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Implementation Approach (implementation + approach)
Selected AbstractsProviders' Beliefs, Attitudes, and Behaviors before Implementing a Computerized Pneumococcal Vaccination ReminderACADEMIC EMERGENCY MEDICINE, Issue 12 2006Judith W. Dexheimer MS Abstract Background The emergency department (ED) has been recommended as a suitable setting for offering pneumococcal vaccination; however, implementations of ED vaccination programs remain scarce. Objectives To understand beliefs, attitudes, and behaviors of ED providers before implementing a computerized reminder system. Methods An anonymous, five-point Likert-scale, 46-item survey was administered to emergency physicians and nurses at an academic medical center. The survey included aspects of ordering patterns, implementation strategies, barriers, and factors considered important for an ED-based vaccination initiative as well as aspects of implementing a computerized vaccine-reminder system. Results Among 160 eligible ED providers, the survey was returned by 64 of 67 physicians (96%), and all 93 nurses (100%). The vaccine was considered to be cost effective by 71% of physicians, but only 2% recommended it to their patients. Although 98% of physicians accessed the computerized problem list before examining the patient, only 28% reviewed the patient's health-maintenance section. Physicians and nurses preferred a computerized vaccination-reminder system in 93% and 82%, respectively. Physicians' preferred implementation approach included a nurse standing order, combined with physician notification; nurses, however, favored a physician order. Factors for improving vaccination rates included improved computerized documentation, whereas increasing the number of ED staff was less important. Relevant implementation barriers for physicians were not remembering to offer vaccination, time constraints, and insufficient time to counsel patients. The ED was believed to be an appropriate setting in which to offer vaccination. Conclusions Emergency department staff had favorable attitudes toward an ED-based pneumococcal vaccination program; however, considerable barriers inherent to the ED setting may challenge such a program. Applying information technology may overcome some barriers and facilitate an ED-based vaccination initiative. [source] Measuring the perceived impact of facilitation on implementing recommendations from external assessment: lessons from the Dutch visitatie programme for medical specialistsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 6 2005M. J. M. H. (Kiki) Lombarts PhD Abstract Objective, To evaluate the impact of facilitation by management consultants on implementing recommendations from external quality assessment (visitatie). Design, Data collection through a postal survey amongst 205 medical specialists, representing 50 hospital-based specialist groups in, the ,Netherlands., Setting, Under the auspices of the specialty societies of surgeons, paediatricians and gynaecologists, 25 groups were offered ,20 h of management consulting to support the implementation of recommendations for quality improvement and were compared to 25 specialist groups not receiving the support. Intervention, The Quality Consultation (QC) took a site-specific multifaceted implementation approach. Main measures, Self-reported degree of implementation of recommendations, specialists' judgement of implementation result and process; experienced obstructing factors in implementing recommendations. Results, The response rate was 54% (n = 110). The supported specialist groups were more successful in partially or fully implementing the recommendations from external peer assessment: 66.1% vs. 53.8%. The implementation result and process were also rated significantly higher for the supported groups. The supported groups reported significantly less (P < 0.005) obstructing factors; in particular for the barriers ,expectation of implementation advantages', ,acceptance of the recommendations' and ,assessed self-efficacy'. The experienced obstructing factors are strongly related with the degree of implementation (spearman rho 0.57,32.5%). Conclusions, This study suggests QC is a powerful implementation strategy. It also shows the limitations of merely quantitatively analysing multifaceted strategies: it does not offer any insight into the ,black box' of the QC. It is recommended that these limitations are met by also exploring multifaceted strategies qualitatively. [source] The ,partnership' between international NGOs (non-governmental organisations) and local NGOs in BangladeshJOURNAL OF INTERNATIONAL DEVELOPMENT, Issue 5 2006Mokbul Morshed Ahmad Abstract ,Partnership' has become a standard buzzword in the NGO and ,development' world. Until 1980s it was common for many Northern NGOs (NNGOs) to implement their own ,development' programmes and projects. This implementation approach has shifted to one in which local ,partner' organisations are identified and do most of the work, with the NNGOs in a funding and organisational support role. Also many Northern donors started funding the Southern NGOs directly making many NNGOs irrelevant. This paper reviews the current literature on ,partnership' between Northern and Southern NGOs and concludes that the new role of the NNGOs in the North should be to work with governments and business to change policies which create poverty