Implementation Timeline Research Articles

Synergising tools for capacity assessment and One Health operationalisation.

Multisectoral, One Health collaboration is essential for addressing national and international health threats that arise at the human-animal-environment interface. Thanks to the efforts of multiple organisations, countries now have an array of One Health tools available to assess capacities within and between sectors, plan and prioritise activities, and strengthen multisectoral, One Health coordination, communication, and collaboration. By doing so, they are able to address health threats at the human-animal-environment interface, including emerging zoonotic and infectious diseases, more efficiently. However, to ensure optimal outcomes for the countries using these One Health tools, the partners responsible for implementation should regularly collaborate and share information such as implementation timelines, results and lessons learned, so that one process can inform the next. This paper presents a consensus framework on how commonly implemented One Health tools might align to best support countries in strengthening One Health systems. Twelve One Health tools were selected based on their high implementation rates, authors' experience with these tools and their focus on multisectoral, One Health coordination. Through a four-step process, the authors: a) jointly carried out a landscape analysis of One Health tools, using a Cloudbased spreadsheet to share the unique characteristics and applications of each tool; b) performed an implementation analysis to identify and share implementation dynamics and identify respective outcomes and synergies; c) jointly created a consensus conceptual model of how the authors suggest the tools might logically work together; and d) extrapolated from steps 1-3 an agreed-upon overarching conceptual framework for how current and future One Health tools could be categorised to best support One Health system strengthening at the national level. Highlighted One Health tools include the States Parties Annual Reporting Tool under the International Health Regulations (IHR), the World Organisation for Animal Health Performance of Veterinary Services (PVS) Pathway, the Joint External Evaluation process, IHR/PVS National Bridging Workshops, the Centers for Disease Control and Prevention One Health Zoonotic Disease Prioritization Tool, the Food and Agriculture Organization (FAO) Laboratory Mapping Tool, the FAO Assessment Tool for Laboratories and Antimicrobial Resistance Surveillance Systems, the FAO Surveillance Evaluation Tool, the One Health Systems Mapping and Analysis Resource Toolkit, the National Action Plan for Health Security, and IHR Monitoring and Evaluation Framework tools for After Action Reviews and Simulation Exercises. A new guidance document entitled, Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries was also included as a framework that provides guidance to support the implementation of the outputs of the tools described.

Assessing health systems in Guinea for prevention and control of priority zoonotic diseases: A One Health approach

To guide One Health capacity building efforts in the Republic of Guinea in the wake of the 2014–2016 Ebola virus disease (EVD) outbreak, we sought to identify and assess the existing systems and structures for zoonotic disease detection and control. We partnered with the government ministries responsible for human, animal, and environmental health to identify a list of zoonotic diseases – rabies, anthrax, brucellosis, viral hemorrhagic fevers, trypanosomiasis and highly pathogenic avian influenza – as the country's top priorities. We used each priority disease as a case study to identify existing processes for prevention, surveillance, diagnosis, laboratory confirmation, reporting and response across the three ministries. Results were used to produce disease-specific systems “maps” emphasizing linkages across the systems, as well as opportunities for improvement. We identified brucellosis as a particularly neglected condition. Past efforts to build avian influenza capabilities, which had degraded substantially in less than a decade, highlighted the challenge of sustainability. We observed a keen interest across sectors to reinvigorate national rabies control, and given the regional and global support for One Health approaches to rabies elimination, rabies could serve as an ideal disease to test incipient One Health coordination mechanisms and procedures. Overall, we identified five major categories of gaps and challenges: (1) Coordination; (2) Training; (3) Infrastructure; (4) Public Awareness; and (5) Research. We developed and prioritized recommendations to address the gaps, estimated the level of resource investment needed, and estimated a timeline for implementation. These prioritized recommendations can be used by the Government of Guinea to plan strategically for future One Health efforts, ideally under the auspices of the national One Health Platform. This work demonstrates an effective methodology for mapping systems and structures for zoonotic diseases, and the benefit of conducting a baseline review of systemic capabilities prior to embarking on capacity building efforts.

Collaborative implementation of a community-based exercise intervention with a partnering rural American Indian community.

