Sustainable Implementation Research Articles

Perceptions of healthcare providers on benefits, risks and barriers regarding intradialytic exercise among haemodialysis patients

ABSTRACTPurposeClinical guidelines call for the inclusion of exercise interventions in every patient’s dialysis session, but these recommendations are rarely adopted. Healthcare providers play a key role in this. Therefore, the aim of this study was to explore how healthcare providers perceive the benefits, risks and barriers of intradialytic exercise (IDE).MethodsWe conducted 21 individual, semi-structured interviews with 11 nurses, 5 nephrologists, 3 training assistants and 2 managers from two dialysis centres in Slovakia. Verbatim transcripts of digitally recorded interviews were thematically analysed using MAXQDA®.ResultsParticipants reported the benefits of IDE as improvements in patients’ physical and psychosocial functioning, independence and self-efficacy, clinical profile and quality of therapy. As risks of IDE, they most frequently reported exercise-related damage to vascular access, insufficient individualization of training and musculoskeletal injuries. The presence of psychological problems among patients was reported as a major barrier for initiating and maintaining patients’ exercise. Other reported barriers included limitations in financial and personnel resources of haemodialysis care.ConclusionsSafe and sustainable implementation of IDE, which might improve a patient’s well-being, need to be prescribed in alignment with the patient’s clinical profile, be delivered individually according to the patient’s characteristics and requires adjustments in the available resources.

Factors Predicting Sustained Implementation of Tier 2 and Tier 3 Positive Behavioral Interventions and Supports

Factors Predicting Sustained Implementation of Tier 2 and Tier 3 Positive Behavioral Interventions and Supports

Critical Success Factors of Sustainability Implementation in the Construction Industry

Sustainability is one of the emerging areas in building construction, and it is widely investigated in terms of bringing sustainable technology into construction. However, one of the biggest challenges in the construction industry is implementing sustainability. Building contractors and construction practitioners mostly struggle with the implementation of sustainability due to the lack of certain parameters that define sustainability. Therefore, this study investigates the factors for effective sustainability implementation to provide industry practitioners with the benefit of the extensive list of parameters when designing their sustainability program. To research the parameters, a questionnaire was designed and administered to construction professionals with wide experience in sustainability implementation. The respondents were asked to evaluate a set of sustainability factors in the economic, social, and environmental domains. This way, the study provides reflections from construction practitioners working on large projects. The findings indicated that Ethical and Relational Factors in economic sustainability, Historical and Social Relations Factors in social sustainability, and Material Usage Factors in environmental sustainability are the most important for effective sustainability implementation. The findings are expected to help construction practitioners understand metrics of sustainability, effectively manage their projects, and successfully implement sustainability with the consideration of proper metrics.

Correlation of Sales, Business Climate Change Through Economic The Correlation of SME Sales, Business Climate Change Impact, and Economic Growth in Sustainable Green Economy Implementation

East Java actively promotes the concept of green economy as an integral part of its efforts to sustain national development. This concept emphasizes not only job creation, economic growth, and environmental preservation but also serves as a foundation for advancing the province further. The implementation of green economy is expected to manage natural resources sustainably while strengthening existing economic sectors. This study aims to examine the direct impacts of green economy practices on key aspects in East Java, including overall economic growth, climate change, SME sales, and their contribution to sustainable development. With a focus on over one million SMEs in the province, the study employs quantitative survey methods to gather comprehensive data. The Economic Base Theory serves as the theoretical framework, highlighting that regional economic growth is driven by external demand for local goods and services. The research aims to provide valuable insights for policymakers and economic practitioners in developing effective and sustainable green economy strategies at the regional level. It also aims to contribute positively to global efforts addressing climate change challenges and environmental conservation.

Five lessons from a mid-level health manager intervention to increase uptake of tuberculosis prevention therapy in Uganda: ‘it is a completely different thing to implement what you know.’

