Context Matters—But What Aspects? The Need for Evidence on Essential Aspects of Context to Better Inform Implementation of Quality Improvement Initiatives

Subramanian, Laura; Elam, Meagan; Healey, Amanda Jurczak; Paquette, Elodie; Henrich, Natalie

doi:10.1016/j.jcjq.2021.08.007

Cited by 3 publications

(5 citation statements)

References 39 publications

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“…Second, although the importance of context in IS projects has been widely emphasized, funding agencies remain hesitant to fund contextual analyses as they are not yet recognized as a crucial of an IS project. A contextual analysis' rigor and thoroughness both reflect the available resources such as time, personnel, and especially funding [74,75]. These circumstances should be considered when evaluating contextual analysis and interpreting its results.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, considering that available resources (time, funding, personnel) for contextual analysis are usually constrained, researchers need to strike a "balance between speed and rigor" [74]. This balance will influence how extensively a contextual analysis can be carried out and which methods can be applied [75].…”

Section: Component 4: Study Design For Contextual Analysismentioning

confidence: 99%

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Unraveling implementation context: the Basel Approach for coNtextual ANAlysis (BANANA) in implementation science and its application in the SMILe project

Mielke

Leppla

Valenta

et al. 2022

Implement Sci Commun

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Background Designing intervention and implementation strategies with careful consideration of context is essential for successful implementation science projects. Although the importance of context has been emphasized and methodology for its analysis is emerging, researchers have little guidance on how to plan, perform, and report contextual analysis. Therefore, our aim was to describe the Basel Approach for coNtextual ANAlysis (BANANA) and to demonstrate its application on an ongoing multi-site, multiphase implementation science project to develop/adapt, implement, and evaluate an integrated care model in allogeneic SteM cell transplantatIon facILitated by eHealth (the SMILe project). Methods BANANA builds on guidance for assessing context by Stange and Glasgow (Contextual factors: the importance of considering and reporting on context in research on the patient-centered medical home, 2013). Based on a literature review, BANANA was developed in ten discussion sessions with implementation science experts and a medical anthropologist to guide the SMILe project’s contextual analysis. BANANA’s theoretical basis is the Context and Implementation of Complex Interventions (CICI) framework. Working from an ecological perspective, CICI acknowledges contextual dynamics and distinguishes between context and setting (the implementation’s physical location). Results BANANA entails six components: (1) choose a theory, model, or framework (TMF) to guide the contextual analysis; (2) use empirical evidence derived from primary and/or secondary data to identify relevant contextual factors; (3) involve stakeholders throughout contextual analysis; (4) choose a study design to assess context; (5) determine contextual factors’ relevance to implementation strategies/outcomes and intervention co-design; and (6) report findings of contextual analysis following appropriate reporting guidelines. Partly run simultaneously, the first three components form a basis both for the identification of relevant contextual factors and for the next components of the BANANA approach. Discussion Understanding of context is indispensable for a successful implementation science project. BANANA provides much-needed methodological guidance for contextual analysis. In subsequent phases, it helps researchers apply the results to intervention development/adaption and choices of contextually tailored implementation strategies. For future implementation science projects, BANANA’s principles will guide researchers first to gather relevant information on their target context, then to inform all subsequent phases of their implementation science project to strengthen every part of their work and fulfill their implementation goals.

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Section: Discussionmentioning

confidence: 99%

Section: Component 4: Study Design For Contextual Analysismentioning

confidence: 99%

Unraveling implementation context: the Basel Approach for coNtextual ANAlysis (BANANA) in implementation science and its application in the SMILe project

Mielke

Leppla

Valenta

et al. 2022

Implement Sci Commun

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“…6,7 Building an understanding of what is needed to support quality improvement and achievement of a high-performing primary healthcare system is critical in the current environment. 6,8 Literature highlights the impact of context on QI outcomes, [9][10][11] but the relationships between the context, QI intervention (QII) and implementation process have not been established. 10,12 Research into factors influencing QI success has predominantly occurred in secondary care settings.…”

Section: Introductionmentioning

confidence: 99%

“…18 Pfadenhauer defines context as 'comprising not only the setting but also roles, interactions and relationships', 19 supporting thinking that the people-related factors of QI, such as teamwork, leadership, and culture, are critical contextual factors. 9,16 Fig. 1 provides a high-level view of current research into understanding factors and their relationships influencing primary care QI.…”

Section: Introductionmentioning

confidence: 99%

Developing a model for primary care quality improvement success: a comparative case study in rural, urban and Kaupapa Māori organisations

