This document discusses implementation strategies for improving healthcare practices. It defines implementation strategies as methods used to promote the adoption of clinical programs. Effective strategies include assessing current performance, analyzing barriers and facilitators, developing an implementation plan, and continuous evaluation. Common strategies discussed include audit and feedback, educational outreach, reminders, and financial incentives. The document notes that no single strategy is clearly most effective and that tailoring strategies to the local context is important. It also introduces several tools for assessing the context, such as the COACH framework which examines multiple dimensions like work culture, leadership, and resources.
Process of Educational Planning in Pakistan (1).pptxDrHafizKosar
Educational Planning
The planning process consists of setting goals, creating tasks to achieve those goals, figuring out what resources are needed, putting together a schedule, deciding on monitoring and evaluation, completing the plan, and giving it to the team. Large companies, management groups, and individual employees can all use the process to create and finish a plan.
Educational planning and decision-making, like planning in other social sectors, is a complex, interactive process involving many policy-making, technical, and administrative bodies at the National and Provincial levels. The general purpose of national educational planning in any country is to assist and facilitate the development of the educational system.
At minimum, this task includes: linking education to the economy, culture, and society; maintaining the integrity of the system in order that the different levels and kinds of education reinforce one another; and, developing a system which monitors its own performance and responds accordingly.
The educational planning process involves a vision, objectives, policy review, program explanation, and resource assessment. It involves simple and complex methodologies. Effective planning requires reliable data for system adjustments and budget development. Matching priorities to a feasible budget is crucial for influencing change.
Need for Educational Planning
Resource Allocation.
Goal Setting and Achievement
Curriculum Development
Quality Assurance
Adaptation to Changing Needs
Process of Educational Planning in Pakistan
The steps in the planning process include developing objectives, developing tasks to meet objectives, determining needed resources, creating a timeline, determining tracking and assessment, finalizing the plan, and distributing the plan to the team.
These phases come in the following sequence:
• Pre-Planning
• Planning
• Plan Formulation
• Plan Elaboration
• Plan Implementation
• Plan Evaluation
Process of Educational Planning in Pakistan (1).pptxDrHafizKosar
Educational Planning
The planning process consists of setting goals, creating tasks to achieve those goals, figuring out what resources are needed, putting together a schedule, deciding on monitoring and evaluation, completing the plan, and giving it to the team. Large companies, management groups, and individual employees can all use the process to create and finish a plan.
Educational planning and decision-making, like planning in other social sectors, is a complex, interactive process involving many policy-making, technical, and administrative bodies at the National and Provincial levels. The general purpose of national educational planning in any country is to assist and facilitate the development of the educational system.
At minimum, this task includes: linking education to the economy, culture, and society; maintaining the integrity of the system in order that the different levels and kinds of education reinforce one another; and, developing a system which monitors its own performance and responds accordingly.
The educational planning process involves a vision, objectives, policy review, program explanation, and resource assessment. It involves simple and complex methodologies. Effective planning requires reliable data for system adjustments and budget development. Matching priorities to a feasible budget is crucial for influencing change.
Need for Educational Planning
Resource Allocation.
Goal Setting and Achievement
Curriculum Development
Quality Assurance
Adaptation to Changing Needs
Process of Educational Planning in Pakistan
The steps in the planning process include developing objectives, developing tasks to meet objectives, determining needed resources, creating a timeline, determining tracking and assessment, finalizing the plan, and distributing the plan to the team.
These phases come in the following sequence:
• Pre-Planning
• Planning
• Plan Formulation
• Plan Elaboration
• Plan Implementation
• Plan Evaluation
The scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice and hence improve the quality and effectiveness of health services
Curriculum: Concept, Models , Curriculum design and developmentMd. Nazrul Islam
the Concept of Curriculum
what is Curriculum Development?
the Purpose of Curriculum Development
Basic Elements of Curriculum
Curriculum strategies
Key aspects of the curriculum
Curriculum Development Process
Curriculum Evaluation and Review
Curriculum Format at Course and program Levels
Standard 4: Curriculum (BAC)
Curriculum Model
Characteristics of Exemplary Curriculum
Integrated teaching for effective learning in health professionsK Raman Sethuraman
Health professions education, being complex is ideally suited for integrated teaching-learning. This is a slide-set that will help you to conduct a 100-minute session set in a workshop mode. Suitable for Educators of Medicine, Dentistry, Nursing and allied health professions.