ABSTRACT Background Leadership skills are essential for middle-level healthcare manager efficacy. Capacity-building efforts may attempt behavioural change by filling ‘knowledge gaps’ while neglecting a sustainable application of that knowledge. Sustainable application of that knowledge, or implementation know-how, must resonate with local cultural patterns. When it is neglected, root issues like unclear decision-making space and local authority to interpret policy during implementation remain unaddressed. Particularly in decentralized healthcare systems, the impact can appear in implementation challenges, subjective decision-making, poor teamwork, and an absence of disseminating best practices. Objectives The SEARCH-IPT trial led a series of mini-collaborative meetings, which provided business leadership and management training for an intervention group of mid-level healthcare system managers in rural Eastern, East-Central, and Southwestern Uganda to see whether this would increase uptake of isoniazid-prevention therapy (IPT) for people living with HIV (PLHIV) in intervention districts. IPT is known to reduce active tuberculosis (TB), a leading cause of death among PLHIV, by 40–60%. Methods We performed a thematic analysis of six focus-group discussions from this intervention (held in May 2019, January 2020, September 2021) and 23 key informant interviews with control group participants (between February and August 2019 and September and December 2020). Results Analysis revealed five implementation skill sets District Health Officers (DHOs) and District Tuberculosis and Leprosy Supervisors (DTLSs) deployed to achieve sustainable implementation and realize their decision-making space. The five practices were as follows: data-based decision-making, root-cause analysis, quality assurance, evidence-based empowerment, and sharing best practices with colleagues. Conclusion These practices reached beyond outcome measures to address root problems around the DHO’s range of authority and elicit buy-in from district health workers. For successful capacity building at the mid-manager level, focusing on core practices as part of competency is objectively implementable and measurable at the system level and does not rely on DHO self-assessments.

Sustainable Implementation of Citizen-Based Plastic Monitoring of Fresh Waters in Western Africa

Citizen science projects globally have increasingly been implemented in collecting and analysing environmental data. At the same time, these initiatives are often project-based and, therefore, of short duration. This presents a challenge as data from such activities may not be used in research and political decision-making. This research aims to explore the barriers and solutions for establishing a sustainable long-term citizen-based plastic monitoring strategy in fresh waters based on a case study in Accra, Ghana. This case study is particularly relevant due to the significant issue of plastic pollution in the region, limited official monitoring data to effectively address the problem, and the potential role of citizen science in addressing this data gap in the long term. Data on barriers and solutions were collected based on eight expert interviews, a survey amongst 17 stakeholders, and subsequent roundtable discussions with 24 experts and stakeholders from academia, the private sector, the public sector, and civil society. From this, we identified 30 types of barriers and 21 types of solutions to implement citizen science in the long term. These barriers and solutions relate to five fields of action (social, economic, environmental, technical, and management and governance) and four stakeholder groups (public sector, private sector, civil society, and academia) to implement solution pathways for long-term citizen science projects. Based on our findings, we make suggestions as to how citizen science can be implemented more sustainably in the future in different fields of action and from various institutional perspectives. With this, we hope to advance the potential use of citizen science and citizen science data in research and policy design related to plastics in fresh waters.

Implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana: a mixed methods analysis

BackgroundThe World Health Organization (WHO) encourages all member states to adopt and implement a package of essential evidence-based interventions called the Best Buys to reduce the burden of non-communicable diseases (NCDs). To date, little is known about the implementation of national policies and interventions for NCD control in the WHO member states in sub-Saharan Africa. Our study aimed to evaluate the implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana.MethodsThis was explanatory mixed methods research which started with a document review of Ghana’s WHO Best Buys scores from the 2015, 2017, 2018, 2020 and 2022 WHO NCD Progress Monitor Reports. Thereafter, we conducted 25 key informant interviews and one focus group discussion (11 participants) with key policymakers and stakeholders in the NCD landscape in Ghana to understand the implementation of the NCD policies and interventions, and the policy implementation gaps and challenges faced. Data from the NCD Progress reports were presented using mean scores whilst the qualitative data was analysed thematically.ResultsGhana has shown some advancements in the implementation of the WHO Best Buys measures. Ghana’s implementation scores for 2015, 2017, 2020 and 2022 were 5.0, 9.0, 5.0 and 5.5 respectively, against the mean implementation scores of 7.6/19 for lower-middle-income countries and 9.5/19 for upper-middle-income countries. Efforts to decrease major risk factors such as excessive alcohol consumption and unhealthy diet have been progressing slowly. The most common challenges were related to a) the role of socio-cultural factors, b) stakeholder engagement, c) enforcement and implementation of public health policies, d) implementation guidelines, e) public awareness and education on NCDs, f) financing of NCD prevention and control, g) curative-centered health systems, and h) over-centralization of NCD care.ConclusionGhana has made progress in adopting the WHO Best Buys targeting risk factors of NCDs. However, the country faces contextual barriers to effective implementation. With the retrogression of some measures over time despite making progress in some earlier years, further investigation is needed to identify facilitators for sustained implementation of the WHO Best Buys interventions.

