Implementation Team Research Articles

Collaboration strategies affecting implementation of a cross-systems intervention for child welfare and substance use treatment: a mixed methods analysis

Abstract Background Collaboration strategies refer to policies and practices used to align operations and services across organizations or systems. These strategies can influence implementation of cross-system interventions focused on improving integration of care, but remain under-specified and under-examined. This study identifies collaboration strategies and the conditions under which they affected implementation of Sobriety Treatment and Recovery Teams (START), an evidence-based intervention focused on integrating child welfare and behavioral health services for families involved with both systems. Methods Our study sample included 17 county child welfare agencies that implemented START. Data on collaboration strategies and organizational context were obtained from key informant interviews, frontline worker surveys, and contracts. Contextual data were drawn from secondary data, and fidelity data were drawn from an administrative database. Qualitative and quantitative data were integrated using coincidence analysis, and used to identify combinations of conditions that uniquely differentiated agencies with higher and lower fidelity to START. Results Fidelity was lower for intervention components requiring cross-system collaboration. Although key informants acknowledged the importance of collaboration for START implementation, few agencies used formal collaboration strategies other than staff co-location or reported high communication quality between frontline staff in child welfare and behavioral health. In coincidence analysis, four conditions differentiated agencies with higher and lower fidelity with 100% consistency and 88% coverage. We found that either strong leadership support or, in high need communities, third-party resource support from local behavioral health boards were sufficient for high fidelity. Similarly, in high need communities, absence of third-party resource support was sufficient for low fidelity, while in low need communities, absence of communication quality was sufficient for low fidelity. Conclusion Administrators, frontline workers, and interested third parties (i.e., other stakeholders not directly involved in implementation) can use collaboration strategies to facilitate implementation. However, the effectiveness of collaboration strategies depends on local context. In agencies where internal leadership support for implementation is low but need for intervention is high, third-party resource support may still be sufficient for high fidelity. Further research is needed to test effectiveness of collaboration strategies in different conditions and on a broader range of process and implementation outcomes. Trials registration ClinicalTrials.gov, NCT03931005, Registered 04/29/2019, https://classic.clinicaltrials.gov/ct2/show/NCT03931005.

Focusing the Juggernaut

Education technology (EdTech) is at the forefront of many universities' desires to improve, evolve and better the student experience. From learning management systems to hybrid capabilities, many processes are updated to ensure relevance in the face of challenges and modern trends (Josué et al., 2023). These updates can be small and incremental but can also come in the form of large-scale, institution-wide EdTech rollouts. Due to the scale and the diversity of our institutions, this is fraught with issues including aligning technology with pedagogy, ensuring digital literacy and training for educators (Bower, 2017), and infrastructure adequacy (Al-Busaidi and Al-Shihi, 2012). Universities invest heavily in resources to address challenges and promote sustained EdTech adoption (Deacon et al., 2022). Strategic and flexible educators, sometimes with differing perspectives from their institutions, can leverage these resources to achieve their individual educational objectives. This case study, situated at the University of New South Wales (UNSW), involved one such large scale EdTech adoption in the form of an institutionally wide digital assessment platform, InsperaTM, with a view to streamline and enhance the online assessment experience. This had a significant impact, reaching approximately 67 courses and 8.8k students in its first 3 terms of piloting, and to aid this implementation UNSW deployed multiple resources in the form of dedicated staff, in-depth training and central support for high stakes exams. With many educators already using other forms of digital assessment, the adoption was not uniformly accepted, creating friction and causing some to reject the platform. It also created opportunities for others. Wanting to uplift a newly inherited course, Dr Megan Kalucy saw InsperaTM, and the resources associated, as an ideal opportunity to improve student experience and reduce educator workload. With the support of the implementation team, Dr Kalucy adopted InsperaTM for specific in-course assessments, reaching approximately 300 students. Paper-based, short-answer, invigilated assessments, which were administratively inefficient and suffered from delays were replaced by weekly multiple-choice-question (MCQ) quizzes in InsperaTM. Automated marking, immediate feedback, and broader content coverage resulted in an overall improved experience for both staff and students, which was reflected in improved student feedback and reduced workload. This work investigates sector wide issues focusing on the research question of how educators can leverage collective EdTech resources to achieve individual goals. It addresses two key challenges; achieving widespread institutional adoption of EdTech and helping educators with increasing workloads find the time and resources to update their courses. A mixed-methods approach was used, employing a case study methodology comparing student satisfaction data, before and after, to validate the improvements made to the course through the adoption of Inspera. Qualitative data from staff and students was used to inform, implement and revise these improvements. The study found that technology adoption in the educational landscape is not exclusively dependent on knowledge of advancements, but more significantly about leveraging the resources available (Oyetade et al., 2020). Here, the universities adoption of Inspera employed strategies such as training, hands-on support, as well as platform and student support, lowering the energy barrier for improvement to Education Focused staff. These resources were deployed practically and with a focus on educators, increasing the number of early adopters and the uptake of Inspera across the university. This case study also shows that the diverse needs of various disciplines need to be considered for uniform EdTech adoption, as a ‘one size fits all’ approach is often ineffective.

