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PubMed1981

Implementing comprehensive health education: educational innovations and social change.

The effectiveness of health education is ultimately determined by whether it is implemented, and how it is implemented. Although a given health education innovation may be designed and experimentally assessed to promote well-being with some measure of effectiveness and efficiency, the actual impact of the innovation will depend upon the manner in which it is disseminated, initiated, and maintained. The implementation of health education programs in schools or elsewhere is a function of the types of innovations available, certain characteristics of those innovations that influence their use, and the manner in which the innovations are brought into practice. This paper has been prepared to review, synthesize, and apply current and relevant information about educational innovations and social change to provide a conceptual base for the design, execution, and analysis of efforts to implement health education in schools. The American system of public and private schools could be an agent vitally important to the realization of a second public health revolution. Indeed, in a democratic society, the implementation of health education in schools seems a condition necessary for such a revolution. By analyzing and learning from our own health education efforts, as well as the efforts of those experienced with implementing other types of educational innovations in schools, we might ensure that future populations are informed sufficiently about factors that influence their health and well-being.

Adolescent↗

PubMed1984

Competitive bidding as a cost-containment strategy for indigent medical care: the implementation experience in Arizona.

The State of Arizona recently instituted a competitive bidding process, in order to establish a health services delivery system for indigents and to determine capitated reimbursement levels for providers in that system. This article describes the implementation of that bidding process, and identifies factors which had a significant impact on the implementation experience. Implementation of competitive bidding in Arizona encountered problems which appear to be common to the implementation of innovative public programs. It also uncovered political liabilities that suggest that effective implementation of competitive bidding for indigent medical care contracts in other environments will be difficult, even if technical implementation problems can be overcome.

Arizona↗

PubMed1998

Implementing nurse-based systems to provide American Indian women with breast and cervical cancer screening.

OBJECTIVE: To describe the factors critical to implementation of a nurse-based system to increase access for American Indian women to breast and cervical cancer screening. MATERIAL AND METHODS: We report the experience of 103 nurses at 40 clinics who were trained to use the nurse-based screening system. In addition, the critical elements are discussed in the context of one particularly successful site. RESULTS: Fifteen factors were identified as critical to the implementation of a nurse-based cancer screening process once a nurse had been trained to perform clinical breast examinations and collect Papanicolaou (Pap) test specimens: knowledge of benefit, skills, organization, adequate return, perceived patient demand, perceived effectiveness, legitimacy, confidence, commitment, adequate resources, a data-driven iterative approach to program implementation, an objective measure of quality, leadership, the passage of time, and a focus on delivering the service to the patient. For example, in one site that was particularly successful, the nurses, administrators, and other key health-care professionals contributed their respective resources to implement the screening program. The program was also supported by the lay community, the state board of nursing, and the state health department breast and cervical cancer control program. During the 3-year study period, the 103 nurses performed screening tests on 2,483 women, and only 18 of the Pap test specimens were unsatisfactory. CONCLUSION: Nurse-based systems designed to collect high-quality Pap test specimens and perform detailed clinical breast examinations can be implemented if the factors that are critical to implementation are identified and addressed.

Breast Neoplasms↗

PubMed1979

Implementing a human services program: how hard will it be?

A framework is presented for examining obstacles to the implementation of human services delivery programs. These obstacles appear to arise from three basic sources: (1) from the operational demands implied by a particular program concept, (2) from the nature and availability of the resources required to run the program, and (3) from the need to share authority with, or retain support of, other bureaucratic and political actors in the implementation process. Within these three broad categories, fifteen areas deserve special attention: the people to be served, the nature of the service, the likelihood of distortions or irregularities, the controllability of the program, money, personnel, space, supplies and technical equipment, and intersections with overhead agencies, other line agencies, elected politicians, higher levels of government, private-sector providers, special-interest groups, and the press. By searching each of these fifteen areas diligently and systematically--with the aid of some 44 "factors for consideration"--it appears possible to make relatively powerful predictions about the obstacles that the implementation of a given human services program will entail. In addition, the framework can be used as a comparative instrument in allocating scarce political, managerial, and financial resources among human services programs, and as an aid to decision-making within particular programs and to identifying obstacles that cut across programs. Finally, some general guidance is offered on how implementing agency managers might deal with one of the more important and difficult dimensions of program implementation--namely, getting the cooperation of players in the implementation game whom the managers do not control, and who have different interests and agendas.

