Key Factors For Successful Implementation Research Articles

The effect of a 'Sip til Send' policy on patient satisfaction: a quality improvement project.

Patients often are nil by mouth for prolonged periods pre-operatively, which is associated with adverse effects including discomfort, anxiety, thirst and nausea. As a result, several hospitals have introduced a more liberal regimen of pre-operative drinking, with patients encouraged to sip small volumes of water until transfer to the operating theatre ('Sip til Send'). The impact of 'Sip til Send' on patient satisfaction is still to be determined. We hypothesised that the introduction of a 'Sip til Send' policy would increase patient's satisfaction with their pre-operative fluid management regimen. We conducted a staged implementation of a 'Sip til Send' quality improvement initiative in two campuses of a large tertiary teaching hospital. This involved a targeted education and implementation programme that was refined and delivered through 'plan, do, study and act' cycles. Patient satisfaction with their pre-operative fluid management was measured by rating the statement "I am happy with the management of pre-operative drinking", against a five-point Likert scale (0, strongly disagree; 1, disagree; 2, neutral; 3, agree; and 4, strongly agree). Patient satisfaction with pre-operative fluid management was high at baseline, with pooled data for both campuses showing a median (IQR [range]) satisfaction score of 4 (3-4 [1-4]). After the implementation of 'Sip til Send', this improved to a median (IQR [range]) satisfaction score of 4 (4-4 [2-4]) (p < 0.001). The introduction of a 'Sip til Send' policy resulted in an increase in patient satisfaction. Key factors in successful implementation included the provision of a clear explanation of the underlying rationale to patients, nursing and anaesthetic staff, and establishing the policy as the default position for all elective patients.

Implementing Measurement-Based Care (MBC) for Mental Health in a Paediatric Hospital Setting

Introduction: Measurement-Based Care (MBC) is the routine, systematic use of validated measures (e.g., patient-reported outcome measures [PROMs]) before or during clinical encounters to inform treatment decision-making. A large body of evidence, including randomized controlled trials, suggest that MBC outperforms usual care in response to treatment, remission rates, time to response and remission for individuals with depression, anxiety and other mental health conditions. MBC is a standard of care for most chronic conditions (e.g., diabetes, hypertension, asthma), however, it is underutilized in pediatric mental healthcare, despite well documented benefits and feasibility. As part of the hospital’s broader mandate to better integrate physical and mental healthcare, the MBC implementation team set out to develop an MBC system for evaluation of mental health concerns across the hospital with the goal to facilitate monitoring and response of mental health metrics at the patient, provider, organizational, and system levels.&#x0D; Methods: An environmental scan was conducted to understand the priority areas for health systems’ improvement. Stakeholders engaged in the process were physician leaders, clinical operational directors, clinical staff, Youth and Family Advisory Panel members across hospital departments. The environmental scan and follow-up focus groups (n=57) highlighted the need to prioritize implementation of standardized mental assessment tools hospital-wide for patients at each health system encounter as part of a vision to deliver holistic, integrated care and improve quality of patient care. Early identification of mental health needs of patients across the hospital and the importance of establishing standardized metrics for common mental health conditions were additional key priorities. Hospital surveys highlighted anxiety and depression as the top mental health concerns across the hospital. An extensive review was conducted to identify validated tools available and to understand implementation best practices.&#x0D; Learnings: Learnings from our review pointed to some key factors for successful implementation. These included the need for tools that are brief and easy to use, are validated and sensitive to change, are user friendly and visually appealing for the pediatric population and are integrated into the electronic health record with appropriate decision support tools to enable real time review. The need for extensive patient and provider education about the value of MBC and its implementation was also a key learning.&#x0D; &#x0D; Work in progress &amp; next steps: Work is underway to map out clinical workflows, including ensuring a timely response to results, addressing implementation challenges such as virtual vs. in-person tool completion, and managing accessibility of sensitive data to the patient or their proxy in the electronic health record. Workflows will take an integrated, holistic care approach, whereby, a patient’s care team will action appropriate interventions based on a standardized algorithm that engages an interdisciplinary care team. Voxe, an external, patient-friendly platform to administer the two chosen assessment tools will be trialed. Discussions are underway with Information Management and Technology teams to integrate Voxe and clinical workflows in the hospital’s electronic health record. Evaluation of implementation of MBC in clinical settings will consider both process and outcome measures such as uptake, timely receipt of services, and clinical response.