The prevalence and socioeconomic burden of childhood obesity and diabetes has increased rapidly in the United States in the last 30 years. American Indians have the highest prevalence of type 2 diabetes among newly diagnosed youth in the country. Contributing factors include environmental, behavioral, and genetic components. Some American Indian tribal communities have explored innovative ways to combat this epidemic including collaborations with academic centers on community-based research. From 2012 to 2017, the University of Oklahoma Health Science Center and the Choctaw Nation of Oklahoma partnered on a National Institutes of Health-funded project to determine if financial incentives would elicit an increase in physical activity in Native youth. This was a community-based behavioral intervention for overweight or obese American Indian youth ages 11-20 living in a rural community at risk for developing diabetes. Tribal leaders and staff identified culturally appropriate strategies to aid implementation of the trial in their community. Their identified implementation strategies helped standardize the study in order to maintain study integrity. The mutually agreed strategies included co-review of the study by tribal and University research review boards (but designation of the Choctaw Nation review board as the "Board of Record"), training of community-based staff on research ethics and literacy, standardization of the informed consent process by videotaping all study information, creation of a viable and culturally appropriate timeline for study implementation, adapting tribal wellness center operations to accommodate youth, and development of effective two-way communication through training sessions, on-site coordination, and bi-monthly conference calls. In an effort to partner collectively on a randomized clinical research trial to combat childhood diabetes, tribal leaders and staff implemented strategies that resulted in a culturally appropriate and organized community-based behavioral intervention research project.

Implementing quiet hours on a medical telemetry unit

Implementing quiet hours on a medical telemetry unit

A Quality and Lean Foundation for "Cancer's Newest Miracle Cure"

Analysis of Problem CAR T Cell Therapy Logic Model for Program Design Methodology A quality and lean strategy approach was utilized in program design. The assembly of working group, core operations teams and executive committees for the advancement of program goals and barrier removal was utilized in creation and implementation of the CAR T Cell Therapy Program. Use of full life cycle of service perspective in the decision-making process prompted utilization of all involved members working together at the top of their license. Waste identification occurred at the point of design requirements and features; allowing a process to be created that minimizes waste and reduces risk of process defects. Key tools were utilized to support the planning and implementation process; these included the use of: a Logic Model, Project Timeline, Process Maps, Standard Operating Procedures, Risk Assessment and Dashboard. The dashboard evaluated process, satisfaction and outcomes measure for program creation and continuous process improvement opportunities. CAR T Cell Therapy Program Design Methodology Recommendation and Design Details Through evaluation of primary and support service 5 primary process maps were completed along with 12 sub processes being mapped. Risk was assessed utilizing hazard vulnerability assessment tools, in correlation with identified processes. Risks were identified to allow for preparedness of multidisciplinary cross functional responses. A dashboard was created to track process measures for achieving vendor certification, patient readiness, and patient service volume predication during the program design phase. The full dashboard measures process, satisfaction and the outcomes. Follow up Implementation occurred using communication, implementation and project timeline planning. Sustainment and handoff with continuous improvement cycles occurs with the utilization of process maps with the whole team providing comment regarding Plus/ Delta review, resolutions, and escalation of identified barriers or process defects. Process waste and defect analysis are completed with the use of dashboard, risk assessment and process map guided facilitation.

The Use of GIS in Major Sport Events Management; the Host City’s Lessons Learned from Gold Coast 2018, Commonwealth Games

This paper documents the use of Geographic Information System (GIS) in the delivery of recent major sporting events with a specific focus on the Gold Coast 2018 Commonwealth Games (GC2018). It details the process that was undertaken by GC2018 Partner organisations in managing an integrated GIS solution. Governance structures, data sets, information custodianship and implementation timelines are explored to provide a holistic understanding of the GC2018 GIS journey. The paper then explores the challenges that were faced and conversely the recommendations for future Host Cities. Integrated GIS use was a critical element in the success of GC2018 and provided a City legacy in terms of information sharing, governance and broader use of GIS systems. It recognises that whilst GIS was an integral part of the planning and operations of GC2018 significant benefits could be derived by Host Cities by ensuring integration of GIS into Games governance and committing to roles and responsibilities three or 4 years in advance of the event.

Development, implementation, and initial results of the UC San Diego Health Moores Cancer Center Wellbeing Screening Tool.