For a School of Information class on medical librarianship, this presentation was created to provide a very basic introduction and overview of the concepts, expectations, and experience of the librarian portion of working in a systematic review team.
The scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice and hence improve the quality and effectiveness of health services
Curriculum: Concept, Models , Curriculum design and developmentMd. Nazrul Islam
the Concept of Curriculum
what is Curriculum Development?
the Purpose of Curriculum Development
Basic Elements of Curriculum
Curriculum strategies
Key aspects of the curriculum
Curriculum Development Process
Curriculum Evaluation and Review
Curriculum Format at Course and program Levels
Standard 4: Curriculum (BAC)
Curriculum Model
Characteristics of Exemplary Curriculum
Integrated teaching for effective learning in health professionsK Raman Sethuraman
Health professions education, being complex is ideally suited for integrated teaching-learning. This is a slide-set that will help you to conduct a 100-minute session set in a workshop mode. Suitable for Educators of Medicine, Dentistry, Nursing and allied health professions.
For a School of Information class on medical librarianship, this presentation was created to provide a very basic introduction and overview of the concepts, expectations, and experience of the librarian portion of working in a systematic review team.
[Ann Emerg Med. 2009;53:685-687.]
Systematic Review Source
This is a systematic review abstract, a regular feature of the Annals' Evidence-Based Emergency Medicine (EBEM) series. Each features an abstract of a systematic review from the Cochrane Database of Systematic Reviews and a commentary by an emergency physician knowledgeable in the subject area.
The source for this systematic review abstract is: O'Brien MA, Freemantle N, Oxman AD, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2001;(2):CD003030.
The Annals' EBEM editors helped prepare the abstract of this Cochrane systematic review, as well as the Evidence-Based Medicine Teaching Points.
Objective
To determine the effects of continuing educational meetings on professional practice and health care outcomes.
Data Sources
The Cochrane Effective Practice and Organization of Care Group specialized register, MEDLINE, and the Research and Development Resource Base in Continuing Medical Education were searched. The reference list of related systematic reviews and all articles obtained were reviewed. This review was amended in 2006 from the previous one published in 2001; a formal update is currently underway.
Study Selection
Studies were included if they were randomized controlled trials or nonequivalent group designs with nonrandom allocation. The participants of the studies were qualified health professionals or health professionals in postgraduate training (eg, resident physicians). Studies involving only undergraduate students were excluded. All types of educational activities were included (eg, meeting, conferences, lectures, workshop, seminar), and interventions were didactic, interactive, or a mixed didactic and interactive nature. Didactic intervention offered minimal participant interaction such as lectures or presentations; interactive interventions included role play, case discussion, or hands-on training in small (<10 people), moderate (10 to 19 people), or large (>19 people) participant groups. Only the studies that objectively measured health professional practice behavior or patient outcomes in the setting in which health care was provided were included.
Data Extraction
Two authors independently applied inclusion criteria, assessed the quality of each study, and extracted the data. Each study was then assigned a quality rating of protection against bias according to 3 criteria: study design, blinded outcome assessment, and completeness of follow-up. Studies were analyzed according to the type of intervention, subjective assessment of complexity of targeted behaviors, and the level of baseline compliance and protection against bias.
Main Results
Educational Meeting Versus No Intervention
Of the 32 studies with 35 comparisons between educational meeting and noninterventional control groups, 24 studies reported marked improvement in professional practice. There were statistically significant ...
