System Leaders Research Articles

대내·외 정책 변화 요인이 추동한 북·러관계 연구

State relations accelerate the close cooperation and promotion when national interests coincide. The signing of the North Korea-Russia alliance treaty and Kim's first and second visits to Russia served as a driving force when domestic and foreign policy changes interact with national interests. If the China-Soviet conflict and the strengthening of the South Korea-U.S.-Japan alliance led to the 1961 North Korea-Soviet Alliance Treaty, changes in the environment of the international order, including the dissolution of the Soviet Union in 1991, the ROK’s northern policy and Putin's equidistant foreign policy, led to the signing of the 2002 North Korea-Russia Friendship Treaty. A comparative analysis of Kim's first and second visits to Russia enabled the derivation of facilitating factors that accelerated the close relationship between North Korea and Russia and challenging factors. This shows that under the international order dominated by power, close contact is accelerated when national interests, such as domestic and foreign environmental factors of North Korea and Russia, namely, domestic political system (leadership), diversification of economy and diplomacy, and securing resources. It is time for strategic thinking that can bring maximum effect with minimal effort through stable situation management of the impact of the US-China-Russia mutual state relations variable. Amid expectations of changes in domestic and foreign exchange environments, it is necessary to closely analyze the impact of North Korea-Russia relations on security in Northeast Asia and devise countermeasures while strengthening the South Korea-U.S.-Japan alliance.

The dependence structure and causality detection in crude oil markets

ABSTRACT It is essential to capture the dependence structure among the world’s dominant crude oil markets for understanding the world’s crude oil pricing mechanism. The dependence structure and interaction between Shanghai International Energy Exchange (INE) market and other major crude oil markets in the world are investigated to determine whether the world crude oil market is efficient. Using the vine copula model based on GARCH, we analyze the dependence structure and interactions among these markets. The highest dependence is found between West Texas Intermediate (WTI) and BRENT crude oil markets, displaying strong symmetric tail dependence. DUBAI market exhibits unidirectional Granger causality to WTI and INE markets. Empirical results suggest that the world crude oil markets are not efficient and are far from One Great Pool. DUBAI and Brent markets emerge as leaders in the current international crude oil pricing system, while INE markets do not significantly influence DUBAI and BRENT markets.

Knowledge translation strategies used for sustainability of an evidence-based intervention in child health: a multimethod qualitative study

BackgroundSustainability of evidence-based interventions (EBIs) is suboptimal in healthcare. Evidence on how knowledge translation (KT) strategies are used for the sustainability of EBIs in practice is lacking. This study examined what and how KT strategies were used to facilitate the sustainability of Alberta Family Integrated Care (FICare)™, a psychoeducational model of care scaled and spread across 14 neonatal intensive care units, in Alberta, Canada.MethodsFirst, we conducted an environmental scan of relevant documents to determine the use of KT strategies to support the sustainability of Alberta FICare™. Second, we conducted semi-structured interviews with decision makers and operational leaders to explore what and how KT strategies were used for the sustainability of Alberta FICare™, as well as barriers and facilitators to using the KT strategies for sustainability. We used the Expert Recommendations for Implementation Change (ERIC) taxonomy to code the strategies. Lastly, we facilitated consultation meetings with the Alberta FICare™ leads to share and gain insights and clarification on our findings.ResultsWe identified nine KT strategies to facilitate the sustainability of Alberta FICare™: Conduct ongoing training; Identify and prepare local champions; Research co-production; Remind clinicians; Audit and provide feedback; Change record systems; Promote adaptability; Access new funding; and Involve patients/consumers and family members. A significant barrier to the sustainability of Alberta FICare™ was a lack of clarity on who was responsible for the ongoing maintenance of the intervention. A key facilitator to sustainability of Alberta FICare was its alignment with the Maternal, Newborn, Child & Youth Strategic Clinical Network (MNCY SCN) priorities. Co-production between researchers and health system partners in the design, implementation, and scale and spread of Alberta FICare™ was critical to sustainability.ConclusionThis research highlights the importance of clearly articulating who is responsible for continued championing for the sustainability of EBIs. Additionally, our research demonstrates that the adaptation of interventions must be considered from the onset of implementation so interventions can be tailored to align with contextual barriers for sustainability. Clear guidance is needed to continually support researchers and health system leaders in co-producing strategies that facilitate the long-term sustainability of effective EBIs in practice.