Behavioral Health Integration on Inpatient Obstetric Units: Program Development, Strategies for Implementation, and Lessons Learned.

Perinatal mood and anxiety disorders and substance use disorders are the primary causes of maternal mortality in the postpartum period and represent major public health concerns. Despite this, these conditions remain undertreated. Behavioral health integration in outpatient obstetric settings is necessary but insufficient to meet the needs of all patients. Inpatient behavioral health integration represents a promising avenue for addressing gaps in care. Results from recent program development indicate that needs assessment, stakeholder backing, collaboration with existing programs, and adaptability are key factors in successful implementation.

Patient and Clinician Satisfaction in Teledermatology: Key Factors for Successful Implementation.

Teledermatology has emerged as a promising solution for remote dermatologic care, especially during COVID-19 pandemic. It improves access to care through information and communication technologies. This paper explores patient and clinician satisfaction in teledermatology. Patient satisfaction encompasses various aspects, including future willingness, the quality of care, technical quality, and access to care. Clinician satisfaction is influenced by quality of care, implementation, technical aspects, clinician-patient rapport, and financial considerations. It is important to evaluate patient and clinician satisfaction in different teledermatology models, including store-and-forward, live interactive, and hybrid interactive approaches. By evaluating satisfaction within different teledermatology models and addressing the factors that impact satisfaction, teledermatology can ensure high-quality care and promote positive outcomes. With proper implementation and ongoing evaluation, teledermatology has the potential to become a widely accepted and valuable component of dermatologic care, offering enhanced access to specialized services.

Understanding for whom, under what conditions, and how atrial fibrillation screening interventions are successful: a realist review

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme. Background/introduction The treatment of atrial fibrillation (AF) with oral anticoagulants reduces stroke risk. Most initial AF diagnoses result from symptom related rhythm monitoring or are after stroke. However, as AF is often asymptomatic detecting it by screening could initiate oral anticoagulant treatment. Purpose We aimed to understand for whom, under what conditions, and how AF screening programmes can increase the number of new AF diagnoses and lead to guideline-adherent care. Methods A realist review of AF screening for those aged ≥18 years. We developed an initial programme theory; systematically searched four databases until October 2022; and selected documents that included details about factors relating to the implementation of AF screening programmes. We extracted, analysed, and synthesised data using realist techniques to create context–mechanism–outcome configurations, and a refined programme theory. Results We screened 2,707 documents and included 70. The refined programme theory included 15 context–mechanism–outcome configurations to explain how different screening programme implementation affects outcomes. Key factors in successful implementation included 1) locations accessible to those at most risk of undiagnosed AF; 2) targeted, inclusive invitations; 3) training to increase understanding and competence of those undertaking screening; 4) using digital technology for convenience and accuracy; 5) organisational support mechanisms such as automated prompts to increase awareness of who to screen; and 6) standardised follow-up pathways. The best system for screening is unclear. Single time point screening is convenient, potentially leading to higher uptake. Prolonged screening may result in a higher paroxysmal AF yield (Figure 1). Conclusions Well implemented AF screening programmes could increase the number of new AF diagnoses and lead to guideline-adherent care, thereby reducing stroke risk.

Branding as a tool for enhancing enterprise competitiveness: theoretical foundations and key factors for successful implementation

Branding as a tool for enhancing enterprise competitiveness: theoretical foundations and key factors for successful implementation

The Role of Parliamentarians in Implementing SDGs in Pakistan: A Qualitative Study Incorporating Lessons Learned across Eight Countries

The Sustainable Development Goals (SDGs) provide a comprehensive framework for addressing social, economic, and environmental challenges facing countries around the world. The role of parliaments in implementing the SDGs has been widely recognized, but the extent of their impact remains uncertain, particularly in developing countries such as Pakistan. This paper aims to investigate the role of parliament in implementing the SDGs in Pakistan and to draw lessons from other countries that have successfully integrated the SDGs into their legislative processes. To achieve this objective, a qualitative research design was employed, which included a comprehensive analysis of lessons learned from other countries. The findings suggest that while the Pakistani parliament has taken steps towards aligning its policies with the SDGs, there is still a long way to go in terms of effective implementation. Lessons learned from other countries indicate that parliamentary oversight, public participation, and capacity building are key factors in successful implementation of the SDGs. The paper concludes with a series of recommendations for enhancing the role of parliament in implementing the SDGs in Pakistan.

