Practices For Successful Implementation Research Articles

Evaluation of a longitudinal subspecialty clinic for internal medicine residents

ABSTRACT BACKGROUND The traditional model for subspecialty education in internal medicine (IM) residencies is a short inpatient consult rotation, which often lacks outpatient exposure and continuity with faculty. Our IM residency program developed a longitudinal subspecialty clinic (LSC) experience, which pairs categorical IM residents with a faculty preceptor in their subspecialty of interest. Residents work in their preceptor’s clinic for one half-day per week during ambulatory blocks throughout the PGY2 year. OBJECTIVE To evaluate the LSC program’s educational impact and determine best practices for successful implementation.METHODS: From May to July 2019, we surveyed residents and preceptors who participated in an LSC between 2014 and 2019, gathering quantitative and qualitative data on their experiences RESULTS Survey response rates were 66.4% (N=93/140) for residents, 57.7% (N=15/26) for preceptors. Most residents and preceptors were very or extremely satisfied with their LSC experience (83.3% and 71.4%, respectively). Most residents and preceptors reported that the LSC experience was very or extremely effective in enabling residents to explore their subspecialty of interest (76.0%, 86.7%), form a mentoring relationship with their preceptor (71.3%, 80.0%), obtain a letter of recommendation (76.1%, 64.3%), prepare for fellowship (76.3%, 66.7%), gain exposure to outpatient subspecialty practice (90.0%, 73.3%), and gain medical knowledge (84.6%, 80.0%). CONCLUSIONS Our data showed that LSCs are effective in facilitating longitudinal subspecialty career exploration, mentorship, and education for residents. Opportunities for improvement include developing a more structured curriculum, addressing scheduling issues, and adding the option to extend the experience to the PGY3 year.

Implementing remote triage in large health systems: A qualitative evidence synthesis.

Remote triage (RT) allows interprofessional teams (e.g., nurses and physicians) to assess patients and make clinical decisions remotely. RT use has developed widespread interest due to the COVID-19 pandemic, and has future potential to address the needs of a rapidly aging population, improve access to care, facilitate interprofessional team care, and ensure appropriate use of resources. However, despite rapid and increasing interest in implementation of RT, there is little research concerning practices for successful implementation. We conducted a systematic review and qualitative evidence synthesis of practices that impact the implementation of RT for adults seeking clinical care advice. We searched MEDLINE®, EMBASE, and CINAHL from inception through July 2018. We included 32 studies in this review. Our review identified four themes impacting the implementation of RT: characteristics of staff who use RT, influence of RT on staff, considerations in selecting RT tools, and environmental and contextual factors impacting RT. The findings of our systemic review underscore the need for a careful consideration of (a) organizational and stakeholder buy-in before launch, (b) physical and psychological workplace environment, (c) staff training and ongoing support, and (d) optimal metrics to assess the effectiveness and efficiency of implementation. Our findings indicate that preimplementation planning, as well as evaluating RT by collecting data during and after implementation, is essential to ensuring successful implementation and continued adoption of RT in a health care system.

Ensuring continued use of a digital library: a qualitative approach

PurposeThis paper aims to identify the factors affecting continued use of digital libraries in a military context.Design/methodology/approachSemi-structured interviews with four focus groups consisting of 21 respondents, who are military education instructors and librarians, were carried out. This qualitative approach study adopted content analysis methods that were designed to contrast and make comparisons based on the participants’ responses. The valid responses were analyzed using NVivo 12 Plus.FindingsUsing semi-structured interviews, this study presents five dimensions of critical success factors generated from the analysis of the content of the qualitative data. The dimensions highlighted are as follows: perceived quality factors; perceived instrumental support; perceived ease of use; users’ expectation and users’ satisfaction; and net benefits and perceived usefulness.Research limitations/implicationsThis study is only focussing on military education instructors and librarians in the vicinity of four regions in Peninsular Malaysia. For practical implications, it provides an understanding of how the organization could sustain the continued use of a military-context digital library (DL).Practical implicationsThis study makes a new practical contribution to DL information systems’ successful implementation practices in a military context. This study also serves as a guideline for the organizational stakeholders to have a better understanding of their knowledge and the digitalization environment. The findings of this study provide an understanding of how the organization could sustain the continued use of digital libraries in a military context.Originality/valueThis study fills the void in the literature by investigating the DL use in the context of a military setting.

