Successful Implementation Research Articles

Successes and Failures of the Implementation of the Rural Development Programme 2014–2020 Measure “Agri-Environment and Climate” in Lithuania

The focus on environment and climate-friendly farming is increasingly important in the European Union (EU) Common Agricultural Policy (CAP). Activities of the Measure M10 “Agri-environment and Climate” of the Rural Development Programme (RDP) 2014–2020 were those policy instruments that pursued environmental and climate goals over large areas under agricultural activities, but their effectiveness is still being questioned. After evaluating implementation successes and failures of the activities of the Measure M10 “Agri-environment and Climate” of the Lithuanian RDP 2014–2020, we aim to contribute to policy instruments that are better designed, more effective, and more attractive for farmers to achieve environmental and climate goals. This research was conducted in several stages: (1) a thorough analysis of the Measure M10 and its implementation; (2) analysis of the Measure M10 activities’ contribution to the policy target areas; (3) multi-criteria evaluation of the activities; (4) survey of beneficiaries and discussions in the focus groups. The data available from the Ministry of Agriculture of the Republic of Lithuania, Agricultural Data Center, and National Paying Agency under Ministry of Agriculture of the Republic of Lithuania was used for the analysis. Analysis of the strategic documents and data on the implementation of Measure M10 was supplemented with results from studies focused on the environmental impact of the implementation of Measure M10 in Lithuania. Multi-criteria evaluation methods were used to arrange the activities of the Measure with respect to the selected indicators. The results from the survey of beneficiaries and discussions in the focus groups let us better clarify the motives, experiences, and preferences of farmers’ participation in the activities of Measure M10. The questionnaire was distributed to 2455 beneficiaries through the National Paying Agency and 342 answers were received back, i.e., 13.9%. Five discussions in focus groups, formed from farmers participating and not participating in the activities, representatives of implementing institutions, and employees of consulting and scientific institutions, were organized. The research has revealed areas for improvement in Measure M10, and suggestions for improvement were prepared to better achieve environmental and climate objectives.

Developing a codebook to characterize barriers, enablers, and strategies for implementing learning health systems from a multilevel perspective

AbstractIntroductionLearning health systems (LHSs) play a crucial role in improving healthcare delivery and outcomes through continuous learning and data‐driven decision‐making. Implementation of LHSs spans individual, organization, and systemic levels of healthcare. This paper outlines a systematic approach for developing a comprehensive codebook to identify barriers, enablers, and strategies associated with the establishment and operation of LHS from a multilevel perspective.MethodsThe codebook development process was divided into two phases and employed a coding team. Phase 1 involved the synthesis of previous literature, which drove the development of initial codes. Phase 2 included the testing of the codebook with a pilot dataset to derive new codes or iterative refinement, ensuring robustness, and validity.ResultsThe literature search revealed 12 papers that detailed the barriers, enablers, and strategies for LHS implementation. Micro‐level codes were derived from a mixture of existing literature and our pilot dataset. Most meso‐level codes barriers and enablers were derived from the literature, with some subcodes derived from participant interviews. All strategies for implementation at the meso‐level were identified in the literature. At the macro‐level, all codes and subcodes were from the literature.ConclusionsThe codebook contributes to the advancement of implementation science in LHS. The codebook facilitates effective analysis and understanding of the key factors influencing the success of LHS implementation, offering practical insights for policymakers, healthcare practitioners and researchers engaged in the ongoing evolution of LHS.

Recommendations for implementing digital alcohol interventions in primary care: lessons learned from a Norwegian feasibility study.