Corporate Technology for the Implementation of an Automated System: Functional, Technological and Methodological Aspects

The purpose of the study is to form a methodological justification for the pedagogical model of the individual trajectory of professional development of bachelors and masters for the implementation of the stages of creating an automated system based on the principles of continuity and experimental verification of its application in the educational process of the university in accordance with the requirements of IT departments, vendors and employers. It is shown that there is a gap between the socio-economic order for the training of IT specialists with high professional competence in the field of information systems and the insufficient level of targeted formation of their readiness to implement the stages of creating automated systems. In addition, the lack of methods and practical recommendations for the implementation of such systems in the context of maximum preservation of corporate standards and taking into account the requirements of Russian legislation, as well as specialists competent in these matters, determined the feasibility of conducting the study in two aspects - functional-technological and pedagogical.Methods and materials. The key methods are structural-functional and process modeling, interactive methods of organizing the educational process (project method, etc.). The research materials include a functional model for developing a corporate technology for implementing an automated system in the form of a function tree.Results. The results present a model of causes and factors determining the success of the projects for the implementation of the automatization systems. The role of the factor “qualification of the performing team” and the possibilities of the educational environment of the university to influence this factor are considered. The pedagogical aspect of the research problem is determined by the methodological justification for conducting students’ project work within a number of disciplines for training bachelors and masters in the field of “Applied Informatics”. The description of the structure and requirements for students’ projects gives an idea of the level of formed competencies, their consistency with the work functions of specialists in the field of information systems.Conclusion. At this stage of work on the research problem, its dual nature was determined. On the one hand, modern IT projects require their own technologies and management methodologies, which should change from project to project, so it is important to have practical recommendations for the development of corporate technology for the implementation of an automated system. On the other hand, one of the success factors of the project for the implementation of an automated system is the “Project Implementation Team”, its level of qualification. This factor is successfully determined and influenced by educational institutions responsible for training specialists in this field. In this direction, the project method plays a key role. It ensures the development of communication skills, the ability to independently pose a problem and develop a way to solve it together. Methodological aspects and practical results, generalizing the pedagogical model for training bachelors in the field of creating automated systems presented in the paper, as well as the development of corporate technology for the implementation of information systems, were reflected in three electronic multimedia educational publications: “Portfolio of Software Engineering Projects”, “Theory and Practice of IS Implementation”, “Theory and Practice of IS Maintenance”.

Implementasi Program Tikasim (Tirta Kencana Siap Minum) di Lapas Kelas II B Kabupaten Jombang

This study aims to analyze the implementation of the TIKASIM (Tirta Kencana Siap Minum) program in Class II B Correctional Institution Jombang Regency. Using the theory according to George C. Edwards III by looking at four indicators which include communication, resources, disposition, and bureaucratic structure. This research was compiled using a qualitative approach. Obtaining primary data sources from interviews and observations is complemented by secondary data such as images, journals, reports, previous research, and other archives that have relevance. The research locus is in Class II B Correctional Institution of Jombang Regency. The results of the study show that the communication indicators in the implementation of the TIKASIM Program have been running well, explained by the clear and consistent transmission of information between Perumdam Tirta Kencana Jombang and Class II B Jombang Correctional Facility. Then the resource indicator is also quite well supported by a sufficient number of staff and adequate facilities. The disposition or attitude of policy implementers also shows communication and commitment among the entire implementation team. The bureaucratic structure has been running according to the guidelines of PERMENKUMHAM number 40 of 2017 concerning Guidelines for the Implementation of food for Prisoners, children and Prisoners.

