Innovation as Discipline, Not Fad

Asch, David A.; Rosin, Roy

doi:10.1056/nejmp1506311

Cited by 62 publications

(45 citation statements)

References 1 publication

(1 reference statement)

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“…4 For example, to test a texting-based intervention to remind parents or children to take their medication, exercise, or diet change, a pediatrician or other office staff member can text a small number of patients to see if and how it works, make any needed changes, then go on to a scaled up automated system avoiding much time and money if it does not work. 5 …”

Section: Two-generation Approach To Care: a New Frame And Design Chalmentioning

confidence: 99%

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Two-Generation Pediatric Care: A Modest Proposal

Zuckerman

2016

Pediatrics

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To reduce inequities in child health, we need to reduce the gap between what we know and what we do. We must challenge our practices and traditions, develop new solutions and have the strength and courage to change how we practice. Based on my experience that the best way to help children is to help their parents, and the best way to reach parents is through their children, I propose a new frame of a 2-generation approach that focuses not only on the child but also on the parents and their relationship to guide our innovation and target improvements. Pediatricians' knowledge and empathy for families is a special base to use new strategies to test ideas on a small number of families with minimal time and cost. Examples from our work includes the following: (1) identify and refer parents with mental health conditions and lack of effective contraception, (2) develop more effective approaches to explain illness and disease to parents, and (3) educate parents about the impact of social relations from infancy on; love can amplify and stress can impair brain and child development. I encourage clinicians to think about what should be changed and more importantly to be excited and brave enough to take the first steps to design and test an idea.

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Section: Two-generation Approach To Care: a New Frame And Design Chalmentioning

confidence: 99%

“…Clinicians have special knowledge of and natural empathy for families in their practices and are in an ideal position to develop and test new ideas. 4,5 I propose a new frame to guide innovations and target improvements: a 2-generation approach that focuses not only on the child but also on parents and on their relationship.…”

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confidence: 99%

Two-Generation Pediatric Care: A Modest Proposal

Zuckerman

2016

Pediatrics

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“…There are many models for delivering innovation, but, particularly in response to the drive for person-centred approaches (Berwick 2013), the approach offered by design is gathering support (Asch and Rosin 2015) whilst more evidence around participatory designs' ability to promote person-centred behaviour (Wolstenholme et al 2016) is reported.…”

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confidence: 99%

A co-design approach to service improvement resulted in teams exhibiting characteristics that support innovation

2017

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This paper analyzes a subset of data from a project that sought to transfer knowledge and skills around design led approaches for service improvement to teams working in Health and Social Care in the United Kingdom. Through this analysis the authors sought to understand the range of responses that individual participants had to undertaking service improvement work in a design led project. This was a qualitative study using interviews to gain reflections from participants. These interview transcripts were analyzed using framework analysis. Participants were recruited from three disparate organizations, a public health team of a local authority, a mental health charity and a UK National Health Service mental health initiative. Six main themes were identified, namely; design practice, collaborative working, creating an environment for innovation, team skills and attitudes and transfer of knowledge. The findings suggest that the design approach can contribute to a range of factors that have been identified as valuable for innovative teams. The paper adds to the evidence base and supports further exploration of the use of design in Service improvement and wider innovation endeavours.

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“…Future development of AT programmes should fully and effectively involve these and other stakeholder groups, such as charities. Time prohibited iterative testing and adjustment before the pilot 224,225 may have improved the intervention. The study team made it insufficiently clear to physiotherapists that they should generate a focused and achievable prescription to guide intervention sessions, leading to suboptimal prescriptions in five boys.…”

Section: Development and Implementation Of The Interventionmentioning

confidence: 99%

“…The resulting intervention should be subject to evaluation through a series of iterative mini pilots. [223][224][225] 3. Recruitment to large-scale evaluations of AT is hindered by a small, diffuse population of boys with DMD, an absence of parental equipoise and a prohibition on co-enrolment to randomised studies.…”

Section: Costs Borne By Patientsmentioning

confidence: 99%

Aquatic therapy for children with Duchenne muscular dystrophy: a pilot feasibility randomised controlled trial and mixed-methods process evaluation

Hind

Parkin

Whitworth

et al. 2017

Health Technol Assess

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BackgroundDuchenne muscular dystrophy (DMD) is a rare disease that causes the progressive loss of motor abilities such as walking. Standard treatment includes physiotherapy. No trial has evaluated whether or not adding aquatic therapy (AT) to land-based therapy (LBT) exercises helps to keep muscles strong and children independent.ObjectivesTo assess the feasibility of recruiting boys with DMD to a randomised trial evaluating AT (primary objective) and to collect data from them; to assess how, and how well, the intervention and trial procedures work.DesignParallel-group, single-blind, randomised pilot trial with nested qualitative research.SettingSix paediatric neuromuscular units.ParticipantsChildren with DMD aged 7–16 years, established on corticosteroids, with a North Star Ambulatory Assessment (NSAA) score of 8–34 and able to complete a 10-m walk without aids/assistance. Exclusions: > 20% variation between baseline screens 4 weeks apart and contraindications.InterventionsParticipants were allocated on a 1 : 1 ratio to (1) optimised, manualised LBT (prescribed by specialist neuromuscular physiotherapists) or (2) the same plus manualised AT (30 minutes, twice weekly for 6 months: active assisted and/or passive stretching regime; simulated or real functional activities; submaximal exercise). Semistructured interviews with participants, parents (n = 8) and professionals (n = 8) were analysed using Framework analysis. An independent rater reviewed patient records to determine the extent to which treatment was optimised. A cost-impact analysis was performed. Quantitative and qualitative data were mixed using a triangulation exercise.Main outcome measuresFeasibility of recruiting 40 participants in 6 months, participant and therapist views on the acceptability of the intervention and research protocols, clinical outcomes including NSAA, independent assessment of treatment optimisation and intervention costs.ResultsOver 6 months, 348 children were screened – most lived too far from centres or were enrolled in other trials. Twelve (30% of target) were randomised to AT (n = 8) or control (n = 4). People in the AT (n = 8) and control (n = 2: attrition because of parental report) arms contributed outcome data. The mean change in NSAA score at 6 months was –5.5 [standard deviation (SD) 7.8] for LBT and –2.8 (SD 4.1) in the AT arm. One boy suffered pain and fatigue after AT, which resolved the same day. Physiotherapists and parents valued AT and believed that it should be delivered in community settings. The independent rater considered AT optimised for three out of eight children, with other children given programmes that were too extensive and insufficiently focused. The estimated NHS costs of 6-month service were between £1970 and £2734 per patient.LimitationsThe focus on delivery in hospitals limits generalisability.ConclusionsNeither a full-scale frequentist randomised controlled trial (RCT) recruiting in the UK alone nor a twice-weekly open-ended AT course delivered at tertiary centres is feasible. Further intervention development research is needed to identify how community-based pools can be accessed, and how families can link with each other and community physiotherapists to access tailored AT programmes guided by highly specialised physiotherapists. Bayesian RCTs may be feasible; otherwise, time series designs are recommended.Trial registrationCurrent Controlled Trials ISRCTN41002956.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 27. See the NIHR Journals Library website for further project information.

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Innovation as Discipline, Not Fad

Cited by 62 publications

References 1 publication

Two-Generation Pediatric Care: A Modest Proposal

Two-Generation Pediatric Care: A Modest Proposal

A co-design approach to service improvement resulted in teams exhibiting characteristics that support innovation

Aquatic therapy for children with Duchenne muscular dystrophy: a pilot feasibility randomised controlled trial and mixed-methods process evaluation

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