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At least 199 records · Page 11Linked to original sources

PubMed2003

Why social workers do not implement decisions to remove children at risk from home.

OBJECTIVES: The study explores why social workers do not always implement their decisions to remove children at risk from their homes. METHOD: Social workers in Israel filled out questionnaires for 96 children at risk at two points of time: when they began to consider whether or not to remove the child, they completed questionnaires tapping their own, the parents', and the children's features. Six months later, they reported their decision, whether or not they had carried it out, and if not, why not. RESULTS: Some 21% of the workers' decisions were not implemented, almost all of them decisions to remove. The main reasons given were the objections of the parents and/or the child. Decisions were implemented for all the children whose mothers were alcohol or drug addicts. Implementation was lower for older children, children who were uncooperative with the social worker, and for children whose parents were uncooperative. It was also lower among experienced workers than novices. CONCLUSIONS: Further study is required to examine the generalizability of these findings to other countries, to understand better the reasons for the non-implementation, and to follow-up on the consequences of the non-implementation.

Adolescent↗

PubMed1997

Healthcare access and mobility between the UK and other European Union states: an 'implementation surplus'.

European Union (EU) policy on mobility requires ensuring healthcare access for EU residents who travel between EU states. This case-study investigates how this policy has been implemented in respect of EU visitors to the UK. EU visitors to the UK have similar access to 'immediately needed' National Health Service (NHS) healthcare to UK residents. For non-urgent healthcare, the NHS has official systems to discourage 'medical tourism' and divert such patients to the private sector or to reclaim the costs of NHS hospital treatment for EU visitors. Yet these official systems contrast with the flexibility and liberality of actual NHS practice towards EU visitors. Research on health policy implementation mostly examines reasons for 'implementation failure'. However, the present study indicates a health policy being implemented more fully than policy-makers may have anticipated. In the case of healthcare access for EU visitors to the UK, an implementation surplus is evident rather than an implementation deficit.

Europe↗

PubMed2002

Empowering patients: how to implement a diabetes passport in hospital care.

The purpose was to ascertain the views of patients with diabetes and patient care teams on the introduction of a recently developed diabetes passport in order to plan effective implementation. A semi-qualitative study by eight semi-structured focus group discussions with patient care teams and patients in four Dutch hospitals was organised. In total 29 patients participated (range five to nine per hospital). Patient care teams ranged from four to six participants. Each team included at least one specialised diabetic nurse and an internist. Taped views were transcribed and coded on the basis of a structured checklist. Various potential barriers to the implementation of the diabetes passport were found. Although patients recognized the diabetes passport as a handy tool, most of them expected starting problems and little co-operation from the internists; in this respect they rely more on the diabetes specialist nurse (DSN). Internists had mixed feelings about the diabetes passport. Lack of motivation and lack of time were important perceived barriers. The specialised diabetes nurses had the highest expectations of the diabetes passport and perceived themselves as those who would effectuate implementation. The main potential barriers to effective implementation of the diabetes passport were found in setting the agenda of the passport and fitting it into the organization of diabetes care. These barriers need to be considered when implementing the passport. The DSN could play an important part in its implementation.

Attitude of Health Personnel↗

PubMed1997

Exact ART: A Complete Implementation of an ART Network.

In this article we introduce a continuous time implementation of adaptive resonance theory (ART). ART designed by Grossberg concerns neural networks that self-organize stable pattern recognition categories of arbitrary sequences of input patterns. In contrast to the current implementations of ART we introduce a complete implementation of an ART network, including all regulatory and logical functions, as a system of ordinary differential equations capable of stand-alone running in real time. This means that transient behavior is kept in tact. This implementation of ART is based on ART 2 and is called Exact ART. Exact ART includes an implementation of a gated dipole field and an implementation of the orienting sub-system. The most important features of Exact ART, which are the design principles of ART 2, are proven mathematically. Also simulation studies show that Exact ART self-organizes stable recognition codes that agree with the classification behavior of ART 2. Copyright 1997 Elsevier Science Ltd.

Journal Article↗

PubMed2000

From kidnapping to corruption: some trials and tribulations in the implementation of rapid assessment studies.

