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Davy C, Windle A, Marshall A, Harvey G. Leading the way: implementing aged care innovations. JBI Evid Implement 2024:02205615-990000000-00132. [PMID: 39291725 DOI: 10.1097/xeb.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
OBJECTIVES The objective of this study was to identify the key characteristics of leaders that support the implementation of innovations in aged care settings. METHODS We conducted a secondary analysis of papers from a large scoping review that identified how leaders supported the implementation of innovations in aged care. Once imported into NVivo12, the findings were deductively coded using the domains of Bloom's taxonomy of learning. Each parent code was then inductively analyzed to identify key characteristics within each domain. RESULTS Our review identified four types of knowledge, five skills, and six attitudes that leaders should exhibit to better support the implementation of innovations within aged care settings. In addition to our findings regarding Bloom's learning domains, we identified nine leadership behaviors that participants in the included papers perceived as valuable for enhancing the implementation process. Furthermore, we identified four key organizational elements that support leaders in navigating and facilitating the implementation of innovations within aged care settings. CONCLUSION Our review identified the characteristics that leaders should demonstrate when supporting the implementation of innovations in aged care. Importantly, our findings also emphasized the changing role of leadership from a hierarchical approach to a more collaborative, supportive, and empowering style. The insights identified in this review will help to guide aged care leaders, stressing the significance of adaptable and relational leadership styles that will guide the implementation of innovations within the aged care sector. SPANISH ABSTRACT http://links.lww.com/IJEBH/A271.
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Affiliation(s)
- Carol Davy
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Alice Windle
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Amy Marshall
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Teede H, Cadilhac DA, Purvis T, Kilkenny MF, Campbell BCV, English C, Johnson A, Callander E, Grimley RS, Levi C, Middleton S, Hill K, Enticott J. Learning together for better health using an evidence-based Learning Health System framework: a case study in stroke. BMC Med 2024; 22:198. [PMID: 38750449 PMCID: PMC11094907 DOI: 10.1186/s12916-024-03416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 04/30/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND In the context of expanding digital health tools, the health system is ready for Learning Health System (LHS) models. These models, with proper governance and stakeholder engagement, enable the integration of digital infrastructure to provide feedback to all relevant parties including clinicians and consumers on performance against best practice standards, as well as fostering innovation and aligning healthcare with patient needs. The LHS literature primarily includes opinion or consensus-based frameworks and lacks validation or evidence of benefit. Our aim was to outline a rigorously codesigned, evidence-based LHS framework and present a national case study of an LHS-aligned national stroke program that has delivered clinical benefit. MAIN TEXT Current core components of a LHS involve capturing evidence from communities and stakeholders (quadrant 1), integrating evidence from research findings (quadrant 2), leveraging evidence from data and practice (quadrant 3), and generating evidence from implementation (quadrant 4) for iterative system-level improvement. The Australian Stroke program was selected as the case study as it provides an exemplar of how an iterative LHS works in practice at a national level encompassing and integrating evidence from all four LHS quadrants. Using this case study, we demonstrate how to apply evidence-based processes to healthcare improvement and embed real-world research for optimising healthcare improvement. We emphasize the transition from research as an endpoint, to research as an enabler and a solution for impact in healthcare improvement. CONCLUSIONS The Australian Stroke program has nationally improved stroke care since 2007, showcasing the value of integrated LHS-aligned approaches for tangible impact on outcomes. This LHS case study is a practical example for other health conditions and settings to follow suit.
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Affiliation(s)
- Helena Teede
- Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, VIC, Australia.
- Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, Australia.
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 2 Monash University Research, Victorian Heart Hospital, 631 Blackburn Rd, Clayton, VIC, Australia.
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia.
| | - Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 2 Monash University Research, Victorian Heart Hospital, 631 Blackburn Rd, Clayton, VIC, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 2 Monash University Research, Victorian Heart Hospital, 631 Blackburn Rd, Clayton, VIC, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Bruce C V Campbell
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Coralie English
- School of Health Sciences, Heart and Stroke Program, University of Newcastle, Hunter Medical Research Institute, University Drive, Callaghan, NSW, Australia
| | - Alison Johnson
- Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, VIC, Australia
| | - Rohan S Grimley
- School of Medicine and Dentistry, Griffith University, Birtinya, QLD, Australia
- Clinical Excellence Division, Queensland Health, Brisbane, Australia
| | - Christopher Levi
- John Hunter Hospital, Hunter New England Local Health District and University of Newcastle, Sydney, NSW, Australia
| | - Sandy Middleton
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia
- Nursing Research Institute, St Vincent's Health Network Sydney and and Australian Catholic University, Sydney, NSW, Australia
| | - Kelvin Hill
- Stroke Foundation, Level 7, 461 Bourke St, Melbourne, VIC, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, VIC, Australia
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Ossenberg C, Henderson A. Coalition of social learning and implementation theory in a federated model to advance practice change. Worldviews Evid Based Nurs 2024. [PMID: 38576079 DOI: 10.1111/wvn.12723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Christine Ossenberg
- Nursing Practice Development Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Central Queensland University, Brisbane, Queensland, Australia
| | - Amanda Henderson
- Nursing Practice Development Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Central Queensland University, Brisbane, Queensland, Australia
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Saeb S, Korst LM, Fridman M, McCulloch J, Greene N, Gregory KD. Capacity-Building for Collecting Patient-Reported Outcomes and Experiences (PRO) Data Across Hospitals. Matern Child Health J 2023:10.1007/s10995-023-03720-6. [PMID: 37347378 PMCID: PMC10359358 DOI: 10.1007/s10995-023-03720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Patient-reported outcomes and experiences (PRO) data are an integral component of health care quality measurement and PROs are now being collected by many healthcare systems. However, hospital organizational capacity-building for the collection and sharing of PROs is a complex process. We sought to identify the factors that facilitated capacity-building for PRO data collection in a nascent quality improvement learning collaborative of 16 hospitals that has the goal of improving the childbirth experience. DESCRIPTION We used standard qualitative case study methodologies based on a conceptual framework that hypothesizes that adequate organizational incentives and capacities allow successful achievement of project milestones in a collaborative setting. The 4 project milestones considered in this study were: (1) Agreements; (2) System Design; (3) System Development and Operations; and (4) Implementation. To evaluate the success of reaching each milestone, critical incidents were logged and tracked to determine the capacities and incentives needed to resolve them. ASSESSMENT The pace of the implementation of PRO data collection through the 4 milestones was uneven across hospitals and largely dependent on limited hospital capacities in the following 8 dimensions: (1) Incentives; (2) Leadership; (3) Policies; (4) Operating systems; (5) Information technology; (6) Legal aspects; (7) Cross-hospital collaboration; and (8) Patient engagement. From this case study, a trajectory for capacity-building in each dimension is discussed. CONCLUSION The implementation of PRO data collection in a quality improvement learning collaborative was dependent on multiple organizational capacities for the achievement of project milestones.