Excessive alcohol consumption is a leading global risk factor for ill-health and premature death. Digital alcohol interventions can be effective at reducing alcohol consumption, but their widespread adoption is lagging behind. This study aimed to identify factors promoting or inhibiting the implementation of a digital alcohol intervention in Norwegian primary care, by using Normalization Process Theory (NPT). A mixed methods feasibility study combining quantitative and qualitative methods. A digital alcohol intervention called "Endre" was implemented across four GP practices in Stavanger and Oslo. Usage of the intervention was logged on the digital platform. General practitioners (GPs) reported their perceived uptake of the intervention via a web-based survey. The Normalization MeAsure Development (NoMAD) survey was used to measure support staff's perceived normalization of the intervention. Qualitative data were analyzed using the NPT framework, with quantitative data analyzed descriptively and using χ 2 and Wilcoxon signed-rank test for differences in current and future normalization. Thirty-seven GPs worked in the clinics and could recruit patients for the digital intervention. Thirty-six patients registered for the intervention. Nine patients dropped out early and 25 completed the intervention as intended. Low normalization scores at follow-up (n = 27) indicated that Endre did not become fully embedded in and across practices. Nonetheless, staff felt somewhat confident about their use of Endre and thought it may become a more integral part of their work in the future. Findings from six semi-structured group interviews suggested that limited implementation success may have been due to a lack of tailored implementation support, staff's lack of involvement, their diminished trust in Endre, and a lack of feedback on intervention usage. The outbreak of the Covid-19 pandemic further limited opportunities for GPs to use Endre. This study investigated the real-world challenges of implementing a digital alcohol intervention in routine clinical practice. Future research should involve support staff in both the development and implementation of digital solutions to maximize compatibility with professional workflows and needs. Integration of digital solutions may further be improved by including features such as dashboards that enable clinicians to access and monitor patient progress and self-reported outcomes.

The impact of cultural practices on the outcome of IT risk management implementation

PurposeThe objectives of this research are two-fold. The first is to explore, describe and explain the relevance of the concept of Information Technology risk management (ITRM) implementation processes. In this regard, we were required to understand the interaction between contextual issues, the ITRM framework itself, IT individual interpretations toward them and their effect on implementation. The second objective is to develop a theoretical model for use in guiding the design and analysis of the proposed empirical work. The study introduces a fresh perspective to an established research area. It is argued that without more emphasis on the dynamic nature of the implementation process, an incomplete understanding of the problem will result.Design/methodology/approachThe study adopts an interpretive methodology to a multiple case study design gathering and analysing qualitative evidence. A series of three case studies was designed around 22 semi-structured in-depth interviews conducted to investigate IT individuals’ role in facilitating a successful ITRM implementation.FindingsThe findings provide new insights in relation to ITRM implementation by considering IT individual culture. The research develops a substantive theory involving a schematic model involving a set of theoretical propositions. These findings suggest a dynamic approach to implementing IT risk management framework — one that considers the interaction over time of intentions, context, process and action around risk management frameworks.Research limitations/implicationsThis study makes important theoretical contributions to the understanding of organizational implementations by taking a dynamic view of implementation, identifying different individual IT culture archetypes, emphasizing the role of social aspects and developing a set of key factors and contextual conditions.Practical implicationsThis model offers managers an understanding of how IT individual culture and the factors and contextual conditional work together over time to ensure a successful ITRM implementation. Meanwhile, it sheds some light on how managers treat IT individuals with different levels of experience differently.Originality/valueWe theorize IT individual culture and the factors and contextual conditional and show their effects on ITRM implementation success, thus making an essential contribution to the information systems and implementation research and practice. Moreover, we provide a novel methodology to conceptualize ITRM implementation as a cultural process through which IT people socially construct the meanings and purposes of their work activities. This research answers scholars’ call to construct more accurate explanations of innovation outcomes in an increasingly IS implementation world.

Implementation of the Plavon Program in Population Administration Services

Background: The increasing reliance on technology in public service delivery has led local governments to adopt e-government systems. Specific Background: This study explores the implementation of the PLAVON e-government program in a rural context, addressing the operationalization of such systems in local governance. Knowledge Gap: Existing research highlights e-government frameworks, yet the challenges and successes of community-level implementation remain underexplored. Aims: This research aims to analyze PLAVON's implementation, focusing on standard operating procedures (SOPs) and community engagement. Results: Findings reveal that structured SOPs enhance efficiency and transparency in public services, enabling self-service for citizens. Novelty: This study offers insights into the challenges and strategies of rural e-government implementation. Implications: Results underscore the importance of tailored bureaucratic practices and community involvement, providing valuable lessons for similar programs in rural areas. Highlights : Efficiency: Structured SOPs enhance the efficiency of public service delivery. Transparency: Clear procedures foster transparency in administrative processes. Community Involvement: Active participation of local citizens is crucial for successful implementation. Keywords: E-Government, PLAVON, SOP, Community Engagement, Rural Implementation