In between the description of the methodology and the discussion of assessment results, lies a crucial area, namely that of implementation. If assessment methods cannot be implemented, there will be no assessment report, and no recommendations for intervention or policy development. Implementation is a critical, yet neglected, area of drug policy delivery. This paper describes some of the problems associated with the implementation of rapid assessment studies commissioned by the United Nations International Drug Control Programme (UNDCP) over the last 5 years. Drawing on the author's experience of commissioning rapid assessments on the extent and nature of drug use in a variety of international settings and political contexts, the paper draws eight main lessons for rapid assessments commissioned within the context of international development programmes. These are: (1) the need to get high level political support; (2) the need to employ competent social scientists to run the assessment; (3) the need to define exactly the object of the assessment; (4) the necessity of spelling out the methodology and the time scale; (5) the careful establishment of the financial framework; (6) the importance of cultivating contacts; (7) the necessity of actually getting a report; and (8) the danger of accepting an unseen or unread consultant's report as the basis for programme implementation. The paper emphasises the critical importance of planning prior to implementation and flexibility during it.

Journal Article↗

PubMed2003

Barriers to the implementation of clinical guidelines.

Clinical guidelines in wound care have recently been formulated at the national and international level, reflecting a shift from locally derived guidelines common during the 1990s. There remains considerable uncertainty regarding the extent of implementation and monitoring of these new guidelines. This paper presents the results of a survey of members of the Tissue Viability Society that sought their views upon the guidelines in place within their workplace--how were these guidelines developed, was the impact of guidelines monitored and how and finally what barriers limited their full implementation. Of the 1500 members, 476 returned completed questionnaires (34.0% response rate). Most (n = 422, 88.4%) worked within environments that implemented clinical guidelines in some aspect of wound care, with guidance upon pressure ulcer prevention being most commonly reported (n = 351). The use of national guidelines (either in their original format or locally modified to reflect local circumstances) was relatively common--reported by 307 of the 476 respondents. Few reported that guidelines were fully implemented (n = 77; 18.3%) with lack of resources, lack of awareness of the content of the guidelines and, when aware, lack of acceptance of their recommendations being the most commonly cited reasons for the failure to implement. However, it should be noted that only 34.0% of the surveyed population responded--this may question how far the results can be considered to reflect the current status of guideline implementation in the UK given the unreported views of 66% of all those surveyed.

Guideline Adherence↗

PubMed2000

Guideline implementation: what the literature doesn't tell us.

BACKGROUND: Despite large numbers of studies and literature reviews about guideline implementation, it remains unclear whether and how clinical guidelines can be used to improve the quality of medical care. This study sought to learn whether these studies and reviews have recognized the importance of systems thinking and organizational change for implementation. METHODS: A literature search was conducted for systematic reviews of guideline implementation or practice improvement studies. Each review was studied for the extent to which it identified or discussed the value of systems changes, organizational support, practice environmental factors, and use of a change process. RESULTS: Forty-seven good-quality systematic reviews were found. They largely concurred that using reminders and perhaps using feedback in the course of clinical encounters were the most effective ways of implementing guidelines. However, these same reviews rarely identified these strategies as systems changes, and there was little discussion about any need for organizational support or attention to various environmental variables that might affect implementation. The change process required to introduce a new or changed practice system received even less attention. CONCLUSION: Reviews of guideline implementation trials have focused on how to change the behavior of individual clinicians. There has been little attention to the impact of practice systems or organizational support of clinician behavior, the process by which change is produced, or the role of the practice environmental context within which change is being attempted. New attention to these issues may help us to better understand and undertake the process of improving medical care delivery.

Bibliometrics↗

PubMed2003

Examining the role of implementation quality in school-based prevention using the PATHS curriculum. Promoting Alternative THinking Skills Curriculum.

In order for empirically validated school-based prevention programs to "go to scale," it is important to understand the processes underlying program dissemination. Data collected in effectiveness trials, especially those measuring the quality of program implementation and administrative support, are valuable in explicating important factors influencing implementation. This study describes findings regarding quality of implementation in a recent effectiveness trial conducted in a high-risk, American urban community. This delinquency prevention trial is a locally owned intervention, which used the Promoting Alternative THinking Skills Curriculum as its major program component. The intervention involved 350 first graders in 6 inner-city public schools. Three schools implemented the intervention and the other 3 were comparison schools from the same school district. Although intervention effects were not found for all the intervention schools, the intervention was effective in improving children's emotional competence and reducing their aggression in schools which effectively supported the intervention. This study, utilizing data from the 3 intervention schools (13 classrooms and 164 students), suggested that 2 factors contributed to the success of the intervention: (a) adequate support from school principals and (b) high degree of classroom implementation by teachers. These findings are discussed in light of the theory-driven models in program evaluation that emphasized the importance of the multiple factors influencing the implementation of school-based interventions.

