Combining Improvement and Implementation Sciences and Practices for the Post COVID-19 Era

Øvretveit, John; Mittman, Brian; Rubenstein, Lisa V.; Ganz, David A.

doi:10.1007/s11606-020-06373-1

Cited by 7 publications

(5 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We defined PDSA cycles as “small rapid cycle tests of change” 15 and performed 21 discrete PDSA cycles across four sequential phases: (phase I) Team Formation, (phase II) Team Training, (phase III) Process Standardization, and (phase IV) Maintaining Improvement. Figure 2 shows timing and sequence of PDSA cycles, and the Data Supplement (online only) provides a more detailed description of individual PDSA cycles.…”

Section: Resultsmentioning

confidence: 99%

Interdisciplinary Approach and Patient/Family Partners to Improve Serious Illness Conversations in Outpatient Oncology

Wasp

Cullinan

Anton

et al. 2022

JCO Oncology Practice

View full text Add to dashboard Cite

PURPOSE: We aimed to increase Serious Illness Conversations (SIC) from a baseline of, at or near, zero to 25% of eligible patients by December 31, 2020. METHODS: We assembled an interdisciplinary team inclusive of a family partner and used the Model for Improvement as our quality improvement framework. The team developed a SMART Aim, key driver diagram, and SIC workflow. Standardized screening for SIC eligibility was implemented using the 2-year surprise question. Team members were trained in SIC communication skills by a trained facilitator and received ongoing coaching in quality improvement. We performed Plan-Do-Study-Act cycles and used audit-feedback data in weekly team meetings to inform iterative Plan-Do-Study-Act cycles. The primary outcome was the percent of eligible patients with documented SIC. RESULTS: Over 18 months, three clinics identified 63 eligible patients; of these, 32 (51%) were diagnosed with head and neck cancer and 31 (49%) with sarcoma. The SIC increased from a baseline near zero to 43 of 63 (70%) patients demonstrating three shifts in the median (95% CI). Conversations were interdisciplinary with 25 (57%) by oncology MD, six (14%) by advanced practice registered nurse, and 13 (30%) by specialty palliative care. We targeted four key drivers: (1) standardized work, (2) engaged interdisciplinary team, (3) engaged patients and families, and (4) system-level support. CONCLUSION: Our approach was successful in its documentation of end points and required resource investment (training and time) to embed into team workflows. Future work will evaluate scaling the approach across multiple clinics, the patient experience, and outcomes of care associated with oncology clinician–led SIC.

show abstract

Section: Resultsmentioning

confidence: 99%

Interdisciplinary Approach and Patient/Family Partners to Improve Serious Illness Conversations in Outpatient Oncology

Wasp

Cullinan

Anton

et al. 2022

JCO Oncology Practice

View full text Add to dashboard Cite

show abstract

“…Health services researchers are increasingly asked to evaluate newly implemented healthcare delivery system programs or policy changes [ 13 , 53 ]. Large scale implementation is often driven by organizational or political priorities, such as those identified by the US Congress in the case of CRH, and by associated tight timelines that prevent full program or evaluation design prior to implementation.…”

Section: Discussionmentioning

confidence: 99%

Learning from national implementation of the Veterans Affairs Clinical Resource Hub (CRH) program for improving access to care: protocol for a six year evaluation