All accredited cancer institutions are required to screen patients for psychosocial distress. This paper describes the development, implementation, and preliminary outcomes of the University of California San Diego Health Moores Cancer Center Wellbeing Screening Program. Essential steps learned in a formal National Cancer Institute-funded training workshop entitled "Implementing Comprehensive Biopsychosocial Screening" were followed to ensure successful program implementation. These steps included identification of stakeholders; formation of a working committee; establishment of a vision, process, and implementation timeline; creation of a screening tool; development of patient educational material; tool integration into an electronic medical record system; staff training and pilot testing of tool administration; and education about tool results and appropriate follow-up actions. Screening data were collected and analyzed retrospectively for preliminary results and rapid cycle improvement of the wellbeing screening process. Over an 8-month implementation and assessment period, the screening tool was administered 5,610 times of 7,664 expected administrations (73.2%.) to 2,394 unique patients. Visits in which the questionnaire was administered averaged 39.6 ± 14.8 minutes, compared with 40.3 ± 15.2 minutes for visits in which the questionnaire was not administered (t = -1.76, df = 7,662, p = 0.079). This program provides a process and a tool for successful implementation of distress screening in cancer centers, in a meaningful way for patients and providers, while meeting accreditation standards. Further, meaningful data about patient distress and tool performance were able to be collected and utilized.

Special Challenges of the “No Child Left Behind” Act for Rural Schools and Districts

Across the country, states are concentrating efforts to meet the requirements and the spirit of No Child Left Behind (NCLB). The implementation provisions and timelines are demanding and challenging for all districts. NCLB is particularly daunting, however, for rural and small districts. This paper outlines the characteristics of rural schools and districts that create special problems in implementing the legislation and summarizes the major challenges of the NCLB for these districts. Reprinted with permission from the Rural School and Community Trust (www.ruraledu.org). Lorna Jimerson is the Program Coordinator for the Policy Program of the Rural Trust.

Stakeholder involvement in the systematic optimisation of two school-based relationships and sex education interventions, Project Respect and Positive Choices

BackgroundThere is increasing emphasis on involving intended beneficiaries and other stakeholders in the development of public health interventions to maximise acceptability and remove barriers to adoption, implementation, and maintenance before costly implementation. Yet the processes whereby key actors are engaged in intervention development are rarely reported, and frameworks for carrying out such work remain limited. We outline our approach to involving stakeholders in the optimisation of two school-based relationships and sex education programmes (Project Respect and Positive Choices) and reflect on the challenges of co-producing with teachers, students, and other partners. MethodsSystematic optimisation of both interventions involved a review of existing literature on effective approaches; consultation with staff and students on intervention content and delivery; drafting of intervention materials; further consultation with schools; and then intervention refinement in preparation for a pilot. Seven focus groups took place in southeast and southwest England involving 75 students aged 13–15 years and 22 school staff. A group of young people trained to advise on public health research were consulted on two occasions and a wide range of sexual health and sex education practitioners and policy makers shared their views at a stakeholder event. FindingsConsultation provided useful insights to inform intervention adaption in relation to who should deliver the programmes in schools; whether lessons should be taught in single sex classes; the format that guidance and lesson plans should take; the relevance and acceptability to students and teachers; and the need for the flexibility for materials to adapt to different school contexts. Genuine consultation and incorporation of school stakeholder views was challenging where stakeholder availability was limited and intervention development and implementation timelines were tight. Challenges also arose in relation to the weight to give divergent opinions among stakeholders and between stakeholders and researchers. InterpretationCarrying out structured stakeholder engagement activities can yield valuable insights that can improve the applicability of interventions to local contexts before they are formally trialled. To genuinely engage stakeholders in intervention development requires sufficient time to both consult and adapt. In such consultations, it is important to attend not just to the voices of those who are the loudest and most powerful. FundingNational Institute for Health Research (NIHR).