Developing a culture of safety is a core element of many efforts t.docxduketjoy27252
Developing a culture of safety is a core element of many efforts to
improve patient safety and care quality. This systematic review
identifies and assesses interventions used to promote safety culture
or climate in acute care settings. The authors searched MEDLINE,
CINAHL, PsycINFO, Cochrane, and EMBASE to identify relevant
English-language studies published from January 2000 to October
2012. They selected studies that targeted health care workers practicing
in inpatient settings and included data about change in patient
safety culture or climate after a targeted intervention. Two
raters independently screened 3679 abstracts (which yielded 33
eligible studies in 35 articles), extracted study data, and rated study
quality and strength of evidence. Eight studies included executive
walk rounds or interdisciplinary rounds; 8 evaluated multicomponent,
unit-based interventions; and 20 included team training or
communication initiatives. Twenty-nine studies reported some improvement
in safety culture or patient outcomes, but measured
outcomes were highly heterogeneous. Strength of evidence was
low, and most studies were pre–post evaluations of low to moderate
quality. Within these limits, evidence suggests that interventions
can improve perceptions of safety culture and potentially
reduce patient harm.
Ann Intern Med. 2013;158:369-374. www.annals.org
For author affiliations, see end of text.
THE PROBLEM
Developing a culture of safety is a core element of
many efforts to improve patient safety and care quality in
acute care settings (1, 2). Several studies show that safety
culture and the related concept of safety climate are related
to such clinician behaviors as error reporting (3), reductions
in adverse events (4, 5), and reduced mortality (6, 7).
Accreditation bodies identify leadership standards for
safety culture measurement and improvement (8), and promoting
a culture of safety is a designated National Patient
Safety Foundation Safe Practice (9). A search of the Agency
for Healthcare Research and Quality (AHRQ) Patient
Safety Net (www.psnet.ahrq.gov) yields more than 5665
articles, tips, and fact sheets related to improving safety
culture. Although much work has focused on promoting a
culture of safety, understanding which approaches are most
effective and the implementation factors that may influence
effectiveness are critical to achieving meaningful improvement
(10).
Drawing on the social, organizational, and safety sciences,
patient safety culture can be defined as 1 aspect of an
organization’s culture (11, 12). Specifically, it can be personified
by the shared values, beliefs, norms, and procedures
related to patient safety among members of an organization,
unit, or team (13, 14). It influences clinician and
staff behaviors, attitudes, and cognitions on the job by
providing cues about the relative priority of patient safety
compared with other goals (for example, throughput or
efficiency) (11). Culture also shapes clinician and staff perce.
Assignment WK 9Assessing a Healthcare ProgramPolicy Evaluation.docxjesuslightbody
Assignment: WK 9Assessing a Healthcare Program/Policy Evaluation
Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.
Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.
To Prepare:
· Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
· Select an existing healthcare program or policy evaluation or choose one of interest to you.
· Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.
The Assignment: (2–3 pages)
Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:
· Describe the healthcare program or policy outcomes.
· How was the success of the program or policy measured?
· How many people were reached by the program or policy selected?
· How much of an impact was realized with the program or policy selected?
· At what point in program implementation was the program or policy evaluation conducted?
· What data was used to conduct the program or policy evaluation?
· What specific information on unintended consequences was identified?
· What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
· Did the program or policy meet the original intent and objectives? Why or why not?
· Would you recommend implementing this program or policy in your place of work? Why or why not?
· Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.
By Day 7 of Week 10
Submit your completed healthcare program/policy evaluation analysis.
Milstead, J. A., & Short, N. M. (2019).
Health policy and politics: A nurse's guide (6th ed.). Jones & Bartlett Learning.
· Chapter 7, “Health Policy and Social Program Evaluation” (pp. 116–124 only)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409875/
https://www.sciencedirect.com/science/article/pii/S0029655418300617
i J LUUU^S
.
Soraya Ghebleh - Clinical Integration and Care CoordinationSoraya Ghebleh
Here is a simple slidedeck of research done that examined which systemic care coordination practices should be maximized according to the literature to improve clinical integration within and between healthcare organizations.
Reflective Journal Week 5Topic Philosophies and Theories for Ad.docxsodhi3
Reflective Journal Week 5
Topic: Philosophies and Theories for Advanced Nursing Practice
Course objective:
1. Examine disciplinary influences on nursing inquiry such as biology, medicine, psychology, sociology, and philosophy, among others.
