patients. The implementation of a DVA team decreased the mean lab order-to-lab completion time by 115 minutes (P < 0.0001). Decreases in the number of attempts were not statistically significant. Patients requiring increased numbers of IV attempts also had many common characteristics including history of multiple attempts, poor skin quality, and IV drug use. The use of a dedicated team for DVA reduces the lag time from physician orders to actionable diagnostics or administration of medication. A dedicated DVA technician is a concrete solution to threats of patient safety, as well as ED crowding, and has the potential to affect both patient- and department-level care. Copyright © 2018 Elsevier Inc. All rights reserved.

Electromagnetic system for detection and localization of the miners caught by accident in mine

NASA Astrophysics Data System (ADS)

Pronenko, Vira; Dudkin, Fedir

2016-04-01

It is well known that the profession of a miner is one of the most dangerous in the world. Among the main causes of the people death in the underground coal mining enterprises is their untimely alerting of the accident, as well as the lack of information for the rescuers about the actual location of the miners after the accident. As world practice shows, the electromagnetic (EM) systems for the search and detection of people across a massive layer of rock are the most effective. Such systems are under development almost half a century in many countries dealing with mine industry. However, substantial progress related to the localization of personnel at a distance at least of 20-30 meters through the rock is not reached. In an emergency situation (failure or destruction of underground infrastructure), personnel search behind and beneath of obstruction should be provided urgently. But none of the standard technologies (RFID, DECT, WiFi, emitting cable), which use the stationary technical devices in mines, do not provide notification of people caught by accident location. The only technology that provides guaranteed delivery of messages about the accident to the mine personnel, regardless of their location and under any destruction in the mine, is low-frequency radio technology able to operate through the thickness of rocks. From the general theoretical considerations, it is clear that the miners localization system requires solving the inverse problem of the magnetic field source coordinates determining using the data of 3-component magnetic field measurements. A fundamentally new approach, based on the measurement of the magnetic field of the miner's responder beacon by two fixed and spaced three-component magnetic field receivers and solution of the inverse problem using the results of the magnetic field measurement, was proposed. As a result, the concept of the equipment for miners beacon search and localization implementation (MILES - miner's location emergency system) was designed. The system consists of: - miner's responder beacon (MRB) which is working using a principle of "friend or foe". MRB consists of transmitting coil (MC - miner's coil), powered by a crystal-controlled oscillator and magnetic field receiver (MS - miner's sensor) with a circuit for extraction and identifying of the individually coded pulse sequence dispatched by rescue team instrumentation; - rescue team instrumentation (RTI), consisting of the source of magnetic field (RTC - rescue team coil) to call a specific MRB, and two three-component magnetic field receivers (RTS - rescue team sensors), connected to a portable computer such as a laptop. The details of MILES system are presented in the report, as well as the results of its tests are discussed. They showed that the system has a high resource for remote operation even in the presence of large amounts of ferromagnetic masses between the miner's responder beacon and the rescue team instrumentation and under the influence of electromagnetic interference. The MILES assured miner's responder beacon call at the distance up to 100 m, and its detection and localization - up to 30 meters.

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.

Improvement in neonatal intensive care unit care: a cluster randomised controlled trial of active dissemination of information.

PubMed

Acolet, Dominique; Allen, Elizabeth; Houston, Rosie; Wilkinson, Andrew R; Costeloe, Kate; Elbourne, Diana

2011-11-01

Research findings are not rapidly or fully implemented into policies and practice in care. To assess whether an 'active' strategy was more likely to lead to changes in policy and practice in preterm baby care than traditional information dissemination. Cluster randomised trial. 180 neonatal units (87 active, 93 control) in England; clinicians from active arm units; babies born <27 weeks gestation. CONTROL ARM: Dissemination of research report; slides; information about newborn care position statement. ACTIVE ARM: As above plus offer to become 'regional 'champion' (attend two workshops, support clinicians to implement research evidence regionally), or attend one workshop, promote implementation of research evidence locally. timing of surfactant administration; admission temperature; staffing of resuscitation team present at birth. 48/87 Lead clinicians in the active arm attended one or both workshops. There was no evidence of difference in post-intervention policies between trial arms. Practice outcomes based on babies in the active (169) and control arms (186), in 45 and 49 neonatal units respectively, showed active arm babies were more likely to have been given surfactant on labour ward (RR=1.30; 95% CI 0.99 to 1.70); p=0.06); to have a higher temperature on admission to neonatal intensive care unit (mean difference=0.29(o)C; 95% CI 0.22 to 0.55; p=0.03); and to have had the baby's trunk delivered into a plastic bag (RR=1.27; 95% CI 1.01 to 1.60; p=0.04) than the control group. The effect on having an 'ideal' resuscitation team at birth was in the same direction of benefit for the active arm (RR=1.18; 95% CI 0.97 to 1.43; p=0.09). The costs of the intervention were modest. This is the first trial to evaluate methods for transferring information from neonatal research into local policies and practice in England. An active approach to research dissemination is both feasible and cost-effective. Current controlled trials ISRCTN89683698.