Fostering Scientific Collaborations for Cancer Research Between High and Low/Middle Income Countries Through International Partnerships

Background: Much remains to be learned about the causes of several major cancers. Implementing and sustaining global initiatives aimed to advance cancer research requires concerted efforts among government agencies, the industry and philanthropic institutions. Aiming to tackle this challenge, in 2015 the Azrieli Foundation, Canada's International Development Research Centre, the Canadian Institutes of Health Research, and the Israel Science Foundation launched the Joint Canada-Israel Health Research Program (JCIHRP), a 7-year CA$35 million partnership that draws on the scientific strengths of Canadian, Israeli and low and middle income countries (LMICs) researchers in the broad field of biomedicine. Aim: JCIHRP aims to advance research and discovery in the biomedical sciences; encourage scientific collaboration between Canadian and Israeli researchers; and build capacity and foster scientific relations and collaborations with researchers and trainees in LMICs. Methods: JCIHRP will fund up to 30 research projects from 2015 to 2022 in diverse areas of the biomedical sciences (neurosciences, immunology, cancer and metabolism). So far, the program is supporting 9 projects in cancer research. Teams are led by a Canadian and Israeli principal investigators and a collaborator from a LMIC. Three years is the maximum duration of each grant and teams can request up to CA$1.17 million. The program launches 1 competition each year and activities are coordinated by a directors working group, which is responsible for program implementation and coordination among the agencies. Annual implementation timeline can be divided into 4 phases: competition development and application; proposals' eligibility, selection and decision; research phase; and reporting and monitoring. In deploying these phases, the funding partners have shared effort and costs. Results: Among cancer research projects, 4 teams are developing strategies to improve effectiveness of cancer immunotherapy. Five other teams use advanced genomics and protein engineering techniques to elucidate molecular mechanisms associated with tumor development, progression and resistance to therapy in pancreatic, breast, hepatic and brain cancer. These projects are supporting 26 established researchers in 7 Canadian, 6 Israeli and 9 institutions based in Brazil, Mexico, China, India, Argentina and Turkey. Additionally, 19 graduate students and 9 postdoctoral fellows are directly involved in research activities. Type of collaboration can be grouped into 2 categories: research and training (5 projects) and research, training and exchange (4 projects). Conclusion: JCIHRP multicentre funding model allows international integration of researchers promoting scientific advances, new collaborations and enhancing teams' overall competitiveness by prioritizing research topics with potential for global impact in cancer research.

Understanding the Stages of Concerns


 
 
 
 This study investigated the initial implementation processes of the Common Core State Standards (CCSS) in public and private schools in a single Loui- siana district. Results suggested participants’ high level of concern in many aspects of the implementation of the CCSS in public schools related to the timeline and instability of curriculum decisions, which negatively affected teachers’ confidence levels. Private school teachers experienced greater stability in their curricula, a more feasible timeline of implementation, positive professional development, and positive experiences with CCSS implementation, affecting their teacher identity and impact on students. However, public school teachers reported instability in their curricula, difficult timelines of implementation, unsupportive professional development, and overall negative experiences, affecting their teacher identity and impact on students with the implementation of the CCSS.
 
 
 

ERM for Health Care Organizations: An Economic Enterprise Risk Management Innovation Program (E2RMhealth care)

BackgroundIn recent years, health care organizations have looked to enterprise risk management (ERM) for novel systems to obtain more accurate data on which to base risk strategies. ObjectiveThis study proposes a conceptual ERM framework specifically designed for health care organizations. MethodsWe explore how hospitals in the United States and Brazil are structuring and implementing ERM processes within their management structure. This study incorporates interviews with 15 chief risk officers (8 from the United States and 7 from Brazil) with qualitative data analysis using NVivo (QSR International software). ResultsThe interviews confirm that adopting ERM for health care organizations has gained momentum and become a priority, and that the demand for risk economic assessment orientation is common among health care risk managers. ConclusionWe propose an ERM model for health care (Economic Enterprise Risk Management in Health Care) divided into four maturity levels and complemented by an implementation timeline. The model is accompanied by guidelines to orient the gradual implementation of ERM, including orientation to perform risk economic assessment.