2. Evaluate the application and adaptation of borrowed theories to nursing practice.
Discussion Question: 5 DQ 1
Learning theories have implications for advanced practice nurses outside the classroom. Share an example describing the application of learning theory or theories to develop a program targeting change to a specific organizational issue, patient lifestyle, or specific unhealthy behaviors.
Nursing education is essential to equip professionals with appropriate skills and competencies in line with the changing demands. In this regard, learning theories offer important guidelines for planning of an educational system within the clinical training. Two important areas highlighted in any theory include a change of behavior and talent development. Overall, the stimulus and responses emanating from clinical training should be aimed at improving the skills of clinical professionals. Health professions also need to show the regular use of theories and clear reasoning in educational activities, interactions with patients and clients, management, employee training, continuing education and health promotion programs, especially in the current health care structure.
For example, behaviorists underscore that learning should be a continuous process: the process should aim at achieving the needs that arise in the course of time. DeCoux (2016) observes that regular training of clinical workers is appropriate at all times as the latter reinforces positive behaviors. For instance, poor work relations and productivity among the clinical workers can be enhanced through training. The process also offers practical skills that are not normally taught in the classroom environment. Moreover, such a training program is created with great consideration of the specific needs and organizational interests. The trainers are given an opportunity to understand the needs of workers in a manner that influences the formulation of tactical human resource strategies.
In the same vein, clinical training is critical in talent development. The move allows administrators to assign duties according to the skills and qualifications of an individual. The process is helpful to enhance productivity and positive performance among the workers. Hessler & Henderson (2013) recognize that learning for nursing professionals should be interactive where their participation is paramount. Through this form of training, workers develop a better way to relate and connect with one another. It is also noteworthy that the clinical environment is changing by the day with new needs and dynamics that different approaches to offering to the right interventions. Therefore, clinical administrators need to promote continuous practical training among the staff.
Learni ...
Looking at implementation: how useful is realist evaluation?valéry ridde
Presentation by Emilie Robert (McGill University).
Global Health Workshop: Methods For Implementation Science in Global Health.
http://www.equitesante.org/implementation-science-methods-in-global-health/
Stakeholder Engagement in a Patient-Reported Outcomes Implementation by a Pra...Marion Sills
Kwan BM, Sills MR, Graham D, Hamer MK, Fairclough DL, Hammermeister KE, Kaiser A, Diaz-Perez MJ, Schilling LM. Stakeholder Engagement in a Patient-Reported Outcomes Implementation by a Practice-Based Research Network. JABFM. In Press.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
2. What is an implementation
strategy?
Clinical intervention: The ‘what-to’
implement component, e.g.
exclusive breastfeeding
Implementation strategy: The
‘how-to’ implement component,
e.g. lecture, training, audit-
feedback etc.
The implementation strategy is essentially the
intervention tested in a implementation science
4. The problem
As far as optimizing quality and safety
of patient care is concerned, there is no
convincing evidence that any particular
strategy is more effective than another
in any particular situation.
5. Effective implementation
Assessing the actual performance and
mapping the problems relating to the
practice change
Analyzing the target group and the
setting: what factors are stimulating or
hampering the process of change?
Formulating a concrete, well-developed
and attainable proposal for change with
clear targets including a description of
developed or selected strategies for
change.
Grol and Wensing, Improving Patient Care: The Implementation of Change in Health Care
6. Effective implementation cont.
Developing and executing an
implementation plan containing
activities, tasks, time schedule and
clear roles
Integrating the improvement within the
normal practice routines
Evaluating and revising the plan:
continuous monitoring on the basis of
indicators
Grol and Wensing, Improving Patient Care: The Implementation of Change in Health Care
7. Phases of change
Orientation: promote awareness, stimulate
interest and involvement
Insight and understanding: create
understanding, develop insight into the own
routines
Acceptance: develop positive attitude for
change, create positive intentions or
decisions to change
Change: try out change in practice, confirm
benefit and value of change
Maintenance: integrate new practice into
routines, embed new practice in the
organization
8. Effective Practice and
Organization of Care group
(EPOC) taxonomy
To undertake systematic reviews of
educational, behavioural, financial,
regulatory and organisational
interventions designed to improve health
professional practice and the
organisation of health care services.