Promoting Best Practices regarding Exertional Heat Stroke: A Perspective from the Team Physician

ERIC Educational Resources Information Center

Mazerolle, Stephanie M.; Pagnotta, Kelly D.; McDowell, Lindsey; Casa, Douglas J.; Armstrong, Lawrence

2012-01-01

Context: Knowing the team physician's perspective regarding the use of evidence-based practice (EBP) for treatment of exertional heat stroke (EHS) may help increase the number of athletic trainers (ATs) implementing best practices and avoiding the use of improper assessment tools and treatment methods. Objective: To ascertain team physicians'…

Insights of health district managers on the implementation of primary health care outreach teams in Johannesburg, South Africa: a descriptive study with focus group discussions.

PubMed

Moosa, Shabir; Derese, Anselme; Peersman, Wim

2017-01-21

Primary health care (PHC) outreach teams are part of a policy of PHC re-engineering in South Africa. It attempts to move the deployment of community health workers (CHWs) from vertical programmes into an integrated generalised team-based approach to care for defined populations in municipal wards. There has little evaluation of PHC outreach teams. Managers' insights are anecdotal. This is descriptive qualitative study with focus group discussions with health district managers of Johannesburg, the largest city in South Africa. This was conducted in a sequence of three meetings with questions around implementation, human resources, and integrated PHC teamwork. There was a thematic content analysis of validated transcripts using the framework method. There were two major themes: leadership-management challenges and human resource challenges. Whilst there was some positive sentiment, leadership-management challenges loomed large: poor leadership and planning with an under-resourced centralised approach, poor communications both within the service and with community, concerns with its impact on current services and resistance to change, and poor integration, both with other streams of PHC re-engineering and current district programmes. Discussion by managers on human resources was mostly on the plight of CHWs and calls for formalisation of CHWs functioning and training and nurse challenges with inappropriate planning and deployment of the team structure, with brief mention of the extended team. Whilst there is positive sentiment towards intent of the PHC outreach team, programme managers in Johannesburg were critical of management of the programme in their health district. Whilst the objective of PHC reform is people-centred health care, its implementation struggles with a centralising tendency amongst managers in the health service in South Africa. Managers in Johannesburg advocated for decentralisation. The implementation of PHC outreach teams is also limited by difficulties with formalisation and training of CHWs and appropriate task shifting to nurses. Change management is required to create true integrate PHC teamwork. Policy review requires addressing these issues.

Dedication increases productivity: an analysis of the implementation of a dedicated medical team in the emergency department.

PubMed

Ramos, Pedro; Paiva, José Artur

2017-12-01

In several European countries, emergency departments (EDs) now employ a dedicated team of full-time emergency medicine (EM) physicians, with a distinct leadership and bed-side emergency training, in all similar to other hospital departments. In Portugal, however, there are still two very different models for staffing EDs: a classic model, where EDs are mostly staffed with young inexperienced physicians from different medical departments who take turns in the ED in 12-h shifts and a dedicated model, recently implemented in some hospitals, where the ED is staffed by a team of doctors with specific medical competencies in emergency medicine that work full-time in the ED. Our study assesses the effect of an intervention in a large academic hospital ED in Portugal in 2002, and it is the first to test the hypothesis that implementing a dedicated team of doctors with EM expertise increases the productivity and reduces costs in the ED, maintaining the quality of care provided to patients. A pre-post design was used for comparing the change on the organisational model of delivering care in our medical ED. All emergency medical admissions were tracked in 2002 (classic model with 12-h shift in the ED) and 2005/2006 (dedicated team with full-time EM physicians), and productivity, costs with medical human resources and quality of care measures were compared. We found that medical productivity (number of patients treated per hour of medical work) increased dramatically after the creation of the dedicated team (X 2 KW = 31.135; N = 36; p < 0.001) and costs with ED medical work reduced both in regular hours and overtime. Moreover, hospitalisation rates decreased and the length of stay in the ED increased significantly after the creation of the dedicated team. Implementing a dedicated team of doctors increased the medical productivity and reduced costs in our ED. Our findings have straightforward implication for Portuguese policymakers aiming at reducing hospital costs while coping with increased ED demand.