Funding Learning Health System Research: Challenges and Strategies.

A growing number of health systems are establishing learning health system (LHS) programs, where research focuses on rapidly improving the health system's internal operations and performance. The authors examine funding challenges facing such initiatives and identify strategies for managing tensions between reliance on external research funding and directly contributing to improvement and learning within the researchers' own system. Qualitative case studies of LHS research programs in 5 health systems were performed via 38 semistructured interviews (October 2019-April 2021) with 35 diverse respondents. Inductive and deductive rapid qualitative analysis supported interview, system-level, and cross-system summaries and analysis. External funding awards to LHS researchers facilitated some internal improvement and learning, scientific advancements, and the reputation of researchers and their systems, but reliance on external funding also challenged researchers' responsiveness to concerns of system leaders, managers, practitioners, and system needs. Gaps between external funding requirements and internally focused projects arose in objectives, practical applicability, audiences, timetables, routines, skill sets, and researchers' careers. To contribute more directly to system improvement, LHS researchers needed to collaborate with clinicians and other nonresearchers and pivot between long research studies and shorter, dynamic improvement, evaluation, and data analysis projects. With support from system executives, LHS program leaders employed several strategies to enhance researchers' internal contributions. They aligned funded-research topics with long-term system needs, obtained internal funding for implementing and sustaining practice change, and diversified funding sources. To foster LHS research contributions to internal system learning and improvement, LHS program leaders need to manage tensions between concentrating on externally funded research and fulfilling their mission of providing research-based services to their own system. Health system executives can support LHS programs by setting clear goals for them; appropriately staffing, budgeting, and incentivizing LHS researchers; and developing supportive, system-wide teamwork, skill development programs, and data infrastructures.

The Work Environment of the School Leader in Australia: The Case for Sustained Change in Role and Practice

The questions addressed in this essay are (1) how has the work environment of school leaders changed in the early years of the 21st century, (2) how have these changes affected the role of the school leader, (3) what is the association between an evident deterioration in the work environment and the trend to more autonomy for schools and their leaders, and (4) how can school systems be more effective in supporting school leaders? The essay is organised into three domains that emerged from a review of the literature on changes in the work environment: intensification–intimidation, autonomy–accountability and system–support. Six recommendations are derived from the evidence: principals should have greater control over their work environment, system leaders should remove many reporting requirements from schools, there should be “organised abandonment” of outdated practices, the potential benefits of AI should be realised, there should be more engagement in planning for the future, and there should be further research on processes and outcomes through randomised controlled trials of new practices. It is not so much new theories in leadership but rather new roles and new practices within different arrangements for governance, informed by ongoing research as the context changes, amid evidence of deterioration in professional wellbeing.

Validity and Reliability of 360 Degree Healthcare Leadership Model

Background/Purpose: Leadership assessments in the literature based on only self-reports but this is not enough anymore. It could be evaluated by all stakeholders. The objective of this study was to investigate the goodness of fit of 360 degree healthcare leadership scale developed by National Health System Leadership Academy in Turkish population and carry out reliability and validity of the 360 degree healthcare leadership model. Methods: This is a questionnaire validation study. It was conducted in 10 public hospitals with 750 healthcare professionals. Healthcare managers assessed their own leadership skills (171 participants). Later, healthcare professionals were assessed by peers, managers and direct reports, and a 360-degree assessment was completed. Validity, internal consistency and CFA was conducted in this study via SPSS and SPSS AMOS software. Results: Item-total correlation was above 0.30. The Cronbach’s α values were between 0.72 and 0.86 in sub dimensions. Construct validity scores are as follows: CMIN/DF: 2.32; CFI: 0.89; GFI: 0.77; NFI: 0.83; IFI: 0.90. Conclusion: Turkish version of 360 degree healthcare leadership model which included 9 dimensions was approved its applicability in Turkish healthcare organizations and it could be a valuable measurement tool for effective leadership.