Electronic Health Record Serious Illness Conversation Dashboards: An Implementation Case Series

IntroductionDashboards are used to track and visualize quality indicators within health systems to improve clinical performance. Structured serious illness conversation (SIC) documentation templates within electronic health records (EHR) have enabled the development of SIC dashboards for quality improvement. Little is known about the successes and challenges of SIC dashboards. MethodsThis implementation case series describes findings from semi-structured interviews and surveys with nine palliative care leaders in eight health systems that implemented SIC dashboards. Interviews and case information were analyzed to identify themes. ResultsFive themes were identified. First, dashboards focus on process metrics. By creating transparent and efficient access to data on EHR-documented SICs, dashboards facilitated monitoring of the results of clinician training and quality improvement efforts. Second, palliative care leaders used dashboard data on documented SICs to implement clinician practice change strategies (e.g. data feedback; quality incentives), but clinicians had mixed reactions to data. Third, dashboards facilitated leadership investment in SIC efforts and required financial and technical resources to build and maintain. Fourth, while dashboards streamlined data collection for implementation teams, participants noted challenges with data reliability, including inadequate clinician use of structured SIC documentation templates (which most dashboards rely on for measurement). Fifth, needs and tensions arose with integrating patient-centered outcome measures as part of dashboards. ConclusionDashboards can be powerful tools for identifying gaps in SIC and driving interventions for clinician practice change. However, challenges related to clinician adoption of structured templates for SIC documentation and mixed clinician receptivity to data feedback may limit their reliability and use.

A novel operational protocol for the establishment of a medical facility for receiving returning hostages: structure, process and outcomes

BackgroundOn October 7, 2023, Hamas carried out an unprecedented attack on the State of Israel and kidnapped 251 people into captivity to the Gaza Strip. Several months later, as part of a humanitarian exchange deal, 105 hostages were released in five phases and admitted to one of six hospitals throughout the country for treatment. Shamir Medical Center (SMC) was one of these facilities. This study aims to describe the structure, process and outcomes of establishing a comprehensive, multi-step, operational protocol for receiving hostages returning from captivity.MethodThe process of preparing SMC as a receiving center, the establishment of procedures for implementation of the medical protocol, and the assessment of multi-disciplinary team preparedness and implementation and outcomes in an institutional protocol are described.Results24 returning hostages were received at SMC. Social workers, dietitians and translators were used by 100% of the majority group of returning hostages from the same country of origin and the sole individual from the other country of origin utilized a dietitian, social worker, ENT consultations, and a hearing test. Among the majority group, orthopedic and dermatological consultations were utilized by 17.4% and 13% received an ENT consultation. Of the administered imaging, 13% received a chest X-ray, 8.7% received a limb X-ray, 17.4% received a head CT scan, and 4.3% received an abdominal CT. In addition, 21.7% were provided antibiotic therapy. Protocol efficacy was measured by assessing time to various operational aspects of protocol implementation and medical procedures such as mean hours to room assignment, primary physician evaluation and social worker session. No correlation between age and operational variables was found.ConclusionThis novel operational protocol was successfully implemented and may serve as a framework for managing similar unpredictable sensitive events in the case of future need.

From fragmentation to functionality: Enhancing coherence of digital health integration in health systems.

Digital health programs continue to be implemented within Canadian health systems at a steady pace. The effectiveness of digital health initiatives has been rigorously analyzed, with both benefits and drawbacks extensively commented on. While the discussion about digital health continues, both positive and negative perspectives of it are approaching saturation in their themes. Accepting that digital health is here to stay post-pandemic, the focus should shift to strategies and supports needed to avoid the fragmentation of care through digital health implementation. This short article poses three questions which policy-makers and decision-makers should explore as part of a level-setting exercise with involved stakeholders at the outset of a digital health program's consideration. An implementation team should design the digital health program to have equity as its foundational focus, conduct value-based evaluations, and position the program in a learning health system framework to guard against the fragmentation of care.