The power of a collaborative relationship between technical assistance providers and community prevention teams: A correlational and longitudinal study

PubMed Central

Chilenski, Sarah M.; Perkins, Daniel F.; Olson, Jonathan; Hoffman, Lesa; Feinberg, Mark E.; Greenberg, Mark; Welsh, Janet; Crowley, D. Max; Spoth, Richard

2015-01-01

Background Historically, effectiveness of community collaborative prevention efforts has been mixed. Consequently, research has been undertaken to better understand the factors that support their effectiveness; theory and some related empirical research suggests that the provision of technical assistance is one important supporting factor. The current study examines one aspect of technical assistance that may be important in supporting coalition effectiveness, the collaborative relationship between the technical assistance provider and site lead implementer. Methods Four and one-half years of data were collected from technical assistance providers and prevention team members from the 14 community prevention teams involved in the PROSPER project. Results Spearman correlation analyses with longitudinal data show that the levels of the collaborative relationship during one phase of collaborative team functioning associated with characteristics of internal team functioning in future phases. Conclusions Results suggest that community collaborative prevention work should consider the collaborative nature of the technical assistance provider – prevention community team relationship when designing and conducting technical assistance activities, and it may be important to continually assess these dynamics to support high quality implementation. PMID:26476860

Performance factors in women's team handball: physical and physiological aspects--a review.

PubMed

Manchado, Carmen; Tortosa-Martínez, Juan; Vila, Helena; Ferragut, Carmen; Platen, Petra

2013-06-01

Team handball is an Olympic sport played professionally in many European countries. Nevertheless, a scientific knowledge regarding women's elite team handball demands is limited. Thus, the purpose of this article was to review a series of studies (n = 33) on physical characteristics, physiological attributes, physical attributes, throwing velocity, and on-court performances of women's team handball players. Such empirical and practical information is essential to design and implement successful short-term and long-term training programs for women's team handball players. Our review revealed that (a) players that have a higher skill level are taller and have a higher fat-free mass; (b) players who are more aerobically resistant are at an advantage in international level women team handball; (c) strength and power exercises should be emphasized in conditioning programs, because they are associated with both sprint performance and throwing velocity; (d) speed drills should also be implemented in conditioning programs but after a decrease in physical training volume; (e) a time-motion analysis is an effective method of quantifying the demands of team handball and provides a conceptual framework for the specific physical preparation of players. According to our results, there are only few studies on on-court performance and time-motion analysis for women's team handball players, especially concerning acceleration profiles. More studies are needed to examine the effectiveness of different training programs of women's team handball players' physiological and physical attributes.

The Cooperate Assistive Teamwork Environment for Software Description Languages.

PubMed

Groenda, Henning; Seifermann, Stephan; Müller, Karin; Jaworek, Gerhard

2015-01-01

Versatile description languages such as the Unified Modeling Language (UML) are commonly used in software engineering across different application domains in theory and practice. They often use graphical notations and leverage visual memory for expressing complex relations. Those notations are hard to access for people with visual impairment and impede their smooth inclusion in an engineering team. Existing approaches provide textual notations but require manual synchronization between the notations. This paper presents requirements for an accessible and language-aware team work environment as well as our plan for the assistive implementation of Cooperate. An industrial software engineering team consisting of people with and without visual impairment will evaluate the implementation.

A Mixed Methods Approach to Evaluate Partnerships and Implementation of the Massachusetts Prevention and Wellness Trust Fund.