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Affiliation(s)
- Samia Saeb
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | | | - Naomi Greene
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Bucalon B, Whitelock-Wainwright E, Williams C, Conley J, Veysey M, Kay J, Shaw T. Thought Leader Perspectives on the Benefits, Barriers, and Enablers for Routinely Collected Electronic Health Data to Support Professional Development: Qualitative Study. J Med Internet Res 2023; 25:e40685. [PMID: 36795463 PMCID: PMC9982719 DOI: 10.2196/40685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/22/2022] [Accepted: 01/20/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Hospitals routinely collect large amounts of administrative data such as length of stay, 28-day readmissions, and hospital-acquired complications; yet, these data are underused for continuing professional development (CPD). First, these clinical indicators are rarely reviewed outside of existing quality and safety reporting. Second, many medical specialists view their CPD requirements as time-consuming, having minimal impact on practice change and improving patient outcomes. There is an opportunity to build new user interfaces based on these data, designed to support individual and group reflection. Data-informed reflective practice has the potential to generate new insights about performance, bridging the gap between CPD and clinical practice. OBJECTIVE This study aims to understand why routinely collected administrative data have not yet become widely used to support reflective practice and lifelong learning. METHODS We conducted semistructured interviews (N=19) with thought leaders from a range of backgrounds, including clinicians, surgeons, chief medical officers, information and communications technology professionals, informaticians, researchers, and leaders from related industries. Interviews were thematically analyzed by 2 independent coders. RESULTS Respondents identified visibility of outcomes, peer comparison, group reflective discussions, and practice change as potential benefits. The key barriers included legacy technology, distrust with data quality, privacy, data misinterpretation, and team culture. Respondents suggested recruiting local champions for co-design, presenting data for understanding rather than information, coaching by specialty group leaders, and timely reflection linked to CPD as enablers to successful implementation. CONCLUSIONS Overall, there was consensus among thought leaders, bringing together insights from diverse backgrounds and medical jurisdictions. We found that clinicians are interested in repurposing administrative data for professional development despite concerns with underlying data quality, privacy, legacy technology, and visual presentation. They prefer group reflection led by supportive specialty group leaders, rather than individual reflection. Our findings provide novel insights into the specific benefits, barriers, and benefits of potential reflective practice interfaces based on these data sets. They can inform the design of new models of in-hospital reflection linked to the annual CPD planning-recording-reflection cycle.
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Affiliation(s)
- Bernard Bucalon
- Human Centred Technology Research Cluster, School of Computer Science, The University of Sydney, Sydney, Australia
| | - Emma Whitelock-Wainwright
- Centre for Learning Analytics, Faculty of Information Technology, Monash University, Melbourne, Australia
| | | | | | - Martin Veysey
- Division of Medicine, Royal Darwin Hospital, Tiwi, Australia
| | - Judy Kay
- Human Centred Technology Research Cluster, School of Computer Science, The University of Sydney, Sydney, Australia
| | - Tim Shaw
- Research in Implementation Science and e-Health Group, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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de Bruin J, Bos C, Struijs JN, Drewes HW, Baan CA. Conceptualizing learning health systems: A mapping review. Learn Health Syst 2023; 7:e10311. [PMID: 36654801 PMCID: PMC9835050 DOI: 10.1002/lrh2.10311] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/23/2022] [Accepted: 04/12/2022] [Indexed: 01/21/2023] Open
Abstract
Introduction Health systems worldwide face the challenge of increasing population health with high-quality care and reducing health care expenditure growth. In pursuit for a solution, regional cross-sectoral partnerships aim to reorganize and integrate services across public health, health care and social care. Although the complexity of regional partnerships demands an incremental strategy, it is yet not known how learning works within these partnerships. To understand learning in regional cross-sectoral partnerships for health, this study aims to map the concept Learning Health System (LHS). Methods This mapping review used a qualitative text analysis approach. A literature search was conducted in Embase and was limited to English-language papers published in the period 2015-2020. Title-abstract screening was performed using established exclusion criteria. During full-text screening, we combined deductive and inductive coding. The concept LHS was disentangled into aims, design elements, and process of learning. Data extraction and analysis were performed in MAX QDA 2020. Results In total, 155 articles were included. All articles used the LHS definition of the Institute of Medicine. The interpretation of the concept LHS varied widely. The description of LHS contained 25 highly connected aims. In addition, we identified nine design elements. Most elements were described similarly, only the interpretation of stakeholders, data infrastructure and data varied. Furthermore, we identified three types of learning: learning as 1) interaction between clinical practice and research; 2) a circular process of converting routine care data to knowledge, knowledge to performance; and performance to data; and 3) recurrent interaction between stakeholders to identify opportunities for change, to reveal underlying values, and to evaluate processes. Typology 3 was underrepresented, and the three types of learning rarely occurred simultaneously. Conclusion To understand learning within regional cross-sectoral partnerships for health, we suggest to specify LHS-aim(s), operationalize design elements, and choose deliberately appropriate learning type(s).