10.M. Scientific session: JA ImpleMENTAL Abstract Workshop

Abstract JA ImpleMENTAL is major initiative across Europe and was initiated on the request of Member States, on October 2021 under the European Union 3rd Health Programme. The workshop is organized by JA ImpleMENTAL in partnership with EUPHA Mental Health Section, a member of the JA ImpleMENTAL Stakeholder Forum. It will include four presentations that will contribute to an interesting discussion about the future of community mental health services that are user-centered, recovery-oriented and human rights based as well as about the synergies with national strategies and the EU Initiatives. Vasileia Konte the JA ImpleMENTAL Coordinator will provide an overview of the Mental Health System Reforms based on the Belgian Best Practice model, which is implemented in 11 countries. It will elaborate on key activities and prioritized key areas of mental health system transformation as well as enablers, barriers and key lessons learned from the implementation process. Danijela Štimac Grbić from Croatia will present the Croatian experience in the implementation of a mobile rehabilitation team for providing psychosocial interventions in the community in which peer workers are employed for the first time. Based on the successful work of the mobile team, Croatia has included 30 new mobile teams in its network of public health services that will operate throughout Croatia. Teresa Nicolas Lopez from Murcia Spain will present the project “Inclusive Life Projects” which offers comprehensive community care to adults with severe mental illness within projects of autonomous living and provides a concrete and real response to their needs, with the ultimate objective of avoiding the risk of institutionalization. Anna Paradesioti from Cyprus will focus on how to achieve a smooth transition from inpatient to community mental health services promoting collaboration among those services and professionals, by adopting an intersectoral approach. Jutta Lindert will provide valuable comments by bringing helpful insights and views of the Stakeholder Forum. Key messages • Transformation towards community based care increase availability and efficiency of services. • User’s centered human rights based recovery approach care with engaging stakeholders including people with lived experience.

Improving joy at work and reducing burnout in health care workers in Victoria, Australia using the Institute for Healthcare Improvement joy in work framework: A mixed-methods study.

Burnout in health care workers (HCWs) has serious ramifications for individual well-being, patients, organizations, and health systems. Global evidence demonstrates the COVID-19 pandemic has amplified the risk of burnout. Scalable interventions to address burnout are critical to protect HCW well-being. Underpinned by the Conservation of Resources theory, this study examines the impacts of a statewide improvement initiative (the Initiative), using the Institute for Healthcare Improvement Joy in Work (JiW) Framework, to reduce burnout and increase joy at work across participating health care organizations in Victoria, Australia. An impact evaluation was undertaken utilizing a mixed-methods design. Quantitative outcomes included burnout and joy at work measured using an adapted Mini Z tool. In-depth interviews with implementation teams sought insights into the effectiveness of interventions. Overall, 20 teams from 17 organizations across diverse health care settings and geographical locations participated. At a statewide level, outcomes in burnout and joy at work were inconclusive due to limited data. However, five out of eight teams reporting sufficient data achieved measurable improvements in one or more outcomes. Qualitative data revealed the Initiative increased workplace resources and supports such as providing "permission" for HCWs to prioritize well-being at work, improved communications between management and HCWs, and increased HCWs' teamwork and camaraderie, resulting in safer and more positive workplaces. The JiW Framework, implemented across diverse settings, provided organizations with a structured process to develop multifaceted improvements that resulted in enhanced resources that appeared to improve HCW well-being. Compared to individual well-being support, this approach offers organization-level change and scalability potential.

An action plan to improve organizational health literacy in hospitals in the Czech Republic

Abstract Background The National Institute for Health Literacy conducted in 2023 as part of the M-POHL network and in close collaboration with the team of the Klaudian Hospital a survey on the level of organizational health literacy using the OHL-Hos tool. The OHL-Hos tool was proven by the project implementation team as suitable for initiating and monitoring organizational change. Methods Based on the self-assessment and the results of the consensus workshop, the project implementation team identified development priorities that were submitted and approved by the hospital management. To keep the sustainability of the implementation, the hospital management decided to formulate an action plan, with the time horizon 2025. Results The proposed action plan, approved by hospital management, focuses on feasible measures within a given time horizon. For each development goal, responsible teams, time frames, and expected results were formulated. The implementation project team evaluated as the most innovative standard the standard dealing with internal communication with patients and their family after discharge and thus to ensure the continuity in supporting personal health literacy of patients and relatives. In addition, as further important standards, easy navigation and access to documents, materials, and services for patients and healthcare professionals were recognized. Interventions focusing on public education, especially for children and students of all school levels, have been proposed to enhance external communication and increase health knowledge in the region. Conclusions The process of regular OHL assessment of set up measures has been considered as a way how to ensure the long-term fulfilment of the newly adopted action plan by the hospital.