in both the North and the South. It also examines the ,partnership' between a NNGO (Save the Children (UK)) and local NGOs in Bangladesh. There are probably more and bigger NGOs in Bangladesh than in any other country of its size. This paper concludes that in Bangladesh the relationship is led by the financial constraints of the NNGOs not by any intention to build partnership. In other words it is ,donorship' rather than ,partnership'. Copyright © 2006 John Wiley & Sons, Ltd. [source] Quality improvement and hospital financial performanceJOURNAL OF ORGANIZATIONAL BEHAVIOR, Issue 7 2006Jeffrey A. Alexander The objective of this study was to examine the association between the scope and intensity of Quality improvement (QI) implementation in hospitals and organizational performance. A sample of 1,784 community hospitals was used to assess relationships between QI implementation approach and two hospital-level performance indicators: cash flow and cost per case. Two-stage instrumental variables estimation, in which predicted values (instruments) of eight QI intensity and scope variables plus control (exogenous) variables were used to estimate hospital-level performance indicators. Our results suggest that QI has a measurable impact on global measures of organizational performance and that both control and leaning approaches to QI matter in these settings. Hospitals that implement QI effectively can reasonably expect to improve their financial and cost performance, or at least not place the hospital at risk for investing in quality improvement. These outcomes are specific to QI strategies that emphasize both control and learning. Copyright © 2006 John Wiley & Sons, Ltd. [source] Implementing HoNOS: An eight stage approachCLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 2 2001Derek Milne The Health of the Nation Outcome Scales (HoNOS) were developed as a brief way to quantify progress towards the national target of improving significantly the health and social functioning of mentally ill people (Wing et al., 1998). As an instrument, HoNOS was regarded as adequate for this purpose and so field testing was deemed to be the next task. However, the implementation of an outcome measure such as HoNOS under routine service conditions represents a significant implementation challenge. Therefore, we conducted an eight stage approach to implementation, with a sample of multi-disciplinary care managers from one county in the UK (N = 30). The results of shadowing and initial interviews indicated that significant barriers to implementation were insufficient staff and the high level of routine demands on staff for the completion of paperwork. These barriers outweighed the perceived boosters, including the favourable responses of colleagues and the benefits of data feedback from HoNOS. More staff, standardized training in the use of HoNOS, regular feedback and less paperwork were amongst ten suggestions for facilitating implementation. During a pilot period, staff received training, used HoNOS and were given graphical feedback of the HoNOS results. They were then re-interviewed, at which time they reported becoming fairly positive about the use of HoNOS and definitely valued the implementation approach. However, it is concluded that the routine use of HoNOS will require continued effort from staff and their managers (e.g. refresher training courses) and alternative or additional outcome measures may be necessary to provide useful clinical information. Copyright © 2001 John Wiley & Sons, Ltd. [source] A model for intervention research in late-life depressionINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2009George S. Alexopoulos Abstract Objective To serve as a conceptual map of the role of new interventions designed to reduce the burden of late-life depression. Methods We identified three needs to be addressed by intervention research: (1) the need for novel interventions given that the existing treatments leave many older adults depressed and disabled; (2) the need for procedures enabling community-based agencies to offer interventions of known efficacy with fidelity; and (3) the need to increase access of depressed older adults to care. Results Our model orders novel interventions according to their role in serving depressed older adults and according to their position in the efficacy, effectiveness, implementation, and dissemination testing continuum. We describe three interventions designed by our institute to exemplify intervention research at different level of the model. A common element is that each intervention personalizes care both at the level of the individuals served and the level of community agencies providing care. To this end, each intervention is designed to accommodate the strengths and limitations of both patients and agencies and introduces changes in the patients' environment and community agencies needed in order to assimilate the new intervention. Conclusions We suggest that this model provides conceptual guidance on how to shorten the testing cycle and bring urgently needed novel treatments and implementation approaches to the community. While replication studies are important, propose that most of the support should be directed to those projects that take rational risks, and after adequate preliminary evidence, make the next step along the testing continuum. Copyright © 2009 John Wiley & Sons, Ltd. [source] | ||||||||||