Project Champions Research Articles

Reanalysis of genomic data, how do we do it now and what if we automate it? A qualitative study

Automating reanalysis of genomic data for undiagnosed rare disease patients presents a paradigm shift in how clinical genomics is delivered. We aimed to map the current manual and proposed automated approach to reanalysis and identify possible implementation strategies to address clinical and laboratory staff’s perceived challenges to automation. Fourteen semi-structured interviews guided by a simplified process map were conducted with clinical and laboratory staff across Australia. Individual process maps were integrated into an overview of the current process, noting variation in service delivery. Participants then mapped an automated approach and were invited to discuss perceived challenges and possible supports to automation. Responses were analysed using the Consolidated Framework for Implementation Research, linking to the Expert Recommendations for Implementing Change framework to identify theory-informed implementation strategies. Process mapping demonstrates how automation streamlines processes with eleven steps reduced to seven. Although participants welcomed automation, challenges were raised at six of the steps. Strategies to overcome challenges include embedding project champions, developing education materials, facilitating clinical innovation and quality monitoring tools, and altering reimbursement structures. Future work can build on these findings to develop context specific implementation strategies to guide translation of an automated approach to reanalysis to improve clinical care and patient outcomes.

Influence of Project Champions on Sustainability of Early Childhood Development Projects: Case of Baby-Friendly Community Initiative in Dagoretti North Constituency Nairobi County Kenya

<span>The aim of the study was to find out the influence of project champions on the sustainability of Early Childhood Development (ECD) projects, a case of the Baby-Friendly Community Initiative (BFCI) project in Dagoretti North Constituency Nairobi County, Kenya. The study was guided by the system approach theory. The study adopted a descriptive survey design. The target population was made up of 507 BFCI project stakeholders while the sample size was 211. The researchers used self-administered questionnaires to collect quantitative data while an interview guide was used to collect qualitative data in the research. Descriptive and inferential statistics were used. Data collected from the study was analyzed with the help of the Statistical Package for Social Sciences (SPSS Version 23.0). Triangulated qualitative data was analyzed through themes and content analysis. The study found that </span><span lang="EN-GB">project champions determine the sustainability of ECD projects with a high correlation value. Indicators like commitment, confidence level, influence on the community, and the connections a project champion has in the community play a significant role in the sustainability of projects. In-depth discussions with the key informants indicated the importance of project champions. </span><span>Regression analysis indicated that project champions were significant in predicting the sustainability of ECD Projects. The study recommends that </span><span lang="EN-GB">project champions should be appreciated through tokens to motivate them to champion community projects and be involved in planning projects to ensure to take into account the cultural contexts.</span>

Sustainability Project Champions as Environmental Leaders in a City Organization: Driving the Urban Circular Economy

While the role of projects in sustainability change is widely recognized, the understanding of project managers’ behaviour in sustainability projects is limited. We examine project champions who act without hierarchical and authoritative power as environmental leaders and drive sustainability-related changes in the mindsets of actors and in city administration. Based on longitudinal action research, we elaborate on the practices and characteristics of project champions in initiating and advancing the circular economy in a city organization. Our study contributes to the intersection of research on project champions and environmental leaders by increasing the understanding of the ways through which champions develop their potency to promote sustainability in the course of the project.

Lessons learned while starting multi-institutional genetics research in diverse populations: A report from the Clinical Sequencing Evidence-Generating Research (CSER) consortium

BackgroundIncreasing diversity in clinical trial participation is necessary to improve health outcomes and requires addressing existing social, structural, and geographic barriers. The Clinical Sequencing Evidence-Generating Research Consortium (CSER) included six research projects to enroll historically underrepresented/underserved (UR/US) populations in clinical genomics research. Delays and project re-designs emerged shortly after work began. Understanding common experiences of these projects may inform future trial implementation. MethodsSemi-structured interviews with six CSER principal investigators and seven project managers were performed. An interview guide included questions of research/clinical infrastructure, logistics across sites, language, communication, and allocation of grant-related resources. Interviews were recorded, transcribed verbatim; transcripts were analyzed using inductive coding, thematic analysis and consensus building. ResultsAll projects collaborating with new clinical sub-sites to recruit UR/US populations. Refining trial logistics continued long after enrollment for all projects. Themes of challenges included: sub-site customization for workflow and genetics support, conflicting input from participant advisory groups and approval bodies, developing research personnel, complex data management structures, and external changes (e.g. subcontractors ending contracts) that required redesign. Themes of beneficial lessons included: domains with prior experience were easier, develop project champions at each sub-site, structure communication within the research team, and simplify research design when possible. ConclusionsThe operational aspects of expanding clinical research into novel sub-sites are significant and require investment of time and resources. The themes arising from these interviews suggest priority areas for more quantitative analyses in the future including multi-institutional approval policies and processes, data management structures, and incremental research complexity.