Best Practice Models for Enterprise Resource Planning Implementation and Security Challenges

The objective of this study was to analyze the best practices that have to be adopted in implementing ERP. The study further sought to address security challenges faced in ERP implementation. The researcher used content analysis approach of a number of publications on the subject area of ERP implementation. This research makes use of secondary sources like books, academic journals and other online sources that speak about the best practices to be adapted for implementation of Enterprise resource planning systems for conducting the study. The findings showed that before an organization dives in implementing ERP, the following practices for successful implementation have to be considered: developing a plan with clear goals and objectives, gaining internal support and commitment, selecting the right software, allocating sufficient resources and training and change management. The study also established that integrating user management, internal controls, data and information management and reporting, compliance, and protection against internal and external threats associated with a single solution is a big challenge. The paper concludes that even though ERP is important to organisations, its implementation is challenging and organisations must prepare adequately to get it right.

Non-auditors in the internal audit function: better practices for successful implementation

To bring a high level of expertise on-board Internal Audit Functions (IAFs) increasingly include persons that are not trained as auditor in internal audits. These non-auditors (rotational auditors, guest auditors or subject matter experts) function as part of the IAF for a specific period. This practice ensures the IAF has the expertise and skills required to meet today’s challenges of organizations and their IAFs. However, it provides (professional practice) challenges as these auditors usually have limited experience and knowledge around internal audits and might be conflicted in their objectivity and independence. This article provides better practices to optimize the use of non-auditors and mitigate its risks.

Critical success factors of the continued usage of digital library successful implementation in military-context

PurposeThis paper aims to identify the critical success factors of the continued usage of digital library (DL) successful implementation from the perspective of users with organisation support factors as key antecedents.Design/methodology/approachBased on the extensive literature review, this study has constructed a conceptual framework based on organisational support perspectives and updated Delone and McLean’s information system success model. A pilot study was carried out on a sample of 105 respondents from military-context. A survey instrument including 22 measurement items was designed to identify the level of DL information system (IS) successful implementation practices in military context. Descriptive statistical analysis and reliability analysis were used to analyse the data with SPSS software.FindingsThe findings indicate that training and education, DL environment and communication support, continuation of usage intention, net benefits and user satisfaction are the critical success factors that play key role in ensuring the continued usage DL successful implementation in military context. The military-context DL needs to obtain critical success factors of DL practices implementation to sustain its continued usage, particularly for the active users of its members.Research limitations/implicationsThis study only considered the military personnel who have visited the five main military libraries. For practical implications, the development of instruments in this study may be valuable tools to evaluate DL in other DL settings in Malaysian context other than academic settings.Originality/valueThis study makes a new contribution to DL IS successful implementation practices in military context. This study also provides important information for decision-makers involved in DL IS successful implementation practices and provides useful reference for future researchers in this research area.

Ocena primenjivosti Balanced Scorecard koncepta u malim i srednjim preduzećima

The modern management concept Balanced Scorecard (BSC), thanks to the efficient solutions it offers, draws increasing attention from the management across the globe. BSC is a performance measurement system which unites a traditional, financial perspective with the consumer, internal business processes, and learning and growth perspectives; and provides intelligibility of the company's vision and strategic goals, strengthening of the internal communication of employees, and more efficient realization of key business activities. The implementation of the BSC concept in large enterprises is a quite simple and efficient process, while the procedure of incorporating its postulates into the structure of small and medium-sized enterprises is extremely complex and uncertain. For that reason, the aim of this scientific research is the assessment of the applicability of the BSC in small and medium-sized enterprises, with a simultaneous overview of examples of successful and less successful implementation practices, and the most frequent reasons for non-implementation of the concept itself. The research is inspired by the observation that the world literature has, to a certain extent, neglected the analysis of the application of the BSC concept in small and medium-sized enterprises. The descriptive and comparative method, the technique of analysis and synthesis, as well as analysis of the content of relevant literature of reference, national and foreign authors were used for research purposes. The result of the research is the confirmed assumption that the implementation of the BSC concept in small and medium-sized enterprises is possible but at the same time quite complex and demanding due to the influence of different variables. Accordingly, the recommendations such as that the BSC model should be simplified and burdened with a smaller number of metrics in order to become more applicable in small and medium-sized enterprises were derived in the research.