Integrated care system leadership: a rapid realist review

PurposeGiven the complex nature of integrated care systems (ICSs), the geographical spread and the large number of organisations involved in partnership delivery, the importance of leadership cannot be overstated. This paper aims to present novel findings from a rapid realist review of ICS leadership in England. The overall review question was: how does leadership in ICSs work, for whom and in what circumstances?Design/methodology/approachDevelopment of initial programme theories and associated context–mechanism–outcome configurations (CMOCs) were supported by the theory-gleaning activities of a review of ICS strategies and guidance documents, a scoping review of the literature and interviews with key informants. A refined programme theory was then developed by testing these CMOCs against empirical data published in academic literature. Following screening and testing, six CMOCs were extracted from 18 documents. The study design, conduct and reporting were informed by the Realist And Metanarrative Evidence Syntheses: Evolving Standards (RAMESES) training materials (Wong et al., 2013).FindingsThe review informed four programme theories explaining that leadership in ICSs works when ICS leaders hold themselves and others to account for improving population health, a sense of purpose is fostered through a clear vision, partners across the system are engaged in problem ownership and relationships are built at all levels of the system.Research limitations/implicationsDespite being a rigorous and comprehensive investigation, stakeholder input was limited to one ICS, potentially restricting insights from varied geographical contexts. In addition, the recent establishment of ICSs meant limited literature availability, with few empirical studies conducted. Although this emphasises the importance and originality of the research, this scarcity posed challenges in extracting and applying certain programme theory elements, particularly context.Originality/valueThis review will be of relevance to academics and health-care leaders within ICSs in England, offering critical insights into ICS leadership, integrating diverse evidence to develop new evidence-based recommendations, filling a gap in the current literature and informing leadership practice and health-care systems.

Rationale and Formulation of the Featured Program of Hifdzul Qur'an at Junior High School

This research aims to analyze the rationale and formulation of a featured program, namely Hafidz Quran, which is implemented by educational institutions, especially at Muhammadiyah Sukamara Junior High School. The research was qualitative, which did not use statistical formulas in processing and analyzing data but was described naturally as it was. The study found that the formulation and rationale for the featured program of Hifdzul Qur'an at Muhammadiyah Sukamara Junior High School is the juridical formulation consisting of Law of the Republic of Indonesia Number 20 of 2003 concerning the National Education System and Muhammadiyah Central Leadership Guidelines Number 01/PED/I.0/B /2018 concerning Muhammadiyah Primary and Secondary Education. The religious formulation is based on the guidance of the Quran and Hadith, which are the basic needs of managers and society. Apart from being a continuation program for tahfiz from kindergarten and elementary school, this program is also a necessity for schools and the community in building the nation's life more intelligently.

Developing the future research agenda for the health and social care workforce in the United Kingdom: Findings from a national forum for policymakers and researchers.

There is a gap between healthcare workforce research and decision-making in policy and practice. This matters more than ever given the urgent staffing crisis. As a national research network, we held the first ever United Kingdom (UK) forum on healthcare workforce evidence in March 2023. This paper summarises outputs of the event including an emerging UK healthcare workforce agenda and actions to build research capacity and bridge the gap between academics and decisionmakers. The forum brought together over 80 clinical and system leaders, policymakers and regulators with workforce researchers. Fifteen sessions convened by leading experts combined knowledge exchange with deliberative dialogue over 2days. Topics ranged from workforce analytics, forecasting, international migration to interprofessional working. In the small groups that were convened, important gaps were identified in both the existing research body and uptake of evidence already available. There had not been enough high quality evaluations of recent workforce initiatives implemented at pace, from virtual wards to e-rostering. The pandemic had accelerated many changes in skillmix and professional roles with little learning from other countries and systems. Existing research was often small-scale or focused on individual, rather than organisational solutions in areas such as staff wellbeing. In terms of existing research, managers were often unaware of accepted high quality evidence in areas like the relationship between registered nurse staffing levels and patient outcomes. More work is needed to engage new disciplines from labour economics and occupational health to academic human resources and to strengthen the emerging diverse community of healthcare workforce researchers.