EXAMINING THE NURSING HOME INNER SETTING CHARACTERISTICS THAT LEAD TO THE SUCCESSFUL IMPLEMENTATION OF PAL CARDS

Abstract Implementation efforts of evidence-based practices focusing on the nursing home setting remain understudied. The purpose of this study was to explore the role of the Consolidated Framework for Implementation Research (CFIR) inner setting domain on the implementation of PAL Cards. Monthly qualitative interviews (n=50) with project champions (n=16) were audio-recorded, transcribed, checked for accuracy, and coded using the domain “Inner Setting” from the CFIR in Dedoose. Major themes emerging from the data included networks and communication (e.g., including PAL Card information in employee newsletter) among staff, compatibility of the PAL Cards (e.g., aligns with community values and fits into existing workflows), and available resources (e.g., adequate time and staff to implement the QIP). High-quality communication channels to educate and collaborate were shown to be an integral component of successful implementation. Implications for policy and practice will be discussed.

DIRECT CARE STAFF PERSPECTIVES ON THE IMPACT OF PAL CARDS IN CARE DELIVERY

Abstract This was the third time replicating the Preferences for Activity and Leisure (PAL) Card quality improvement project, but the first conducted entirely during the height of the pandemic. Nursing home providers attempted n=174 PAL Cards and completed n=166 (96%). Feedback from surveys with n=68 staff who came in daily contact with residents (e.g., 26% CNAs, 10% housekeepers, 6% maintenance, 9% dining) were collected by project champions. Staff had worked on average 6 years, indicated that they remember being been told about PAL Cards (81%), noticed them (94%), reported that the information on the PAL Card helped them start a conversation with a resident (79%), and helped them provide care (59%). PAL Cards are a feasible method to communicate important resident preferences to staff who come in daily contact with residents and may not have access to electronic health records. Recommendations for practice will be discussed including staff recommendations for improvements.

Barriers and Facilitators to Stool-Based Screening for Colorectal Cancer Among Black Louisville Residents.

Knowledge of colorectal cancer (CRC) screening options remains suboptimal in Black populations, contributing to screening disparities. Guided by community-based participatory research (CBPR) principles, we partnered with five Black churches in Louisville, a region of Kentucky with high Black-white CRC screening disparities, to explore screening barriers and facilitators for CRC education and outreach. Project champions (n = 5) served as primary points of contact, developed project support within their churches, and were trained to recruit church and community members (n = 39) to participate in five semi-structured focus groups. Interview questions probed actual and perceived barriers to CRC screening, focusing on knowledge and perceptions of stool-based tests. Subsequent questions explored perceptions of different screening tests, CRC knowledge and beliefs, and trusted community locations for screening outreach. Transcripts were analyzed iteratively, and codes were derived inductively and refined to develop overarching themes. Participants experienced multilevel barriers to completing CRC screening. Primary themes about CRC screening included acknowledgment of importance, positive and negative personal experiences, need for increased outreach, and desire for greater cultural representation in educational materials. Participants frequently discussed perceptions of inadequate medical care, with most having only ever been offered colonoscopy; subsequently, knowledge of stool-based tests was low. To address this knowledge gap, participants stressed interpersonal communication from trusted individuals, such as local Black medical providers and CRC survivors. Given the low knowledge of stool-based testing among participants and identified inequities in receipt of clinical care, community-based CRC screening interventions are warranted to reduce Black-white CRC screening disparities.

Cost-Effectiveness Analysis: Personal Systems Approach in Improving Medication Adherence in Adult Kidney Transplant Patients.

Interventions to improve medication nonadherence in transplantation have recently moved from a focus on motivation and intention, to a focus on person-level quality improvement strategies. These strategies link adherence to established daily routines, environmental cues, and supportive people. The objective of this evaluation was to estimate the cost of implementation and the cost-effectiveness of a person-level intervention shown to increase medication adherence. To estimate the intervention costs, a direct measure microcosting approach was used after key informant interviews with project champions and a review of implementation expenditures. Cost-effectiveness was calculated by comparing the incremental implementation costs and healthcare costs associated with nonadherence to the incremental percent adherent, defined as the percent of patients who took greater or equal to 85% of their medication doses, for each pairwise comparison. The intervention was low-resource to implement, costing approximately $520 to implement per patient, and was associated with significant improvements in medication adherence. These implementation costs were more than outweighed by the expected healthcare savings associated with improvements in adherence. This person-level intervention is a low-cost, efficacious intervention associated with significant statistical and clinical improvements in medication adherence in adult kidney transplant recipients.