Recent Issues in the Implementation of the New Basel Minimum Capital Requirements for Market Risk

The Basel Committee suggested new ways of dealing with market risk in banks’ trading and banking books, in its October 2013 consultative paper, and subsequent versions published thereafter, for revised market risk framework FRTB. The Basel Committee estimates that the new rules will result in an approximate median capital increase of 22% and a weighted average capital increase of 40% (BCBS 2016), compared with the current framework. Budget reports on FRTB implementation range from costs of 5-million USD to 250-million USD. Key changes can be found in the internal model approach, in the standard rules and in the approval process. Significant changes introduced by the FRTB include stricter separation of the trading and banking book. Regardless of whether they use standardized or internal models, banks will need to review their portfolios to determine if existing classifications of instruments and desks as trading or banking book are still applicable, or whether a revision of desk structure is needed. In its article ‘Critical appraisal of the Basel fundamental review of the trading book regulation’ (Orgeldinger 2017) the theoretical foundations of the internal model approach IMA were analysed and the criticisms for FRTB risk models were investigated. A recent onslaught of rules is rendering the existing timeline for implementation practically impossible. In this article we present and critically evaluate different approaches to implement the new rules suggested by academics and major consulting companies.

The influence of evaluation recommendations on instrumental and conceptual uses: A preliminary analysis

Evaluation recommendations are sometimes included in evaluation reports to highlight specific actions to be taken to improve a program or to make other changes to its operational context. This preliminary study sought to examine evaluation recommendations drawn from 25 evaluation reports published by Canadian federal government departments and agencies, in order to examine the evaluation issues covered and the focus of the recommendations. Our results show that in keeping with policy requirements, the evaluation recommendations focused on program relevance, effectiveness and efficiency and economy. Furthermore, a significant number of recommendations also focused on the implementation of more rigorous performance measurement strategies. The focus of the recommendations did not vary by publication date, recommendation type, and organizational sector. The findings also show that for the most part, the management responses produced as part of the broader evaluation process support the recommendations included in the report and identify specific timelines for implementation.

Contribution of Quality Management Practices to Sustainability Performance of Vietnamese Firms

This study seeks to investigate the relationship between quality management practices and sustainability performance as well as the moderating effects from quality management implementation timeline, type of industry, and firm size on this relationship. Data were collected from enterprises in Vietnam from July 2016 to March 2017. Based on a sample of 144 valid responses, empirical results indicate that quality management practices have mixed impacts on economic performance and environmental performance, while show positive impact on social performance. The results found four quality management practices that have significantly positive impact on sustainability performance: top management support for quality management, design for quality, quality data and reporting, and continuous improvement. These practices could be considered as critical quality management factors that significantly contribute to sustainability goals. Furthermore, the study found significant moderating effects of three contextual factors on the relationship between quality management practices and sustainability performance. The study enriches the literature on quality management and sustainability management, and offers some important insights into efficient allocation of resources to achieve sustainability goals.

Abstract TP364: Optimization of Data Abstraction and Quality Measure Reporting using EHR

Background and Purpose: Despite significant investment in EHR’s, most stroke centers continue to populate stroke registries, such as Get with the Guidelines - Stroke using manual abstraction. This is necessary because of a lack of EHR integration and persistence of non-discrete required data elements. Methods: American Heart Association (AHA) identified the need to offer a more interoperable version of Get with the Guidelines - Stroke (GWTG-S) as a strategic priority for 2016. AHA engaged a consultant to work with two pilot hospital locations to optimize stroke data collection in the EHR and allowing for automated data population into GWTG-S. The pilot work included: 1) Analysis of current documentation and abstraction methods to support reporting of performance data; 2) Design and implementation of improvement opportunities for a) Discrete capture of data elements for electronic reporting b) Improving clinical documentation and ordering c) Clinical decision support and d) Data structures and transmission. 3) Proof-of-concept data extract report; 4) ROI analysis for improvement opportunities and 5) Proposed implementation strategies and timelines for improvement opportunities. Results: The pilot sites implemented Epic tools including Orders, Notes, Narrators and Flowsheets to increase the percentage of discrete elements available for uploading into GWTG-S and to populate hospital quality reporting systems Conclusion: The optimization process improved stroke team ability to:1) Decrease manual abstraction, and allow the stroke team to conduct more concurrent review and handle additional patients without additional staff; 2) Quantify data collection; abstraction; and analysis processes for the emergency department team; neurology; interventional team; and stroke unit; 3) Leverage EHR tools for the clinical team to improve utilization; and 4) Demonstrated the critical collaboration between clinical operations and the information technology team.