Strategies for unlocking EMR Interoperability: A Narrative Review

Electronic Medical Records (EMR) is intended to solve many issues in patient care pathway besides the administrative roles which equally makes the hospital paperless, but they still face major interoperability issues. When there is no systematic connection between different healthcare providers, medical information pertaining to patients becomes fragmented, incomplete, and outdated. This study was undertaken to investigate the strategies used to overcome interoperability challenges by EMR implementors. A narrative review was conducted, and various keywords were used to search in EBSCO, Google Scholar, and pertinent healthcare informatics articles for papers published between 2012 and 2024. Drawing from a range of studies, the findings indicate that Machine learning and artificial intelligence, Standardization of Data Exchange Protocols, Blockchain technology, EHR-Agnostic Platforms, Training and Organizational Support, Government and Policy Interventions, social factors are the strategies that successful EMR implementers have employed to achieve EMR interoperability.

Paving the Path to EMR Implementation Success: The Role of Vendor IT Capability and Coercive Pressure

Paving the Path to EMR Implementation Success: The Role of Vendor IT Capability and Coercive Pressure

Development and Validation of a Workflow Instrument to Evaluate the Success of Electronic Health Records Implementation from a Nursing Perspective: An Exploratory and Descriptive Study

Introduction Electronic medical records (EMR) have been recognized as practical tools for the improvement of the quality and safety of healthcare despite their occasional use in hospitals worldwide. Epic is an integrated software suite with functionality ranging from patient administration through systems for healthcare providers to billing systems, integration to the primary health sector, and a facility for granting patients access to their data. The implementation process is complicated; creating effective methods requires understanding users’ attitudes about these information technologies. This study aimed to develop and validate a questionnaire that measures the efficacy of using workflow during the EMR (Epic) implementation. Furthermore, it describes the nurses’ views on the use of quality and satisfaction of workflow. Methods Following a literature review, an initial pool of 57 items was generated based on the following three primary constructs: use, quality, and user satisfaction with the tool’s workflow. Internal consistency reliability was assessed by calculating Cronbach’s alpha and correlation coefficients for construct validity. Results The final scale comprised 53 items corresponding to the following five distinct factors: use of workflow, information quality, service quality, use of EMR, and user satisfaction and the influence of workflow on clinical care. The full scale was assessed, and Cronbach’s alpha of 0.95 was found. The construct validity was assessed using the Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett’s Test of Sphericity (0.976). Construct validity was tested twice using Exploratory Factor Analysis-Principal Component Analysis. Conclusion The use of workflow, quality of information, quality of service, use of EMR, and user satisfaction scale have good reliability and validity and can be used to implement technology in healthcare.

Motivation Elements in Game-Based Learning (GBL) for Tajweed Learning

Tajweed is a Quranic knowledge, and it is essential to provide a Quranic generation that is fluently and accurately reading the Quran. Unfortunately, previous studies depicted many students unable to read the Quran and indicated low achievement in Quranic subjects. Therefore, there is a need for efforts to create an interactive environment that can support the teaching and learning process, such as Game-Based Learning (GBL). GBL is a teaching aid that can be customized for teaching and learning and encourages students to be actively involved. Meanwhile, various factors are still being investigated in game design to ensure the success of GBL implementation, including motivational elements as an aspect of game design. Therefore, this study aims to identify the effect of GBL design on students' motivation in learning Tajweed. The game (i-Tajweed) deployed a Game Development Framework (GDF) and was tested using a quasi-experimental method on 120 students at primary schools by a purposive sampling method. The study used a set of questionnaires and a set of Tajweed Tests as the instruments for collecting data. The findings of the analysis revealed that the level of significance (0.000 < 0.05) value of the correlation coefficient (r) is 0.310. The result suggests that there is a significant correlation between student's achievement and motivation. Hence, the result proves that using GBL with motivational elements in the design can increase student motivation positively.

Improving goal-concordant care via a uniquely collaborative and multi-site PFAC model.

