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Moyal-Smith R, Etheridge JC, Karlage A, Sonnay Y, Yuan CT, Havens JM, Brindle ME, Berry W. Defining re-implementation. Implement Sci Commun 2023; 4:60. [PMID: 37277862 DOI: 10.1186/s43058-023-00440-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/19/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The first attempt to implement a new tool or practice does not always lead to the desired outcome. Re-implementation, which we define as the systematic process of reintroducing an intervention in the same environment, often with some degree of modification, offers another chance at implementation with the opportunity to address failures, modify, and ultimately achieve the desired outcomes. This article proposes a definition and taxonomy for re-implementation informed by case examples in the literature. MAIN BODY We conducted a scoping review of the literature for cases that describe re-implementation in concept or practice. We used an iterative process to identify our search terms, pilot testing synonyms or phrases related to re-implementation. We searched PubMed and CINAHL, including articles that described implementing an intervention in the same environment where it had already been implemented. We excluded articles that were policy-focused or described incremental changes as part of a rapid learning cycle, efforts to spread, or a stalled implementation. We assessed for commonalities among cases and conducted a thematic analysis on the circumstance in which re-implementation occurred. A total of 15 articles representing 11 distinct cases met our inclusion criteria. We identified three types of circumstances where re-implementation occurs: (1) failed implementation, where the intervention is appropriate, but the implementation process is ineffective, failing to result in the intended changes; (2) flawed intervention, where modifications to the intervention itself are required either because the tool or process is ineffective or requires tailoring to the needs and/or context of the setting where it is used; and (3) unsustained intervention, where the initially successful implementation of an intervention fails to be sustained. These three circumstances often co-exist; however, there are unique considerations and strategies for each type that can be applied to re-implementation. CONCLUSIONS Re-implementation occurs in implementation practice but has not been consistently labeled or described in the literature. Defining and describing re-implementation offers a framework for implementation practitioners embarking on a re-implementation effort and a starting point for further research to bridge the gap between practice and science into this unexplored part of implementation.
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Affiliation(s)
- Rachel Moyal-Smith
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3Rd Floor West, Boston, MA, 02215, USA.
| | - James C Etheridge
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3Rd Floor West, Boston, MA, 02215, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ami Karlage
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3Rd Floor West, Boston, MA, 02215, USA
| | - Yves Sonnay
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3Rd Floor West, Boston, MA, 02215, USA
| | - Christina T Yuan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joaquim M Havens
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3Rd Floor West, Boston, MA, 02215, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary E Brindle
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3Rd Floor West, Boston, MA, 02215, USA
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - William Berry
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3Rd Floor West, Boston, MA, 02215, USA
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Gransjøen AM, Thorsen K, Lysdahl KB, Wiig S, Hofmann BM. Impact on radiological practice of active guideline implementation of musculoskeletal guideline, as measured over a 12-month period. Acta Radiol Open 2021; 10:2058460120988171. [PMID: 33796335 PMCID: PMC7975584 DOI: 10.1177/2058460120988171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/27/2020] [Indexed: 12/01/2022] Open
Abstract
Background An ever-increasing technological development in the field of radiology urges
a need for guidelines to provide predictable and just health services. A
musculoskeletal guideline was developed in Norway in 2014, without active
implementation. Purpose To investigate the impact of active guideline implementation on the use of
musculoskeletal diagnostic imaging most frequently encountered in general
practice (pain in the neck, shoulders, lower back, and knees). Material and Methods The total number of outpatient radiological examinations across modalities
registered at the Norwegian Health Economics Administration between January
2013 and February 2019 was assessed using an interrupted time series
design. Results A 12% reduction in the total examination of Magnetic Resonance Imaging
shoulder and knee, and x-ray lower back and shoulder was found at a
significant level (p = 0.05). Stratified analysis (Magnetic
Resonance Imaging examination as one group and x-ray examinations as the
other) showed that this reduction mainly was due to the reduction in the use
of Magnetic Resonance Imaging examinations (shoulder and knee) which was
reduced by 24% at a significant level (p = 0.002), while
x-ray examinations had no significant level change
(p = 0.71). No other statistically significant changes were
found. Conclusion The impact of the implementation on the use of imaging of the neck, shoulder,
lower back, and knee is uncertain. Significant reductions were demonstrated
in the use of some examinations in the intervention county, but similar
effects were not seen when including a control group in the analysis. This
indicates a diffusion of the implementation, or other interventions or
events that affected both counties and occurred in the intervention
period.
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Affiliation(s)
- Ann M Gransjøen
- Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | | | - Kristin B Lysdahl
- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway
| | - Siri Wiig
- SHARE-Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Bjørn M Hofmann
- Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.,Center for Medical Ethics, University of Oslo, Blindern, Oslo
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Gransjøen AM, Wiig S, Lysdahl KB, Hofmann BM. Health care personnel's perception of guideline implementation for musculoskeletal imaging: a process evaluation. BMC Health Serv Res 2020; 20:397. [PMID: 32393317 PMCID: PMC7212587 DOI: 10.1186/s12913-020-05272-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/29/2020] [Indexed: 01/29/2023] Open
Abstract
Background The increasing complexity and variability in radiology have significantly fueled the need for guidelines. There are many methods for disseminating and implementing guidelines however; and obtaining lasting changes has been difficult. Implementation outcome is usually measured in a decrease in unwarranted examinations, and qualitative data are rarely used. This study’s aim was to evaluate a guideline implementation process and identify factors influencing implementation outcome using qualitative data. Methods Seven general practitioners and five radiological personnel from a Norwegian county participated in four focus group interviews in 2019. The data were analyzed using qualitative content analysis, where some categories were predetermined, while most were drawn from the data. Results Four main categories were developed from the data material. 1) Successful/unsuccessful parts of the implementation, 2) perceived changes/lack of changes after the implementation, 3) environment-related factors that affected guideline use, and 4) User related factors that affect guideline use. Conclusions Our findings show that clinical guideline implementation is difficult, despite the implementation strategy being tailored to the target groups. Several environment- and user-related factors contributed to the lack of changes experienced in practice for both general practitioners and radiological personnel.
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Affiliation(s)
- Ann Mari Gransjøen
- Department of Health sciences in Gjøvik, Norwegian University of Science and Technology in Gjøvik (NTNU), Teknologiveien 22, 2815, Gjøvik, Norway.
| | - Siri Wiig
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 41, 4036, Stavanger, Norway
| | - Kristin Bakke Lysdahl
- Department of Optometry, Radiography and Lighting Design, Faculty of Health Sciences, University of South-Eastern Norway, Box 235, 3603, Kongsberg, PO, Norway
| | - Bjørn Morten Hofmann
- Department of Health sciences in Gjøvik, Norwegian University of Science and Technology in Gjøvik (NTNU), Teknologiveien 22, 2815, Gjøvik, Norway.,Center for medical ethics, University of Oslo, PO Box 1130, Blindern, 0318, Oslo, Norway
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