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Breton M, Smithman MA, Lamoureux-Lamarche C, Keely E, Farrell G, Singer A, Dumas Pilon M, Bush PL, Nabelsi V, Gaboury I, Gagnon MP, Steele Gray C, Hudon C, Aubrey-Bassler K, Visca R, Côté-Boileau É, Gagnon J, Deslauriers V, Liddy C. Strategies used throughout the scaling-up process of eConsult - Multiple case study of four Canadian Provinces. EVALUATION AND PROGRAM PLANNING 2023; 100:102329. [PMID: 37329836 DOI: 10.1016/j.evalprogplan.2023.102329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/18/2023] [Accepted: 06/07/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND eConsult is a model of asynchronous communication connecting primary care providers to specialists to discuss patient care. This study aims to analyze the scaling-up process and identify strategies used to support scaling-up efforts in four provinces in Canada. METHODS We conducted a multiple case study with four cases (ON, QC, MB, NL). Data collection methods included document review (n = 93), meeting observations (n = 65) and semi-structured interviews (n = 40). Each case was analyzed based on Milat's framework. RESULTS The first scaling-up phase was marked by the rigorous evaluation of eConsult pilot projects and the publication of over 90 scientific papers. In the second phase, provinces implemented provincial multi-stakeholder committees, institutionalized the evaluation, and produced documents detailing the scaling-up plan. During the third phase, efforts were made to lead proofs of concept, obtain the endorsement of national and provincial organizations, and mobilize alternate sources of funding. The last phase was mainly observed in Ontario, where the creation of a provincial governance structure and strategies were put in place to monitor the service and manage changes. CONCLUSIONS Various strategies need to be used throughout the scaling-up process. The process remains challenging and lengthy because health systems lack clear processes to support innovation scaling-up.
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Affiliation(s)
- Mylaine Breton
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil Campus, Longueuil, QC, Canada.
| | - Mélanie Ann Smithman
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil Campus, Longueuil, QC, Canada
| | | | - Erin Keely
- Department of Medicine, University of Ottawa, Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, ON, Canada
| | - Gerard Farrell
- Department of Family Medicine, Memorial University, St-John, NFL, Canada
| | - Alexander Singer
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Maxine Dumas Pilon
- Collège Québécois des Médecins de Famille, Family Medicine Center, St-Mary's Hospital, McGill University, Montréal, QC, Canada
| | - Paula Louise Bush
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Véronique Nabelsi
- Département des sciences administratives, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Isabelle Gaboury
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil Campus, Longueuil, QC, Canada
| | | | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum, Research Institute, Sinai Health System, University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
| | - Catherine Hudon
- Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Regina Visca
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Élizabeth Côté-Boileau
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil Campus, Longueuil, QC, Canada
| | - Justin Gagnon
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Véronique Deslauriers
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil Campus, Longueuil, QC, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, ON, Canada
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Kroon D, van Dulmen SA, Westert GP, Jeurissen PPT, Kool RB. Development of the SPREAD framework to support the scaling of de-implementation strategies: a mixed-methods study. BMJ Open 2022; 12:e062902. [PMID: 36343997 PMCID: PMC9644331 DOI: 10.1136/bmjopen-2022-062902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE We aimed to increase the understanding of the scaling of de-implementation strategies by identifying the determinants of the process and developing a determinant framework. DESIGN AND METHODS This study has a mixed-methods design. First, we performed an integrative review to build a literature-based framework describing the determinants of the scaling of healthcare innovations and interventions. PubMed and EMBASE were searched for relevant studies from 1995 to December 2020. We systematically extracted the determinants of the scaling of interventions and developed a literature-based framework. Subsequently, this framework was discussed in four focus groups with national and international de-implementation experts. The literature-based framework was complemented by the findings of the focus group meetings and adapted for the scaling of de-implementation strategies. RESULTS The literature search resulted in 42 articles that discussed the determinants of the scaling of innovations and interventions. No articles described determinants specifically for de-implementation strategies. During the focus groups, all participants agreed on the relevance of the extracted determinants for the scaling of de-implementation strategies. The experts emphasised that while the determinants are relevant for various countries, the implications differ due to different contexts, cultures and histories. The analyses of the focus groups resulted in additional topics and determinants, namely, medical training, professional networks, interests of stakeholders, clinical guidelines and patients' perspectives. The results of the focus group meetings were combined with the literature framework, which together formed the supporting the scaling of de-implementation strategies (SPREAD) framework. The SPREAD framework includes determinants from four domains: (1) scaling plan, (2) external context, (3) de-implementation strategy and (4) adopters. CONCLUSIONS The SPREAD framework describes the determinants of the scaling of de-implementation strategies. These determinants are potential targets for various parties to facilitate the scaling of de-implementation strategies. Future research should validate these determinants of the scaling of de-implementation strategies.