Leadership to Accelerate Healthcare's Digital Transformation: Evidence From 33 Health Systems.

The COVID-19 pandemic, healthcare market disruptors, and new digital healthcare technologies have made a substantial impact on the delivery of healthcare services, highlighting the critical roles of leaders in hospitals and health systems. This study sought to understand the evolving roles of CEOs, CIOs, and other executive leaders in the postpandemic era and highlight the adaptability and strategic vision of executives in shaping the future of healthcare delivery. Between October 2022 and May 2023, 51 interviews were conducted with CEOs, CIOs, and other executives responsible for delivering technology solutions for 33 nonprofit health systems in the United States. They were asked to describe their backgrounds; how information solutions and technologies were viewed within their organizations' strategy, operations, and governance; and the key characteristics of executive leaders. The study has found that effective CEOs have an authentic belief in technology's role in achieving their organization's mission and that contemporary CIOs are strategic executive partners who align strategy with culture to improve care. This study examines how healthcare systems are creating digitally savvy executive leadership teams that operate in a new, integrated model that unites previously siloed functions. Some healthcare CIOs are unprepared for current and future business challenges, and some CEOs are unsure how to leverage digital technologies and C-suite expertise to transform their organizations. This research provides insights into how the nation's health systems are building and sustaining leadership teams capable of adapting to the healthcare environment and accelerating organizational transformation.

Child Health Needs and the Pediatric Hospital Medicine Workforce: 2020-2040.

Pediatric hospital medicine (PHM) established a new model of care for hospitalized children in the United States nearly 3 decades ago. In that time, the field experienced rapid growth while distinguishing itself through contributions to medical education, quality improvement, clinical and health services research, patient safety, and health system leadership. Hospital systems have also invested in using in-house pediatricians to manage various inpatient care settings as patient acuity has accelerated. National PHM leaders advocated for board certification in 2014, and the first certification examination was administered by the American Board of Pediatrics in 2019. In this article, we describe the development of the subspecialty, including evolving definitions and responsibilities of pediatric hospitalists. Although PHM was not included in the model forecasting future pediatric subspecialties through 2040 in this supplement because of limited historical data, in this article, we consider the current and future states of the workforce in relation to children's health needs. Expected challenges include potential alterations to residency curriculum, changes in the number of fellowship positions, expanding professional roles, concerns related to job sustainability and burnout, and closures of pediatric inpatient units in community hospitals. We simultaneously forecast growing demand in the PHM workforce arising from the increasing prevalence of children with medical complexity and increasing comanagement of hospitalized children between pediatric hospitalists and other subspecialists. As such, our forecast incorporates a degree of uncertainty and points to the need for ongoing investments in future research to monitor and evaluate the size, scope, and needs of pediatric hospitalists and the PHM workforce.

Evaluating the Quality of Virtual Urgent Care: Barriers, Motivations, and Implementation of Quality Measures.