Community Health Services↗

PubMed1986

Implementing a stand-alone packaged pharmacy computer system in a 580-bed hospital.

The problems experienced by a hospital pharmacy department in implementing a stand-alone packaged computer system are discussed, and recommendations for avoiding and managing these problems are presented. In 1984, a stand-alone packaged computer system was implemented in a 580-bed, tertiary-care institution that provides services from a central pharmacy and five satellite pharmacies. The department developed a request for proposal and contracted with a vender for a system that would support unit dose drug distribution and i.v. admixture services. During the implementation process, the following problems were experienced: The hardware was insufficient for the department's workload, the software design was limited, and personnel were frustrated with learning to use the system. These problems were intensified by the heavy workload and the large number of users. In the 18 months since implementation, the department has purchased more hardware, improved the software applications, and resolved many of the problems associated with employee frustration. Pharmacy departments at other large institutions might avoid some of these problems by training personnel adequately before implementation and by researching and estimating hardware and software needs in advance. In this large hospital, the efficiency of a stand-alone packaged pharmacy computer system has improved 18 months after implementation.

Computers↗

PubMed1984

Research on disseminating and implementing health education programs in schools.

Numerous school health education programs have been developed. No matter how effective a given program may be, however, its impact will be determined by the extent to which it actually is disseminated and maintained in classrooms. The dissemination of a program involves purposeful efforts by agencies usually outside the school to implement the program in many different schools, efforts by agencies usually outside the school to implement the program in many different schools, while program implementation involves efforts by those within a given school to effectively use the program in its classrooms. This paper has been prepared to review concepts, strategies, and methods used to study dissemination and implementation; to specify the functions of dissemination and implementation research; and to describe general approaches and specific procedures to evaluate the effectiveness of dissemination and implementation activities. As we develop more and better school health education interventions, the need for research that will allow us to efficiently transport these interventions to classrooms throughout the nation becomes increasingly important.

Adolescent↗

PubMed1982

A computer primer: systems implementation.

It is important to recognize the process of implementing systems as a process of change. The hospital, through its steering committee, must manage this process, initiating change instead of responding to it. Only then will the implementation of information systems be an orderly process and the impact of these changes on the hospital's organization clearly controlled. The probability of success in implementing new systems would likely be increased if attention centers on gaining commitment to the project, gaining commitment to any changes necessitated by the new system, and assuring that the project is well defined and plans clearly specified. These issues, if monitored throughout the systems implementation, will lead to early identification of potential problems and probable failures. This highly increases the chance of success. A probably failure, once identified, can be given specific attention to assure that associated problems are successfully resolved. The cost of this special attention, monitoring and managing systems implementation, is almost always much less than the cost of the eventual implementation failure.

Computers↗

PubMed1993

Problems in interpreting cost effectiveness in clinical trials. Experimental versus implementation costs.

OBJECTIVE: To demonstrate the difficulty of estimating cost effectiveness of alternative implementation strategies using clinical trial data. DESIGN: Two examples drawn from a hearing-aid intervention trial and a physical-therapy trial for frail elderly are used to demonstrate how alternative implementation strategies may affect cost effectiveness. Sensitivity analysis is used to document a range of possible economic outcomes for each example and show how assumptions based on trials may bias implementation decisions. MAIN OUTCOME MEASURES: Costs and cost-effectiveness ratios are estimated for alternative implementation strategies and compared with trial results. MAIN RESULTS: Staffing and equipment substitutions, reconfigurations, and economies of scale can reduce the cost of trial interventions substantially. Such resource alterations as well as protocol and target group modifications may also have an impact on effectiveness. In both examples effectiveness can be reduced by as much as 50% and under certain conditions alternative implementation strategies will still be cost effective. CONCLUSIONS: Cost effectiveness of implementations can differ substantially from a trial when different resources or target populations are incorporated. Institutions must conduct preimplementation studies which consider alternative resource configurations before adopting an intervention based on trial results.

Aged↗

PubMed1995

Understanding the dynamics of information technology implementation: a study of clinical information systems.

