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Implementation Studies (implementation + studies)

Distribution by Scientific Domains
Medical Sciences42%

Selected Abstracts

Implementation Studies: Time for a Revival?

PUBLIC ADMINISTRATION, Issue 2 2004
Personal Reflections on 20 Years of Implementation Studies
This paper presents a review of three decades of implementation studies and is constructed in the form of a personal reflection. The paper begins with a reflection upon the context within which the book Policy and Action was written, a time when both governments and policy analysts were endeavouring to systematize and improve the public decision-making process and to place such decision-making within a more strategic framework. The review ends with a discussion about how public policy planning has changed in the light of public services reform strategies. It is suggested that as a result of such reforms, interest in the processes of implementation have perhaps been superseded by a focus upon change management and performance targets. It is further argued that this has resulted in the reassertion of normative, top-down processes of policy implementation. The paper raises points that are important ones and indeed are reflected throughout all four papers in the symposium issue. These are: (1) the very real analytical difficulties of understanding the role of bureaucratic discretion and motivation; (2) the problem of evaluating policy outcomes; and (3) the need to also focus upon micro political processes that occur in public services organizations. In conclusion, the paper emphasizes the continued importance of implementation studies and the need for policy analysts to understand what actually happens at policy recipient level. [source]

Implementation of oral health recommendations into two residential aged care facilities in a regional Australian city

INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 3 2006
Tony Fallon BAppSc(Hons) PhD
Abstract Background, Residents of aged care facilities usually have a large number of oral health problems. Residents who suffer from dementia are at particular risk. A systematic review of the best available evidence with regard to maintaining the oral health of older people with dementia in residential aged care facilities provided a number of recommendations. Objectives, The aim of the implementation project was to introduce evidence-based oral hygiene practices for patients with dementia in two publicly funded residential aged care facilities and monitor for changes in nursing awareness, knowledge, documentation and practice to improve patient outcomes and ensure appropriate accreditation standards were met. An additional aim was to identify barriers and strategies to overcome barriers to implementation of evidence-based recommendations. Methods, Two facilities, a 40-bed facility and a 71-bed facility in the health service district of the regional Australian city of Toowoomba, provided the setting. A quality improvement approach was taken, using a number of strategies from the National Health and Medical Research Council guidelines for implementation studies. The implementation involved a number of stages, including project development, interactive oral health education, oral audits of residents, changes to oral hygiene practice via care plans and critical reflection. Results, The multidisciplinary approach to improving oral healthcare appeared to improve knowledge and awareness and move oral health practices in facilities closer to best practice. Specialised training in oral health was provided to a Clinical Nurse Consultant. Regular oral audits were introduced and facility staff were trained in the use of the oral audit tool. Care plans at one facility were of better quality and more comprehensive than before the intervention. Comments made during critical reflection suggested improvements in the oral health of residents, increased use of oral swabs and saliva substitutes, improved care of dentures and mention of the use of mouth props in resident care plans. There was also some evidence that changes brought about by the implementation are sustainable. Conclusion, The majority of recommendations provided in the systematic review of oral healthcare for dementia patients were applicable to the applied context. The importance of day-to-day leaders was highlighted by the apparently varied outcomes across target facilities. The quality improvement approach would appear to have considerable advantages when applied to improving practice in residential aged care. [source]

The prevention science of reading research within a Response-to-Intervention model

PSYCHOLOGY IN THE SCHOOLS, Issue 1 2010
Erica S. Lembke
The purpose of this article is to describe research-based reading intervention within a Response-to-Intervention (RTI) model, using prevention science as a context. First, RTI is defined and a rationale is provided for its use in improving the reading performance of all students, particularly those students identified as at risk for reading-related learning disabilities. Next, reading risk is defined and discussed, including prevalence, antecedents, and how risk is assessed through universal screening and progress monitoring. Existing literature on the use of RTI models in reading is summarized, including small- and large-scale implementation studies. Finally, future research directions in the area of reading within an RTI model are discussed. © 2009 Wiley Periodicals, Inc. [source]

Implementation Studies: Time for a Revival?