Improving Residents’ Knowledge and Interest in Outpatient Neurology through an Interactive, Discussion-Based, Patient-Centered Didactic Series (P2-2.006)

<h3>Objective:</h3> Our interactive, discussion-based, patient-centered didactic series aimed to (1) improve residents’ understanding of the roles and responsibilities of outpatient neurologists; (2) share patients’ perspectives of living with chronic neurological disease; and (3) increase residents’ understanding of effective shared decision making (SDM). <h3>Background:</h3> Neurology residency training is inpatient focused, underemphasizing outpatient disorders. We implemented a novel didactic series of facilitated discussions between a patient and their outpatient neurologist to expose residents to outpatient careers, topics, and management. <h3>Design/Methods:</h3> Residents in a large academic neurology program participated. Bimonthly sessions were held in-person in 2016 (n=6) and virtually on Zoom in 2020 (n=6). Each 60-minute session focused on one disorder. The format was conversational and moderated by a course director. Discussion points were pre-planned, focusing on patients’ experiences living with chronic neurological disease and SDM. Residents, faculty, and patients were surveyed for program evaluation. <h3>Results:</h3> A majority of residents, all faculty, and all patients agreed the series met its objectives. Residents and faculty found the format as effective as traditional lectures, without added burden for faculty preparation. The unique format also allowed for instruction on topics rarely covered in lectures. Residents indicated diseases covered were underrepresented in their direct patient care experiences in training. 48% of residents reported increased interest in outpatient careers. Qualitative comments identified hearing patients’ perspectives as the most valuable component. Patients felt sharing their experiences would help physicians better understand their illness and care for future patients; all would participate again. <h3>Conclusions:</h3> Our series educated residents effectively about underrepresented topics in outpatient neurology. Hearing patients’ perspectives was instrumental in achieving our learning objectives. Key factors for successful implementation included a faculty moderator, pre-planned questions, and summary slides emphasizing key learning points. Future work can evaluate if increased knowledge and interest translates into sustained behavior change in residents and more residents choosing outpatient careers. <b>Disclosure:</b> Dr. Gheihman has nothing to disclose. Dr. Cho has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon Therapeutics. Dr. Cho has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. The institution of an immediate family member of Dr. Cho has received research support from NIH. Dr. Cho has received publishing royalties from a publication relating to health care. Dr. Milligan has nothing to disclose. Dr. Doughty has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Doughty has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Doughty has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Adler¦Cohen¦Harvey¦Wakeman¦Guekguezian, LLP. Dr. Doughty has received research support from NINDS/NeuroNEXT. Dr. Doughty has received personal compensation in the range of $500-$4,999 for serving as a Grant Advisory Board Member with Dysimmune Diseases Foundation. Dr. Doughty has received personal compensation in the range of $500-$4,999 for serving as a CME Lecturer with Oakstone Publishing.

