[Systematic translation and cross-validation of defined implementation outcomes in health care services]

[Bridging the know-do gap: Implementation approaches to complex family interventions]

BACKGROUND

The introduction of complex family interventions poses a challenge since they consist of various interacting components which affect multiple players and often require changes in behaviour and work processes. Implementation success is strongly influenced by environmental factors. The comprehensive implementation of complex interventions therefore needs a deliberate and systematic implementation process, including its evaluation. Implementation science offers a variety of theories and methods to support the integration and evaluation of complex family health interventions in real-world settings, requiring a broad spectrum of knowledge and skills for clinicians and researchers alike. Hence, specific examples may be relevant to both clinicians and researchers who wish to systematically address know-do gaps in clinical practice.

AIM

The aim is to describe and illustrate how complex family interventions can be systematically designed, evaluated and implemented using implementation science frameworks and methods by drawing on two research projects - namely the Family Support in Intensive Care Units (FICUS) and Bereavement Support for Families (B4F).

METHODICAL STEPS TO IMPLEMENTATION

Five steps were used to implement and evaluate the interventions across both research projects: 1) engaging key persons and families, 2) identifying gaps in care and developing/adapting the intervention, 3) understanding the implementation context, 4) tailoring implementation approaches, and 5) evaluating implementation progress and success.

DISCUSSION AND CONCLUSION

The five illustrated steps allow for a theory-guided but nevertheless pragmatic approach in the implementation of complex family interventions. This approach may serve as a guide to integrate complex interventions and evidence-based practices into routine care and to close know-do gaps.

Acceptability, Appropriateness and Feasibility of a Nurse-Led Integrated Care Intervention for Patients with Severe Exacerbation of COPD from the Healthcare Professional's Perspective - A Mixed Method Study

Purpose

To improve inpatient care and self-management in patients with severe acute exacerbations of COPD, we implemented a nurse-led behavioral intervention. This study aimed to assess implementation outcomes from the perspective of the healthcare professionals (HCP) who delivered it.

Methods

Using an explanatory sequential mixed method approach, we conducted an online questionnaire and two small group interviews. We applied descriptive statistics for quantitative data, a framework analysis for qualitative data, and a mixed methods matrix to integrate the results.

Results

A total of 19 of 27 invited participants answered the online questionnaire; 9 of 19 participated in the group interviews. The intervention's overall acceptability, appropriateness, and feasibility was rated high to very high (median 5/5; 4/5 and 4/5). Enablers to implementation included general recognition of the need for specialized care, sufficient knowledge of the intervention by HCP, and strong interprofessional collaboration. Main barriers included the lack of resident physician's resources and difficulties in adaptability.

Conclusion

While the acceptance of the intervention was very high, the perceived appropriateness and feasibility were affected by its complexity. The availability of a knowledgeable interprofessional core team is a strategy that supports the implementation of complex interventions.

Indicators for implementation outcome monitoring of reporting and learning systems in hospitals: an underestimated need for patient safety

Objective

We aimed to investigate the perception of the implementation success of reporting and learning systems in German hospitals, the perceived relevance of the implementation outcomes and whether and how these implementation outcomes are monitored. An reporting and learning system is a tool used worldwide for patient safety that identifies and analyses critical events, errors, risks and near misses in healthcare.

Methods

A pretested exploratory cross-sectional online survey was conducted with reporting and learning system experts from 51 acute care hospitals. For communicative validation, the results were discussed in person in an expert panel discussion (N=23).

Results

Fifty-three per cent (n=27) of the participants (N=51) of the online survey perceived that their reporting and learning system was being comprehensively and successfully implemented. However, no service or patient outcomes were reported to ultimately capture the concept of implementation success. Most of the participants reported a (high) relevance of the implementation outcomes’ acceptability and sustainability. In total, 44 measures were provided to monitor implementation outcomes. However, most of the quantitative measures were based on the (relative) number of entered reports. Qualitative measures were reported in relation to the ‘quality of the report’. In general, the measures were poorly specified.

Conclusion

There is an underestimated need to develop validated ‘implementation patient safety indicator(s) (sets)’ to monitor implementation outcomes of reporting and learning systems. We also identified a potential need to facilitate awareness of the concept of implementation success and its relevance for patient safety. Drafts of indicators that could be used as a starting point for the further development of ‘implementation patient safety indicators’ were provided.

Barriers and Facilitators for Conducting Implementation Science in German-Speaking Countries: Findings from the Promote ImpSci Interview Study

On a global scale, implementation science has developed considerably as a discipline in recent years. In German-speaking countries, the field has been gaining significance as well, but respective efforts in building capacity and advancing the research infrastructure are still rare. The present study investigates barriers and facilitators for conducting implementation science in German-speaking countries with the goal of formulating recommendations for creating a more supportive research infrastructure. We conducted an interview study with nine well-established implementation researchers affiliated with universities in Austria, Germany, or Switzerland. The interviews were held via Zoom or phone in November and December 2020, transcribed verbatim and analyzed using thematic analysis. Barriers that relate to characteristics of the discipline were difficulties in building a common understanding of the field and the complexity of implementation research projects. Although supportive scientific networks were important facilitators, interviewees mentioned challenges in connecting with likeminded researchers. A further barrier was the lack of opportunities for education and training in implementation science, especially in the German language. Also, participants reported a missing readiness in academia for establishing implementation science that should be addressed by advocacy of the discipline toward academic decision makers. Moreover, since most national funding agencies prioritize basic research over applied research, some interviewees named flexibility in handling research funds as a facilitator for implementation research. The results inform an agenda for promoting implementation science in German-speaking countries and can be beneficial to other countries that are currently advancing their implementation research capacity and infrastructure.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43477-022-00046-3.