Child↗

PubMed1999

Implementation of Fetal and Infant Mortality Review (FIMR): experience from the national Healthy Start program.

OBJECTIVES: The implementation of the Fetal and Infant Mortality Review (FIMR) process was examined as part of the evaluation of the national Healthy Start program, a federal program designed to reduce infant mortality in several communities. The implementation of the FIMR process over the 5-year funding period is described in terms of productivity, barriers and facilitators to implementation, and project expenditures. METHODS: Data were derived from grant continuation applications and personal interviews with program staff to produce a qualitative description. RESULTS: As of the summer of 1996, 14 of the 15 Healthy Start sites in the national evaluation had successfully implemented the FIMR process. Most sites had developed a two-tiered review process for examination of case data in which a review by health and social services professionals was followed by community review. In the period 1993 to 1995, the percentage of fetal and infant deaths reviewed had a median of 34% with a range of 4-79% across the sites at a cost of $600 to $3400 per death reviewed. Recommendations were variably implemented. CONCLUSIONS: The FIMR process provides an important opportunity to contribute to the knowledge base regarding infant mortality in these communities. The process, however, has important logistical requirements and may require substantial financial resources that may affect implementation of confidential inquiries into infant mortality and other health problems.

Data Collection↗

PubMed2001

Implementing computerized technology: an organizational analysis.

Why do some organizations succeed and others fail in implementing the innovations they adopt? To begin to answer this question, the authors studied the implementation of manufacturing resource planning, an advanced computerized manufacturing technology, in 39 manufacturing plants (number of individual respondents = 1,219). The results of the plant-level analyses suggest that financial resource availability and management support for technology implementation engender high-quality implementation policies and practices and a strong climate for implementation, which in turn foster implementation effectiveness--that is, consistent and skilled technology use. Further research is needed to replicate and extend the findings.

Computer Systems↗

PubMed2026

The role of pathology laboratories in integrating genetic testing into Australian primary care: an implementation science perspective.

As genomic testing moves into mainstream healthcare, non-genetic healthcare professionals, including general practitioners (GPs), play a critical role as gatekeepers to genetic services. Laboratories are essential in supporting this transition by providing not only high-quality genetic tests but also point-of-care tools, educational materials and clinical guidance to support their use. This study aimed to explore how these tools and supports are conceptualized, developed, implemented and evaluated and how laboratories integrate them into their relationships with GPs, an essential process for paving the way toward better use of genomics in primary care. A qualitative study design was employed using semi-structured, in-depth interviews with representatives from genetic laboratories across Australia. The Consolidated Framework for Implementation Research (CFIR) guided deductive content analysis of data. Findings spanned the four CFIR domains (Intervention Characteristics, Outer Setting, Inner Setting and Implementation Process) across 34 constructs. Participants reported that laboratories viewed point-of-care tools and resources as essential responses to persistent genomic knowledge gaps among GPs. Development of evidence-based, practice-driven and adaptable resources was supported and rewarded within laboratory organisations. A strong culture of clinical responsibility and implementation readiness, combined with robust networks and communications, enabled timely support for GPs. Gaps identified included lack of implementation planning, misalignments between laboratory-developed resources and GPs' real-world needs and inadequate mechanisms for obtaining GPs' feedback, which made evaluation problematic. By applying an implementation science framework, these findings provide insights for future efforts to build and sustain the provision of point-of-care tools and support, ultimately improving the integration of genomics in primary care.

Journal Article↗

PubMed1996

Achieving improvement through quality: an evaluation of key factors in the implementation process.