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Affiliation(s)
| | | | | | | | - Rudolf B Kool
- IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
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Koorts H, Maple JL, Eakin E, Lawrence M, Salmon J. Complexities and Context of Scaling Up: A Qualitative Study of Stakeholder Perspectives of Scaling Physical Activity and Nutrition Interventions in Australia. Front Public Health 2022; 10:771235. [PMID: 35419340 PMCID: PMC8995799 DOI: 10.3389/fpubh.2022.771235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/03/2022] [Indexed: 01/07/2023] Open
Abstract
Background Scaling up population health interventions is a context-orientated, dynamic and multi-stakeholder process; understanding its influences is essential to enhance future scaling efforts. Using physical activity and nutrition interventions in Australia as case examples, the aim of this paper is to identify core influences involved in scaling up physical activity and nutrition interventions, and how these may differ by context and stakeholder. Methods A qualitative study involving semi-structured telephone interviews with individuals representing academic, government and non-government organizations with involvement in scaling up state and national physical activity and nutrition interventions. Interview questions were derived from the WHO report “20 Questions for Developing a Scaling up Case Study”, and mapped against four key principles and five core areas in the WHO ExpandNet framework for scaling up: (1) The innovation; (2) User organization; (3) Environment; (4) Resource team and; (5) Scale up strategy. Data were analyzed thematically. Results Nineteen interviews were conducted (government = 3; non-government = 5; and academic = 11 sectors) involving eight scaled up interventions, targeting nutrition (n = 2), physical activity (n = 1) or a combination (n = 5). Most themes aligned to the “Environment”, including: (i) political (e.g., personal agendas); (ii) social (e.g., lack of urgency); and (iii) sector/workforce (e.g., scale up accountability) factors. Themes relating to “Scale up strategy” (e.g., flexibility and evaluation transparency) were next most commonly occurring. Whilst themes were broadly consistent across participants, government participants had a more policy-oriented perspective on the scale up process. Academics discussed a tension between the generation and use of evidence, and the influence of political climates/interest on scale up decisions. Conclusion Attributes of the “Environment” and “Scale up strategy” consistently featured as major influences on successful outcomes, while the role of evidence differed greatly between participant groups. A multisector scale up strategy for future interventions may enable the complexities of environmental and political contexts to be incorporated into scale up planning.
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Affiliation(s)
- Harriet Koorts
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Jaimie-Lee Maple
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Elizabeth Eakin
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Mark Lawrence
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Jo Salmon
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
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A review of implementation frameworks to operationalize health technology assessment recommendations for medical technologies in the Singapore setting. Int J Technol Assess Health Care 2021; 37:e56. [PMID: 33843519 DOI: 10.1017/s0266462321000222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Methodologies of health technology assessment (HTA) for medical technologies are well established; yet, operational frameworks that enable appropriate uptake of HTA recommendations into routine clinical practice are lacking. This review aims to identify the key themes needed to guide the planning and implementation of HTA subsidy decisions for medical technologies such as diagnostics, medical devices, and services and to monitor their impact on a complex multipayer healthcare system like Singapore. METHODS A literature search of implementation frameworks was conducted up to 20 December 2020 and was documented in a flow diagram. A thematic analysis of the evidence base was performed using the Braun and Clark approach to identify key themes, from which an implementation framework suitable for Singapore's healthcare system could be developed. RESULTS The searches yielded forty-four articles for review, from which twenty themes were identified. The top ten themes constituted the key themes of implementation essential for local adaptation and were categorized into five domains: implementation strategy, organizational support, stakeholder engagement, information dissemination, and implementation outcomes and evaluation. These domains provide operational guidance to methodically identify gaps to facilitate sustainable implementation of HTA-informed medical technology subsidy decisions. CONCLUSION A robust and adaptable implementation of HTA-informed subsidy decisions is crucial to optimize its intended impact of improving patient outcomes per dollar spent. The key themes of an implementation framework should capture the important aspects of organizational feasibility to ensure successful adoption in a complex multipayer healthcare system like Singapore.