A Personal Health Record for patients with multiple sclerosis: A 2-year evaluation study

Abstract Background Multiple sclerosis (MS) is a chronic disease impacting the central nervous system, affecting 2.8 million people worldwide. Effective self-management is crucial for treating chronic diseases, including MS. Personal health records (PHRs) show promise in supporting self-management, potentially empowering patients and enhancing their engagement in treatment and health. However, implementation challenges persist. Objectives This study aimed to) assess the feasibility and usability of the PHR according to patients and healthcare professionals (HCPs), and 2) evaluate implementation determinants, and exploring preliminary effects on a range of outcomes related to the quality, efficiency, and costs of care, as well as health-related outcomes. Methods A mixed-methods study was conducted in a Dutch hospital. Quantitative data from 80 patients and 12 HCPs were collected via questionnaires at baseline (T0), after one (T1) and 2 years (T2). Focus group interview were conducted at T2 with 7 patients and 4 HCPs. Results Most patients never logged in during the first year and logged in a couple of times during the second year, with 15 minutes per log-in session. The HCPs mainly logged in a couple of times per year, averaging six minutes per session. Patients’ and HCPs’ usability and satisfaction scores were below average and moderate respectively. Various facilitators and barriers were identified, including knowledge gaps, staff capacity issues, and ICT obstacles. No significant differences were found in preliminary effects. Qualitative data highlighted benefits in terms of gaining insight into health data but revealed challenges with log-in issues and information retrieval. Conclusions Implementation challenges hindered PHR adoption. The evolving nature of PHRs requires ongoing evaluation and adaptation to optimize their potential benefits. Utilizing a participatory design approach and a dedicated implementation team could enhance adoption and maximize benefits. Key messages • A personal health record (PHR) for patients with MS was evaluated within the care setting of a Dutch hospital, demonstrating limited usability and moderate satisfaction. • Diverse obstacles impeded the adoption and uptake of the PHR, but potential solutions lie in continuous development with a participatory design approach and dedicated implementation team.

Exploring work engagement of public sector employees during the COVID-19 pandemic, Namibia

Orientation: In Namibia, the public sector employs a majority of employees which contributes to significant economic growth and development of the country.Research purpose: This study investigated the association among job satisfaction, burnout and work engagement. This study explored if work engagement is experienced differently based on the biographical variables.Motivation for the study: Namibia aims to achieve the sustainable development goals (SDGs), Harambee Prosperity Plan (HPP) and National Development Goals. The state-owned enterprises are required to provide quality services to the nation through their employees. The health and well-being of these employees facilitate the productivity of these state-owned enterprises (SDGs 1, 2, 3, 8, 11 and 16).Research approach/design and method: A total of n = 130 public sector employees were randomly selected and responded to a questionnaire. The questionnaire included demographic questions, the Job Satisfaction Survey, the Maslach Burnout Inventory and the Utrecht Work Engagement Scale. Data analysis was performed through the Statistical Package for Social Sciences software to test the hypotheses of the study.Main findings: Positive relationships were found between job satisfaction, burnout and work engagement. Work engagement reported a positive relationship with burnout. Work engagement is experienced the same in relation to the biographical variables.Practical/managerial implications: The study suggests a constant evaluation of job attitudes, implementation of effective performance management systems, team building activities and implementation of workplace wellness programmes.Contribution/value-add: This study adds to the understanding of job satisfaction, burnout and work engagement within state-owned enterprises in Namibia.