PubMed

Lee, Rebekka M; Ramanadhan, Shoba; Kruse, Gina R; Deutsch, Charles

2018-01-01

Background: Strong partnerships are critical to integrate evidence-based prevention interventions within clinical and community-based settings, offering multilevel and sustainable solutions to complex health issues. As part of Massachusetts' 2012 health reform, The Prevention and Wellness Trust Fund (PWTF) funded nine local partnerships throughout the state to address hypertension, pediatric asthma, falls among older adults, and tobacco use. The initiative was designed to improve health outcomes through prevention and disease management strategies and reduce healthcare costs. Purpose: Describe the mixed-methods study design for investigating PWTF implementation. Methods: The Consolidated Framework for Implementation Research guided the development of this evaluation. First, the study team conducted semi-structured qualitative interviews with leaders from each of nine partnerships to document partnership development and function, intervention adaptation and delivery, and the influence of contextual factors on implementation. The interview findings were used to develop a quantitative survey to assess the implementation experiences of 172 staff from clinical and community-based settings and a social network analysis to assess changes in the relationships among 72 PWTF partner organizations. The quantitative survey data on ratings of perceived implementation success were used to purposively select 24 staff for interviews to explore the most successful experiences of implementing evidence-based interventions for each of the four conditions. Conclusions: This mixed-methods approach for evaluation of implementation of evidence-based prevention interventions by PWTF partnerships can help decision-makers set future priorities for implementing and assessing clinical-community partnerships focused on prevention.

Improving family satisfaction and participation in decision making in an intensive care unit.

PubMed

Huffines, Meredith; Johnson, Karen L; Smitz Naranjo, Linda L; Lissauer, Matthew E; Fishel, Marmie Ann-Michelle; D'Angelo Howes, Susan M; Pannullo, Diane; Ralls, Mindy; Smith, Ruth

2013-10-01

Background Survey data revealed that families of patients in a surgical intensive care unit were not satisfied with their participation in decision making or with how well the multidisciplinary team worked together. Objectives To develop and implement an evidence-based communication algorithm and evaluate its effect in improving satisfaction among patients' families. Methods A multidisciplinary team developed an algorithm that included bundles of communication interventions at 24, 72, and 96 hours after admission to the unit. The algorithm included clinical triggers, which if present escalated the algorithm. A pre-post design using process improvement methods was used to compare families' satisfaction scores before and after implementation of the algorithm. Results Satisfaction scores for participation in decision making (45% vs 68%; z = -2.62, P = .009) and how well the health care team worked together (64% vs 83%; z = -2.10, P = .04) improved significantly after implementation. Conclusions Use of an evidence-based structured communication algorithm may be a way to improve satisfaction of families of intensive care patients with their participation in decision making and their perception of how well the unit's team works together.

Interactional Resources for Quality Improvement: Learning From Participants Through a Qualitative Study.

PubMed

Brooks, Joanna Veazey; Gorbenko, Ksenia; Bosk, Charles

Implementing quality improvement in hospitals requires a multifaceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis. We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: (1) a critical outside perspective on their implementation progress; (2) opportunities to learn from peers, especially around clinical innovations; and (3) external validation to help establish visibility for and commitment to the project. Quality improvement in hospitals is both a clinical endeavor and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work. Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs.

Interactional Resources for Quality Improvement: Learning from Participants through a Qualitative Study

PubMed Central

Brooks, Joanna Veazey; Gorbenko, Ksenia; Bosk, Charles

2017-01-01

BACKGROUND Implementing quality improvement in hospitals requires a multi-faceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. METHODS Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis. RESULTS We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: 1) a critical outside perspective on their implementation progress; 2) opportunities to learn from peers, especially around clinical innovations; and 3) external validation to help establish visibility for and commitment to the project. CONCLUSIONS Quality improvement in hospitals is both a clinical and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work. IMPLICATIONS Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs. PMID:28375951

Implementing the Patient-Centered Medical Home: Observation and Description of the National Demonstration Project

PubMed Central

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

2010-01-01

PURPOSE We provide an overall description of the National Demonstration Project (NDP) intervention to transform family practices into patient-centered medical homes. METHODS An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and project meetings, site visits to practices, depth interviews with practice members and implementation team members, access to practice communications (eg, telephone calls, e-mails), and public domain materials (eg, the NDP Web site). RESULTS The American Academy of Family Physicians created a new division called TransforMED, which launched the 24-month NDP in June 2006. From 337 family medicine practices completing an extensive online application, 36 were selected and randomized to a facilitated group, which received tailored, intensive assistance and services from TransforMED, or a self-directed group, which received very limited assistance. Three facilitators from diverse backgrounds in finance, practice management, and organizational psychology used multiple practice change strategies including site visits, e-mails, metrics, and learning sessions. The self-directed practices worked primarily on their own, but self-organized a retreat midway through the project. The intervention model for the project evolved to be consistent with the emerging national consensus principles of the patient-centered medical home. The independent evaluation team studied the NDP and provided ongoing feedback to inform the implementation process. CONCLUSIONS The NDP illustrates that complex practice change interventions must combine flexibility in the intervention model, implementation strategy, and the evaluation, in order to maximize ongoing learning. PMID:20530392

Implementing the patient-centered medical home: observation and description of the national demonstration project.