Implementation of dihydropyrimidine dehydrogenase deficiency testing in Europe

The main cause for fluoropyrimidine-related toxicity is deficiency of the metabolizing enzyme dihydropyrimidine dehydrogenase (DPD). In 2020, the European Medicines Agency (EMA) recommended two methods for pre-treatment DPD deficiency testing in clinical practice: phenotyping using endogenous uracil concentration or genotyping for DPYD risk variant alleles. This study assessed the DPD testing implementation status in Europe before (2019) and after (2021) the release of the EMA recommendations. The survey was conducted from 16 March 2022 to 31 July 2022. An electronic form with seven closed and three open questions was e-mailed to 251 professionals with DPD testing expertise of 34 European countries. A descriptive analysis was conducted. We received 79 responses (31%) from 23 countries. Following publication of the EMA recommendations, 87% and 75% of the countries reported an increase in the amount of genotype and phenotype testing, respectively. Implementation of novel local guidelines was reported by 21 responders (27%). Countries reporting reimbursement of both tests increased in 2021, and only four (18%) countries reported no coverage for any testing type. In 2019, major implementation drivers were 'retrospective assessment of fluoropyrimidine-related toxicity' (39%), and in 2021, testing was driven by 'publication of guidelines' (40%). Although the major hurdles remained the same after EMA recommendations-'lack of reimbursement' (26%; 2019 versus 15%; 2021) and 'lack of recognizing the clinical relevance by medical oncologists' (25%; 2019 versus 8%; 2021)-the percentage of specialists citing these decreased. Following EMA recommendations, 25% of responders reported no hurdles at all in the adoption of the new testing practice in the clinics. The EMA recommendations have supported the implementation of DPD deficiency testing in Europe. Key factors for successful implementation were test reimbursement and clear clinical guidelines. Further efforts to improve the oncologists' awareness of the clinical relevance of DPD testing in clinical practice are needed.

Curriculum Innovations: Improving Residents' Knowledge and Interest in Outpatient Neurology Through an Interactive Patient-Centered Didactic Series

Introduction and Problem Statement Neurology residency training is inpatient focused, underemphasizing outpatient disorders. We implemented a novel didactic series of facilitated discussions between a patient and their outpatient neurologist to expose residents to outpatient topics and management skills. Objectives (1) Improve residents' understanding of the roles and responsibilities of the neurologist in the outpatient setting; (2) share with residents the patient's perspective of living with chronic neurologic disease; and (3) improve residents' understanding of what effective shared decision making entails. Methods and Curriculum Description Residents in an academic neurology program participated. Six bimonthly, 1-hour sessions were piloted in person in 2016; participants were surveyed after each session to refine the format. The formal program (6 sessions) was held virtually in 2020–2021. Each session focused on 1 disorder. The format was conversational and moderated by a course director. Discussion points were preplanned and focused on patients' experiences living with chronic neurologic disease and shared decision making. Residents, participating faculty, and patients were surveyed at the conclusion of the 2020–2021 series to evaluate its effectiveness. Results and Assessment Data Fifty-five survey responses were completed by residents during the pilot. Only 12 residents (22%) indicated that they longitudinally followed more than 1 patient with the condition represented in the session. Qualitative comments from residents and faculty (n = 5) identified that hearing the patient perspective was the most valuable component of the series. Twenty-one of 54 residents evaluated the final program. A majority of residents, 100% of faculty (n = 6), and 100% of patients (n = 6) felt that the program's 3 learning objectives were met. Forty-eight percent of residents reported increased interest in outpatient careers. Faculty agreed that the session format was as effective as traditional lecture, without added preparation burden. Patients felt that sharing their experiences would help physicians better understand their illness and improve care for future patients; all would participate again. Discussion and Lessons Learned Our series effectively educated residents about underrepresented outpatient topics. Hearing patients' perspectives was instrumental in achieving our learning objectives. Key factors for successful implementation included a faculty moderator, preplanned questions, and teaching slides to emphasize key learning points. Future work should evaluate whether residents' increased knowledge and interest translates into sustained behavior change and more residents selecting outpatient careers.

Using cognitive interviews to improve a measure of organizational readiness for implementation