Experts estimate virtual urgent care programs could replace approximately 20% of current emergency department visits. In the absence of widespread quality guidance to programs or quality reporting from these programs, little is known about the state of virtual urgent care quality monitoring initiatives. We sought to characterize ongoing quality monitoring initiatives among virtual urgent care programs. Semi-structured interviews of virtual health and health system leaders were conducted using a pilot-tested interview guide to assess quality metrics captured related to care effectiveness and equity as well as programs' motivations for and barriers to quality measurement. We classified quality metrics according to the National Quality Forum Telehealth Measurement Framework. We developed a codebook from interview transcripts for qualitative analysis to classify motivations for and barriers to quality measurement. We contacted 13 individuals, and ultimately interviewed eight (response rate, 61.5%), representing eight unique virtual urgent care programs at primarily academic (6/8) and urban institutions (5/8). Most programs used quality metrics related to clinical and operational effectiveness (7/8). Only one program reported measuring a metric related to equity. Limited resources were most commonly cited by participants (6/8) as a barrier to quality monitoring. We identified variation in quality measurement use and content by virtual urgent care programs. With the rapid growth in this approach to care delivery, more work is needed to identify optimal quality metrics. A standardized approach to quality measurement will be key to identifying variation in care and help focus quality improvement by virtual urgent care programs.

Understanding paramedic work in general practice in the UK: a rapid realist synthesis

BackgroundGeneral practice in the UK is under substantial pressure and practices are increasingly including paramedics as part of their workforce. Little is known about how different models of paramedic working may affect successful implementation of the role, as viewed from patient, clinician and system perspectives. This realist synthesis developed theories about ‘models of paramedic working in general practice’ in different UK contexts to understand their impact.MethodsThe rapid realist synthesis comprised data from: (1) empirical and grey literature searches; (2) semi-structured realist interviews with system leaders involved with the implementation of the role; and (3) a stakeholder event with healthcare professionals and the public, to develop initial programme theories that can be tested in future work. Sources were analysed using a realist approach that explored the data for novel or causal insights to generate initial programme theories.ResultsEmpirical sources (n = 32), grey sources (n = 95), transcripts from system leader interviews (n = 7) and audio summaries from the stakeholder event (n = 22 participants) were synthesised into a single narrative document. The findings confirmed the presence of a wide variety of models of paramedic working in UK general practice. The perceived success of models was influenced by the extent to which the paramedic service was mature and embedded in practice, and according to four theory areas: (1) Primary care staff understanding and acceptance of the paramedic role; (2) Paramedic induction process, including access to training, supervision and development opportunities; (3) Patient understanding and acceptance of the role; (4) Variations in paramedic employment models.ConclusionsVariability in how the paramedic role is operating and embedding into general practice across the UK affects the success of the role. These findings provide a theoretical foundation for future research to investigate various ‘models of paramedic working’ in different contexts.

Do Performance Measurement Systems and Ethical Leadership Style Affect Sustainable Investment Decisions? An Experimental Evidence

Do Performance Measurement Systems and Ethical Leadership Style Affect Sustainable Investment Decisions? An Experimental Evidence

International collaborative research, systems leadership and education: reflections from academic biomedical researchers in Africa

ScopeAcademic biomedical researchers and educators in African countries navigate complex local, national, and international systems to conduct grant-funded research. To secure funding, collaboration with researchers from high-income countries is often necessary. Existing literature highlights that these global health initiatives are commonly fraught with unequal power dynamics and lead by the foreign partners. Despite these inequalities, African faculty can benefit from these collaborations, fostering the development of their labs and careers. This study delves into reflections on lived experiences from academic biomedical researchers in Africa to better understand the impact of foreign collaborations.MethodsWe designed a qualitative study using the Interpretative Phenomenological Analysis (IPA) method and used Self-determination and Complex Systems Leadership theories to frame this study. Ten academic biomedical researchers in Africa consented to join this study. The participants submitted a four-week series of reflective journals through an online data management platform. Subsequently, IPA methods were employed to analyze the collected journals.ResultsParticipants’ reflections yielded six thematic key findings, encompassing their experiences in international collaborative research. The findings included: foreign dominance within the international macrosystem; resource challenges in their local microsystems; mesosystem dependency from collaborations; scholarly identity within research relationships; collaborative leadership; and the impact of the foreign perspective. From these findings, three implications were drawn suggesting that participants were (1) motivated by scholarly identity found in collaborations; (2) depended on collaborations that were colonialist but beneficial; and (3) created change through leadership at the microsystem level.ImplicationsForeign collaborators and funders in global health education and research should critically consider how implications of this study relate to their collaborative work. Based on our analysis, recommendations for foreign collaborators and funders include prioritizing local leadership and perspectives in education initiatives and research grants; reviewing and leveraging collective leadership; engaging in bidirectional training, and mentoring opportunities; participating in power assessments; and removing publication barriers for researchers in Africa (and low-and middle-income countries). Insights from this study could impact global health research and education in multiple ways including new initiatives in mentorship and training in international collaborations along with increased awareness and correction of colonialism within these collaborations.