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Takaoka A, Tam B, Vanstone M, Clarke FJ, Hoad N, Swinton M, Toledo F, Boyle A, Woods A, Duan EH, Heels-Ansdell D, Waugh L, Soth M, Rudkowski J, Alhazzani W, Perri D, Ligori T, Jaeschke R, Zytaruk N, Cook DJ. Scale-up and sustainability of a personalized end-of-life care intervention: a longitudinal mixed-methods study. BMC Health Serv Res 2021; 21:218. [PMID: 33691684 PMCID: PMC7944608 DOI: 10.1186/s12913-021-06241-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scaling-up and sustaining healthcare interventions can be challenging. Our objective was to describe how the 3 Wishes Project (3WP), a personalized end-of-life intervention, was scaled-up and sustained in an intensive care unit (ICU). METHODS In a longitudinal mixed-methods study from January 12,013 - December 31, 2018, dying patients and families were invited to participate if the probability of patient death was > 95% or after a decision to withdraw life support. A research team member or bedside clinician learned more about each of the patients and their family, then elicited and implemented at least 3 personalized wishes for patients and/or family members. We used a qualitative descriptive approach to analyze interviews and focus groups conducted with 25 clinicians who cared for the enrolled patients. We used descriptive statistics to summarize patient, wish, and clinician characteristics, and analyzed outcome data in quarters using Statistical Process Control charts. The primary outcome was enrollment of terminally ill patients and respective families; the secondary outcome was the number of wishes per patient; tertiary outcomes included wish features and stakeholder involvement. RESULTS Both qualitative and quantitative analyses suggested a three-phase approach to the scale-up of this intervention during which 369 dying patients were enrolled, having 2039 terminal wishes implemented. From a research project to clinical program to an approach to practice, we documented a three-fold increase in enrolment with a five-fold increase in total wishes implemented, without a change in cost. Beginning as a study, the protocol provided structure; starting gradually enabled frontline staff to experience and recognize the value of acts of compassion for patients, families, and clinicians. The transition to a clinical program was marked by handover from the research staff to bedside staff, whereby project catalysts mentored project champions to create staff partnerships, and family engagement became more intentional. The final transition involved empowering staff to integrate the program as an approach to care, expanding it within and beyond the organization. CONCLUSIONS The 3WP is an end-of-life intervention which was implemented as a study, scaled-up into a clinical program, and sustained by becoming integrated into practice as an approach to care.
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Affiliation(s)
- Alyson Takaoka
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Benjamin Tam
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - France J Clarke
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Neala Hoad
- Department of Critical Care Medicine, St Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada
| | - Marilyn Swinton
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Feli Toledo
- Department of Spiritual Care, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Anne Boyle
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Palliative Care, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Anne Woods
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Palliative Care, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Erick H Duan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care Medicine, St Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lily Waugh
- Department of Critical Care Medicine, St Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada
| | - Mark Soth
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care Medicine, St Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada
| | - Jill Rudkowski
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care Medicine, St Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care Medicine, St Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada
| | - Dan Perri
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care Medicine, St Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada
| | - Tania Ligori
- Department of Critical Care Medicine, St Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Roman Jaeschke
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care Medicine, St Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada
| | - Nicole Zytaruk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
- Department of Critical Care Medicine, St Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada.
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James HM, Papoutsi C, Wherton J, Greenhalgh T, Shaw SE. Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework. J Med Internet Res 2021; 23:e23775. [PMID: 33434141 PMCID: PMC7837451 DOI: 10.2196/23775] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/27/2020] [Accepted: 12/17/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND COVID-19 has thrust video consulting into the limelight, as health care practitioners worldwide shift to delivering care remotely. Evidence suggests that video consulting is acceptable, safe, and effective in selected conditions and settings. However, research to date has mostly focused on initial adoption, with limited consideration of how video consulting can be mainstreamed and sustained. OBJECTIVE This study sought to do the following: (1) review and synthesize reported opportunities, challenges, and lessons learned in the scale-up, spread, and sustainability of video consultations, and (2) identify transferable insights that can inform policy and practice. METHODS We identified papers through systematic searches in PubMed, CINAHL, and Web of Science. Included articles reported on synchronous, video-based consultations that had spread to more than one setting beyond an initial pilot or feasibility stage, and were published since 2010. We used the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework to synthesize findings relating to 7 domains: an understanding of the health condition(s) for which video consultations were being used, the material properties of the technological platform and relevant peripherals, the value proposition for patients and developers, the role of the adopter system, organizational factors, wider macro-level considerations, and emergence over time. RESULTS We identified 13 papers describing 10 different video consultation services in 6 regions, covering the following: (1) video-to-home services, connecting providers directly to the patient; (2) hub-and-spoke models, connecting a provider at a central hub to a patient at a rural center; and (3) large-scale top-down evaluations scaled up or spread across a national health administration. Services covered rehabilitation, geriatrics, cancer surgery, diabetes, and mental health, as well as general specialist care and primary care. Potential enablers of spread and scale-up included embedded leadership and the presence of a telehealth champion, appropriate reimbursement mechanisms, user-friendly technology, pre-existing staff relationships, and adaptation (of technology and services) over time. Challenges tended to be related to service development, such as the absence of a long-term strategic plan, resistance to change, cost and reimbursement issues, and the technical experience of staff. There was limited articulation of the challenges to scale-up and spread of video consultations. This was combined with a lack of theorization, with papers tending to view spread and scale-up as the sum of multiple technical implementations, rather than theorizing the distinct processes required to achieve widespread adoption. CONCLUSIONS There remains a significant lack of evidence that can support the spread and scale-up of video consulting. Given the recent pace of change due to COVID-19, a more definitive evidence base is urgently needed to support global efforts and match enthusiasm for extending use.