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Affiliation(s)
- Josefien de Bruin
- Department of Quality of Care and Health EconomicsNational Institute for Public Health and the Environment, Center for Nutrition, Prevention and Health ServicesBilthoventhe Netherlands
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgthe Netherlands
| | - Cheryl Bos
- Department of Quality of Care and Health EconomicsNational Institute for Public Health and the Environment, Center for Nutrition, Prevention and Health ServicesBilthoventhe Netherlands
| | - Jeroen Nathan Struijs
- Department of Quality of Care and Health EconomicsNational Institute for Public Health and the Environment, Center for Nutrition, Prevention and Health ServicesBilthoventhe Netherlands
- Department of Public Health and Primary Care/LUMC‐Campus The HagueLeiden University Medical CentreThe Haguethe Netherlands
| | - Hanneke Wil‐Trees Drewes
- Department of Quality of Care and Health EconomicsNational Institute for Public Health and the Environment, Center for Nutrition, Prevention and Health ServicesBilthoventhe Netherlands
| | - Caroline Astrid Baan
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgthe Netherlands
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Nordmark S, Lindberg I, Zingmark K. “It’s all about time and timing”: nursing staffs’ experiences with an agile development process, from its initial requirements to the deployment of its outcome of ICT solutions to support discharge planning. BMC Med Inform Decis Mak 2022; 22:186. [PMID: 35843948 PMCID: PMC9288650 DOI: 10.1186/s12911-022-01932-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Agile projects are statistically more likely to succeed then waterfall projects. The overall aim of this study was to explore the nursing staffs’ experiences with an agile development process, from its initial requirements to the deployment of its outcome of ICT solutions aimed at supporting discharge planning.
Methods
An explorative design with quantitative and qualitative methods was used. Qualitative data was collected through seven focus group interviews. Quantitative data was collected via an ICT-system, and with an evaluation form submitted by fourteen registered nurses and nine district nurses.
Results
Qualitative result of the experiences with the agile development process and its outcome resulted in one theme, four categories, and ten subcategories. The theme was found to be about time and timing, namely the amount of time for the different activities and the timing of activities within and between organisations. The agile development process increased the participants’ readiness for change by offering time to learn, practice, engage and reflect, and then adopt the ICT as a support to daily practice. Quantitative results showed a variated adoption of the ICT.
Conclusion
There is a need for time to prepare, understand and adopt new tools, services and procedures and a need for additional time to prepare, understand and adopt the new among individuals, collectives, organizations, and sometimes even between different collectives or organizations. The agile development process offered the end-users involvement through the development process, which gave them time to change it both individually and collectively. However, there is a need for close collaboration between the development project team and management to reach an organizational change that is timely for both the individual and the collective change. When time or timing fails in the development or implementation process, there is a huge risk of non-adoption of new tools, services, or procedures or among the end-users.
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Anderson JL, Mugavero MJ, Ivankova NV, Reamey RA, Varley AL, Samuel SE, Cherrington AL. Adapting an Interdisciplinary Learning Health System Framework for Academic Health Centers: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1564-1572. [PMID: 35675482 DOI: 10.1097/acm.0000000000004712] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Learning health systems (LHSs), defined as a systematic process for aligning science, informatics, and clinical practice to integrate providers, researchers, and patients as active participants in an evidence-based care continuum, can provide an ideal environment for academic health centers to rapidly adopt evidence-based guidelines and translate research into practice. However, few LHS frameworks are specifically adapted for academic health centers. The authors wanted to identify the definitions, components, and other features of LHSs to develop an interdisciplinary LHS framework for use within academic health centers. METHOD The authors conducted a scoping review of the literature to identify definitions, components, and other features of LHSs that are useful to academic health centers. In January 2021, they searched PubMed, Academic Search Premier, and Scopus databases and identified English-language, peer-reviewed articles pertaining to LHS, LHS frameworks, organization, components, and models. Since the phrase learning health system is relatively new terminology, they conducted a supplemental review with alternative phrases, including embedded research and coordinated or collaborative research network . They used the Knowledge to Action (KTA) Framework to integrate the generation and flow of research into practice. RESULTS The primary review retrieved 719 articles and the supplemental review retrieved 209; of these, 49 articles were retained to synthesize common definitions, components, and other features of LHS frameworks. Seven structural components of LHSs were identified: organization and collaborations, performance, ethics and security, scientific approaches, data, information technology, and patient outcomes. An adapted interdisciplinary LHS framework was developed that incorporated research and learning engines derived from the KTA and adaptations of common components and other features within the reviewed articles to fit the interests of providers, researchers, and patients within academic health centers. CONCLUSIONS The adapted LHS framework can be used as a dynamic foundation for development and organization of interdisciplinary LHSs within academic health centers.