Nurses' and midwives' experiences of providing group antenatal and postnatal care at 18 health centers in Rwanda: A mixed methods study.

BackgroundThe East Africa Preterm Birth Initiative-Rwanda began a cluster randomized controlled trial of group antenatal care (ANC) and postnatal care (PNC) in Rwanda in 2017. That trial will report its primary outcome, gestational length at birth, after data collection concludes in 2019. This nested study includes providers of ANC and/or PNC at the 18 health centers randomized to provide the group model of ANC/PNC and the 18 health centers randomized to continue providing ANC/PNC in the traditional, individual visit model. The objective of this study is to understand the experiences of providers of group ANC/PNC and compare their job satisfaction and perceived stress with individual ANC/PNC providers.MethodsWe collected both quantitative and qualitative data from providers (nurses and midwives) who were recruited by health center directors to participate as group ANC and PNC facilitators at intervention sites and from a similar number of providers of standard ANC and PNC at control sites. Quantitative data was collected with questionnaires administered at baseline and approximately 9 months later (follow up). Qualitative data was collected in 3 focus groups of group ANC/PNC providers conducted one year after group care began.ResultsEighty-six percent of nurses and midwives surveyed who implemented group ANC and PNC reported that they prefer group care to the traditional individual model of ANC and PNC. Perceived stress levels and job satisfaction results were similar between groups. Mixed focus group discussions among both nurses and midwives experienced in group ANC and PNC suggest that the group model of care has advantages for both service beneficiaries and providers. When providers described implementation challenges, their peers in the focus groups offered them suggestions to cope and improve service delivery.DiscussionThese results are consistent with studies of providers of group ANC and PNC in other LMIC contexts with respect to the perceived benefits of group care. This study adds new insights into the ways peer providers can help one another solve implementation problems. When given the opportunity to meet as a group, these study participants offered one another peer support and shared knowledge about best practices for successful implementation of group ANC/PNC.This trial is registered at clinicaltrials.gov as NCT03154177.

Patient Portals Facilitating Engagement With Inpatient Electronic Medical Records: A Systematic Review.

BackgroundEngaging patients in the delivery of health care has the potential to improve health outcomes and patient satisfaction. Patient portals may enhance patient engagement by enabling patients to access their electronic medical records (EMRs) and facilitating secure patient-provider communication.ObjectiveThe aim of this study was to review literature describing patient portals tethered to an EMR in inpatient settings, their role in patient engagement, and their impact on health care delivery in order to identify factors and best practices for successful implementation of this technology and areas that require further research.MethodsA systematic search for articles in the PubMed, CINAHL, and Embase databases was conducted using keywords associated with patient engagement, electronic health records, and patient portals and their respective subject headings in each database. Articles for inclusion were evaluated for quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) for systematic review articles and the Quality Assessment Tool for Studies with Diverse Designs for empirical studies. Included studies were categorized by their focus on input factors (eg, portal design), process factors (eg, portal use), and output factors (eg, benefits) and by the valence of their findings regarding patient portals (ie, positive, negative, or mixed).ResultsThe systematic search identified 58 articles for inclusion. The inputs category was addressed by 40 articles, while the processes and outputs categories were addressed by 36 and 46 articles, respectively: 47 articles addressed multiple themes across the three categories, and 11 addressed only a single theme. Nineteen articles had high- to very high-quality, 21 had medium quality, and 18 had low- to very low-quality. Findings in the inputs category showed wide-ranging portal designs; patients’ privacy concerns and lack of encouragement from providers were among portal adoption barriers while information access and patient-provider communication were among facilitators. Several methods were used to train portal users with varying success. In the processes category, sociodemographic characteristics and medical conditions of patients were predictors of portal use; some patients wanted unlimited access to their EMRs, personalized health education, and nonclinical information; and patients were keen to use portals for communicating with their health care teams. In the outputs category, some but not all studies found patient portals improved patient engagement; patients perceived some portal functions as inadequate but others as useful; patients and staff thought portals may improve patient care but could cause anxiety in some patients; and portals improved patient safety, adherence to medications, and patient-provider communication but had no impact on objective health outcomes.ConclusionsWhile the evidence is currently immature, patient portals have demonstrated benefit by enabling the discovery of medical errors, improving adherence to medications, and providing patient-provider communication, etc. High-quality studies are needed to fully understand, improve, and evaluate their impact.