70 Implementation of nurse facilitated, structured, post-event clinical debriefs in four neonatal intensive care units using the INFO model

Abstract Background Neonatal intensive care units (NICUs) often experience acute clinical events. Post-event team debriefs can reinforce success, identify areas for improvement, and improve healthcare providers’ (HCP) psychological coping. However, barriers exist to successful debriefs, and poor debriefs can increase HCP stress. Objectives To implement and evaluate structured post-event clinical debriefs for NICUs within a regional neonatal program. Design/Methods We assembled a multi-disciplinary implementation team, adapted an existing tool (INFO Clinical Debriefing Tool), and identified champions for each site (2 level 2 NICUs, 1 level 3 perinatal NICU, and 1 level 4 surgical NICU). A REDCap database, debrief triggers, feedback process for recommendations to quality improvement leads and frontline HCPs were developed. We chose charge nurses as facilitators as they were consistently present but were not team leads. Facilitators were trained in 2-hour Zoom sessions with a didactic presentation followed by simulated debriefing practice. Debriefs were then started and tracked. A post-implementation survey was conducted at 6 months. Results Eighty-one HCPs responded to the pre survey, identifying time stress and skill / availability of facilitators as main barriers. Most nurses (75%) were comfortable participating in debriefs; this approached 100% in other disciplines. However, there were negative experiences reported. (Table 1) Ninety-five debriefs were conducted in 6 months; 50% were delivery room resuscitations, 14% were in-unit events. Median 7 (IQR 5-8) HCPs attended; 85% had 3 or more disciplines attending. Most (81%) were led by trained facilitators, with 80% led by nurses or respiratory therapists. Debriefs took a median 12 minutes (IQR 8-17), and generated recommendations for improvements to equipment, team communication, and processes. Two sites had more success with uptake, facilitated by consistent presence of champions. Barriers to implementation included: availability of trained facilitators, time constraints, competing unit priorities. The post survey (85 responses) showed a positive view of INFO debriefs. Most respondents (88%) had participated in at least 1 debrief; of these 76% report positive / very positive experience, 76% thought team members always had the chance to speak up, and 78% felt the INFO process provided an effective mechanism for communicating concerns. Participants still listed time pressure as the main barrier.(Table 2) Conclusion Nurse-led, structured post-event clinical debriefs can be implemented in NICUs and are positively viewed by participants. NICUs experience implementation barriers that need to be considered.

Enhancing healthcare delivery: the results of implementing mobile anesthesia teams at Romagna Local Health Authority, Italy

BackgroundHealthcare systems face challenges including physician shortages and the need for cost-effective, accessible services. This study aimed to describe the implementation of itinerant anesthesiologist teams to maintain surgical activities within the Romagna Local Health Authority (AUSL Romagna), Italy.MethodItinerant anesthesiologist teams were implemented at AUSL Romagna from February 2021 to December 2022. Data on surgical waiting lists and activities from before and after the implementation were collected using administrative regional data. Additionally, we conducted a satisfaction survey among participating anesthesiologists. Descriptive statistics were used to compare pre- and post-implementation metrics and to report participants’ satisfaction.ResultsThe project enabled 2034 h of surgical activity in 2021 and 3354 in 2022 across specialties including neurosurgery, breast surgery, interventional cardiology, and pediatric surgery. By 2022, surgical waiting times returned to pre-COVID-19 levels. Survey results from 32 participating anesthesiologists (48.5%) indicated high satisfaction with the program.ConclusionThe implementation of itinerant anesthesiology teams in the AUSL Romagna health system shows promise as a potential solution for improving care delivery and reducing waiting times. However, further research is needed to definitively establish its effectiveness and generalizability to other healthcare settings.

Cost-Effectiveness of a Shock Team Approach in Refractory Cardiogenic Shock.

Multidisciplinary Shock Teams have improved clinical outcomes for cardiogenic shock, but their implementation costs have not been studied. This study's objective was to compare costs between patients treated with and without a Shock Team and determine if the team's implementation is cost-effective compared with standard of care. We examined patients with refractory cardiogenic shock treated with or without a Shock Team at a tertiary academic hospital from 2009 to 2018. Real-world hospital data were used to compare costs and outcomes, including survival at discharge, 1-year survival, and quality-adjusted life years gained at 1 year. Incremental cost-effectiveness ratios were calculated over a 1-year time horizon, with parameter uncertainty evaluated through probabilistic sensitivity analysis using 1000 second-order Monte Carlo simulations. The study involved 244 patients, with 123 treated by the Shock Team and 121 receiving standard of care. Patients were predominantly male (77.5%), with a mean age of 58 (18-92) years. The Shock Team approach improved survival rates at hospital discharge and 1-year follow-up (61.0% versus 47.9%; P=0.04 and 55.0% versus 40.5%; P=0.03, respectively). The incremental cost-effectiveness ratio for increases in survival probability at discharge for the multidisciplinary Shock Team compared with standard of care was $102 088. The incremental cost-effectiveness ratio for increases in survival probability at 1-year was estimated at $96 152 and at $127 862 per 1 quality-adjusted life year gained. Probabilistic sensitivity analysis estimates showed that the Shock Team was cost-effective in the majority of simulations using a willingness-to-pay threshold of $150 000, while it was also dominant in almost one-third of the simulations. The Shock Team approach for treating refractory cardiogenic shock may be a cost-effective alternative to traditional standard of care. These findings can help prioritize the implementation of Shock Team initiatives to further improve cardiogenic shock outcomes.