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Affiliation(s)
- Jami L Anderson
- J.L. Anderson is a predoctoral trainee, Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael J Mugavero
- M.J. Mugavero is professor, Division of Infectious Diseases, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nataliya V Ivankova
- N.V. Ivankova is professor, Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rebecca A Reamey
- R.A. Reamey is assistant professor, Division of Infectious Diseases, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Allyson L Varley
- A.L. Varley is a researcher, Division of Preventive Medicine, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, and Health Services Research and Development, Birmingham VA Health System, Birmingham, Alabama
| | - Shekwonya E Samuel
- S.E. Samuel is a graduate research assistant, Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrea L Cherrington
- A.L. Cherrington is professor, Division of Preventive Medicine, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Vilendrer S, Saliba‐Gustafsson EA, Asch SM, Brown‐Johnson CG, Kling SM, Shaw JG, Winget M, Larson DB. Evaluating clinician-led quality improvement initiatives: A system-wide embedded research partnership at Stanford Medicine. Learn Health Syst 2022; 6:e10335. [PMID: 36263267 PMCID: PMC9576232 DOI: 10.1002/lrh2.10335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Many healthcare delivery systems have developed clinician-led quality improvement (QI) initiatives but fewer have also developed in-house evaluation units. Engagement between the two entities creates unique opportunities. Stanford Medicine funded a collaboration between their Improvement Capability Development Program (ICDP), which coordinates and incentivizes clinician-led QI efforts, and the Evaluation Sciences Unit (ESU), a multidisciplinary group of embedded researchers with expertise in implementation and evaluation sciences. Aim To describe the ICDP-ESU partnership and report key learnings from the first 2 y of operation September 2019 to August 2021. Methods Department-level physician and operational QI leaders were offered an ESU consultation to workshop design, methods, and overall scope of their annual QI projects. A steering committee of high-level stakeholders from operational, clinical, and research perspectives subsequently selected three projects for in-depth partnered evaluation with the ESU based on evaluability, importance to the health system, and broader relevance. Selected project teams met regularly with the ESU to develop mixed methods evaluations informed by relevant implementation science frameworks, while aligning the evaluation approach with the clinical teams' QI goals. Results Sixty and 62 ICDP projects were initiated during the 2 cycles, respectively, across 18 departments, of which ESU consulted with 15 (83%). Within each annual cycle, evaluators made actionable, summative findings rapidly available to partners to inform ongoing improvement. Other reported benefits of the partnership included rapid adaptation to COVID-19 needs, expanded clinician evaluation skills, external knowledge dissemination through scholarship, and health system-wide knowledge exchange. Ongoing considerations for improving the collaboration included the need for multi-year support to enable nimble response to dynamic health system needs and timely data access. Conclusion Presence of embedded evaluation partners in the enterprise-wide QI program supported identification of analogous endeavors (eg, telemedicine adoption) and cross-cutting lessons across QI efforts, clinician capacity building, and knowledge dissemination through scholarship.
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Affiliation(s)
- Stacie Vilendrer
- Department of Medicine, Division of Primary Care and Population HealthStanford University School of MedicineCaliforniaUSA
| | - Erika A. Saliba‐Gustafsson
- Department of Medicine, Division of Primary Care and Population HealthStanford University School of MedicineCaliforniaUSA
| | - Steven M. Asch
- Department of Medicine, Division of Primary Care and Population HealthStanford University School of MedicineCaliforniaUSA
| | - Cati G. Brown‐Johnson
- Department of Medicine, Division of Primary Care and Population HealthStanford University School of MedicineCaliforniaUSA
| | - Samantha M.R. Kling
- Department of Medicine, Division of Primary Care and Population HealthStanford University School of MedicineCaliforniaUSA
| | - Jonathan G. Shaw
- Department of Medicine, Division of Primary Care and Population HealthStanford University School of MedicineCaliforniaUSA
| | - Marcy Winget
- Department of Medicine, Division of Primary Care and Population HealthStanford University School of MedicineCaliforniaUSA
| | - David B. Larson
- Department of RadiologyStanford University School of MedicineCaliforniaUSA
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Bismantara H, Ahern S, Teede HJ, Liew D. Academic health science centre models across the developing countries and lessons for implementation in Indonesia: a scoping review. BMJ Open 2022; 12:e051937. [PMID: 36691121 PMCID: PMC9453943 DOI: 10.1136/bmjopen-2021-051937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/10/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To describe models of academic health science centres (AHSCs) across developing countries, in order to inform AHSC development in Indonesia. DESIGN Scoping review with systematic methods. DATA SOURCES Ovid MEDLINE, ProQuest Central, Wiley online library, Scopus and Web of Sciences were searched for relevant publications from 1 January 2015 to 1 December 2020. 'Grey literature' was hand searched by targeted website searches, Google searches, as well as personal communication held with stakeholders in Indonesia specifically. Relevant articles regarding AHSCs in developing countries are included. The review would be synthesised to focus on the purpose, structure and core activities of AHSCs. Strategies for success were also considered. RESULTS Twenty-six recognised AHSCs in developing countries were identified, located in Asia (n=13), Europe (n=1), South America (n=7) and Africa (n=5). Innovation, health system improvement and enhancement in academic capacity were the common visions. Most centres are functionally integrated and university-led. Most AHSCs include community health services to complement primary stakeholders such as academic institutions and hospitals. Limited information was identified regarding patient and public involvement and workforce capacity building. Five AHSCs have been piloted in Indonesia since 2018, integrating universities, academic hospitals and provincial health offices. However, information regarding their core activities and successes is limited. CONCLUSIONS The review suggests that limited published data are available on AHSC models in developing countries, but they still provide important insight into AHSC development in Indonesia. Innovation and health systems strengthening are the common visions. Functional integration with university leadership is the most common model of governance. Other than universities and hospitals, community health centres, research centres and regional health offices are common partners. There is a little description of community engagement and workforce capacity building.