Implementing Precision Medicine Programs and Clinical Trials in the Community-Based Oncology Practice: Barriers and Best Practices.

There has been a rapid uptick in the pace of oncology precision medicine advancements over the past several decades as a result of increasingly sophisticated technology and the ability to study more patients through innovative trial designs. As more precision oncology approaches are developed, the need for precision medicine trials is increasing in the community setting, where most patients with cancer are treated. However, community-based practices, as well as some academic centers, may face unique barriers to implementing precision medicine programs and trials within their communities. Such challenges include understanding the tissue needs of molecular tests (e.g., tumor, blood), identifying which molecular tests are best used and when tissue should be tested, interpreting the test results and determining actionability, understanding the role of genetic counseling and/or follow-up testing, determining clinical trial eligibility, and assessing patient attitudes and financial concerns. The purpose of this article is to provide guidance to community-based oncology practices currently conducting clinical trials who want to expand their research program to include precision medicine trials. Here, we describe the core components of precision medicine programs and offer best practices for successful implementation of precision medicine trials in community-based practices.

Implementation of immediate postpartum LARC in Georgia

Objectives: Currently, little evidence exists to support health care institutions or states implementing immediate postpartum long-acting reversible contraceptive (LARC) programs. This qualitative study sought to describe the steps required to implement immediate postpartum LARC programs in different Georgia hospitals and to identify barriers and facilitators of immediate postpartum LARC implementation. Methods: We interviewed 32 key stakeholders from 10 Georgia hospitals undertaking immediate postpartum LARC implementation. Data were analyzed using directed qualitative content analysis principles with the Promoting Action on Research Implementation in Health Services and Active Implementation frameworks forming the basis for initial analysis, followed by analysis of emerging inductive themes and finally interpretation with a systematic exploration and integration of themes. Results: At the study's completion, LARC methods were available for immediate postpartum placement at seven hospitals. Important potential facilitators of immediate postpartum LARC were champions for the implementation effort, an implementation team, anticipatory guidance and a resource guide. Potential barriers included financial concerns, lack of knowledge about immediate postpartum LARC and competing clinical and administrative priorities. Described implementation experiences detailed stakeholder identification and ongoing communication; interdependent stakeholder-specific tasks; piloting with ongoing improvements; and payer preparedness and payment challenges. We consolidated these experiences into a roadmap for immediate postpartum LARC implementation. Conclusions: Future interventions to improve immediate postpartum LARC method availability should include stakeholder education and administrative tools while incorporating successful implementation practices. The roadmap can help support and focus the efforts of other institutions, states or communities of practice implementing immediate postpartum LARC programs.

NURSES’ INITIAL PERCEPTIONS OF AN INTERPROFESSIONAL EARLY WARNING SIGNS PROTOCOL FOR PREVENTION OF FAILURE TO RESCUE: PART OF A COLLABORATIVE HOSPITAL-BASED QUALITY IMPROVEMENT PROJECT

Failure to rescue has long been recognized and continues to be an area of concern within the health care system. Accordingly, a university-affiliated hospital network based in Quebec, has developed an institutional protocol to act primarily on early signs of patient deterioration and streamlining the response when these signs occur. The goals are preventing in-hospital cardiac arrests, decreasing intensive care admissions, and improving patient outcomes. A quality improvement project was developed to ensure successful implementation practices of the protocol across the institution.