Health care institutions are considering a variety of emerging information technologies (ITs) in the hope of increasing efficiency, reducing costs, re-engineering work processes, and improving quality of care. The recent, rapid advances made in the use of innovative ITs in the health care field can present a plethora of problems to the administrative staff. Perhaps the most pressing of these concerns is the ability of today's hospitals to effectively create and utilize computer-based information systems. IT implementation has long been of great interest for information systems researchers. This branch of information system study seeks to identify those factors that are integral to optimizing the usage of IT. For example, researchers have advised practitioners that managerial support, high quality system design, commitment to advancing with the field, and extensive project planning are all key elements of successful system. In sum, previous research has produced a set of managerial proscriptions which, taken as a whole, constitute the "ideal" way to implement an IT system. Yet despite these normative principles and proscriptions, many health care institutions continue to find their attempts to make use of IT fraught with difficulty. Therefore, the objective of this study is to broaden and edify our understanding of IT implementation. More specifically, we seek to dispel the myth of the "ideal" system setup by exploring some of the alternative systems in use. We wish to investigate how and why the components of these alternative systems interact to produce utilization success (or failure). The study investigates the establishment and subsequent use of three clinical information systems (CIS) in a large tertiary care teaching hospital. The first case study is that of the hospital-wide implementation of a computer system that allows physicians to sign their medical records electronically. The second case examines the use of an electronic patient chart used to support the work of a variety of clinicians. Finally, we study a nursing assessment system used by two groups of nurses (intensive care unit and resuscitation unit) at a state-of-the-art, newly established Trauma Center. Qualitative was gathered through semi-structured interviews with people involved in the implementation process as well as a sample of user representatives. More than 90 interviews were conducted over a period of six months. Observational data completed our qualitative assessment. Quantitative evidence was gathered through questionnaires administered to a small sample of key informants. Three techniques of qualitative data analysis are being used in combination, namely, coding, analytical memos and displays. Data analysis is still in its infancy at this point. Regarding its relevance to the role of the administrator, this study will allow general and health care management as well as IT professionals to gain insight into the dynamics of the implementation of innovative technologies. In other words, results from this study will provide clear and relevant answers to the questions of how and why the outcome of the information system project is influenced by the way in which the technology is introduced.

Attitude to Computers↗

PubMed1996

Implementation of computer-based patient records in primary care: the societal health economic effects.

OBJECTIVE: Exploration of the societal health economic effects occurring during the first year after implementation of Computerised Patient Records (CPRs) at Primary Health Care (PHC) centres. DESIGN: Comparative case studies of practice processes and their consequences one year after CPR implementation, using the constant comparison method. Application of transaction-cost analyses at a societal level on the results. SETTING: Two urban PHC centres under a managed care contract in Ostergötland county, Sweden. MAIN OUTCOME MEASURES: Central implementation issues. First-year societal direct normal costs, direct unexpected costs, and indirect costs. Societal benefits. RESULTS: The total societal effect of the CPR implementation was a cost of nearly 250,000 SEK (USD 37,000) per GP team. About 20% of the effect consisted of direct unexpected costs, accured from the reduction of practitioners' leisure time. The main issues in the implementation process were medical informatics knowledge and computer skills, adaptation of the human-computer interaction design to practice routines, and information access through the CPR. CONCLUSIONS: The societal costs exceed the benefits during the first year after CPR implementation at the observed PHC centres. Early investments in requirements engineering and staff training may increase the efficiency. Exploitation of the CPR for disease prevention and clinical quality improvement is necessary to defend the investment in societal terms. The exact calculation of societal costs requires further analysis of the affected groups' willingness to pay.

Computer Literacy↗

PubMed1998

TQM implementation strategies in hospitals: an empirical perspective.

This article reports an analysis of the effectiveness of Total Quality Management (TQM) programs. The objective of the study was gain a better understanding of how hospitals implement TQM and quality improvement initiatives. Results show that some hospital staffs have not realized that they are implementing TQM, even though they report to be using the strategies for quality improvement. On the other hand, some hospitals said that they were involved in quality programs, though not practically implementing TQM strategies. These results suggest two major conclusions about the implementation of TQM programs. First, data indicate that TQM programs may not be as effective as promised, due to a lack of understanding about TQM by the people within the organization. Second, implementation strategies that are statistically correlated are identified. These conclusions may be helpful for successful TQM implementation in from healthcare organizations as well as other service industries.

Cross-Sectional Studies↗

PubMed1994

Community-oriented primary care. Implementation of a national rural demonstration.