BackgroundOrganizational readiness is a key factor for successful implementation of evidence-based interventions (EBIs), but a valid and reliable measure to assess readiness across contexts and settings is needed. The R = MC2 heuristic posits that organizational readiness stems from an organization’s motivation, capacity to implement a specific innovation, and its general capacity. This paper describes a process used to examine the face and content validity of items in a readiness survey developed to assess organizational readiness (based on R = MC2) among federally qualified health centers (FQHC) implementing colorectal cancer screening (CRCS) EBIs.MethodsWe conducted 20 cognitive interviews with FQHC staff (clinical and non-clinical) in South Carolina and Texas. Participants were provided a subset of items from the readiness survey to review. A semi-structured interview guide was developed to elicit feedback from participants using “think aloud” and probing techniques. Participants were recruited using a purposive sampling approach and interviews were conducted virtually using Zoom and WebEx. Participants were asked 1) about the relevancy of items, 2) how they interpreted the meaning of items or specific terms, 3) to identify items that were difficult to understand, and 4) how items could be improved. Interviews were transcribed verbatim and coded in ATLAS.ti. Findings were used to revise the readiness survey.ResultsKey recommendations included reducing the survey length and removing redundant or difficult to understand items. Additionally, participants recommended using consistent terms throughout (e.g., other units/teams vs. departments) the survey and changing pronouns (e.g., people, we) to be more specific (e.g., leadership, staff). Moreover, participants recommended specifying ambiguous terms (e.g., define what “better” means).ConclusionUse of cognitive interviews allowed for an engaged process to refine an existing measure of readiness. The improved and finalized readiness survey can be used to support and improve implementation of CRCS EBIs in the clinic setting and thus reduce the cancer burden and cancer-related health disparities.

Strategija za sprovođenje društveno odgovornog ponašanja u situaciji ekonomske krize

Creating and adopting local, and global strategy of socially responsible behaviour, and establishment of a national, and international body for the certification of socially responsible behaviour is key factor for successful implementation. The suggested at global strategy is applying model of "House of social responsibility". Effective implementation of this model requires: knowledge, resources, strategy, legislation, the supervisory body for the certification and control of social responsibility. The new industrial revolution known as Industrial 4.0 have large effect on sustainability, and it can be used as a tool for his proper applications. After COVID-19, in times of political, energetic and economic crisis, countries are faced with new challenges that require urgent solutions in order to create the conditions for the creation of socially responsible communities. The need for socially responsible behaviour increases in a situation of political, energetic and economic crisis raises with more issues and more task to solve. It requires a global change in behaviour and a revision of the existing list priorities, both for companies and for people.

Using the Theoretical Framework of Acceptability to understand the acceptability of e-training for nurse led prevention of unwanted sexual behaviour in Australia’s residential aged care services

Objective: The aim of this study was to evaluate the acceptability of one specific e-training (intervention) for prevention of unwanted sexual behaviour in Australia’s residential aged care services using the Theoretical Framework of Acceptability. Background: Aged care staff are of fundamental importance in unwanted sexual behaviour incident management and prevention. The research team developed and implemented an evidence-informed intervention designed to increase awareness, promote collaborative practice, and improve prevention and management of such incidents in aged care. Current acceptability of training on this topic is yet to be studied despite it being recognised as a key factor for successful implementation and translation into practice. Study design and methods: This is a qualitative, cross-sectional study employing semi-structured telephone interviews with actively working enrolled and registered aged care nurses who had completed the intervention. Acceptability of the intervention was measured with the Theoretical Framework of Acceptability. Of the 36 participants that signed the consent form, 18 completed interviews. One participant was excluded from analysis as they did not complete all modules of the intervention. Results: Analysis revealed favourable evaluation in all seven domains of the Theoretical Framework of Acceptability, finding high acceptability of the intervention amongst all participants. The intervention aligned with participant’s values and the content was perceived to fill a knowledge gap. This is showcased in participants unanimous belief that it would be helpful for all front-line aged care staff to receive the intervention frequently. Although participants showcased high acceptability of the intervention, participants recommended that sexuality content be included before detailing unwanted sexual behaviour, and that this content inclusion may increase awareness and understanding of unwanted sexual behaviour. Conclusion: Participants reported this e-training to be highly acceptable. They believed it has potential to improve attitudes and awareness of incidents in aged care. However, favourable results may reflect a personal interest with the topic, for example, the content aligned with their personal values, experience, and beliefs. More research is needed to understand both the acceptability and the efficacy of the training short and long-term. Implications for research, policy, and practice: This study indicates that larger scale national staff training on this topic is possible and considered necessary by the sample. Future national policy should explore the inclusion of this topic in the curriculum standards. Future research should focus on evaluating the efficacy of the training in changing attitudes, awareness and influencing professional practice. What is already known about the topic? Known prevalence of unwanted sexual behaviour in aged care suggests most nursing staff will be required, at some stage, to provide care to a resident who has been a target, or exhibitor of unwanted sexual behaviour. Previous studies of this pilot intervention indicate that it provides a useful model and curriculum of specific topics to guide development of training on unwanted sexual behaviour initiatives nationally and internationally. Acceptability of healthcare interventions is a critical measure in facilitating their implementation and in this instance, capacity of the aged care workforce to be trained on unwanted sexual behaviour. What this paper adds E-training about prevention of unwanted sexual behaviour is acceptable to aged care nurses. E-training filled an existing program gap in education provision and addressed current staff knowledge deficits that aged care nurses perceived as important for better resident care and reducing work related stress. Lack of prior learning about intimacy and sexuality hampered optimal learning about prevention of unwanted sexual behaviour.