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Affiliation(s)
- Hannah M James
- Department of Knowledge Integration, University of Waterloo, Waterloo, ON, Canada
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Iqbal U, Li YC(J. Improvements scale-up and rapid response systems in the hospitals. Int J Qual Health Care 2020; 32:721. [DOI: 10.1093/intqhc/mzx191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Usman Iqbal
- Masters Program in Global Health & Development Department, College of Public Health, Taipei Medical University, 250-Wuxing Street, Xinyi District, Taipei 11031, Taiwan
- International Center for Health Information Technology, Taipei Medical University, 250-Wuxing Street, Xinyi District, Taipei 11031, Taiwan
- Health Informatics Department, COMSATS Institute of Information Technology (CIIT), Islamabad, Park Road, Islamabad-44000, Pakistan
| | - Yu-Chuan (Jack) Li
- International Center for Health Information Technology, Taipei Medical University, 250-Wuxing Street, Xinyi District, Taipei 11031, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, 250-Wuxing Street, Xinyi District, Taipei 11031, Taiwan
- Department of Dermatology, Wan Fang Hospital, No. 111, Section 3, Xinglong Road, Wenshan District, Taipei City, 116, Taiwan
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8
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Lillo-Crespo M, Sierras-Davó MC, Taylor A, Ritters K, Karapostoli A. Mapping the Status of Healthcare Improvement Science through a Narrative Review in Six European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4480. [PMID: 31739419 PMCID: PMC6887973 DOI: 10.3390/ijerph16224480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/03/2019] [Accepted: 11/11/2019] [Indexed: 01/09/2023]
Abstract
With the aim to explore how improvement science is understood, taught, practiced, and its impact on quality healthcare across Europe, the Improvement Science Training for European Healthcare Workers (ISTEW) project "Improvement Science Training for European Healthcare Workers" was funded by the European Commission and integrated by 7 teams from different European countries. As part of the project, a narrative literature review was conducted between 2008 and 2019, including documents in all partners' languages from 26 databases. Data collection and analysis involved a common database. Validation took place through partners' discussions. Referring to healthcare improvement science (HIS), a variety of terms, tools, and techniques were reported with no baseline definition or specific framework. All partner teams were informed about the non-existence of a specific term equivalent to HIS in their mother languages, except for the English-speaking countries. A lack of consensus, regarding the understanding and implementation of HIS into the healthcare and educational contexts was found. Our findings have brought to light the gap existing in HIS within Europe, far from other nations, such as the US, where there is a clearer HIS picture. As a consequence, the authors suggest further developing the standardization of HIS understanding and education in Europe.
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Affiliation(s)
- Manuel Lillo-Crespo
- Nursing Department and International Mobility Coordinator, Faculty of Health Sciences, University of Alicante, Carretera de San Vicente del Raspeig s/n, 03690 San Vicente del Raspeig, Alicante, Spain
| | - Maria Cristina Sierras-Davó
- Nursing Department, Faculty of Health Sciences, University of Alicante, Carretera de San Vicente del Raspeig s/n, 03690 San Vicente del Raspeig, Alicante, Spain
| | - Alan Taylor
- Department of Social, Therapeutic and Community Studies, Coventry University, Gosford St, Coventry CV1 5DL, UK
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Côté-Boileau É, Denis JL, Callery B, Sabean M. The unpredictable journeys of spreading, sustaining and scaling healthcare innovations: a scoping review. Health Res Policy Syst 2019; 17:84. [PMID: 31519185 PMCID: PMC6744644 DOI: 10.1186/s12961-019-0482-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/01/2019] [Indexed: 11/20/2022] Open
Abstract
Innovation has the potential to improve the quality of care and health service delivery, but maximising the reach and impact of innovation to achieve large-scale health system transformation remains understudied. Interest is growing in three processes of the innovation journey within health systems, namely the spread, sustainability and scale-up (3S) of innovation. Recent reviews examine what we know about these processes. However, there is little research on how to support and operationalise the 3S. This study aims to improve our understanding of the 3S of healthcare innovations. We focus specifically on the definitions of the 3S, the mechanisms that underpin them, and the conditions that either enable or limit their potential. We conducted a scoping review, systematically investigating six bibliographic databases to search, screen and select relevant literature on the 3S of healthcare innovations. We screened 641 papers, then completed a full-text review of 112 identified as relevant based on title and abstract. A total of 24 papers were retained for analysis. Data were extracted and synthesised through descriptive and inductive thematic analysis. From this, we develop a framework of actionable guidance for health system actors aiming to leverage the 3S of innovation across five key areas of focus, as follows: (1) focus on the why, (2) focus on perceived-value and feasibility, (3) focus on what people do, rather than what they should be doing, (4) focus on creating a dialogue between policy and delivery, and (5) focus on inclusivity and capacity building. While there is no standardised approach to foster the 3S of healthcare innovations, a variety of practical frameworks and tools exist to support stakeholders along this journey.