265 Background: Studies reveal a mismatch between the goals of care (GOC) of cancer patients and actual care received. The 10 members of the Alliance of Dedicated Cancer Centers (ADCC) convened the Improving Goal Concordant Care (IGCC) initiative to address system gaps. IGCC was led by palliative care and oncology experts, with guidance from patient and family advisors. Uniquely, the advisors were identified from patient family advisory councils (PFAC) at each center, forming a collaborative Advisory Group (AG) with the lived experience of each center and the knowledge of advocating for the patient/family voice locally. Methods: PFAC members were recruited from each site to serve on the AG. The 19 member AG met quarterly, with minutes shared with the IGCC oversight group, the Implementation Workgroup (IWG). In September 2023, all AG members were surveyed about perceptions of PFAC engagement and local impact of IGCC. In May 2024, 20 IWG members were surveyed about implementation successes and barriers, including items related to PFAC engagement. Results: AG evaluation and recommendations altered IGCC planned core implementation and evaluation actions meaningfully; for example in 1) selection of structured fields in electronic health record (EHR) and universally accessible GOC documentation and in 2) centering patients in the GOC measure set, including incorporating “Heard & Understood” survey into IGCC evaluation. Other AG guidance around direct patient engagement readiness for GOC conversations and implementing patient GOC surveys was left to individual sites to consider with variable adoption. AG Survey: 63% response rate. 80% noted that the GOC program was discussed with their local PFAC and 92% experienced changed routine patient care after GOC implementation. IWG Survey: 100% response rate. 68% agreed that their center sought guidance from their PFAC during GOC implementation and that leadership presented to their PFAC about their GOC implementation. 26% indicated reporting data to their PFAC; of those that did, 80% agreed that this positively impacted their GOC implementation. Conclusions: While PFACs are occasionally included in quality interventions, this model centered the patient/family voice by supporting a PFAC stakeholder feedback loop working collaboratively and locally to support implementation and evaluation of IGCC objectives. While not all AG recommendations were formally integrated into IGCC, all were considered and many adopted at individual centers. Despite ongoing IGCC-level involvement, center-specific engagement of PFACs varied. Future efforts can track this during process evaluation as local PFAC engagement was highly valued. Consensus building for national best practice implementation and evaluation by recruiting local experts including PFAC members into national collaborative efforts is a successful model for local change.

Use of implementation mapping to develop a multifaceted implementation strategy for an electronic prospective surveillance model for cancer rehabilitation

BackgroundElectronic Prospective Surveillance Models (ePSMs) remotely monitor the rehabilitation needs of people with cancer via patient-reported outcomes at pre-defined time points during cancer care and deliver support, including links to self-management education and community programs, and recommendations for further clinical screening and rehabilitation referrals. Previous guidance on implementing ePSMs lacks sufficient detail on approaches to select implementation strategies for these systems. The purpose of this article is to describe how we developed an implementation plan for REACH, an ePSM system designed for breast, colorectal, lymphoma, and head and neck cancers.MethodsImplementation Mapping guided the process of developing the implementation plan. We integrated findings from a scoping review and qualitative study our team conducted to identify determinants to implementation, implementation actors and actions, and relevant outcomes. Determinants were categorized using the Consolidated Framework for Implementation Research (CFIR), and the implementation outcomes taxonomy guided the identification of outcomes. Next, determinants were mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy of strategies using the CFIR-ERIC Matching Tool. The list of strategies produced was refined through discussion amongst our team and feedback from knowledge users considering each strategy’s feasibility and importance rating via the Go-Zone plot, feasibility and applicability to the clinical contexts, and use among other ePSMs reported in our scoping review.ResultsOf the 39 CFIR constructs, 22 were identified as relevant determinants. Clinic managers, information technology teams, and healthcare providers with key roles in patient education were identified as important actors. The CFIR-ERIC Matching Tool resulted in 50 strategies with Level 1 endorsement and 13 strategies with Level 2 endorsement. The final list of strategies included 1) purposefully re-examine the implementation, 2) tailor strategies, 3) change record systems, 4) conduct educational meetings, 5) distribute educational materials, 6) intervene with patients to enhance uptake and adherence, 7) centralize technical assistance, and 8) use advisory boards and workgroups.ConclusionWe present a generalizable method that incorporates steps from Implementation Mapping, engages various knowledge users, and leverages implementation science frameworks to facilitate the development of an implementation strategy. An evaluation of implementation success using the implementation outcomes framework is underway.