PUBLIC ADMINISTRATION, Issue 2 2004
Personal Reflections on 20 Years of Implementation Studies
This paper presents a review of three decades of implementation studies and is constructed in the form of a personal reflection. The paper begins with a reflection upon the context within which the book Policy and Action was written, a time when both governments and policy analysts were endeavouring to systematize and improve the public decision-making process and to place such decision-making within a more strategic framework. The review ends with a discussion about how public policy planning has changed in the light of public services reform strategies. It is suggested that as a result of such reforms, interest in the processes of implementation have perhaps been superseded by a focus upon change management and performance targets. It is further argued that this has resulted in the reassertion of normative, top-down processes of policy implementation. The paper raises points that are important ones and indeed are reflected throughout all four papers in the symposium issue. These are: (1) the very real analytical difficulties of understanding the role of bureaucratic discretion and motivation; (2) the problem of evaluating policy outcomes; and (3) the need to also focus upon micro political processes that occur in public services organizations. In conclusion, the paper emphasizes the continued importance of implementation studies and the need for policy analysts to understand what actually happens at policy recipient level. [source]

Big Windows and Little Windows: Implementation in the ,Congested State'

PUBLIC ADMINISTRATION, Issue 2 2004
Mark Exworthy
This paper argues for the need to re-assess models of policy implementation in the ,congested state'. This re-appraisal focuses on two main directions. The first involves locating implementation in the context of wider models of the policy process. We fuse three models, those of Kingdon, Wolman, and Challis et al., to form a new ,policy streams' approach. The second examines implementation in multi-level governance. In the UK and elsewhere, much of the focus of traditional implementation studies has been on the link between one central government department and a local agency. However, this vertical (central-local) dimension fails to give sufficient stress to the other horizontal dimensions of ,central-central' and ,local-local'. Paraphrasing Kingdon's terms, implementation models also need to incorporate the ,little windows' at local level as well as the ,big' windows at national level. Using evidence relating to the implementation of UK policy towards health inequalities, this paper argues successful implementation is more likely when the three policy streams are linked across the three dimensions. The model is thought to be applicable to other areas of the public sectors and complex issues facing all governments. [source]

The Tree Theme Method as an intervention in psychosocial occupational therapy: Client acceptability and outcomes

AUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 3 2009
A. Birgitta Gunnarsson
Background/aim:,The Tree Theme Method (TTM) is an intervention in which the client paints trees representing certain periods in his/her life. The intervention comprises five sessions, using trees as a starting point to tell one's life story. This study, which is part of an implementation project, aimed to examine the therapeutic alliance and client satisfaction, in relation to perceptions of everyday occupations and health-related factors, with clients going through a TTM intervention. Methods:,Nine occupational therapists recruited 35 clients, at general outpatient mental health care units, for the TTM intervention. Self-rating instruments, targeting therapeutic alliance (HAq-II), different aspects of daily occupations (Canadian Occupational Performance Measure, Satisfaction with Daily Occupations), health-related factors (Sense of Coherence measure, Mastery Scale, Symptom Checklist-90-R) and client satisfaction (Client Satisfaction Questionnaire), were administrated before and after the intervention. Results:,A good initial therapeutic alliance, experienced by both therapists and clients, was correlated to increased changes regarding occupational performance and self-mastery. According to the therapists' ratings, a good initial therapeutic alliance was correlated to increased sense of coherence and a decreased level of psychiatric symptoms. The results showed positive significant changes in occupational performance and health-related factors. High ratings of the therapeutic alliance by the therapists were also related to high client satisfaction. Conclusions:,The TTM seemed to function well in psychosocial occupational therapy, but there is a need for further implementation studies to deepen our understanding of the treatment process, comprising both technique and formation of the therapeutic alliance. [source]

Implementation of Clinical Decision Rules in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Ian G. Stiell MD
Clinical decision rules (CDRs) are tools designed to help clinicians make bedside diagnostic and therapeutic decisions. The development of a CDR involves three stages: derivation, validation, and implementation. Several criteria need to be considered when designing and evaluating the results of an implementation trial. In this article, the authors review the results of implementation studies evaluating the effect of four CDRs: the Ottawa Ankle Rules, the Ottawa Knee Rule, the Canadian C-Spine Rule, and the Canadian CT Head Rule. Four implementation studies demonstrated that the implementation of CDRs in the emergency department (ED) safely reduced the use of radiography for ankle, knee, and cervical spine injuries. However, a recent trial failed to demonstrate an impact on computed tomography imaging rates. Well-developed and validated CDRs can be successfully implemented into practice, efficiently standardizing ED care. However, further research is needed to identify barriers to implementation in order to achieve improved uptake in the ED. [source]