Addressing Lean and Safety Readiness Assessment in Territorial Ambulatory Healthcare

Within the international healthcare landscape, it is incumbent upon all organisations to proactively address individual patient needs by offering a wide range of services. In this context, Territorial Ambulatory Healthcare (TAH) is critical to promote equal access to care as the primary point of contact between National Healthcare Systems and individuals. To achieve this goal, the adoption of Lean and Safety Management (L&SM), a managerial approach to proactively reduce clinical risk and process inefficiencies, can support organisations in pursuing high quality care objectives. Despite the positive benefits associated with the adoption of this approach, the feasibility of guaranteeing a sustainable care quality over time may encounter several challenges. Among these, key contributors to failure include the lack of tailored tools and practices suitable for the healthcare environment, insufficient readiness of the context for implementation, and the absence of a comprehensive system-wide performance strategy. Recent studies in literature address these issues presenting theoretical and practical models to assess readiness levels, highlighting opportunities for future developments of these topics. The current empirical study contributes to the existing knowledge by creating a framework to assess the level of readiness for L&SM implementations within TAH. While this context is essential for ensuring high-quality care and equitable access to care services, successfully implementing L&SM initiatives within TAH is challenging due to the organizational complexity and the involvement of multiple, fragmented stakeholders and care providers. Addressing weak Critical Readiness Factors (CRFs) before starting a project can significantly contribute to successfully implement L&SM and sustain improvement over time. This study will be conducted within the TAH setting of a healthcare organisation in Northern Italy and aims 1) to evaluate the specific care setting readiness for L&SM implementations and 2) to develop practical guidelines to support the organisation in increasing its actual readiness level. The theoretical framework will be grasped integrating prior research on Lean readiness assessment, along with specific literature on L&SM sustainability implementation factors within TAH. Once refined and tested with the purpose of developing a practical assessment tool, the framework will be applied within the selected setting, leading to the identification of practical guidelines to facilitate project success and improvements sustainability. Overall, this research will contribute to enrich the knowledge about L&SM implementation within TAH, supporting health organisations, managers, and clinical leadership to sustainably improve care quality, enhancing the role of territorial care to foster social well-being.

Abstract 4136822: Implementation of a Community-Engaged Amputation Prevention Intervention in Rural Appalachia

Amputation is a devastating complication of diabetes and peripheral artery disease and a marker for health inequity. Implementation Science (IS) and Community Engaged-Research (CenR) allow for real-world adaptation of evidence-based interventions and provide critical frameworks for reproducibility and sustainability. However, few amputation interventions use these approaches. We describe the feasibility and acceptability of an IS and CEnR driven amputation intervention in a high-risk rural community. A Pre-Post mixed methods design was used (Fig 1). Intervention components were mapped to the Social-Ecological Model (Fig 2) and guided by the CFIR. Community and Project Advisory Boards collaborated on needs assessment, mobilizing resources, intervention adaptation, data review and dissemination. A 3-component intervention was implemented in 2 clinics to improve local foot care. Components included diabetic foot exams (DFEs), a multidisciplinary limb preservation team, and a “hot-foot” hotline. Pre-implementation, a retrospective chart review was performed along with focus groups. DFE training was then conducted at each site. After training, a prospective chart review was performed with clinic check-ins for 12 months. Focus groups were held 6- and 12-months post-implementation. Concurrently, monthly multidisciplinary teleconferences were held, and a “hot-foot” phoneline connected providers to specialty nurses. At baseline, 155/224 (69.2%) patients received an annual DFE, 17% had all four exam components, 15.6% had foot abnormalities identified and 3.6% were referred to specialists. At 12-months 212/268 (79.1%) patients received a DFE, 84.7% had all components, 54.9% had abnormalities and 20.1% were referred. All findings were statistically significant. Clinically there was a significant decrease in patients with foot wounds, infection, and foot-related hospitalization/ED visits. There were no changes in amputations. (Table 1) The virtual teleconference completed 12 sessions. The hotline was used once with clinicians reporting they did not need it. We demonstrate successful, sustained implementation of an amputation prevention intervention in a high-risk rural community using IS and CEnR. This approach was crucial for overcoming barriers to intervention implementation in a resource poor environment. Additional research to assess patient experience, understand key components of the intervention and study scalability and clinical effectiveness is planned.