National Experience of Technology-based Eye Care Services: A Comprehensive Ophthalmology Telemedicine Initiative

Technology-Based Eye Care Services (TECS) is a tele-ophthalmology program operating in the Veterans' Administration since 2015. This study explores characteristics of the national TECS population, evaluates implementation and sustainability of TECS, and analyzes possible associations and effects of demographic characteristics and social determinants of health (SDOH) on being diagnosed with a vision threatening (VT) disease. Implementation and sustainability of TECS from 2015-2022 was examined along with the sociodemographic characteristics of Veterans served through TECS in 2021. Veteran patients seen in TECS nationwide. Characteristics, disease prevalence and diagnoses, implementation success rate, sustainability rate, preliminary analysis of outcomes and disparity. Per quarter from 2015-2022, TECS sites were classified as implementing, active, or sustained. Standard Query Language (SQL) was used to determine sociodemographic data and logistic regression models were used to identify risk factors associated with VT eye diagnosis. 21,712 Veterans, 52.1% rural or highly rural, were served by TECS in 2021. The average age was 64.7 years, with females comprising 10.9% of the population served. From 2015-2022, of the 67 TECS sites initiated, 6 were implementing with 51 of 61 initiated sites still operational in the first quarter (Q1) of 2022 (83.6% success rate).Macular degeneration (AMD) and cataracts were more prevalent in rural and highly rural populations (7.6% and 11.3%, and 48.8% and 55.0%, respectively) vs. urban populations; glaucoma and diabetic retinopathy (DR) had the opposite association. The prevalence of any type of VT eye disease was lowest in the Mountains/Central region (0.54%) and highest in the Southeast region (3.2%) of the US. Rural and highly rural residents were 1.3 and 2.5 times as likely, respectively, to be diagnosed with a VT eye disease than urban residents. Implementation and sustainability of TECS has been promising. The data provides key information that can be utilized to improve the deployment of TECS and similar programs, along with the possible future direction of TECS services. Moreover, experience from one national ocular telehealth program clearly illustrates that telemedicine can address eye care disparities in the Veteran population and may be utilized for other vulnerable groups as well.

Blockchain enabled traceability — An analysis of pricing and traceability effort decisions in supply chains

Despite numerous use cases, enterprise-wide implementations of blockchains have seen limited success. This raises the question of when do firms adopt blockchains and do blockchains benefit supply chains. To answer this, we examine a dyadic supply chain consisting of a buyer and a supplier and analyze their traceability effort and pricing decisions. Our results show that the demand-side, supply-side and reputational factors influencing blockchain adoption are primarily complementary and in the absence of one of them, firms can still adopt blockchain. Furthermore, even in the absence of individual benefits for a supply chain partner, there exist conditions under which blockchain adoption benefits the supply chain that can incentivize players to join blockchain. Overall, we contribute by offering a framework that supply chain players can use to assess the likelihood of blockchain implementation success or failure and address the challenges pertaining to incentives and cost imbalances in blockchain implementation.

Enabling efficient patient discharge with a mindset, toolset, and skillset framework.

33 Background: Timely access to care for patients coming through the emergency center can be achieved by efficiently discharging patients. When continued bed growth is not sustainable, improvements in team-based approaches to discharges are necessary and require a multi-pronged approach. Our institution embarked on a process improvement effort anchored on completing 1 out of 2 patients discharged by 12PM. We hypothesize that a discharge before noon will assist with getting our next patient to a bed by 2PM. We conducted a pilot on our Stem Cell Transplant units to test and enable our case for change allowing for scale and spread to other units. Methods: Our multi-pronged framework was focused on mindset, toolset, and skillset. As our first step, executive leadership set direction to achieve a shift in mindset by socializing the case for change using a hospital throughput framework including a 9-12-2 branding. A discharge launchpad [toolset] was established to define expectations of discharge tasks including accountability within a 2-day window of medical readiness for discharge. This served as the tool aligning various teams to a date for task completion. Lastly, we evaluated skillset and defined best practices for the unit RN role and APP, along with others, which included empowering various roles to discharge patients. Results: For discharges during the baseline period of 12/1/2022 - 11/30/2023 from the Stem Cell Transplant service, the percent of discharge orders in by 9AM was 10.3% and discharges completed by 12PM was 12.2%. The pilot period month of April 2024 resulted in a month close performance of 52.5% for orders in by 9AM and 55.4% of patients discharged by 12PM. The average time spent by Stem Cell patients boarding in our emergency center during the baseline period was 6 hours and 34 minutes with a reduction to 2 hours and 23 minutes in April 2024. There were no Stem Cell beds added during the pilot period compared to baseline. The period of 12/1/2023 – 3/31/2024 was excluded to limit any improving data from the Hawthorne effect since throughput socialization began during those months. Conclusions: We met the goal within one month with plans underway to assess sustainability for implementation readiness for scale and spread to other units. Early efforts made to scale this model within the institution confirm the multi-pronged model approach is necessary. Additionally, we believe that a frontline leadership model would contribute best to implementation success. Missing any component of the multi-pronged approach or team member, such as the APP role without the RN role, will not yield the ultimate result of discharging patients by noon. This change requires a coordinated, team-based approach. The new institutional governance structure for hospital throughput, including academic and operational departments, and a logistics center in the future may contribute to building trust in leadership’s commitment to improving patient care.