http://epoc.cochrane.org/our-reviews
9. EPOC cont.
Delivery arrangements: Changes in how, when and
where healthcare is organized and delivered, and who
delivers healthcare
Financial arrangements: Changes in how funds are
collected, insurance schemes, how services are
purchased, and the use of targeted financial incentives
or disincentives
Governance arrangements: Rules or processes that
affect the way in which powers are exercised,
particularly with regard to authority, accountability,
openness, participation, and coherence
Implementation strategies: Interventions designed to
bring about changes in healthcare organizations, the
behaviour of healthcare professionals or the use of
health services by healthcare recipients
http://epoc.cochrane.org/epoc-taxonomy
10. EPOC – Implementation
strategies
Interventions targeted at healthcare
organisations (n=3): Strategies to change
organisational culture
Interventions targeted at healthcare
workers (n=33): Audit and feedback,
Clinical incident reporting, Continuous
quality improvement, Educational
meetings, Educational games, Inter-
professional education and reminders
Interventions targeted at specific types of
11. An example: Interventions targeted at specific
types of practice, conditions or settings
Interventions that will increase and
sustain the uptake of vaccines in low- and
middle-income countries
Giving information about vaccination to parents and
community members, handing out specially designed
vaccination reminder cards, offering vaccines through
regular immunisation outreach with and without
household incentives (rewards), identifying
unvaccinated children through home visits and
referring them to health clinics, and integrating
vaccination services with other services may lead to
more children getting vaccinated. However, offering
parents money to vaccinate their children may not
12. Audit and Feedback
“Any summary of clinical performance of
health care over a specified period of time
given in written, electronic or verbal format”
Cochrane review Number of
trials
Median change on dichtomous
performance measures
Audit and feedback (Ivers, 2012) 108 +4.3%
Conclusion: Audit and feedback generally leads to
small but potentially important improvements in
professional practice. The effectiveness of audit and
feedback seems to depend on baseline performance
and how the feedback is provided. Future studies of
audit and feedback should directly compare different
ways of providing feedback.
13. Educational outreach visits
“Describe a personal visit by a trained
person to health professionals in their
own settings”Cochrane review Number
of trials
Median change on
dichtomous performance
measures
Educational outreach visits (O’Brien
2007)
34 +5%
Conclusion: Education outreach visits alone
or when combined with other interventions
have effects on prescribing that are relatively
consistent and small, but potentially
important. Their effects on other types of
professional performance vary from small to
modest improvements.
14. (Electronic) Reminders
Includes paper-base and computer-
based remindersCochrane review Number of
trials
Median change on dichtomous
performance measures
Electronic reminders (Arditi, 2012) 32 +7% (+4% if together with
other strategies)
Conclusion: There is moderate quality evidence that
computer-generated reminders delivered on paper to
healthcare professionals achieve moderate improvement in
process of care. Two characteristics emerged as significant
predictors of improvement: providing space on the
reminder for a response from the clinician and providing an
explanation of the reminder’s content or advice. The
heterogeneity of the reminder interventions included in this
review also suggests that reminders can improve care in
various settings under various conditions.
15. Financial incentives
Cochrane review Number of trials
Financial incentives (Flodgren,
2011)
32
“Financial incentives are sources of motivation
when an individual receives a monetary transfer
which is made conditional on acting in a particular
way”
Conclusion: Financial incentives may be
effective in changing healthcare professional
practice
16. Inter-professional education
”An intervention where the members of more
than one health or social care profession, or
both, learn interactively together, for the explicit
purpose of improving interprofessional
collaboration or the health/well being of
patients/clients, or both.”
Cochrane review Number of trials
Inter-professional education (Reeves
2013)
15
Conclusion: These studies reported some positive
outcomes, due to the small number of studies and
the heterogeneity of interventions and outcome
measures, it is not possible to draw generalisable
inferences about the key elements of IPE and its
effectiveness.