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Affiliation(s)
- Haryo Bismantara
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helena J Teede
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Partners Academic Health Science Centre, Melbourne, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Mousa M, Skouteris H, Boyle JA, Currie G, Riach K, Teede HJ. Factors that influence the implementation of organisational interventions for advancing women in healthcare leadership: A meta-ethnographic study. EClinicalMedicine 2022; 51:101514. [PMID: 35856039 PMCID: PMC9287475 DOI: 10.1016/j.eclinm.2022.101514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Gender inequity in healthcare leadership persists and progress is slow, with the focus firmly on problems, barriers and on requiring women themselves to adapt and compete in a system not designed for them. Women are individually burdened to advance their careers, with little effort given to addressing systemic barriers in the health sector. A recent systematic review prioritised organisational-level approaches and demonstrated effective interventions. In this meta-ethnographic study, we further this work by examining factors in implementation of organisational interventions for advancing women in leadership. METHODS The meta-ethnographic framework applied here follows the Noblit and Hare approach for synthesising findings and applying interpretive analysis to original research. We generated a new line-of-argument with insights for the healthcare sector. The protocol is registered (CRD42020162115) on the International Prospective Register of Systematic Reviews. Three academic databases (MEDLINE, PsycINFO, SCOPUS) were searched systematically between 2000 and 2021. Studies were analysed if they included organisational-level interventions that sought to measurably advance women in leadership. Study characteristics were extracted using a standard template for intervention details. Quality appraisal was conducted using the Critical Appraisal Skills Program tool. Data synthesis was conducted across 19 criteria of the Meta-Ethnography Reporting Guide (eMERGe). FINDINGS Fifteen qualitative studies were included. Analysis revealed three meta-themes that are central to successful implementation of organisational interventions that advance women in healthcare leadership: (1) leadership commitment and accountability, influenced by internal and external organisational settings, salient for long term outcomes and for developing an inclusive leadership culture; (2) intervention fit with individuals with consideration given to personal beliefs, preferences, experiences, capabilities or life circumstances, including capacity for leadership roles in their broader life context; balanced against maintaining interventional fidelity, and (3) cultural climate and organisational readiness for change, addressing traditional, conservative and constrictive perspectives on gender and leadership in health, highlighting the facilitating role of male colleagues. INTERPRETATION This meta-ethnographic research extends past work by integrating empirical evidence from a systematic literature review of effective organisational level interventions, with the identification of pragmatic themes to generate, implement, evaluate and embed evidence-based organisational interventions to advance women in healthcare leadership. This work can inform initiatives and policymakers to generate and implement new knowledge to advance women in healthcare leadership. FUNDING Epworth Health and Monash University provided scholarships for MM. HT is funded by an NHMRC / MRFF Practitioner Fellowship, JB by an NHMRC fellowship and HS by a Monash Warwick University Professorship.
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Affiliation(s)
- Mariam Mousa
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Melbourne, Australia
- Epworth Healthcare, Melbourne, Victoria, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Australia
- Warwick Business School, Warwick University, Coventry, UK
| | - Jacqueline A. Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Melbourne, Australia
- Epworth Healthcare, Melbourne, Victoria, Australia
- Monash Partners Academic Health Science Centre, Melbourne, Australia
- Health Systems and Equity, Eastern Health Clinical School, Monash University
| | - Graeme Currie
- Warwick Business School, Warwick University, Coventry, UK
| | - Kathleen Riach
- Adam Smith Business School, University of Glasgow, Scotland, UK
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Melbourne, Australia
- Monash Partners Academic Health Science Centre, Melbourne, Australia
- Endocrine and Diabetes Units, Monash Health, Melbourne, Australia
- Warwick Business School, Warwick University, Coventry, UK
- Corresponding author at: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne, VIC 3168, Australia.
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12
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Levin A, Malbeuf M, Hoens AM, Carlsten C, Ryerson CJ, Cau A, Bryan S, Robinson J, Tarling T, Shum J, Lavallee DC. Creating a provincial post COVID-19 interdisciplinary clinical care network as a learning health system during the pandemic: Integrating clinical care and research. Learn Health Syst 2022; 7:e10316. [PMID: 35942206 PMCID: PMC9348470 DOI: 10.1002/lrh2.10316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/16/2022] [Accepted: 05/02/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Coronavirus Disease-2019 (COVID-19) affects multiple organ systems in the acute phase and also has long-term sequelae. Research on the long-term impacts of COVID-19 is limited. The Post COVID-19 Interdisciplinary Clinical Care Network (PC-ICCN), conceived in July 2020, is a provincially funded resource that is modelled as a Learning Health System (LHS), focused on those people with persistent symptoms post COVID-19 infection. Methods The PC-ICCN emerged through collaboration among over 60 clinical specialists, researchers, patients, and health administrators. At the core of the network are the post COVID-19 Recovery Clinics (PCRCs), which provide direct patient care that includes standardized testing and education at regular follow-up intervals for a minimum of 12 months post enrolment. The PC-ICCN patient registry captures data on all COVID-19 patients with confirmed infection, by laboratory testing or epi-linkage, who have been referred to one of five post COVID-19 Recovery Clinics at the time of referral, with data stored in a fully encrypted Oracle-based provincial database. The PC-ICCN has centralized administrative and operational oversight, multi-stakeholder governance, purpose built data collection supported through clinical operations geographically dispersed across the province, and research operations including data analytics. Results To date, 5364 patients have been referred, with an increasing number and capacity of these clinics, and 2354 people have had at least one clinic visit. Since inception, the PC-ICCN has received over 30 research proposal requests. This is aligned with the goal of creating infrastructure to support a wide variety of research to improve care and outcomes for patients experiencing long-term symptoms following COVID-19 infection. Conclusions The PC-ICCN is a first-in-kind initiative in British Columbia to enhance knowledge and understanding of the sequelae of COVID-19 infection over time. This provincial initiative serves as a model for other national and international endeavors to enable care as research and research as care.