Assessing Infrastructure Development in Kedungrejo Village Work Plan

Background: Effective policy implementation is essential for achieving developmental goals, particularly in rural areas. Specific Background: This study examines the implementation of the Government Work Plan (RKP) in Kedungrejo, Jabon District, Sidoarjo. Knowledge Gap: There is limited research on the operational challenges of RKP implementation in rural Indonesia. Aims: The research analyzes RKP implementation, focusing on communication, resources, disposition, and bureaucratic structure per Edward III’s framework. Results: Findings reveal that village officials engage in monitoring infrastructure projects but lack Standard Operating Procedures (SOPs) and dedicated oversight teams. Novelty: This study offers empirical insights into the practical challenges faced in RKP implementation. Implications: Establishing SOPs and dedicated teams is recommended to improve coordination and accountability, enhancing governance and community participation in rural development efforts. Highlights : Lack of SOPs: Absence of Standard Operating Procedures hinders effective project oversight. Community Engagement: Village officials emphasize the importance of involving the community in development efforts. Bureaucratic Structure: The existing bureaucratic framework influences the coordination and success of RKP implementation. Keywords: RKP, rural development, governance, implementation, community participation

Integrating Blockchain and AI for Optimized Digital Identity Verification

The rapid evolution of the digital age the use of blockchain and artificial intelligence to improve digital identification methods responds to the challenges of ensuring the security and reliability of personal data. Traditional verification methods are increasingly inadequate, evidenced by the alarming escalation in identity fraud incidents. In response, this research explores an innovative integration of blockchain technology and artificial intelligence to fortify the security, efficiency, and privacy of digital identity verification processes. Blockchain's decentralized and immutable ledger offers a new paradigm for secure and manageable digital identities, while AI's capabilities in automating complex processes and detecting fraud through pattern analysis provide a complementary, synergistic solution. This study addresses the challenges of traditional verification systems, highlights the potential of integrating blockchain and artificial intelligence, and presents a methodology for creating an identity verification information system. Results validated through a series of tests, demonstrating significant improvements in verification accuracy, speed, and resistance to fraudulent activities. Despite promising outcomes, challenges such as scalability, privacy, and integration complexity were identified, with proposed solutions aiming to address these issues for the practical implementation and long-term success of integrated digital identity verification systems.

ВПРОВАДЖЕННЯ ПРАКТИК САМОМЕНЕДЖМЕНТУ ДЛЯ ПОКРАЩЕННЯ КОРПОРАТИВНОЇ КУЛЬТУРИ

In the course of writing the scientific article, the main stages of implementing self-management practices to improve corporate culture were determined. It was found that the effectiveness of such practices largely depends on the level of organizational support and adaptation to specific conditions. Key aspects affecting the success of self-management implementation, including personnel motivation, adaptation to military challenges, and changes in the corporate structure, are analyzed. The study showed that the implementation of self-management strategies makes it possible to increase the adaptability of organizations to the rapidly changing conditions of war, contributing to the preservation and improvement of corporate culture even in difficult and unstable conditions. The key aspects of the implementation of such practices are summarized, which is an important factor for maintaining the stability and efficiency of organizations in the conditions of a long war. The impact of self-management on various aspects of corporate culture in the context of war is systematized, in particular, on the interaction between employees, management processes and the general atmosphere in the organization. The results of the study indicate the need for full or partial integration of various self-management practices into the general management strategies of Ukrainian organizations, which allows them to effectively cope with challenges arising in crisis situations caused by war.

Factors associated with successful FLOW implementation to improve mental health access: a mixed-methods study.