18. Challenges relation to effect
measures
Use mass media
Use media to reach large numbers of people
to spread the word about the clinical
innovation
Distribute educational material
Distribute educational materials (including
guidelines, manuals, and toolkits) in person,
by mail, and/or electronically
Powell et al, 2015
19. Modifiable elements of audit
and feedback
Content: Comparative or not, anonymous or
not?
Intensity: Monthly, quarterly, semi-annually,
annually?
Method of delivery: By post, peer, or non-
peer?
Duration: Six months, one year, or two
years?
Context: Primary care or secondary care?
288 combinations Eccles et al., 2006
20. Challenges relation to effect
measures
Terms and definitions for implementation
strategies are inconsistent
Inconsistent use of words (same word has
multiple meaning/different terms having the
same meaning)
Description of implementation strategies
too often do not include sufficient detail to
enable either scientific or real-world
replication
21. Prerequisites to measuring
implementation strategies
Name and define the implementation
strategies in ways that are consistent
with the published literature, and
carefully specify the following elements:
Actor: who enacts the strategy?
Action(s): what are the specific
actions, steps, or processes that need
to be enacted?
Action target: what constructs are
targeted? What is the unit of analysis?Proctor et al., 2013
22. Prerequisites to measuring
implementation strategies cont.
Temporality: when is the strategy
used?
Dose: what is the intensity?
Implementation outcome: what
implementation outcome(s) are likely
to be affected by each strategy?
Justification: what is the empirical,
theoretical, or pragmatic justification
for the choice of implementation
strategy? Proctor et al., 2013
24. Effective implementation of
improvements
The cognitive approach - considering and
weighing rational arguments. Selected
strategy: Evidence-based medicine and
guidelines
The motivational approach - driven by
internal motivation. Selected strategy:
Problem based learning
The marketing approach - attractive
messages
Selected strategy: Needs analysis, using
25. Effective implementation of
improvements cont.
Social interaction - learn and change by the
example
Selected strategies: opinion leaders,
outreach visits
Management approach - poor quality care is
a ‘systems problem’. Selected strategies:
redesigning care processes, teambuilding
Control and compulsion - the power of
external pressure. Selected strategies:
legislation, inspection, performance
27. Sub-groups response to
strategies
Innovators Middle
majority
Laggards
Motivatio
n to
change
Intrinsic, seeing
the advantages
Belonging to a
group, relation to
others
Extrinsic,
coercion,
economic
pressure
Effective
influence
Aimed at
cognition
Aimed at attitude Aimed at
behavior
Methods Good
information,
credible sources,
written methods
Personal
sources, opinion-
leaders, activities
with colleagues,
feedback from
Regulations and
agreements,
reward and
sanctions, help
with practical
Green et al 1989, Grol 1992. Rogers 200
28. The problem
As far as optimizing quality and safety
of patient care is concerned, there is
neither convincing evidence that any
particular strategy is more effective than
another in any particular situation…
…nor if it is better to use one or
multifaceted strategies
29. Tailoring
Strategies that are designed to achieve
desired changes in healthcare practice based
on an assessment of determinants of
healthcare practice.
Systematic tailoring entails three key steps:
Identification of factors influencing of
healthcare practice
Designing implementation strategies
appropriate to the identified factors
Application and assessment of
implementation strategies that are tailored
to the identified factors.
Wensing M et al. Impl Sci 2011
30. Barriers and facilitators
Factors that might prevent or enable
improvements, including factors that can
be modified and non-modifiable factors
that can be used to target interventions
Oxman, 2011
The innovation
The users (‘different levels’)
The practice setting (local context)
The organization
The outer context
31. The innovation
Underlying
knowledge
sources
Clarity
Degree of fit with
existing practice
and values
(compatibility or
contestability)
Degree of novelty
Useability
Relative
advantage
Trialability
Observable
results
Kitson and Harvey, 201
32. The users (recipients)
Motivation
Values and beliefs
Goals
Skills and
knowledge
Time, resources
and support
Local opinion
leaders
Collaboration and
teamwork
Existing networks
Learning
environment
Power and
authority
Presence of
boundaries
Kitson and Harvey, 201
33. Inner context (practice
setting)
Formal and informal leadership
support
Culture
Past experience of innovation and
change
Mechanisms for embedding change
Evaluation and feedback processes
Kitson and Harvey, 201
34. Inner context (organizational
level)
Organisational priorities
Leadership and senior management
support
Culture
Structure and systems
History of innovation and change
Absorptive capacity
Learning networks
Kitson and Harvey, 201
35. Outer context
Organisational priorities
Policy drivers and priorities
Incentives and mandates
Regulatory frameworks
Environmental (in)stability
Inter-organisational networks and
relationships
36. Known barriers and
facilitators
Knowledge management (overload)
Structural barriers (e.g. financial
disincentives),
Organizational barriers (e.g.