Barriers and Facilitators to Implementing Immediate Postpartum Contraceptive Implant Programs: A Formative Implementation Research.

ObjectiveThis study sought to identify the factors that act as barriers and facilitators to developing and implementing Immediate postpartum (IPP) insertion of contraceptive implants service according to the Consolidated Framework for Implementation Research (CFIR).MethodsWe conducted in-depth interviews and focus group discussions to explore IPP contraceptive implantation programs implemented in community, regional, and university hospitals in Thailand. The CFIR was used to guide the data collection and analyses.ResultsAll CFIR domains were found to have an impact on planning and implementation. Out of 38 constructs, nine were identified as either barriers or facilitators, and four were determined to be both. Barriers included an insufficient training budget, lack of policy to support non-teenagers, disconnect among organizations, and lack of knowledge on the part of the clients. Facilitators included the relative advantage of implants over other contraceptive methods, reimbursement policy, laws that promote teenage autonomy, setting IPP implants as a key performance indicator (KPI), identifying project champions, and educating clients through antenatal counseling or multimedia intervention.ConclusionBarriers and facilitators to the successful implementation of an IPP contraceptive implant program were identified. In order to successfully implement this service, modifiable barriers should be overcome and facilitators should be strengthened. Strategies tailored to the local context should be developed to ensure the sustainability of the program. Educating clients is crucial and need both hospital- and community interventions.

Facilitators and barriers to the implementation of the Primary Care Asthma Paediatric Pathway: a qualitative analysis

ObjectiveThe aim of this qualitative study was to use a theory-based approach to understand the facilitators and barriers that impacted the implementation of the Primary Care Asthma Paediatric Pathway.DesignQualitative semistructured...

Approaches for overcoming barriers to cross-sector data sharing.

To characterize factors influencing the development and sustainability of data sharing in the Mid-Ohio Farmacy (MOF), a produce referral program implemented in partnership between a community-based organization (the Mid-Ohio Food Collective ["Food Collective"]) and an academic medical center (The Ohio State University Wexner Medical Center [OSUWMC]). We used an in-depth case study approach to identify challenges that arose during implementation of the MOF and related solutions via semistructured interviews with representatives of both organizations (May-September2020). Key informants from OSUWMC (n = 20) and the Food Collective (n = 11) were identified using a combination of purposive and convenience sampling; they included administrators, project champions, clinical providers, and food pantry representatives. Interview transcripts were coded using a deductive dominant approach guided by a logic model aimed at determining the resources and activities relevant to the development of the partnership. Challenges of cross-sector data sharing fit into 3 themes: data sharing regulations, data exchange capabilities, and cross-sector data integration. Overcoming these challenges required creative workarounds-for example, linking patients across organizations was done via establishment of a unique, partnership-specific patient identifier, which was incorporated into the health system's electronic health record for continuity. Our findings suggest that current regulatory frameworks are misspecified to the growing interest in cross-sector partnerships between health care and community-based organizations. Future efforts to support these relationships should consider clarifying rules around data sharing and increasing Medicaid support for nonmedical, health-related social needs.

We're Still Very Much in Limbo: Providers' Perspectives on Implementing a Person-Centered Project

Background: The Preferences for Everyday Living Inventory assists nursing home (NH) providers in assessing residents’ preferences and can be used to make Preferences for Activity and Leisure (PAL) Cards, which are personalized 5x7 laminated cards that reflect a resident’s recreation and leisure preferences. We sought to understand the barriers and facilitators to implementing PAL Cards in NH communities during COVID-19. Methods: NH providers from five states (n=29) were recruited to create PAL Cards in their communities. Monthly coaching calls with project champions assessed the implementation process. Calls were recorded, transcribed verbatim, checked for accuracy, and coded via thematic analysis. Results: Four themes emerged: Adapting to COVID, Preoccupied with COVID, Future Thinking, and PAL Cards Filling the Gaps. Conclusion: Some providers were successful adapting to COVID, while others struggled to implement a new program during the pandemic. Those that were successful expressed how PAL Cards helped promote person-centered care.