The Role of Artificial Intelligence in Latin Americas Energy Transition

Latin Americas energy transition involves the massive integration of sustainable energy, different than hydro, at large and small scale, consumer empowerment, and the adoption of emerging information and communication technologies (ICT) in the entire electricity sector. These factors boost the usage of Artificial Intelligence (AI) to transform the traditional energy industry into a more complex cyber-physical ecosystem. But unlocking the full AI potential requires understanding working principles, current existing applications, and its comprehensive impact on the energy value chain. This paper discusses the role of AI in this context, emphasizing the key factors for successful implementation in the region and proposing an AI maturity model for the energy transition that allows determining the status and gaps for AI adoption.

Private-Sector Partner Selection for Public-Private Partnership Projects Based on Improved CRITIC-EMW Weight and GRA -VIKOR Method

When the government decides to use the public-private partnership (PPP) in projects, such as infrastructure construction, selecting a private-sector partner that meets the project's needs is one of the key factors for successful implementation, but this is ignored in existing research. On this basis, this paper proposes a GRA-VIKOR method based on the combined weight of the improved CRITIC-entropy weight method (EWM). The traditional CRITIC method is improved by combining it with EWM. The combined weights are measured, which reduces the limitations of the single weight. Considering the inherent correlation of evaluation indicators, the VIKOR method is combined with the grey relational analysis (GRA), which makes the results of the selection assessment more reasonable. This paper carries out a case study of the first inland navigation PPP project in China. Through preliminary tracking studies, it tests the effectiveness of the proposed method, the superiority of which is demonstrated by comparing the evaluation results with those of the traditional GRA methods, VIKOR, and TOPSIS.

Implementation of a telemedicine, stroke evaluation service; a qualitative study

BackgroundAcute ischemic stroke requires early medical imaging with a computed tomography (CT) scan and immediate thrombolysis treatment. In rural areas, the long distance to the nearest hospital reduce the patients’ probability of receiving medical assistance within the 4.5-h period. The aim of this study was to assess how the service was set-up, and how managers and personnel experience the organisation and value of a rural telemedicine, remote controlled CT stroke service.MethodsTen semi-structured individual interviews and one semi-structured focus group interview were conducted. The sample included 15 participants involved in the telemedicine service in Hallingdal, Norway. The interview guide consisted of questions on the service, experience of working with the service, value and quality, management, and challenges. Interviews were recorded and transcribed verbatim. Thematic content analysis was used to develop a narrative of the findings.ResultsFindings were categorised into three main categories; value of the service, organisation of the project, and from project to permanent service. Participants perceived the service to be valuable for patients and the local community. The service included task shifting from radiographers and junior doctors to the local paramedics. To enable long- term operation of the service the participants suggested management, coordination, and continuous training as important factors.ConclusionsThe service was perceived as valuable to the local community, providing a sense of healthcare security and equitability. Management’s involvement, flexibility, and coordination appears to be a key factor for successful implementation and long-term sustainability of the service.