A major objective of community-oriented primary care (COPC) is to focus the clinical practice on the health care problems of the community that the practice serves. The COPC process defines the community of interest, identifies and prioritizes community health problems, and implements and evaluates interventions. Under sponsorship from the W. K. Kellogg Foundation, the COPC National Rural Demonstration Program was established to explore the feasibility of implementing COPC in 13 rural practices. An evaluation of the program found that local communities played critical roles in defining and implementing COPC interventions. These interventions were most often focused on health promotion/illness prevention activities. At most sites, clinical practices were limited in their ability to incorporate COPC activities by staff and physician turnover and the extensive patient demands on the time of rural primary care physicians. While the COPC process proceeded at different rates across the sites, after 2 1/2 years of grant funding, most sites continued to devote the majority of their resources to designing and implementing interventions. Thus, it appears that coordination by dedicated nonphysician staff and more than 2 years of effort are required to implement COPC concepts in rural practices in underserved areas.

Community Health Services↗

PubMed2025

Barriers and facilitators to implementing clinical genome-wide sequencing: A scoping review of the global landscape.

PURPOSE: The global demand for clinical genome-wide sequencing (GWS) continues to grow. This study describes the global landscape of genetic service delivery and the barriers and facilitators to implementing clinical GWS. METHODS: A scoping review was conducted using MEDLINE and Embase (January 2009-July 2025) to identify studies related to genetic service delivery, exome and genome sequencing, and implementation. RESULTS: Ninety-six articles representing 35 countries were analyzed using the updated Consolidated Framework for Implementation Research. The most frequently reported barriers were within the outer setting: insufficient Local Conditions (ie, genetics workforce shortage; 54/96, 56%), limited Financing (29/96, 30%), and lack of national Policies and Laws (regulations) for genomic testing (20/96, 21%). Negative Local Attitudes about genomics were reported as a barrier in 11 South American, Middle Eastern, Asian, and African countries. Identified outer setting facilitators included Partnerships and Connections between interested parties (eg, government, academic institutions; 14/96, 15%) and dedicated Funding for national genomics initiatives (6/96, 6%). CONCLUSION: This scoping review identified common barriers to implementing GWS across countries with varying capacities for delivering these services. Findings may help countries to anticipate barriers, leverage facilitators, and develop strategies for implementing genomic testing and services.

Humans↗

PubMed2026

Effectiveness and implementation of task-sharing cognitive-behavioral interventions for perinatal mental health: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of cognitive-behavioral interventions (CBIs) delivered by nonspecialist providers (NSPs) on perinatal depressive (PND) and anxiety symptoms, and to narratively synthesize their implementation processes and reported implementation outcomes, including acceptability, feasibility, fidelity, cost, and sustainability. METHODS: We systematically searched eight databases from inception to April 8, 2025. Eligible studies were randomised controlled trials (RCTs) assessing CBIs delivered by NSPs for PND and/or anxiety. Two reviewers independently screened, extracted, and assessed trials. Meta-analyses employed random-effects models, with subgroup, sensitivity, meta-regression, and publication bias analyses conducted in Stata 18.0. Implementation processes and outcomes were reported as frequencies or percentages across trials. RESULTS: A total of 47 trials (11, 357 participants) were included in the systematic review, of which 37 trials (8,709 participants) were included for meta-analyses. CBIs were conducted in 12 countries. Nurses and midwives delivered 45% of CBIs. CBIs were associated with reduced PND post-intervention compared with control conditions (standardized mean difference [SMD] -0.49, 95% CI -0.63 to -0.35; I² = 86.8%). Limited evidence from four trials suggested a small sustained effect at 12 months (SMD -0.14, 95% CI -0.27 to -0.02; I² = 26.4%). Reductions in anxiety symptoms were observed immediately post-intervention (SMD, -0.45, 95% CI -0.65 to -0.25; I²=81%), but evidence for longer-term effects was limited. Subgroup analyses confirmed consistent effects across diverse settings, populations, and intervention characteristics. Reporting of implementation processes (e.g., training, supervision, fidelity) was limited, with only 23.4% of trials assessing fidelity and 10.6% evaluating costs. CONCLUSIONS: NSP-delivered CBIs showed beneficial effects on PND and anxiety, with generally encouraging evidence for acceptability and feasibility. However, evidence for sustained effects beyond the immediate post-intervention period remains limited. Future studies should strengthen long-term follow-up and improve reporting of implementation processes and outcomes, particularly in rural and adolescent perinatal populations, to inform scalable and equitable task-sharing models.