How to leverage implementation research for equity in global health

Implementation research (IR) is important for addressing equity in global health. However, there is limited knowledge on how to operationalize IR for health equity, and pathways for improving health equity through IR in global health settings. This paper provides an overview of guidance and frameworks for thinking about health equity as part of IR while noting the gaps in how this guidance and frameworks apply to global health. It proposes an approach to guide implementation teams in the application of IR for achieving equity in global health considering these gaps. It describes key equity considerations for different aspects of IR (i.e., implementation contexts, strategies, outcomes, and research designs). These considerations can be applied prospectively and retrospectively, and at different stages of IR. The paper further describes causal pathways, intervention levers, and strategies for achieving health equity in global health settings through IR. Central to these pathways is the power asymmetries among different actors involved in IR in global health and how these contribute to health inequities. The paper suggests recommendations and strategies for shifting the balance of power among these actors while addressing the structural and systemic determinants of health inequities as part of IR. Explicit considerations for health equity as part of implementation research and practice are needed for the achievement of global health goals. Such explicit considerations should look back as much as possible, and entail defining and analyzing health inequities and intervening on the underlying causes and mechanisms of health inequities as part of IR on a routine basis.

WhatsApp Versus SMS for 2-Way, Text-Based Follow-Up After Voluntary Medical Male Circumcision in South Africa: Exploration of Messaging Platform Choice.

Telehealth is growing, especially in areas where access to health facilities is difficult. We previously used 2-way texting (2wT) via SMS to improve the quality of postoperative care after voluntary medical male circumcision in South Africa. In this study, we offered males aged 15 years and older WhatsApp or SMS as their message delivery and interaction platform to explore user preferences and behaviors. The objectives of this process evaluation embedded within a larger 2wT expansion trial were to (1) explore 2wT client preferences, including client satisfaction, with WhatsApp or SMS; (2) examine response rates (participation) by SMS and WhatsApp; and (3) gather feedback from the 2wT implementation team on the WhatsApp approach. Males aged 15 years and older undergoing voluntary medical male circumcision in program sites could choose their follow-up approach, selecting 2wT via SMS or WhatsApp or routine care (in-person postoperative visits). The 2wT system provided 1-way educational messages and an open 2-way communication channel between providers and clients. We analyzed quantitative data from the 2wT database on message delivery platforms (WhatsApp vs SMS), response rates, and user behaviors using chi-square tests, z tests, and t tests. The team conducted short phone calls with WhatsApp and SMS clients about their perceptions of this 2wT platform using a short, structured interview guide. We consider informal reflections from the technical team members on the use of WhatsApp. We applied an implementation science lens using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to focus results on practice and policy improvement. Over a 2-month period-from August to October, 2023-337 males enrolled in 2wT and were offered WhatsApp or SMS and were included in the analysis. For 2wT reach, 177 (53%) participants chose WhatsApp as their platform (P=.38). Mean client age was 30 years, and 253 (75%) participants chose English for automated messages. From quality assurance calls, almost all respondents (87/89, 98%) were happy with the way they were followed up. For effectiveness, on average for the days on which responses were requested, 58 (33%) WhatsApp clients and 44 (28%) SMS clients responded (P=.50). All 2wT team members believed WhatsApp limited the automated message content, language choices, and inclusivity as compared with the SMS-based 2wT approach. When presented with a choice of 2wT communication platform, clients appear evenly split between SMS and WhatsApp. However, WhatsApp requires a smartphone and data plan, potentially reducing reach at scale. Clients using both platforms responded to 2wT interactive prompts, demonstrating similar effectiveness in engaging clients in follow-up. For telehealth interventions, digital health designers should maintain an SMS-based platform and carefully consider adding WhatsApp as an option for clients, using an implementation science approach to present evidence that guides the best implementation approach for their setting.