inappropriate skill mix, lack of facilities
or equipment)
Peer group barriers (e.g. local
standards of care not in line with
desired practice)
Professional (e.g. knowledge,
37. How to identify these factors?
Qualitative methods (interviews, focus
groups)
Direct observations (NB: ethics!)
Surveys
No standard approaches available yet
Grimshaw et al., 2012
38. Assignment (only a few
examples!)
Could your study inform the selection of
implementation strategy/strategies?
Are barriers and facilitating factors for selecting
implementation strategy something that would be of
interest to study in your PhD?
Is adoption and maybe modification of
implementation strategies something that would be of
interest to study in your PhD?
Would it make sense to investigate the characteristics
of the innovation, the recipients or the context in
which the OHEP is implemented?
Could your study evaluate the effect of an (or a
package of!) implementation strategies?
39. Why what works where
Understanding ‘context’ is regarded as a
priority field in implementation science
including the need to systematically
study the attributes of context
influencing the implementation of
interventions.
Kanouse D, Int J Technol Assess Health Care, 1988
Siddiqi K, Int J Qual Health Care 2005
English M, Arch Dis Child, 2008
Dieleman M, Health Research Policy and Systems, 2009
McCoy D, International Health, 2010
41. The COACH group
Bangladesh
Dr Anisur Rahman
Dr Jesmin Pervin
Vietnam
Associate Professor Dinh P. Hoa
Dr Nga Nguyen
Mr Duc Minh Duong
Nicaragua
Dr Elmer Zelaya Blandón
Uganda
Dr Peter Waiswa
South Africa
Professor Mark Tomlinson
Mrs. Sarah Skeen
Canada
Professor Carole A. Estabrooks
Associate Professor Janet Squires
Sweden
Professor Lars-Åke Persson (PI)
Dr Anna Bergström
Professor Lars Wallin
Professor Petter Gustavsson
Associate Professor Carina Källestål
Associate Professor Mats Målqvist
Dr Katarina Selling
Professor Stefan Peterson
45. e.g. Work culture
Please think about the unit where you work most of the time and say how much you
agree/disagree with the following statements:
Item
Strongly
Disagree
Disagree
Neither
Agree nor
Disagree
Agree
Strongly
Agree
30. My unit is willing to use new
healthcare practices such as
guidelines and recommendations.
31. My unit helps me to improve and
develop my skills.
32. I am encouraged to seek new
information on healthcare practices.
33. My unit works for the good of the
clients and puts their needs first.
34. Members of the unit feel
personally responsible for improving
healthcare services.
35. Members of the unit approach
clients with respect.
For health worker in a health facility the concept of: Unit means the ward or primary health care centre where you are
working most of the time. Client means the person seeking health services from this unit.
For community health workers: Unit means the group of colleagues and supervisors you are part of. Client means the
members of the community to whom you provide services to.
46. Conclusion
We foresee alternative ways of applying
the COACH tool:
As means of characterizing context
ahead of implementing health
interventions – tailoring
To deepen the understanding of the
outcomes of implementation efforts.
To address and act on locally
identified shortcomings of the health
system
49. Plas et al. taxonomy
Strategies targeted at individuals (end
users): mass media, personal material,
large group meetings
Strategies aimed at organizational
structures: Changes in skill mix, role
(revisions), physical environment
Strategies aimed at work processes:
standardizing/ redesigning work processes
Strategies aimed at organizational
processes: Changes in internal/external