Quality, audit and standard setting are major issues on the present day nursing and health care agenda. Considerable time, energy and resources have been invested in developing and implementing a range of different quality and audit systems, yet there is limited evidence to date to suggest that they are having any significant impact in terms of changing practice and improving patient care. This paper will present the results of a study undertaken to evaluate the implementation of three of the most common nursing quality systems used in the United Kingdom: Monitor, Qualpacs and the dynamic standard setting system (DySSSy). In each case, the focus was on identifying key factors in the process of implementation that could predict positive programme outcomes--defined in terms of acceptance by clinical nursing staff and perceived impact on the quality of patient care. The study adopted a three-stage evaluation design, with three distinct levels of investigation and analysis, and utilized a range of descriptive and exploratory methods. In total, 14 sites implementing one of the three nursing quality systems were studied. Additional data, derived from individuals' experiences of implementing quality in nursing, were used to enhance and validate the findings. The results indicated a number of important system-related, contextual and practical issues of implementation. These were underpinned by two key factors, defined as ownership for quality and action to improve. However, most present day nursing quality programmes appear to be failing to embrace these two concepts simultaneously. The paper will conclude by discussing the implications of these findings for future developments in nursing and health care quality improvement.

Attitude of Health Personnel↗

PubMed2003

Nursing Minimum Data Set development and implementation in Thailand.

BACKGROUND: In 1997, the Thai Ministry of Public Health began planning to implement a national health information system. Development of the nursing component of this system is an ongoing process. The first step in developing a nursing information system is to identify an essential Nursing Minimum Data Set (NMDS). AIM: To describe the development of a NMDS in Thailand and explore the challenges of implementing it, including the issue of the comparability with data sets in other countries, primarily the United States of America. METHODS: The process of developing a NMDS specific to Thailand is reviewed. Strategies for implementing this data set and important issues related to it are then discussed. FINDINGS: Although a preliminary Thai NMDS has been identified, challenges associated with its development and implementation within the Thai National health information system remain. CONCLUSION: A Thai NMDS and its elements have been identified. The International Classification of Nursing Practice was translated and is to be used to implement the data set describing the nursing care of patients and their families. However, many issues, such as the need for conceptual translation and increasing nurses' involvement in the process, still need to be addressed in order to implement the data set successfully.

Data Collection↗

PubMed2005

Provider adherence to implementation of clinical practice guidelines for neurogenic bowel in adults with spinal cord injury.

BACKGROUND/OBJECTIVES: Clinical Practice Guidelines (CPGs) have been published on a number of topics in spinal cord injury (SCI) medicine. Research in the general medical literature shows that the distribution of CPGs has a minimal effect on physician practice without targeted implementation strategies. The purpose of this study was to determine (a) whether dissemination of an SCI CPG improved the likelihood that patients would receive CPG recommended care and (b) whether adherence to CPG recommendations could be improved through a targeted implementation strategy. Specifically, this study addressed the "Neurogenic Bowel Management in Adults with Spinal Cord Injury" Clinical Practice Guideline published in March 1998 by the Consortium for Spinal Cord Medicine METHODS: CPG adherence was determined from medical record review at 6 Veterans Affairs SCI centers for 3 time periods: before guideline publication (T1), after guideline publication but before CPG implementation (T2), and after targeted CPG implementation (T3). Specific implementation strategies to enhance guideline adherence were chosen to address the barriers identified by SCI providers in focus groups before the intervention. RESULTS: Overall adherence to recommendations related to neurogenic bowel did not change between T1 and T2 (P = not significant) but increased significantly between T2 and T3 (P < 0.001) for 3 of 6 guideline recommendations. For the other 3 guideline recommendations, adherence rates were noted to be high at T1. CONCLUSIONS: While publication of the CPG alone did not alter rates of provider adherence, the use of a targeted implementation plan resulted in increases in adherence rates with some (3 of 6) CPG recommendations for neurogenic bowel management.

Aged↗

PubMed2003

Costs of implementing and maintaining a tuberculin skin test program in hospitals and health departments.

OBJECTIVE: To determine (1) the annual costs of implementing and maintaining tuberculin skin test (TST) programs at participating study sites, (2) the cost of the TST program per healthcare worker (HCW), and (3) the outcomes of the TST programs, including the proportion of HCWs with a documented TST conversion and the proportion who accepted and completed treatment for latent TB infection, before and after the implementation of staffTRAK-TB software (Centers for Disease Control and Prevention, Atlanta, GA). DESIGN: Cost analysis in which costs for salaries, training, supplies, radiography, and data analysis were collected for two 12-month periods (before and after the implementation of staffTRAK-TB). SETTING: Four hospitals (two university and two city) and two health departments (one small county and one big city). RESULTS: The annual cost of implementing and maintaining a TST program ranged from dollars 66,564 to dollars 332,728 for hospitals and dollars 92,886 to dollars 291,248 for health departments. The cost of the TST program per HCW ranged from dollars 41 to dollars 362 for hospitals and dollars 176 to dollars 264 for health departments. CONCLUSIONS: Costs associated with implementing and maintaining a TST program varied widely among the participating study sites, both before and after the implementation of staffTRAK-TB. Compliance with the TB infection control guidelines of the Centers for Disease Control and Prevention may require a substantial investment in personnel time, effort, and commitment.