Humans↗

PubMed1997

Implementation of ethnic health policy in community mental health centres in Melbourne.

The implementation of ethnic health policy in community mental health centres was investigated by using structured interviews with coordinators and staff of 13 centres in Melbourne. The major finding was that most policy recommendations were not implemented and that work on ethnic issues resulted from the initiatives of individual staff. The study demonstrates that the successful implementation of ethnic health policy requires higher priority from policy makers and government, greater attention to mechanisms to require or encourage implementation, and a strategy to ensure that resources (new or redirected) are allocated to the implementation process.

Adolescent↗

PubMedDate not supplied

Implementation of preventive services in an HMO practice.

Practice does not conform to guidelines unless the guidelines are specifically implemented and performance is monitored. Several examples of implementation in one health maintenance organization (HMO) are given. These include immunization for influenza and follow up of positive screening tests for colorectal and cervical cancer. Each implementation effort has required the development of systems, which in this HMO are automated. Several issues influencing implementation are discussed, including resource constraints and priorities for the allocation of new resources. Developers cannot expect that their guidelines will be incorporated into clinical practice. They must foster specific implementation plans.

Ambulatory Care Information Systems↗

PubMed1997

Implementation of a radiology electronic imaging network: the community teaching hospital experience.

Because of their typically small in-house computer and network staff, non-university hospitals often hesitate to consider picture archiving and communication system (PACS) as a solution to the very demanding financial, clinical, and technological needs of today's Radiology Department. This article presents the experiences of the 3-year process for the design and implementation of the Radiology Electronic Imaging Network (REIN) in the Department of Radiology at The Western Pennsylvania Hospital (WPH). WPH embarked on this project in late 1994 to find a solution to the very pressing demands to reduce operating costs and improve service to primary care clinicians, both on-site and at WPH-affiliated clinics. A five-member committee consisting of in-house medical, administrative, information services, and medical physics staff was formed to design a network that would satisfy specific needs of WPH by using a phased mini-PACS approach and to select the various vendors to implement it. Suppliers for individual mini-PACS were selected to provide modality-specific solutions. For the backbone network, vendors were evaluated based on their technological progress, competence and resources, the commitment of the company to the imaging network business, and their willingness to embark on a mid-sized PACS project such as this. Based on patient volume, workflow patterns, and image quality requirements, the committee produced proposals detailing number and location of workstations, short- and long-term memory requirements, and so on. Computed tomography/magnetic resonance imaging, computer radiography, ultrasound, nuclear medicine, digital fluoroscopy, and angiography mini-PACS have been implemented over the past 2 years, and most of these are already integrated into the main REIN. This article presents detailed information concerning the design, selection and implementation processes, including storage requirement calculations. This indicates that PACS implementation is achievable for community hospitals with small computer, networking, and physics departments. Also presented are recommendations concerning design and vendor selection, that may be helpful for similar institutions.

Computer Communication Networks↗

PubMed1998

[Spiral CT angiography in diagnosis of acute pulmonary embolism. What factors modify implementation of standard algorithms?].

PURPOSE: Debate about the potential implementation of Spiral-CT in diagnostic algorithms of pulmonary embolism are often focussed on sensitivity and specificity in the context of comparative methodologic studies. We intend to investigate whether additional factors might influence this debate. MATERIALS AND METHODS: On the basis of the current literature and of own experience we study the influence of factors such as availability, acceptance, patient-outcome, and cost effectiveness-studies on the potential implementation of Spiral-CT in diagnostic algorithms of pulmonary embolism. This information is analyzed together with data from comparative methodologic studies. RESULTS: The factors availability, acceptance, patient-outcome, and cost-effectiveness-studies do have substantial influence on the implementation of Spiral-CT in the diagnostic algorithms of pulmonary embolism. Incorporation of these factors into the discussion might lead to more flexible and more patient-oriented algorithms for the diagnosis of pulmonary embolism. CONCLUSION: Availability of equipment, acceptance among clinicians, patient-outcome, and cost-effectiveness evaluations should be implemented into the debate about potential implementation of Spiral-CT in routine diagnostic imaging algorithms of pulmonary embolism.

Acute Disease↗