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Affiliation(s)
- Élizabeth Côté-Boileau
- Health Sciences Research, Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada. .,Charles-Le Moyne - Saguenay-Lac-Saint-Jean Research Center on Health Innovations, Quebec, Canada. .,Doctoral Award Fellow from Quebec's Fonds de recherche du Québec - Santé (FRQS), Quebec, Canada. .,Health Standards Organization, Ottawa, Canada.
| | - Jean-Louis Denis
- Health Administration Department, School of Public Health, University of Montreal, Quebec, Canada.,University of Montreal Hospital Research Center, Quebec, Canada.,Canada Research Chair (Tier I) holder on Health system design and adaptation (Canadian Institutes of Health Research), Montreal, Canada
| | - Bill Callery
- Canadian Foundation for Healthcare Improvement, Corporate Strategy and Program Development, Ottawa, Canada
| | - Meghan Sabean
- Canadian Foundation for Healthcare Improvement, Corporate Strategy and Program Development, Ottawa, Canada
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Abstract
Disseminating innovation across the healthcare system is challenging but potentially achievable through different logics: mechanistic, ecological, and social, say Trisha Greenhalgh and Chrysanthi Papoutsi
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Affiliation(s)
- Trisha Greenhalgh
- Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
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11
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Ovretveit J, Dolan-Branton L, Marx M, Reid A, Reed J, Agins B. Adapting improvements to context: when, why and how? Int J Qual Health Care 2018; 30:20-23. [PMID: 29878138 PMCID: PMC5909662 DOI: 10.1093/intqhc/mzy013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/16/2018] [Indexed: 11/13/2022] Open
Abstract
There is evidence that practitioners applying quality improvements often adapt the improvement method or the change they are implementing, either unknowingly, or intentionally to fit their service or situation. This has been observed especially in programs seeking to spread or 'scale up' an improvement change to other services. Sometimes their adaptations result in improved outcomes, sometimes they do not, and sometimes they do not have data make this assessment or to describe the adaptation. The purpose of this paper is to summarize key points about adaptation and context discussed at the Salzburg Global Seminar in order to help improvers judge when and how to adapt an improvement change. It aims also to encourage more research into such adaptations to develop our understanding of the when, why and how of effective adaptation and to provide more research informed guidance to improvers.The paper gives examples to illustrate key issues in adaptation and to consider more systematic and purposeful adaptation of improvements so as to increase the chances of achieving improvements in different settings for different participants. We describe methods for assessing whether adaptation is necessary or likely to reduce the effectiveness of an improvement intervention, which adaptations might be required, and methods for collecting data to assess whether the adaptations are successful. We also note areas where research is most needed in order to enable more effective scale up of quality improvements changes and wider take up and use of the methods.
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Affiliation(s)
- John Ovretveit
- LIME/MMC, Tomtebodavägen 18A, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Dolan-Branton
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, Quality & Performance Institute, University Research Co., LLC, USA
| | - Michael Marx
- DTM&H University of Heidelberg, Institute of Public Health, Im Neuenheimer Feld 324, Heidelberg, Germany
| | - Amy Reid
- Institute for Healthcare Improvement 20 University Road, Cambridge, MA, USA
| | - Julie Reed
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care Northwest London, Imperial College, Chelsea and Westminster Hospital, London, UK
| | - Bruce Agins
- New York State Department of Health AIDS Institute.,Department of Epidemiology & Biostatistics, Global Health Sciences, University of California San Francisco
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