The investigation of key factors for successful implementation of sustainable halal food supply chain management

Halal food plays an important role in the economic development in various countries. However, halal food supply chains could threaten the environment in several ways. This study was aimed to analyse the best practice of the implementation of a sustainable halal food supply chain from many data sources. The data then transform into managerial knowledge for the halal food industry. The data was collected using SAS Text Miner and analyzed using the decision tree. The analysis shows four key features of sustainable halal food supply chains: pre-slaughtering, warehousing, halal integrity, and packaging. From these features, the two most important factors of successful sustainability implementation in the halal food supply chain are found to be warehousing and packaging. The present study applies a relational view theory and an analysis theory of natural resource-based view, creating and extending new sustainable strategies of halal food chain management to sustainable halal food chain management.

Challenges to the implementation of in situ simulation at HEMS bases: a qualitative study of facilitators\u2019 expectations and strategies

IntroductionFacilitators play an essential role in simulation-based training on helicopter emergency medical services (HEMS) bases. There is scant literature about the barriers to the implementation of simulation training in HEMS. The purpose of this explorative interview study was to identify factors that the local facilitators anticipated would challenge the smooth implementation of the program, and their strategies to overcome these before the national implementation of in situ simulation-based training locally, and subsequently, one year after the programme was initiated, to identify the actual challenges they had indeed experienced, and their solutions to overcome these.MethodsA qualitative study with semi-structured group interviews of facilitators was undertaken before and after one year of simulation-based training on all HEMS bases and one Search and Rescue base. Systematic text condensation was used to extract facilitators’ expectations and experiences.ResultsFacilitators identified 17 themes in the pre-study-year interviews. Pedagogical, motivational and logistical issues were amongst the dominant themes. Other key themes included management support, dedicated time for the facilitators and ongoing development of the facilitator. In the post-study-year interviews, the same themes were identified. Despite anxiety about the perceptions of, and enthusiasm for, simulation training amongst the HEMS crews, our facilitators describe increasing levels of motivation over the study period.ConclusionFacilitators prognosticated the anticipated challenges to the successful implementation of simulation-based training on HEMS bases and suggested solutions for overcoming these challenges. After one year of simulation-based training, the facilitators reflected on the key factors for successful implementation.

AI in healthcare: A narrative review

In this paper, we focus on providing a narrative review of healthcare services in which artificial intelligence (AI) based services are used as part of the operations and analyze key elements to create successful AI-based services for healthcare. The benefits of AI in healthcare are measured by how AI is improving the healthcare outcomes, help caregivers in work, and reducing healthcare costs. AI market in healthcare sector have also a high market potential with 28% global compound annual growth rate. This paper will collect outcomes from multiple perspectives of healthcare sector including financial, health improvement, and care outcome as well as provide proposals and key factors for successful implementation of AI methods in healthcare. It is shown in this paper that AI implementation in healthcare can provide cost reduction and same time provide better health outcome for all.

QUICKSERV: a service quality assessment tool for the quick-service restaurant industry

PurposeThe purpose of this study is to empirically develop and validate a practical, consistent and specific scale to assess perceived service quality at the service encounter at quick-service restaurants (QSRs).Design/methodology/approachDevelopment and validation of the scale involved a five-stage process. Data were collected from 430 customers of a QSR belonging to an international brand located in Barcelona. Surveys were applied immediately after the service encounter, using the face-to-face method. The scale development procedure involved exploratory and confirmatory factor analyses.FindingsThe results suggest a specific and parsimonious measurement scale, whose structure comprises 14 items in four dimensions. In contrast to previous studies, this study identified the appropriateness of splitting the interaction quality dimension into two single dimensions, one focusing on the interaction time and other on staff–customer interaction. Furthermore, these indicate that a speedy service, pleasant treatment and food quality are the most valued attributes in QSR.Practical implicationsThis scale is a useful instrument to administer and assure service quality standards within QSR management systems. Its practical approach and short survey length ease data collection, considering that customers spend short amounts of time in this type of restaurant. Furthermore, it could also be used by franchisors and restaurant operators as a tool to monitor continuing compliance with service quality standards.Originality/valueThe resulting scale introduces a novel four-factor structure with high goodness of fit to effectively measure customers' perceived service quality in QSRs, where the ease of use and speed of gathering client responses are a key factor for successful implementation.