The association of medical, social, and normative factors with the implementation of end-of-life care practices

BackgroundEnd-of-life (EoL) care practices (EoLCP) are procedures carried out at the EoL and bear directly on this stage in the patient’s life. Public support of these practices in Israel is far from uniform. Previous studies show that while ∼30% of participants support artificial respiration or feeding of terminally ill patients, 66% support analgesic treatment, even at the risk of shortening life. This study aimed to create a typology of six end-of-life care practices in Israel and assess the association of medical, social, and normative factors with the implementation of those practices. These practices included mechanical ventilation, artificial feeding, deep sedation, providing information to the patient and family caregivers, including family caregivers in EoL decision-making, and opting for death at home.MethodsThis cross-sectional study was performed as an online survey of 605 adults aged 50 or more in Israel, of which ~ 50% (n = 297) reported supporting a dying terminally ill relative in the last 3 years. Participants were requested to provide their account of the EoL process of their relative dying from a terminal illness in several aspects, as well as the EoL care practices utilized by them.ResultsThe accounts of the 297 interviewees who supported a dying relative reveal a varied EoL typology. The utilization of end-of-life care practices was associated with the socio-normative beliefs of family caregivers but not with their socioeconomic status. Strong correlations were found between family caregiver support for three key practices (mechanical ventilation, artificial feeding, and family involvement in EoL) and the actual utilization of these practices in the care of dying patients.ConclusionsThe findings portray an important image of equity in the utilization of EoLCP in Israel, as the use of these practices was not associated with socioeconomic status. At the same time, the study found substantial diversity in family caregivers’ preferences regarding EoL care practices use not related to socioeconomic status. We believe that differences in preferences that do not lead to problems with equity or other important societal values should be respected. Accordingly, policymakers and health system leaders should resist calls for legislation that would impose uniform EoL practices for all Israelis. Instead, they should take concrete steps to preserve and enhance the widespread current practice of practitioners to adapt EoL care to the varied needs and preferences of Israeli families and cultural, social, and religious subgroups. These steps should include providing frameworks and tools for family caregivers to support their loved ones close to their deaths, such as educational programs, seminars, supportive care before and during the end of life of their loved ones, etc.

Identity as pedagogy: appreciative inquiry into the stories of our pedagogies

ABSTRACT Teacher identity is a dynamic nexus of experiences and narratives on which teachers draw to understand and situate themselves in teaching. Additionally, teacher identity becomes pedagogy as we teach who we are. This narrative inquiry used an Appreciative Inquiry (AI) framework to explore stories of teaching that have interwoven into the teacher identities of a group of teachers, who encompassed various roles within a single educational jurisdiction. In this study, the term teachers broadly included individuals who are part of an educational system including classroom teachers, principals, and system leaders. Each participant teacher drew upon their lived experiences of narratives from within a common educational system that shaped their identity and pedagogy. Through five AI phases, participants named and confronted common system narratives they had encountered in teaching. Furthermore, they reframed these narratives in ways that might potentially bring about system change. The findings from this study can support teachers, teacher educators and system leaders to examine biases and beliefs embedded in pedagogy and, through critical reflection, consider ways system change might emerge.

Shifting gears: Creating equity informed leaders for effective learning health systems.