Association of the Hospital Readmissions Reduction Program With Surgical Readmissions

Importance Readmissions after surgery lead to poor patient outcomes and increased costs. The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals with excess readmissions after specified medical and surgical discharges. Objective To evaluate the association of the HRRP with readmissions after major joint surgery (targeted) and procedures with historically high rates not under its purview (nontargeted). Design, Setting, and Participants In this population-based analysis using a 20% Medicare sample, a retrospective cohort study was performed of patients undergoing one of 5 major surgical procedures between January 1, 2006, and November 30, 2014. The study included 507 663 patients with targeted (total knee arthroplasty and total hip arthroplasty) and 164 472 patients with nontargeted (abdominal aortic aneurysm repair, colectomy, and lung resection) procedures performed at 2773 hospitals. Exposure Implementation of the HRRP policy. Main Outcomes and Measures Hospital-level 30-day risk-adjusted rates of readmission and observation stays were calculated using multivariable logistic regression models. Changes in these rates were analyzed for 3 distinct periods (prepolicy [January 1, 2006, to June 30, 2010], performance [July 1, 2010, to June 30, 2013], and penalty [July 1, 2013, to November 30, 2014]) corresponding to the HRRP implementation timeline for major joint surgery using interrupted time series. Results Among 672 135 Medicare beneficiaries 66 years or older treated at 2773 hospitals, readmissions for all procedures decreased significantly over the study period. Readmission rates after targeted procedures decreased faster during the performance period (slope, −0.060; 95% CI, −0.079 to −0.041) compared with the prepolicy period (slope, −0.012; 95% CI, −0.027 to 0.034) (P Conclusions and Relevance The HRRP effectively decreased readmissions for targeted procedures. There were no associated spillover effects for common nontargeted procedures. A better understanding of differences in the association of the policy with medical and surgical discharges will be necessary to further enhance its generalizability.

Health Information Technology (HIT) Adaptation: Refocusing on the Journey to Successful HIT Implementation.

In past years, policies and regulations required hospitals to implement advanced capabilities of certified electronic health records (EHRs) in order to receive financial incentives. This has led to accelerated implementation of health information technologies (HIT) in health care settings. However, measures commonly used to evaluate the success of HIT implementation, such as HIT adoption, technology acceptance, and clinical quality, fail to account for complex sociotechnical variability across contexts and the different trajectories within organizations because of different implementation plans and timelines. We propose a new focus, HIT adaptation, to illuminate factors that facilitate or hinder the connection between use of the EHR and improved quality of care as well as to explore the trajectory of changes in the HIT implementation journey as it is impacted by frequent system upgrades and optimizations. Future research should develop instruments to evaluate the progress of HIT adaptation in both its longitudinal design and its focus on adaptation progress rather than on one cross-sectional outcome, allowing for more generalizability and knowledge transfer.

Development of a plug and play ImmunoPCR technique for the analysis of biomolecules.

ImmunoPCR technology combines the advantages of specificity and robustness of a ligand binding assay with the amplification potential of PCR. We describe through three case studies a plug-and-play immuno polymerase chain reaction (iPCR) technique to measure biomolecules. Case Study 1 demonstrated feasibility of measurement of IgG1 in cerebrospinal fluid at the desired level of sensitivity with minimal cost and timelines of clinical assay implementation. Case Study 2 translated the iPCR protocol to measure multiple IgG1 analytes in cerebrospinal fluid. Case Study 3 demonstrated broad applicability of the technique to yet another analyte IL-6. The advantages of our iPCR approach were: lack of reliance on a single vendor for technology platform/software, minimal reliance on proprietary reagents and reduced method development times and cost.

An S-band Receiver and Backend System for MeerKAT

AbstractThe MPIfR is working together with SKA-SA and the Universities of Manchester and Oxford to deploy three instruments on MeerKAT: An S-band receiver system, a dedicated beamforming cluster and a flexible pulsar search cluster. Together these instruments will provide MeerKAT with powerful tools for supporting a wide range of scientific applications and in particular will enable large-scale pulsar and fast transient surveys to be performed. In these proceedings we describe the design, implementation and deployment timeline for these instruments.