Cullen,

Childerhouse,

Jayamaha

et al. 2023

J. Prim. Health Care

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Introduction Primary care is under pressure to achieve accessible, equitable, quality health care, while being increasingly under resourced. There is a need to understand factors that influence quality improvement (QI) to support a high-performing primary care system. Literature highlights the impact of context on QI but there is little primary care research on this topic. Aim This qualitative case study research seeks to discover the contextual factors influencing QI in primary care, and how the relationships between contextual factors, the QI initiative, and the implementation process influence outcomes. Methods The Consolidated Framework for Implementation Research was used to frame this qualitative study exploring primary care experiences in depth. Six sites were selected to provide a sample of rural, urban and Kaupapa Māori settings. Qualitative data was collected via semi-structured interviews and compared and contrasted with the organisational documents and data provided by participants. Results Cases reported success in achieving improved outcomes for patients, practices, and staff. Strong internal cultures of ‘Clan’ and ‘Adhocracy’ typologies supported teamwork, distributed leadership, and a learning climate to facilitate iterative sensemaking activities. To varying degrees, external network relationships provided resources, knowledge, and support. Discussion Organisations were motivated by a combination of patient/community need and organisational culture. Network relationships assisted to varying degrees depending on need. Engaged and distributed leadership based on teamwork was observed, where leadership was shared and emerged at different levels and times as the need arose. A learning climate was supported to enable iterative sensemaking activities to achieve success.

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“…The objective is to assess the impact of this program in reducing infections and other complications for women undergoing CS and other obstetric and gynecologic operations. We seek to understand the qualities, characteristics, and resources needed to implement the program, the magnitude of the effect on process compliance and resultant outcomes of care, and the effect the specific activities of process improvement have on compliance with critical standards of perioperative infection prevention and control [13].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an adaptive, multimodal intervention to reduce postoperative infections following cesarean delivery in Ethiopia: study protocol of the CLEAN-CS cluster-randomized stepped wedge interventional trial

Mammo

Feyssa

Haile³

et al. 2022

Trials

Self Cite

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Background We previously developed and pilot tested Clean Cut, a program to prevent postoperative infections by improving compliance with the WHO Surgical Safety Checklist (SSC) and strengthening adherence to infection control practices. This protocol describes the CheckList Expansion for Antisepsis and iNfection Control in Cesarean Section (CLEAN–CS) trial evaluating our program’s ability to reduce infections following CS and other obstetric and gynecological operations in Ethiopia. Methods/design CLEAN-CS is a cluster-randomized stepped wedge interventional trial with five clusters (two hospitals per cluster). It aims to assess the impact of Clean Cut on six critical perioperative infection prevention standards including antiseptic practices, antibiotic administration, and routine SCC use. The trial involves baseline data collection followed by Clean Cut training and implementation in each cluster in randomized order. The intervention consists of (1) modifying and implementing the SSC to fit local practices, (2) process mapping each standard, (3) coupling data and processes with site-specific action plans for improvement, and (4) targeted training focused on process gaps. The primary outcome is 30-day CS infection rates; secondary outcomes include other patient-level complications and compliance with standards. Assuming baseline SSI incidence of 12%, an effect size of 25% absolute reduction, and the ability to recruit 80–90 patients per cluster per month, we require a sample of 8100 patients for significance. We will report our study according to CONSORT. Discussion A cluster-randomized stepped wedge design is well-suited for evaluating this type of surgical safety program. The targeted standards are not in doubt, yet compliance is frequently difficult. Solutions are available and may be recognized by individuals, but teams dedicated to improvement are often lacking. Clean Cut was successfully piloted but requires a more rigorous methodological assessment. We seek to understand the qualities, characteristics, and resources needed to implement the program, the magnitude of effect on processes and outcomes, and to what degree it can enhance compliance with care standards. Challenges include a fraught social and political environment, pandemic travel restrictions, and a limited budget. Trial registration ClinicalTrials.gov NCT04812522 (registered on March 23, 2021); Pan-African Clinical Trials Registry PACTR202108717887402 (registered on August 24, 2021).

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Context Matters—But What Aspects? The Need for Evidence on Essential Aspects of Context to Better Inform Implementation of Quality Improvement Initiatives

Cited by 3 publications

References 39 publications

Unraveling implementation context: the Basel Approach for coNtextual ANAlysis (BANANA) in implementation science and its application in the SMILe project

Unraveling implementation context: the Basel Approach for coNtextual ANAlysis (BANANA) in implementation science and its application in the SMILe project

Developing a model for primary care quality improvement success: a comparative case study in rural, urban and Kaupapa Māori organisations

Evaluation of an adaptive, multimodal intervention to reduce postoperative infections following cesarean delivery in Ethiopia: study protocol of the CLEAN-CS cluster-randomized stepped wedge interventional trial

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