PubMed

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

2010-01-01

We provide an overall description of the National Demonstration Project (NDP) intervention to transform family practices into patient-centered medical homes. An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and project meetings, site visits to practices, depth interviews with practice members and implementation team members, access to practice communications (eg, telephone calls, e-mails), and public domain materials (eg, the NDP Web site). The American Academy of Family Physicians created a new division called TransforMED, which launched the 24-month NDP in June 2006. From 337 family medicine practices completing an extensive online application, 36 were selected and randomized to a facilitated group, which received tailored, intensive assistance and services from TransforMED, or a self-directed group, which received very limited assistance. Three facilitators from diverse backgrounds in finance, practice management, and organizational psychology used multiple practice change strategies including site visits, e-mails, metrics, and learning sessions. The self-directed practices worked primarily on their own, but self-organized a retreat midway through the project. The intervention model for the project evolved to be consistent with the emerging national consensus principles of the patient-centered medical home. The independent evaluation team studied the NDP and provided ongoing feedback to inform the implementation process. The NDP illustrates that complex practice change interventions must combine flexibility in the intervention model, implementation strategy, and the evaluation, in order to maximize ongoing learning.

Integration of research and practice to improve public health and healthcare delivery through a collaborative 'Health Integration Team' model - a qualitative investigation.

PubMed

Redwood, Sabi; Brangan, Emer; Leach, Verity; Horwood, Jeremy; Donovan, Jenny L

2016-06-22

Economic considerations and the requirement to ensure the quality, safety and integration of research with health and social care provision have given rise to local developments of collaborative organisational forms and strategies to span the translational gaps. One such model - the Health Integration Team (HIT) model in Bristol in the United Kingdom (UK) - brings together National Health Service (NHS) organisations, universities, local authorities, patients and the public to facilitate the systematic application of evidence to promote integration across healthcare pathways. This study aimed to (1) provide empirical evidence documenting the evolution of the model; (2) to identify the social and organisational processes and theory of change underlying healthcare knowledge and practice; and (3) elucidate the key aspects of the HIT model for future development and translation to other localities. Contemporaneous documents were analysed, using procedures associated with Framework Analysis to produce summarised data for descriptive accounts. In-depth interviews were undertaken with key informants and analysed thematically. Comparative methods were applied to further analyse the two data sets. One hundred forty documents were analysed and 10 interviews conducted with individuals in leadership positions in the universities, NHS commissioning and provider organisations involved in the design and implementation of the HIT model. Data coalesced around four overarching themes: 'Whole system' engagement, requiring the active recruitment of all those who have a stake in the area of practice being considered, and 'collaboration' to enable coproduction were identified as 'process' themes. System-level integration and innovation were identified as potential 'outcomes' with far-reaching impacts on population health and service delivery. The HIT model emerged as a particular response to the perceived need for integration of research and practice to improve public health and healthcare delivery at a time of considerable organisational turmoil and financial constraints. The concept gained momentum and will likely be of interest to those involved in setting up similar arrangements, and researchers in the social and implementation sciences with an interest in their evaluation.

Code Team Training: Demonstrating Adherence to AHA Guidelines During Pediatric Code Blue Activations.

PubMed

Stewart, Claire; Shoemaker, Jamie; Keller-Smith, Rachel; Edmunds, Katherine; Davis, Andrew; Tegtmeyer, Ken