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Affiliation(s)
- Adeera Levin
- Division of NephrologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Provincial Health Services AuthorityVancouverBritish ColumbiaCanada
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Michelle Malbeuf
- Provincial Health Services AuthorityVancouverBritish ColumbiaCanada
- Providence Health CareVancouverBritish ColumbiaCanada
| | - Alison M Hoens
- Michael Smith Health Research BCVancouverBritish ColumbiaCanada
- Department of Physical TherapyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- Centre for Clinical Epidemiology and EvaluationVancouver Coastal Health Research InstituteVancouverBritish ColumbiaCanada
- Centre for Health Evaluation and Outcome SciencesSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Christopher Carlsten
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung InnovationSt. Paul's HospitalVancouverBritish ColumbiaCanada
- Legacy for Airway HealthVancouver Coastal Health Research InstituteVancouverBritish ColumbiaCanada
| | - Christopher J Ryerson
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung InnovationSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Alessandro Cau
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Stirling Bryan
- Michael Smith Health Research BCVancouverBritish ColumbiaCanada
- Centre for Clinical Epidemiology and EvaluationVancouver Coastal Health Research InstituteVancouverBritish ColumbiaCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Jaclyn Robinson
- Provincial Health Services AuthorityVancouverBritish ColumbiaCanada
- Vancouver Coastal Health AuthorityVancouverBritish ColumbiaCanada
| | - Tamsin Tarling
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Joanne Shum
- Provincial Health Services AuthorityVancouverBritish ColumbiaCanada
| | - Danielle C Lavallee
- Michael Smith Health Research BCVancouverBritish ColumbiaCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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En‐nasery‐de Heer S, Uitvlugt EB, Bet PM, Bemt BJF, Alai A, Bemt PMLA, Swart EL, Karapinar‐Çarkit F, Hugtenburg JG. Implementation of a pharmacist‐led transitional pharmaceutical care programme: Process evaluation of Medication Actions to Reduce hospital admissions through a collaboration between Community and Hospital pharmacists (MARCH). J Clin Pharm Ther 2022; 47:1049-1069. [PMID: 35306683 PMCID: PMC9544789 DOI: 10.1111/jcpt.13645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/03/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
What is known and objective The recently conducted Medication Actions to Reduce hospital admissions through a collaboration between Community and Hospital pharmacists (MARCH) transitional care programme, which aimed to test the effectiveness of a transitional care programme on the occurrence of ADEs post‐discharge, did not show a significant effect. To clarify whether this non‐significant effect was due to poor implementation or due to ineffectiveness of the intervention as such, a process evaluation was conducted. The aim of the study was to gain more insight into the implementation fidelity of MARCH. Methods A mixed methods design and the modified Conceptual Framework for Implementation Fidelity was used. For evaluation, the implementation fidelity and moderating factors of four key MARCH intervention components (teach‐back, the pharmaceutical discharge letter, the post‐discharge home‐visit and the transitional medication review) were assessed. Quantitative data were collected during and after the intervention. Qualitative data were collected using semi‐structured interviews with MARCH healthcare professionals (community pharmacists, clinical pharmacists, pharmacy assistants and pharmaceutical consultants) and analysed using thematic analysis. Results and Discussion Not all key intervention components were implemented as intended. Teach‐back was not always performed. Moreover, 63% of the pharmaceutical discharge letters, 35% of the post‐discharge home‐visits and 44% of the transitional medication reviews were not conducted within their planned time frames. Training sessions, structured manuals and protocols with detailed descriptions facilitated implementation. Intervention complexity, time constraints and the multidisciplinary coordination were identified as barriers for the implementation. What is new and Conclusion Overall, the implementation fidelity was considered to be moderate. Not all key intervention components were carried out as planned. Therefore, the non‐significant results of the MARCH programme on ADEs may at least partly be explained by poor implementation of the programme. To successfully implement transitional care programmes, healthcare professionals require full integration of these programmes in the standard work‐flow including IT improvements as well as compensation for the time investment.
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Affiliation(s)
| | | | - Pierre M. Bet
- Department of Clinical Pharmacology and Pharmacy Amsterdam UMC Amsterdam The Netherlands
| | - Bart J. F. Bemt
- Department of Pharmacy Sint Maartenskliniek Nijmegen The Netherlands
- Department of Pharmacy Radboud University Medical Centre Nijmegen The Netherlands
| | - Aida Alai
- Department of Clinical Pharmacology and Pharmacy Amsterdam UMC Amsterdam The Netherlands
| | - Patricia M. L. A. Bemt
- Department of Clinical Pharmacy and Pharmacology University Medical Center Groningen Groningen The Netherlands
| | - Eleonora L. Swart
- Department of Clinical Pharmacology and Pharmacy Amsterdam UMC Amsterdam The Netherlands
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Melder A, Robinson T, Mcloughlin I, Iedema R, Teede H. Integrating the complexity of healthcare improvement with implementation science: a longitudinal qualitative case study. BMC Health Serv Res 2022; 22:234. [PMID: 35183164 PMCID: PMC8858551 DOI: 10.1186/s12913-022-07505-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/13/2022] [Indexed: 12/05/2022] Open
Abstract
Background Implementation science seeks to enable change, underpinned by theories and frameworks such as the Consolidated Framework for Implementation Research (CFIR). Yet academia and frontline healthcare improvement remain largely siloed, with limited integration of implementation science methods into frontline improvement where the drivers include pragmatic, rapid change. Using the CIFR lens, we aimed to explore how pragmatic and complex healthcare improvement and implementation science can be integrated. Methods Our research involved the investigation of a case study that was undertaking the implementation of an improvement intervention at a large public health service. Our research involved qualitative data collection methods of semi-structured interviews and non-participant observations of the implementation team delivering the intervention. Thematic analysis identified key themes from the qualitative data. We examined our themes through the lens of CFIR to gain in-depth understanding of how the CFIR components operated in a ‘real-world’ context. Results The key themes emerging from our research outlined that leadership, context and process are the key components that dominate and affect the implementation process. Leadership which cultivates connections with front line clinicians, fosters engagement and trust. Navigating context was facilitated by ‘bottom-up’ governance. Multi-disciplinary and cross-sector capability were key processes that supported pragmatic and agile responses in a changing complex environment. Process reflected the theoretically-informed, and iterative implementation approach. Mapping CFIR domains and constructs, with these themes demonstrated close alignment with the CFIR. The findings bring further depth to CFIR. Our research demonstrates that leadership which has a focus on patient need as a key motivator to engage clinicians, which applies and ensures iterative processes which leverage contextual factors can achieve successful, sustained implementation and healthcare improvement outcomes. Conclusions Our longitudinal study highlights insights that strengthen alignment between implementation science and pragmatic frontline healthcare improvement. We identify opportunities to enhance the relevance of CFIR in the ‘real-world’ setting through the interconnected nature of our themes. Our study demonstrates actionable knowledge to enhance the integration of implementation science in healthcare improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07505-5.