Valves for the Voiceless: Time to Speaking Valve Use in Posttracheostomy Patients After Multidisciplinary Initiative.

To review speaking valve (SV) use at a tertiary academic medical center and determine whether a multidisciplinary team implementation of SV protocols increased SV use and decreased time to SV trials. Retrospective case series of patients who underwent a tracheostomy between 2017 and 2023 before and after the dissemination of new protocols from a new multidisciplinary tracheostomy care initiative in 2019. The calendar days between meeting SV eligibility criteria and initial trial of SV were compared. Eligibility criteria for SV was defined as any patient ≥48 hours posttracheotomy who can breathe unassisted, off mechanical ventilation, tolerate a deflated cuff, and participate in an evaluation. Interrupted time series analysis using segmented negative binomial regression assessed the change in time to SV placement before and after protocol implementation. A total of 421 patients were identified. After new protocols were disseminated, eligible patients with a SV trial increased from 75% to 95% with an increase in percentage of patients who tolerated the SV on their first attempt from 60% to 75%. Interrupted time series analysis demonstrated protocol implementation was associated with an overall 80% decrease in time to SV placement. Continued barriers to SV implementation such as elevated tracheal pressures due to large tracheostomy sizes, or inappropriately early consultations with patients unable to participate in SV exam, may be amenable to further institution-level quality improvement initiatives. A multidisciplinary initiative's dissemination of protocols with algorithms for SLP consultation and SV use can help standardize post-operative tracheostomy care.

Psychological Assessment and Intervention at the Boston Marathon.

The Boston Marathon is a highly regarded event in the running world, not just for its prestige and challenging course, but also for its implementation of a psychology team to support runners. The 2013 Boston Marathon bombings underscored the essential role that mental health support plays at this event, prompting the development and expansion of its innovative care model. This review critically outlines, evaluates, and analyzes the approach and effectiveness of the psychological care model provided to runners on race day as part of the Boston Marathon medical team, including the standard of care, how it functions, and best practices for other marathons. The implications for this review contribute to the increasing trend of providing psychological care in marathon and other athletic settings, and to provide a framework for standardizing assessment and intervention procedures for both elite and novice runners.

Improving the quality of psychiatric residency training in Isfahan University of Medical Sciences by learning teams and changing curriculum implementation: An action research study

BACKGROUND: The deficiencies in the training of psychiatric residents in Isfahan, including the segregation of residency programs by year, the confinement of training to hospital departments, and the residents’ limited exposure to the perspectives of other faculty members, had not been given significant attention. However, the inevitable alterations in the Department of Psychiatry and the impact of the coronavirus disease 2019 pandemic have brought these issues to the forefront, highlighting the need for program modifications. The objective of this study is to enhance the quality of psychiatric residency training by changing the implementation of the curriculum. METHODS AND MATERIALS: This proactive action research was conducted in six steps. In the first step, the expectations of a new action were identified. In the second step, the new action – creating learning teams – was designed and implemented; thus, eight learning teams comprising experienced professors, novice professors, and residents from various academic levels were created, who collectively engaged in patient visits, psychotherapy, counseling, and educational sessions. Additionally, the portfolio was used in the training and evaluation of the residents. Steps 3 to 6 involved evaluation using a researcher-made questionnaire, analysis and interpretation of results, and reflection and making decisions for future actions. RESULTS: Step 1 resulted in preparing a list of department expectations from new action. The second step yielded the design of a new action. The survey results showed that more than 60% of respondents agreed that the program had a positive impact on 12 out of 15 items in the questionnaire, particularly in enhancing teamwork skills, facilitating discussions about patients, and fostering residents’ accountability. However, in items related to portfolio, this percentage ranged from 40% to 53%. CONCLUSION: The implementation of learning teams as the main action in the current study has yielded positive outcomes; however, the portfolio intervention requires some adjustments. Hence, it is advisable to employ learning teams in comparable circumstances. The research team anticipates that these outcomes will enhance the quality of psychiatric residency training, positioning the country among the leading and influential nations in the region.