The FLOW program assists mental health providers in transitioning recovered and stabilized specialty mental health (SMH) patients to primary care to increase access to SMH care. In a recent cluster-randomized stepped-wedge trial, nine VA sites implemented the FLOW program with wide variation in implementation success. The goal of this study is to identify site-level factors associated with successful implementation of the FLOW program, guided by the Consolidated Framework for Implementation Research (CFIR). We used the Matrixed Multiple Case Study method, a mixed-methods approach, to compare key metrics hypothesized to impact implementation that were aligned with CFIR. Based upon the number of veterans transitioned at each site, we categorized two sites as higher implementation success, three as medium, and four as lower implementation success. Themes associated with more successful implementation included perceptions of the intervention itself (CFIR domain Innovation), having a culture of recovery-oriented care and prioritizing implementation over competing demands (CFIR domain Inner Setting), had lower mental health provider turnover, and had an internal facilitator who was well-positioned for FLOW implementation, such as having a leadership role or connections across several clinics (CFIR domain Characteristics of Individuals). Other variables, including staffing levels, leadership support, and organizational readiness to change did not have a consistent relationship to implementation success. These data may assist in identifying sites that are likely to need additional implementation support to succeed at implementing FLOW.

Evaluation of the Implementation of a Novel Fluid Resuscitation Device in the Prehospital Care of Sepsis Patients: Application of the Implementation Outcomes Framework

Objectives Early identification and fluid resuscitation are recognized performance measures within sepsis care. Despite fluid resuscitation, fluid goals are often not achieved in the prehospital environment. Furthermore, description of implementation process and evaluation of implementation success are historically underreported in prehospital research. The objective of this study was to contextualize and evaluate the system-wide implementation of a novel fluid resuscitation device, the LifeFlow PLUS®, in the treatment of prehospital sepsis patients. Methods A single urban emergency medical services (EMS) system internally decided to adopt a novel fluid resuscitation device. This EMS system added the device to the clinical care guidelines of suspected sepsis patients. Prior to and during implementation of the new guidelines, several strategies were undertaken to promote consistent, appropriate system-wide use of the device. A mixed methods study design was deployed. Surveys of EMS clinicians and leaders assessed perceptions of the device and sepsis education prior to field implementation of the device. Clinician and leader semi-structured interviews assessed implementation experience and device adoption. Document analysis evaluated deployment of implementation strategies. Data were triangulated to contextualize implementation and evaluate success. Results Clinician (88%) and leader (91%) confidence in appropriate clinician device use and device superiority for sepsis care (73 and 100%, respectively) were high. Clinicians (58%) were less likely to view the device as easy to implement compared to leaders (73%). Three themes were developed from semi-structured interviews, including “exposure” to the device, “reinforcing factors” to prompt device use, and “clinician buy-in.” Twenty unique implementation strategies (e.g., dynamic trainings, mandating change) were used to promote successful system-wide device adoption. Conclusions The overall implementation success of this novel fluid resuscitation device was moderate. Barriers to adoption included complexity of clinical decision-making and ease of device use. Facilitators to adoption included the use of multiple modes of education, clinical reminders, presenting evidence of device benefit, and prehospital culture. Prior to future prehospital implementation programs, EMS systems should focus on identifying and addressing key barriers and facilitators to improve adoption.

How do local governments implement e-government: A case study from Bali Province, Indonesia

The assessment of the e-government index in Indonesia began in 2018. This year, the Bali Province e-government index was only 1.6 (maximum 5). In 2021, 2022, and 2023, the Bali Province e-government index is 3.68, 3.84, and 4.07, respectively. This index is the highest for the provincial category and higher than the national e-government index. This study aims to determine the triumphant factor in implementing e-government in the Bali Province. The research was conducted using structured and in-depth interviews with stakeholders related to e-government management in the Bali Province. Furthermore, a strengths, weaknesses, opportunities, and threats analysis was used to formulate the e-government implementation. The study has discovered five factors influencing the success of e-government implementation in Bali Province, including regional leaders' commitment, regulations, planning, governance and management, and human resources. The result also shows that leadership is the most influential factor in the successful implementation of e-government in Bali Province. Determination of the vision, mission, technical policies, planning, and performance evaluation is carried out in an organised and structured manner. Other evidence of support is realised through allocating a particular budget, providing human resources, and adequately delegating authority. While the findings of this paper will only close a small part of the knowledge gap, further research is still needed by sampling other provinces in Indonesia.