Reactive, Individualistic and Disciplinary: The Urban Resilience Project in Dhaka

ABSTRACT The World Bank’s Urban Resilience Project (URP) champions resilience as the best response to tackle environmental hazards faced by inhabitants in Dhaka, Bangladesh without sacrificing economic development. Embedded within neoliberal risk management and sustainable development frameworks, the URP supports ongoing forms of urban expansion and densification in Dhaka as the key driver of Bangladesh’s economic growth, purporting that this strategy will enable the city to address increasing and intensifying forms of flooding, heat waves, fires and earthquake risk. This paper argues that the URP depoliticises the causes of and proposed solutions to environmental hazards in Dhaka and the manner in which they are unevenly experienced. Drawing on fieldwork using qualitative methods, this paper posits that three facets guide resilience in Dhaka: reactive neoliberal policies, individualism, and disciplinary control. Ultimately, the URP obfuscates a wider regime of urban development in Dhaka that benefits certain groups (the state, international organisations, elite classes) while further economically and environmentally marginalising those living and working informally. In developing theoretical and empirical contributions to understandings of resilience in global political economy the paper contributes to debates in global political economy and environment, the everyday life of global political economy, and the inter-scalar governance of capitalist societies.

Scale-up and sustainability of a personalized end-of-life care intervention: a longitudinal mixed-methods study

BackgroundScaling-up and sustaining healthcare interventions can be challenging. Our objective was to describe how the 3 Wishes Project (3WP), a personalized end-of-life intervention, was scaled-up and sustained in an intensive care unit (ICU).MethodsIn a longitudinal mixed-methods study from January 12,013 - December 31, 2018, dying patients and families were invited to participate if the probability of patient death was > 95% or after a decision to withdraw life support. A research team member or bedside clinician learned more about each of the patients and their family, then elicited and implemented at least 3 personalized wishes for patients and/or family members. We used a qualitative descriptive approach to analyze interviews and focus groups conducted with 25 clinicians who cared for the enrolled patients. We used descriptive statistics to summarize patient, wish, and clinician characteristics, and analyzed outcome data in quarters using Statistical Process Control charts. The primary outcome was enrollment of terminally ill patients and respective families; the secondary outcome was the number of wishes per patient; tertiary outcomes included wish features and stakeholder involvement.ResultsBoth qualitative and quantitative analyses suggested a three-phase approach to the scale-up of this intervention during which 369 dying patients were enrolled, having 2039 terminal wishes implemented. From a research project to clinical program to an approach to practice, we documented a three-fold increase in enrolment with a five-fold increase in total wishes implemented, without a change in cost. Beginning as a study, the protocol provided structure; starting gradually enabled frontline staff to experience and recognize the value of acts of compassion for patients, families, and clinicians. The transition to a clinical program was marked by handover from the research staff to bedside staff, whereby project catalysts mentored project champions to create staff partnerships, and family engagement became more intentional. The final transition involved empowering staff to integrate the program as an approach to care, expanding it within and beyond the organization.ConclusionsThe 3WP is an end-of-life intervention which was implemented as a study, scaled-up into a clinical program, and sustained by becoming integrated into practice as an approach to care.

A75 IMPLEMENTING A CIRRHOSIS ORDER SET: A QUALITATIVE ANALYSIS OF PROVIDER-IDENTIFIED BARRIERS AND FACILITATORS

BackgroundCirrhosis is the leading cause of mortality and morbidity in individuals with gastrointestinal disease. Multiple care gaps exist for hospitalized patients with cirrhosis, resulting in high rates of re-hospitalization (e.g. 44% at 90 days in Alberta). The Cirrhosis Care Alberta (CCAB) is a 4-year multi-component pragmatic trial with an aim to reduce acute-care utilization by implementing an electronic order set and supporting education across eight hospital sites in Alberta.AimsAs part of the pre-implementation evaluation, this qualitative study analyzed data from provider focus groups to identify barriers and facilitators to implementation.MethodsWe conducted focus groups at eight hospital sites with a total of 54 healthcare providers (3–12 per site). A semi-structured interview guide based upon constructs of the Consolidated Framework for Implementation Research (CFIR) and Normalization Process Theory (NPT) frameworks was used to guide the focus groups. Focus groups were recorded and transcribed verbatim. Data was analyzed thematically and inductively.ResultsFive major themes emerged across all eight sites: (i) understanding past implementation experiences, (ii) resource challenges, (iii) competing priorities among healthcare providers, (iv) system challenges, and (v) urban versus rural differences. Site-specific barriers included perceived lack of patient flow, time restraints, and concerns about the quality and quantity of past implementation interventions. Facilitators included passionate project champions, and an ample feedback process.ConclusionsFocus groups were useful for identifying pre-implementation barriers and facilitators of an electronic orders set. Findings from this study are being refined to address the influence of COVID-19, and the data will be used to inform the intervention roll-out at each of the sites.Funding AgenciesAlberta Innovates