Leadership is vital to a well-functioning and effective health system. This importance was underscored during the COVID-19 pandemic. As disparities in infection and mortality rates became pronounced, greater calls for equity-informed healthcare emerged. These calls led some leaders to use the Learning Health System (LHS) approach to quickly transform research into healthcare practice to mitigate inequities causing these rates. The LHS is a relatively new framework informed by many within and outside health systems, supported by decision-makers and financial arrangements and encouraged by a culture that fosters quick learning and improvements. Although studies indicate the LHS can enhance patients' health outcomes, scarce literature exists on health leaders' use and incorporation of equity into the LHS. This article begins addressing this gap by examining how equity can be incorporated into LHS activities and discussing ways leaders can ensure equity is considered and achieved in rapid learning cycles.

Implementing an Organized Colorectal Cancer Screening Program: Lessons Learned From an Academic–Community Practice

IntroductionThe effectiveness of mailed fecal immunochemical test (FIT) outreach might be enhanced through an organized colorectal cancer (CRC) screening program, yet published real-world experiences are limited. We synthesized the process of implementing a CRC screening program which used mailed FIT outreach in a large integrated academic-community practice. Materials and MethodsData from a pilot mailed FIT program were shared with healthcare system leadership which inspired the creation of a cross-institutional organized CRC Screening Program. In partnership with a centralized Population Health Team and Primary Care, we defined: 1) the institutional approach to CRC screening, 2) the target population and method for screening, 3) the team responsible for implementation, 4) the healthcare team responsible for decisions and care, 5) a quality assurance structure, and 6) a method for identifying cancer occurrence. ResultsThe Fred Hutch/UW Medicine Population Health CRC Screening Program began in September 2021. The workflow for mailed FIT outreach included a mailed postcard, a MyChart message from the patient's primary care provider (PCP), a FIT kit with a letter signed by the PCP and program director, and up to three bi-weekly reminders. Patients without a colonoscopy 3 months after an abnormal FIT result received navigation through the program. In the first program year, we identified 9,719 patients eligible for outreach and in an intention to treat analysis, 32% of patients completed CRC screening by FIT or colonoscopy. ConclusionsReal-world experiences detailing how to implement organized CRC screening programs might increase adoption. In our experience, broadly disseminating pilot data, early institutional support, robust data management and strong cross-departmental relationships were critical to successfully implementing a CRC screening program that benefits all patients.

Using implementation science to develop a familial hypercholesterolemia screening program in primary care: The CARE-FH study

We designed the Collaborative Approach to Reach Everyone with Familial Hypercholesterolemia (CARE-FH) clinical trial to improve FH screening in primary care and facilitate guideline-based care. The goal was to incorporate perspectives from end-users (healthcare system leaders, primary care clinicians, cardiologists, genetic counselors, nurses, and clinic staff) and improve translation of screening guidance into practice. We partnered with end-users to sequentially define the current state of FH screening, assess acceptability, feasibility, and appropriateness of implementing an FH screening program, and select clinically actionable strategies at the patient-, clinician-, and system-level to be deployed as a package in the CARE-FH clinical trial. Methods informed by implementation science and human centered design included: contextual inquiries, surveys, and deliberative engagement sessions. Screening for FH occurred rarely in primary care, and then only after a cardiovascular event or sometimes due to a family history of high cholesterol or early heart attack. Surveys suggested FH screening in primary care was acceptable, appropriate, and feasible. Reported and observed barriers to screening include insufficient time at patient encounters to screen, cost and convenience of testing for patients, and knowledge regarding causes of dyslipidemia. Facilitators included clear guidance on screening criteria and new therapies to treat FH. These results led to the development of multilevel strategies that were presented to end-users, modified, and then pilot tested in one primary care clinic. A refined implementation strategy package for FH screening was created with a goal of improving FH awareness, identification, and initiation of guideline-based care. https://clinicaltrials.gov/study/NCT05284513?id=NCT05284513&rank=1 Unique Identifier: NCT05284513.