2017-10-16

Pediatric code blue activations are infrequent events with a high mortality rate despite the best effort of code teams. The best method for training these code teams is debatable; however, it is clear that training is needed to assure adherence to American Heart Association (AHA) Resuscitation Guidelines and to prevent the decay that invariably occurs after Pediatric Advanced Life Support training. The objectives of this project were to train a multidisciplinary, multidepartmental code team and to measure this team's adherence to AHA guidelines during code simulation. Multidisciplinary code team training sessions were held using high-fidelity, in situ simulation. Sessions were held several times per month. Each session was filmed and reviewed for adherence to 5 AHA guidelines: chest compression rate, ventilation rate, chest compression fraction, use of a backboard, and use of a team leader. After the first study period, modifications were made to the code team including implementation of just-in-time training and alteration of the compression team. Thirty-eight sessions were completed, with 31 eligible for video analysis. During the first study period, 1 session adhered to all AHA guidelines. During the second study period, after alteration of the code team and implementation of just-in-time training, no sessions adhered to all AHA guidelines; however, there was an improvement in percentage of sessions adhering to ventilation rate and chest compression rate and an improvement in median ventilation rate. We present a method for training a large code team drawn from multiple hospital departments and a method of assessing code team performance. Despite subjective improvement in code team positioning, communication, and role completion and some improvement in ventilation rate and chest compression rate, we failed to consistently demonstrate improvement in adherence to all guidelines.

Staff perceptions of a Productive Community Services implementation: A qualitative interview study.

PubMed

Bradley, Dominique Kim Frances; Griffin, Murray

2015-06-01

The Productive Series is a collection of change programmes designed by the English National Health Service (NHS) Institute for Innovation and Improvement to help frontline healthcare staff improve quality and reduce wasted time, so that this time can be reinvested into time spent with patients. The programmes have been implemented in at least 14 countries around the world. This study examines an implementation of the Productive Community Services programme that took place in a Community healthcare organisation in England from July 2010 to March 2012. To explore staff members' perceptions of a Productive Community Services implementation. Cross-sectional interview. Community Healthcare Organisation in East Anglia, England. 45 participants were recruited using purposive, snowballing and opportunistic sampling methods to represent five main types of staff group in the organisation; clinical team members, administrative team members, service managers/team leaders, senior managers and software support staff. Team members were recruited on the basis that they had submitted data for at least one Productive Community Services module. Semi-structured individual and group interviews were carried out after the programme concluded and analysed using thematic analysis. This report focuses on six of the themes identified. The analysis found that communication was not always effective, and there was a lack of awareness, knowledge and understanding of the programme. Many staff did not find the Productive Community Services work relevant, and although certain improvements were sustained, suboptimal practices crept back. Although negative outcomes were reported, such as the programme taking time away from patients initially, many benefits were described including improved stock control and work environments, and better use of the Electronic Patient Record system. One of the themes identified highlighted the positive perceptions of the programme, however a focus on five other themes indicate that important aspects of the implementation could have been improved. The innovation and implementation literature already addresses the issues identified, which suggests a gap between theory and practice for implementation teams. A lack of perceived relevance also suggests that similar programmes need to be made more easily adaptable for the varied specialisms found in Community Services. Further research on Productive Community Services implementations and knowledge transfer is required, and publication of studies focusing on the less positive aspects of implementations may accelerate this process. Copyright © 2015 Elsevier Ltd. All rights reserved.

Findings from a mixed-methods study of an interprofessional faculty development program.

PubMed

Abu-Rish Blakeney, Erin; Pfeifle, Andrea; Jones, Mandy; Hall, Leslie Walter; Zierler, Brenda K

2016-01-01

Forty faculty members from eight schools participated in a year-long National Faculty Development Program (NFDP) conducted in 2012-2013, aimed at developing faculty knowledge and skills for interprofessional education (IPE). The NFDP included two live conferences. Between conferences, faculty teams implemented self-selected IPE projects at their home institutions and participated in coaching and peer-support conference calls. This paper describes program outcomes. A mixed methods approach was adopted. Data were gathered through online surveys and semi-structured interviews. The study explored whether faculty were satisfied with the program, believed the program was effective in developing knowledge and skills in designing, implementing, and evaluating IPE, and planned to continue newly-implemented IPE and faculty development (FD). Peer support and networking were two of the greatest perceived benefits. Further, this multi-institutional program appears to have facilitated early organizational change by bringing greater contextual understanding to assumptions made at the local level that in turn could influence hidden curricula and networking. These findings may guide program planning for future FD to support IPE.

Visualizing Interstellar's Wormhole

NASA Astrophysics Data System (ADS)

James, Oliver; von Tunzelmann, Eugénie; Franklin, Paul; Thorne, Kip S.