Exploring the feasibility of Recovery Management Checkups for Primary Care in a Federally Qualified Health Center.

Primary care settings present an opportunity for alcohol and substance use disorder (A/SUD) screening and treatment referral. However, there are recognized deficiencies in widely used treatment referral approaches, including acute care connections, vs. those that can support longer-term recovery. Recovery Management Checkups for Primary Care (RMC-PC) is an intervention with an evidence base for improving treatment referral and subsequent recovery for primary care patients; however, the intervention has never been fully implemented outside of a research context. We conducted a feasibility study to inform a future hybrid study of RMC-PC that will test the implementation and effectiveness of the intervention in primary care practice. We used a convergent mixed method design. The study's setting was a Federally Qualified Health Center (FQHC) located in a large midwestern city. RMC-PC linkage services were administered by one of two treatment linkage managers: an FQHC linkage manager (F-LM) and a research staff linkage manager (R-LM). Quantitative data included (a) rates of positive A/SUD screening among a group of FQHC patients and (b) linkage manager service data (e.g., rate of successful meeting completion and days to completing of key events). Qualitative data included (c) an assessment of linkage manager's motivational interviewing performance and (d) a focus group with FQHC staff focused on their perspectives on RMC-PC implementation determinants. Quantitative data were summarized using descriptive statistics, and linkage manager performance was compared. Qualitative data were analyzed using a hybrid deductive-inductive process. Fifty percent of patients screened met moderate-high A/SUD risk. Eleven of 16 recruited patients completed at least one linkage manager meeting, with 63% completing both meetings. The F-LM delivered RMC-PC services alongside other duties successfully; however, three primary barriers to FQHC implementation were identified (difficulties applying motivational interviewing, incompatibilities of screening with FQHC technology and workflow, and lack of billing mechanism to support services). RMC-PC is feasible for FQHC staff to deliver, though issues identified must be considered to ensure successful and sustainable implementation. Knowledge gained will inform a packaged implementation strategy that will be used in a future hybrid trial.

Traditional and modern methods of construction: Comparative study of the sustainability of single‐family homes

AbstractModern construction methods, such as additive manufacturing, are aimed to enhance the efficiency and quality of construction processes while potentially reducing waste generation and material use, thus contributing to sustainability performance (SP). However, comprehensively understanding the sustainability trade‐offs associated with these methods is crucial for guiding both research and practical applications toward sustainable development. This study aims at quantifying the SP of various construction methods for housing, including traditional, prefabricated, and additive manufacturing approaches. A sustainability index, integrating economic, environmental, social, and technological criteria, is utilized to assess different alternatives. Findings reveal promising aspects of 3D printing technologies, such as potential cost reductions through scale increase and process optimization, minimized material waste generation, creation of skilled employment opportunities, and enhanced construction flexibility and ease. Nevertheless, challenges persist, notably significant greenhouse gas emissions and limited supplier availability. Addressing these challenges is imperative for advancing the sustainable implementation of additive manufacturing in construction.

Shedding light on biodiversity: reviewing existing knowledge and exploring hypothesised impacts of agrophotovoltaics.