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15
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Taylor B, Hewison A, Cross-Sudworth F, Morrell K. Transformational Change in maternity services in England: a longitudinal qualitative study of a national transformation programme 'Early Adopter'. BMC Health Serv Res 2022; 22:57. [PMID: 35022052 PMCID: PMC8753811 DOI: 10.1186/s12913-021-07375-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 11/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Large system transformation in health systems is designed to improve quality, outcomes and efficiency. Using empirical data from a longitudinal study of national policy-driven transformation of maternity services in England, we explore the utility of theory-based rules regarding 'what works' in large system transformation. METHODS A longitudinal, qualitative case study was undertaken in a large diverse urban setting involving multiple hospital trusts, local authorities and other key stakeholders. Data was gathered using interviews, focus groups, non-participant observation, and a review of key documents in three phases between 2017 and 2019. The transcripts of the individual and focus group interviews were analysed thematically, using a combined inductive and deductive approach drawing on simple rules for large system transformation derived from evidence synthesis and the findings are reported in this paper. RESULTS Alignment of transformation work with Best et al's rules for 'what works' in large system transformation varied. Interactions between the rules were identified, indicating that the drivers of large system transformation are interdependent. Key challenges included the pace and scale of change that national policy required, complexity of the existing context, a lack of statutory status for the new 'system' limiting system leaders' power and authority, and concurrent implementation of a new overarching system alongside multifaceted service change. CONCLUSIONS Objectives and timescales of transformation policy and plans should be realistic, flexible, responsive to feedback, and account for context. Drivers of large system transformation appear to be interdependent and synergistic. Transformation is likely to be more challenging in recently established systems where the basis of authority is not yet clearly established.
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Affiliation(s)
- Beck Taylor
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Alistair Hewison
- School of Nursing, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Fiona Cross-Sudworth
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Kevin Morrell
- Cranfield School of Management, College Rd, Cranfield, Wharley End, Bedford, MK43 0AL UK
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16
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An Implementation Science Laboratory as One Approach to Whole System Improvement: A Canadian Healthcare Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312681. [PMID: 34886408 PMCID: PMC8656644 DOI: 10.3390/ijerph182312681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/27/2021] [Accepted: 11/28/2021] [Indexed: 01/04/2023]
Abstract
Implementation science (IS) has emerged as an integral component for evidence-based whole system improvement. IS studies the best methods to promote the systematic uptake of evidence-based interventions into routine practice to improve the quality and effectiveness of health service delivery and patient care. IS laboratories (IS labs) are one mechanism to integrate implementation science as an evidence-based approach to whole system improvement and to support a learning health system. This paper aims to examine if IS labs are a suitable approach to whole system improvement. We retrospectively analyzed an existing IS lab (Alberta, Canada’s Implementation Science Collaborative) to assess the potential of IS labs to perform as a whole system approach to improvement and to identify key activities and considerations for designing IS labs specifically to support learning health systems. Results from our evaluation show the extent to which IS labs support learning health systems through enabling infrastructures for system-wide improvement and research.
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17
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Enticott JC, Melder A, Johnson A, Jones A, Shaw T, Keech W, Buttery J, Teede H. A Learning Health System Framework to Operationalize Health Data to Improve Quality Care: An Australian Perspective. Front Med (Lausanne) 2021; 8:730021. [PMID: 34778291 PMCID: PMC8580135 DOI: 10.3389/fmed.2021.730021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Our healthcare system faces a burgeoning aging population, rising complexity, and escalating costs. Around 10% of healthcare is harmful, and evidence is slow to implement. Innovation to deliver quality and sustainable health systems is vital, and the methods are challenging. The aim of this study is to describe the process and present a perspective on a coproduced Learning Health System framework. The development of the Framework was led by publicly funded, collaborative, Academic Health Research Translation Centres, with a mandate to integrate research into healthcare to deliver impact. The focus of the framework is “learning together for better health,” with coproduction involving leadership by an expert panel, a systematic review, qualitative research, a stakeholder workshop, and iterative online feedback. The coproduced framework incorporates evidence from stakeholders, from research, from data (practice to data and data to new knowledge), and from implementation, to take new knowledge to practice. This continuous learning approach aims to deliver evidence-based healthcare improvement and is currently being implemented and evaluated.