2015-06-01

Christopher Nolan's science fiction movie Interstellar offers a variety of opportunities for students in elementary courses on general relativity theory. This paper describes such opportunities, including: (i) At the motivational level, the manner in which elementary relativity concepts underlie the wormhole visualizations seen in the movie; (ii) At the briefest computational level, instructive calculations with simple but intriguing wormhole metrics, including, e.g., constructing embedding diagrams for the three-parameter wormhole that was used by our visual effects team and Christopher Nolan in scoping out possible wormhole geometries for the movie; (iii) Combining the proper reference frame of a camera with solutions of the geodesic equation, to construct a light-ray-tracing map backward in time from a camera's local sky to a wormhole's two celestial spheres; (iv) Implementing this map, for example, in Mathematica, Maple or Matlab, and using that implementation to construct images of what a camera sees when near or inside a wormhole; (v) With the student's implementation, exploring how the wormhole's three parameters influence what the camera sees—which is precisely how Christopher Nolan, using our implementation, chose the parameters for Interstellar's wormhole; (vi) Using the student's implementation, exploring the wormhole's Einstein ring and particularly the peculiar motions of star images near the ring, and exploring what it looks like to travel through a wormhole.

Implementation of Community-Wide Teen Pregnancy Prevention Initiatives: Focus on Partnerships.

PubMed

Tevendale, Heather D; Fuller, Taleria R; House, L Duane; Dee, Deborah L; Koumans, Emilia H

2017-03-01

Seeking to reduce teen pregnancy and births in communities with rates above the national average, the Centers for Disease Control and Prevention, in partnership with the U.S. Department of Health and Human Services Office of Adolescent Health Teen Pregnancy Prevention Program, developed a joint funding opportunity through which grantees worked to implement and test an approach involving community-wide teen pregnancy prevention initiatives. Once these projects had been in the field for 2.5 years, Centers for Disease Control and Prevention staff developed plans for a supplemental issue of the Journal of Adolescent Health to present findings from and lessons learned during implementation of the community-wide initiatives. When the articles included in the supplemental issue are considered together, common themes emerge, particularly those related to initiating, building, and maintaining strong partnerships. Themes seen across articles include the importance of (1) sharing local data with partners to advance initiative implementation, (2) defining partner roles from the beginning of the initiatives, (3) developing teams that include community partners to provide direction to the initiatives, and (4) addressing challenges to maintaining strong partnerships including partner staff turnover and delays in implementation. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

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.

Integrated Transdisciplinary Teams.

ERIC Educational Resources Information Center

Gallivan-Fenlon, Amanda

1994-01-01

This article reviews the use of transdisciplinary teaming and integrated therapy for young children with multiple disabilities. It presents examples and suggestions for implementation, in the areas of flexibility, Individualized Education Program development, and parent participation. (JDD)

Team Nutrition e-Newsletter, October 2009

ERIC Educational Resources Information Center

US Department of Agriculture, 2009

2009-01-01

The Team Nutrition (TN) e-Newsletter is published periodically to share TN resources developed by United States Department of Agriculture (USDA) and/or by State agencies, and to share ideas for promoting healthy eating and physical activity through Team Nutrition at the State and local levels. This issue includes: (1) Materials Developed by…

Exploring approaches to the administration of a long-term care facility: The application of a community planning and development process.

PubMed

Caldwell, W J

1996-01-01

This article outlines the approaches taken to the management of two long-term care facilities by the County of Huron in southwestern Ontario in 1994. Lay-offs, a move to new facilities, loss of local political confidence, changes in key administrative personnel and low staff morale prompted the county to ask an interim administrative team to develop and implement an appropriate response. The article explains how community development and planning principles and techniques were applied to the management of the homes to achieve an overall improvement in communication, staff morale and attitude. These approaches may prove helpful to other administrations facing major change.

Controlador para un Reloj GPS de Referencia en el Protocolo NTP

NASA Astrophysics Data System (ADS)

Hauscarriaga, F.; Bareilles, F. A.

The synchronization between computers in a local network plays a very important role on enviroments similar to IAR. Calculations for exact time are needed before, during and after an observation. For this purpose the IAR's GNU/Linux Software Development Team implemented a driver inside NTP protocol (an internet standard for time synchronization of computers) for a GPS receiver acquired a few years ago by IAR, which did not have support in such protocol. Today our Institute has a stable and reliable time base synchronized to atomic clocks on board GPS Satellites according to computers's synchronization standard, offering precise time services to all scientific community and particularly to the University of La Plata. FULL TEXT IN SPANISH