Taking prevention to the next step: implementation of a brief, sustainable frailty assessment in a cardiology clinic

BackgroundFrailty measurement is recommended when assessing older adults with cardiovascular disease to individualise prevention and treatment. We sought to address this by incorporating routine gait speed measurement by clinicians into...

Successes and challenges of implementing a lung cancer screening program in federally qualified health centers: a qualitative analysis using the Consolidated Framework for Implementation Research.

In recent years, studies have shown that low-dose computed tomography (LDCT) is a safe and effective way to screen high-risk adults for lung cancer. Despite this, uptake remains low, especially in limited-resource settings. The American Cancer Society (ACS) partnered with two federally qualified health centers and accredited screening facilities on a 2 year pilot project to implement an LDCT screening program. Both sites attempted to develop a referral program and care coordination practices to move patients through the screening continuum and identify critical facilitators and barriers to implementation. Evaluators conducted key informant interviews (N = 46) with clinical and administrative staff, as well as regional ACS staff during annual site visits. The Consolidated Framework for Implementation Research guided our analysis of factors associated with effective implementation and improved screening outcomes. One study site established a sustainable lung screening program, while the other struggled to overcome significant implementation barriers. Increased time spent with patients, disruption to normal workflows, and Medicaid reimbursement policies presented challenges at both sites. Supportive, engaged leaders and knowledgeable champions who provided clear implementation guidance improved staff engagement and were able to train, guide, and motivate staff throughout the intervention. A slow, stepwise implementation process allowed one site’s project champions to pilot test new processes and resolve issues before scaling up. This pilot study provides critical insights into the necessary resources and steps for successful lung cancer screening program implementation in underserved settings. Future efforts can build upon these findings and identify and address possible facilitators and barriers to screening program implementation.

Motivating Corporate Entrepreneurial Effort: Champions, Followers, and How Innovation Climate Matter

Drawing on Self-Determination Theory and championing research, we hypothesize that intending to act as champion or follower of corporate entrepreneurial projects moderates the translation of autonomous and controlled motivations into corporate entrepreneurial intentions and subsequent effort. From a situated cognition perspective, we further hypothesize that pro-innovation organizational climate perceptions moderate the project champions and followers’ long-term corporate entrepreneurial efforts. We test these hypotheses using longitudinal surveys of 326 Finnish employees. We find that, while both autonomous and controlled motivations drive followers’ corporate entrepreneurial intentions, only controlled motivations drive champions’ corporate entrepreneurial intentions. Furthermore, we find that pro-innovation climate positively moderates the relationship between earlier intentions and later corporate entrepreneurial efforts only for champions, but not for followers.

An Effects of Influence Styles of Project Champions on New Product Development Process and Performance

An Effects of Influence Styles of Project Champions on New Product Development Process and Performance

Training and Toolkit Resources to Support Implementation of a Community Pharmacy Fall Prevention Service.

Community pharmacies are an ideal setting to manage high-risk medications and screen older adults at risk for falls. Appropriate training and resources are needed to successfully implement services in this setting. The purpose of this paper is to identify the key training, tools, and resources to support implementation of fall prevention services. The service was implemented in a network of community pharmacies located in North Carolina. Pharmacies were provided with onboard and longitudinal training, and a project coach. A toolkit contained resources to collect medication information, identify high-risk medications, develop and share recommendations with prescribers, market the service, and educate patients. Project champions at each pharmacy received a nine-question, web-based survey (Qualtrics) to identify usefulness of the training and resources. The quantitative data were analyzed using descriptive statistics. Thirty-one community pharmacies implemented the service. Twenty-three project champions (74%) completed the post-intervention survey. Comprehensive onboard training was rated as more useful than longitudinal training. Resources to identify high-risk medications, develop recommendations, and share recommendations with prescribers were considered most useful. By providing appropriate training and resources to support fall prevention services, community pharmacists can improve patient care as part of their routine workflow.