Academic Medical Centers↗

PubMed1994

Valid and invalid implementations of GOR secondary structure predictions.

GOR algorithms have long been a standard methodology for predicting protein secondary structure from primary sequence. We have developed two short validation sequences for the GOR I and GOR II algorithms. Use of these sequences with seven commercial and non-commercial implementations of these algorithms demonstrated that several were incorrect implementations, including two of the three commercial modules implementing the GOR I algorithm. This may be due to an easy misinterpretation of the GOR I algorithm and related data tables. We present the validation sequences and discuss implications of this widely propagated error on secondary and tertiary structure prediction, using several proteins of known structure in three different structural classes as examples. A valid GOR I implementation predicts secondary structure increases the accuracy of predictions by from 1-13 percentage points over an invalid implementation based on the easy misinterpretation. A valid implementation of the GOR I and GOR II algorithms is available from the authors.

Algorithms↗

PubMed2002

Acceptance of guideline recommendations and perceived implementation of coronary heart disease prevention among primary care physicians in five European countries: the Reassessing European Attitudes about Cardiovascular Treatment (REACT) survey.

BACKGROUND: Although primary care is the major target of coronary heart disease (CHD) clinical recommendations, little is known of how community physicians view guidelines and their implementation. The REACT survey was designed to assess the views, and perceived implementation, of CHD and lipid treatment guidelines among primary care physicians. METHODS: Semi-structured validated telephone interviews were conducted, in the relevant native tongue, with 754 randomly selected primary care physicians (GPs and family doctors) in five European countries (France, Germany, Italy, Sweden and the UK). RESULTS: Most physicians (89%) agreed with the content of current guidelines and reported use of them (81%). However, only 18% of physicians believed that guidelines were being implemented to a major extent. Key barriers to greater implementation of guidelines were seen as lack of time (38% of all physicians), prescription costs (30%), and patient compliance (17%). Suggestions for ways to improve implementation centred on more education, both for physicians themselves (29%) and patients (25%); promoting, publicizing or increasing guideline availability (23%); simplifying the guidelines (17%); and making them clearer (12%). Physicians perceived diabetes to be the most important risk factor for CHD, followed by hypertension and raised LDL-C. Most physicians (92%) believe their patients do associate high cholesterol levels with CHD. After establishing that a patient is 'at risk' of CHD, physicians reported spending an average of 16.5 minutes discussing risk factors and lifestyle changes or treatment that is required. Factors preventing this included insufficient time (42%), having too many other patients to see (27%) and feeling that patients did not listen or understand anyway (21%). CONCLUSIONS: Primary care physicians need more information and support on the implementation of CHD and cholesterol guideline recommendations. This need is recognized by clinicians.

Analysis of Variance↗

PubMed1999

Applying a contingency model of strategic decision making to the implementation of smoking bans: a case study.

A model of strategic decision making was applied to study the implementation of worksite smoking policy. This model assumes there is no best way of implementing smoking policies, but that 'the best way' depends on how decision making fits specific content and context factors. A case study at Wehkamp, a mail-order company, is presented to illustrate the usefulness of this model to understand how organizations implement smoking policies. Interview data were collected from representatives of Wehkamp, and pre- and post-ban survey data were collected from employees. After having failed to solve the smoking problem in a more democratic way, Wehkamp's top management choose a highly confrontational and decentralized decision-making approach to implement a complete smoking ban. This resulted in an effective smoking ban, but was to some extent at the cost of employees' satisfaction with the policy and with how the policy was implemented. The choice of implementation approach was contingent upon specific content and context factors, such as managers' perception of the problem, leadership style and legislation. More case studies from different types of companies are needed to better understand how organizational factors affect decision making about smoking bans and other health promotion innovations.

Adult↗