The growing demand for energy and the shift towards green energy solutions have led to the conversion of open spaces and agricultural fields into photovoltaic (PV) power plants, exacerbating the "food-energy-environment" trilemma. Agrophotovoltaics (APVs), a dual-use system combining agriculture and energy production on the same land, presents a potential solution to this challenge. While the environmental impacts of ground-mounted utility-scale PV (USPV) power plants and the effects of APV systems on agricultural yields have been extensively studied and reviewed, the implications for wildlife and biodiversity remain largely unexplored. This knowledge gap is pressing, given the accelerated global adoption of APV systems and the urgency of understanding their broader ecological consequences. In this concise review, we synthesise existing literature on the impacts of USPV installations on biodiversity and the effects of APV on crop production. Building on these foundations, we propose novel hypotheses concerning the potential pathways and mechanisms through which APV systems may influence biodiversity. We explore the complex interactions between agroecosystems and natural ecosystems, examining both direct and indirect effects. Our review culminates in a set of key research questions designed to guide future studies on the biodiversity outcomes of APV deployment. Future research should comprehensively address factors such as habitat type, climate, spatial scale, technology, and agricultural practices, as well as the overarching impacts of climate change. By highlighting the importance of these variables, we aim to facilitate a nuanced understanding of how APV systems can either support or undermine biodiversity. This work not only underscores the critical need for empirical studies in this emerging field but also sets the stage for more informed and sustainable implementation of APV technologies.

Challenges and Approaches to Establishing Multi-Pathogen Serosurveillance: Findings from the 2023 Serosurveillance Summit.

Multiplex-based serological surveillance is a valuable but underutilized tool to understand gaps in population-level exposure, susceptibility, and immunity to infectious diseases. Assays for which blood samples can be tested for antibodies against several pathogens simultaneously, such as multiplex bead immunoassays, can more efficiently integrate public health surveillance in low- and middle-income countries. On March 7-8, 2023 a group of experts representing research institutions, multilateral organizations, private industry, and country partners met to discuss experiences, identify challenges and solutions, and create a community of practice for integrated, multi-pathogen serosurveillance using multiplex bead assay technologies. Participants were divided into six working groups: 1) supply chain; 2) laboratory assays; 3) seroepidemiology; 4) data analytics; 5) sustainable implementation; and 6) use case scenarios. These working groups discussed experiences, challenges, solutions, and research needs to facilitate integrated, multi-pathogen serosurveillance for public health. Several solutions were proposed to address challenges that cut across working groups.

Managerial Challenges in Implementing European Rail Traffic Management System, Remote Train Control, and Automatic Train Operation: A Literature Review

This paper explores the management of digitalization projects within the railway industry. It aims to increase and understand the opportunities presented by digitalization and automation in rail operations. Employing a scoping review methodology, this research investigates the execution of European Rail Traffic Management System (ERTMS), remote train control (RTC), and automatic train operation (ATO) projects spanning from 2005 to 2023, with a particular emphasis on metro automation, the remote control of freight and passenger trains, fully automated trains, and highly assisted driving. The refined selection process yielded 30 papers. The analysis of the retrieved papers identified managerial issues, with stakeholder management, change management, and organizational management emerging as recurring themes. Despite the increasing trend in publications, the limited representation managerial issues in ERTMS, RTC, and ATO projects in scientific research persists, with implications for the industry’s advancement. This research sheds light on the critical intersection of change management and digitalization within the railway industry by showing the impact of ERTMS, RTC, and ATO on organizational and scope dynamics. The need for human-centered systems is highlighted, showing the necessity of involving every echelon of the organization in the change management process. These findings provide insights for practitioners, researchers, and policymakers, emphasizing the need for understanding and addressing managerial aspects for successful and sustainable digitalization implementations.

Enhancing Infection Control Protocols Across Medical Teams: A Comprehensive Approach for Safer Healthcare

Healthcare-associated infections (HAIs) pose significant risks to patient safety and healthcare quality, impacting all levels of medical staff. This article examines the development and implementation of enhanced infection control protocols aimed at reducing infection rates through a unified, multidisciplinary approach. By engaging healthcare providers across roles—including physicians, nurses, support staff, and administrators—we identify key factors affecting protocol adherence and infection control effectiveness. Through a mixed-methods study, we assess quantitative reductions in infection rates alongside qualitative feedback on protocol practicality and ease of use. Results indicate that comprehensive, role-specific infection control measures, paired with continuous training and feedback mechanisms, significantly improve adherence and reduce HAIs. This study underscores the value of adaptable, universally applied protocols to establish safer healthcare environments, advocating for further research and sustained implementation efforts in diverse clinical settings.