Rubenstein¹,

Curtis²,

Wheat³

et al. 2023

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

Background The Veterans Affairs (VA) Clinical Resource Hub (CRH) program aims to improve patient access to care by implementing time-limited, regionally based primary or mental health staffing support to cover local staffing vacancies. VA’s Office of Primary Care (OPC) designed CRH to support more than 1000 geographically disparate VA outpatient sites, many of which are in rural areas, by providing virtual contingency clinical staffing for sites experiencing primary care and mental health staffing deficits. The subsequently funded CRH evaluation, carried out by the VA Primary Care Analytics Team (PCAT), partnered with CRH program leaders and evaluation stakeholders to develop a protocol for a six-year CRH evaluation. The objectives for developing the CRH evaluation protocol were to prospectively: 1) identify the outcomes CRH aimed to achieve, and the key program elements designed to achieve them; 2) specify evaluation designs and data collection approaches for assessing CRH progress and success; and 3) guide the activities of five geographically dispersed evaluation teams. Methods The protocol documents a multi-method CRH program evaluation design with qualitative and quantitative elements. The evaluation’s overall goal is to assess CRH’s return on investment to the VA and Veterans at six years through synthesis of findings on program effectiveness. The evaluation includes both observational and quasi-experimental elements reflecting impacts at the national, regional, outpatient site, and patient levels. The protocol is based on program evaluation theory, implementation science frameworks, literature on contingency staffing, and iterative review and revision by both research and clinical operations partners. Discussion Health systems increasingly seek to use data to guide management and decision-making for newly implemented clinical programs and policies. Approaches for planning evaluations to accomplish this goal, however, are not well-established. By publishing the protocol, we aim to increase the validity and usefulness of subsequent evaluation findings. We also aim to provide an example of a program evaluation protocol developed within a learning health systems partnership.

show abstract

“…For future recommendation, Ovretveit et al suggest to combine implementation and improvement science to enable faster and more effective implementation of changes in rapidly changing situations, such as the COVID-19 pandemic. For example, implementation strategies should consider models of contextual variables as barriers and facilitators of implementation and include rapid cycle testing to provide timely feedback on effects and needed adjustments (30).…”

Section: Discussionmentioning

confidence: 99%

Understanding the dynamics of non-clinical staff reallocation to clinical practice during the first wave of COVID-19—a qualitative study

Johansen¹,

Sørensen²,

Langelo³

et al. 2022

J Hosp Manag Health Policy

View full text Add to dashboard Cite

Background: During the coronavirus disease 2019 (COVID-19) pandemic one responsive strategy to ensure hospital staff capacity was reallocation of staff between departments. Unpredicted factors may influence how such a strategy is executed and knowledge of potential moderating factors is essential to improve future staff contingency plans. The aim of this study was to explore the dynamics of reallocating non-clinical staff from departments with low activity to clinical practice during the first wave of the COVID-19 pandemic at a 530-bed university hospital in the Capital Region of Denmark.Methods: This was a qualitative study based on six individual semi-structured interviews with non-clinical staff who were reallocated during the first wave of the COVID-19 pandemic, and eight interviews with leaders from departments reallocating staff. Data was analyzed using inductive content analysis. Results:The results showed that implementation of a staff contingency plan is influenced by a complex set of structural, perceptional, social, individual, and psychological moderating factors. Even though staff felt obligated and motivated to work and intended to cover shifts, reallocation was influenced by several other factors related to the contingency plan set-up, how the contingency plan and roles were interpreted by staff and leaders, how the leaders prioritized tasks and staff time, and the feeling of psychological safety. We found that staff and leaders interpreted the contingency plan in a social context, navigated the system, and made individual adjustments.Conclusions: This study sheds light on the dynamics of a reallocation process of non-clinical staff during the first wave of the COVID-19 pandemic. Reallocation is affected by a complex set of structural, perceptional, social, individual, and psychological moderating factors. Future staff contingency plans should take these factors into consideration to make better use of human resources in times of crisis and to improve staff experience with reallocation.

show abstract

Combining Improvement and Implementation Sciences and Practices for the Post COVID-19 Era

Cited by 7 publications

References 25 publications

Interdisciplinary Approach and Patient/Family Partners to Improve Serious Illness Conversations in Outpatient Oncology

Interdisciplinary Approach and Patient/Family Partners to Improve Serious Illness Conversations in Outpatient Oncology

Learning from national implementation of the Veterans Affairs Clinical Resource Hub (CRH) program for improving access to care: protocol for a six year evaluation

Understanding the dynamics of non-clinical staff reallocation to clinical practice during the first wave of COVID-19—a qualitative study

Contact Info

Product

Resources

About