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Affiliation(s)
- Joanne C Enticott
- Southern Synergy, Department of Psychiatry, Monash University, Melbourne, VIC, Australia.,Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia.,Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Angela Melder
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia.,Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Alison Johnson
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Tim Shaw
- Sydney Health Partners, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Wendy Keech
- Health Translation South Australia, Adelaide, SA, Australia
| | - Jim Buttery
- Centre for Health Analytics, Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia.,Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
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18
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Jones AR, Tay CT, Melder A, Vincent AJ, Teede H. What Are Models of Care? A Systematic Search and Narrative Review to Guide Development of Care Models for Premature Ovarian Insufficiency. Semin Reprod Med 2021; 38:323-330. [PMID: 33684948 DOI: 10.1055/s-0041-1726131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
No specific model of care (MoC) is recommended for premature ovarian insufficiency (POI), despite awareness that POI is associated with comorbidities requiring multidisciplinary care. This article aims to explore the definitions and central components of MoC in health settings, so that care models for POI can be developed. A systematic search was performed on Ovid Medline and Embase, and including gray literature. Unique definitions of MoC were identified, and thematic analysis was used to summarize the key component of MoC. Of 2,477 articles identified, 8 provided unique definitions of MoC, and 11 described components of MoC. Definitions differ in scope, focusing on disease, service, or system level, but a key feature is that MoC is operational, describing how care is delivered, as well as what that care is. Thematic analysis identified 42 components of MoC, summarized into 6 themes-stakeholder engagement, supporting integrated care, evidence-based care, defined outcomes and evaluation, behavior change methodology, and adaptability. Stakeholder engagement was central to all other themes. MoCs operationalize how best practice care can be delivered at a disease, service, or systems level. Specific MoC should be developed for POI, to improve clinical and process outcomes, translate evidence into practice, and use resources more efficiently.
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Affiliation(s)
- Alicia R Jones
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia.,Department of Endocrinology, Monash Health, Victoria, Australia
| | - Chau T Tay
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia.,Department of Endocrinology, Monash Health, Victoria, Australia
| | - Angela Melder
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia.,Monash Partner's Academic Health Science Centre, Victoria, Australia
| | - Amanda J Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia.,Department of Endocrinology, Monash Health, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia.,Department of Endocrinology, Monash Health, Victoria, Australia.,Monash Partner's Academic Health Science Centre, Victoria, Australia
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19
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Enticott J, Johnson A, Teede H. Learning health systems using data to drive healthcare improvement and impact: a systematic review. BMC Health Serv Res 2021; 21:200. [PMID: 33663508 PMCID: PMC7932903 DOI: 10.1186/s12913-021-06215-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/18/2021] [Indexed: 11/15/2022] Open
Abstract
Background The transition to electronic health records offers the potential for big data to drive the next frontier in healthcare improvement. Yet there are multiple barriers to harnessing the power of data. The Learning Health System (LHS) has emerged as a model to overcome these barriers, yet there remains limited evidence of impact on delivery or outcomes of healthcare. Objective To gather evidence on the effects of LHS data hubs or aligned models that use data to deliver healthcare improvement and impact. Any reported impact on the process, delivery or outcomes of healthcare was captured. Methods Systematic review from CINAHL, EMBASE, MEDLINE, Medline in-process and Web of Science PubMed databases, using learning health system, data hub, data-driven, ehealth, informatics, collaborations, partnerships, and translation terms. English-language, peer-reviewed literature published between January 2014 and Sept 2019 was captured, supplemented by a grey literature search. Eligibility criteria included studies of LHS data hubs that reported research translation leading to health impact. Results Overall, 1076 titles were identified, with 43 eligible studies, across 23 LHS environments. Most LHS environments were in the United States (n = 18) with others in Canada, UK, Sweden and Australia/NZ. Five (21.7%) produced medium-high level of evidence, which were peer-reviewed publications. Conclusions LHS environments are producing impact across multiple continents and settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06215-8.
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Affiliation(s)
- Joanne Enticott
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia. .,Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia.
| | - Alison Johnson
- Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia. .,Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia.
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20
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Enticott J, Braaf S, Johnson A, Jones A, Teede HJ. Leaders' perspectives on learning health systems: a qualitative study. BMC Health Serv Res 2020; 20:1087. [PMID: 33243214 PMCID: PMC7689994 DOI: 10.1186/s12913-020-05924-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background Integrated utilisation of digital health data has the power to transform healthcare to deliver more efficient and effective services, and the learning health system (LHS) is emerging as a model to achieve this. The LHS uses routine data from service delivery and patient care to generate knowledge to continuously improve healthcare. The aim of this project was to explore key features of a successful and sustainable LHS to inform implementation in an Academic Health Science Centre context. Methods We purposively identified and conducted semi-structured qualitative interviews with leaders, experienced in supporting or developing data driven innovations in healthcare. A thematic analysis using NVivo was undertaken. Results Analysis of 26 interviews revealed five themes thought to be integral in an effective, sustainable LHS: (1) Systematic approaches and iterative, continuous learning with implementation into healthcare contributing to new best-practice care; (2) Broad stakeholder, clinician and academic engagement, with collective vision, leadership, governance and a culture of trust, transparency and co-design; (3) Skilled workforce, capability and capacity building; (4) Resources with sustained investment over time and; (5) Data access, systems and processes being integral to a sustainable LHS. Conclusions This qualitative study provides insights into the elements of a sustainable LHS across a range of leaders in data-driven healthcare improvement. Fundamentally, an LHS requires continuous learning with implementation of new evidence back into frontline care to improve outcomes. Structure, governance, trust, culture, vision and leadership were all seen as important along with a skilled workforce and sustained investment. Processes and systems to optimise access to quality data were also seen as vital in an effective, sustainable LHS. These findings will inform a co-designed framework for implementing a sustainable LHS within the Australian healthcare and Academic Health Science Centre context. It is anticipated that application of these findings will assist to embed and accelerate the use of routine health data to continuously generate new knowledge and ongoing improvement in healthcare delivery and health outcomes.
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Affiliation(s)
- Joanne Enticott
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia. .,Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia.
| | - Sandra Braaf
- Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia.,School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Alison Johnson
- Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia.,Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia
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