Utilizing Artificial Intelligence Models to Support Environmental Sustainability Implementation in the Design Process

Eco‐design describes a concept or way of thinking that integrates multifaceted aspects of design and environmentally sustainable considerations.Environmental sustainability is being employed in many industries. How might AI be used during the design process as a tool to aid designers in the implementation of key aspects of environmental sustainability?

Analysis of fiscal sustainability and its impact on enhancing economic growth in Iraq for the period (2004-2021)

The research aims to analyze and measure the reality of the Iraqi economy for the period (2004-2021)by applying the concept of financial sustainability and its indicators on economic growth. The paper's problem lies in the weak implementation of financial sustainability and indicators in most financial decisions in Iraq, negatively impacting economic growth in most economic sectors in Iraq. The paper started from the hypothesis that the weak implementation of financial sustainability in most of Iraq has contributed to the weakness of economic growth. The validity of the hypothesis has been proven using a standard model known as the Multiple Regression Model (ARDL), the study has yielded several results, the most important being the inverse relationship between the budget deficit as an independent variable and economic growth as a dependent variable. The budget deficit reached (59%) of the "gross domestic Product" indicating a deviation from the 3% deficit defined by the Maastricht treaty to ensure deficit coverage. Iraq's deviation from this percentage will lead to a decrease in economic growth. The paper also revealed an inverse relationship between public debt as an independent variable and economic growth as a dependent variable due to Iraq's violation of the golden rule, which dictates allocating debt to the investment side rather than consumptive spending. Paper type: Research paper.

From challenges to opportunities: navigating the human response to automated agents in the workplace

Workers are increasingly embracing Artificial Intelligence (AI) to optimise various aspects of their operations in the workplace. While AI offers new opportunities, it also presents unintended challenges that they must carefully navigate. This paper aims to develop a deeper understanding of workers’ experiences with interactions with automated agents (AA) in the workplace and provide actionable recommendations for organisational leaders to achieve positive outcomes. We propose and test a simulation model that quantifies and predicts workers’ experiences with AA, shedding light on the interplay of diverse variables, such as workload, effort and trust. Our findings suggest that lower-efficiency AA might outperform higher-efficiency ones due to the constraining influence of trust on adoption rates. Additionally, we find that lower initial trust in AA could lead to increased usage in certain scenarios and that stronger emotional and social responses to the use of AA may foster greater trust but result in decreased AA utilisation. This interdisciplinary research blends a systems dynamics approach with management theories and psychological concepts, aiming to bridge existing gaps and foster the sustainable and effective implementation of AA in the workplace. Ultimately, our research endeavour contributes to advancing the field of human-AI interaction in the workplace.

Sustainability Implementation in Romanian Tourism: From the Paris Agreement to Electric Up

Sustainability Implementation in Romanian Tourism: From the Paris Agreement to Electric Up

Forging a green future: Synergizing industry 4.0 technologies and circular economy tactics to achieve net-zero in sustainable supply chains

Industry 4.0 (I4.0) and Circular Economy (CE) are emerging in academic, managerial, and policy debates, leading to integrating sustainable supply chain and net zero paradigms as an important phenomenon for maintaining competitive advantages in business. Although CE and I4.0 have significant benefits, their integration is largely untapped, representing a significant opportunity to integrate technological advancements with sustainable practices. Hence, this study investigates how CE and I4.0 can be integrated to achieve net zero in a knowledge-based sustainable supply chain. As part of this objective, the paper conducts an exploratory systematic review of selected articles published in peer-reviewed journals. Three main categories are identified from the selected articles: (i) CE principles and I4.0 technologies integration, (ii) the role of CE-I4.0 nexus in a sustainable supply chain (iii) leveraging CE-4.0 integration for net zero sustainable supply chains. We propose a multi-perspective framework to analyze the net zero sustainable supply chain implementation level using I4.0, CE, and stakeholders’ perspectives. A recommendation from this study suggests increased attention from sustainable supply chain stakeholders on developing infrastructure, including knowledge-building development and training processes focused on net zero. By utilizing our improved knowledge of I4.0 and CE, the results of the study will help researchers, businesses, and policymakers to develop an effective and integrated strategic approach to foster a net zero sustainable supply chain.