Evidence-based management of ambulatory electronic health record system implementation: An assessment of conceptual support and qualitative evidence

ObjectivesWhile electronic health record (EHR) systems have potential to drive improvements in healthcare, a majority of EHR implementations fall short of expectations. Shortcomings in implementations are often due to organizational issues around the implementation process rather than technological problems. Evidence from both the information technology and healthcare management literature can be applied to improve the likelihood of implementation success, but the translation of this evidence into practice has not been widespread. Our objective was to comprehensively study and synthesize best practices for managing ambulatory EHR system implementation in healthcare organizations, highlighting applicable management theories and successful strategies. MethodsWe held 45 interviews with key informants in six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR implementation. We also conducted six focus groups comprised of 37 physicians. Interview and focus group transcripts were analyzed using both deductive and inductive methods to answer research questions and explore emergent themes. ResultsWe suggest that successful management of ambulatory EHR implementation can be guided by the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. While participants did not acknowledge nor emphasize use of this model, we found evidence that successful implementation practices could be framed using the PDSA model. Additionally, successful sites had three strategies in common: 1) use of evidence from published health information technology (HIT) literature emphasizing implementation facilitators; 2) focusing on workflow; and 3) incorporating critical management factors that facilitate implementation. ConclusionsOrganizations seeking to improve ambulatory EHR implementation processes can use frameworks such as the PDSA QI model to guide efforts and provide a means to formally accommodate new evidence over time. Implementing formal management strategies and incorporating new evidence through the PDSA model is a key element of evidence-based management and a crucial way for organizations to position themselves to proactively address implementation and use challenges before they are exacerbated.

Best practices for successful implementation of single‐use technology and qualification

Single‐use bioprocessing facilities are providing flexible capacity for clinical trials and low‐ to mid‐volume market supply. However, while this production technology reduces manufacturing cost, quantum jumps in healthcare cost efficiency can be expected from new product technology. In the future, new product technology such as virus‐based systems will need smaller bioprocessing capacities which may be provided by single‐use facilities. The single‐use biomanufacturing facility at Rentschler Biotechnologie received the 2012 Facility of the Year Award in the category Equipment Innovation. The award recognizes the project for its flexible, multiproduct manufacturing facility designed to minimize manufacturing costs and product cycle times. This clinical manufacturing facility proves concepts that pave the way toward the factory of the future for commercial biologics manufacturing. From that and more recent projects, we derived the best practices when implementing such a facility during all project phases (when assessing its feasibility, designing, constructing, qualifying, starting up, and operating it). Challenges, potential solutions, and future single‐use bioprocessing facility design objectives are discussed.

The effect of vaccination on undetected persistence of foot-and-mouth disease virus in cattle herds and sheep flocks

The importance of carrier animals (those in whom virus persists after recovery from disease or acute infection) and their potential role in the spread of disease remain open questions within foot-and-mouth disease epidemiology. Using simple probabilistic models we attempt to quantify the effect of emergency vaccination--and especially the time of application--on the likely number of such animals, using data from challenge experiments on both cattle and sheep to determine the probability of persistence in diseased and subclinically infected animals. We show that the number of persistently infected animals in a group is predominantly determined by the number of animals initially infected on premises--the high variability of which ultimately limits the accuracy of any predictions of carrier numbers based upon transmission models. Furthermore, results suggest that, within a cattle herd, carrier numbers may be increased if challenge occurs shortly after vaccination. We show that the quality of inspection is the principal factor influencing whether or not carrier herds occur and that, by reducing clinical signs, the application of vaccination in regularly checked stock also results in an increase in undetected persistently infected animals. Where clinical detection would be poor regardless of the use of vaccination (i.e. particularly in sheep), vaccination will result in a reduction in the probability of a group containing undetected carriers: otherwise there is a benefit only if vaccination is applied sufficiently far in advance of any challenge. The implications of the results for serosurveillance are discussed, including the requisite test sensitivity and practices for successful implementation.