Self-Organization of Interprofessional Staff to Improve Mobility of Hospitalized Patients with STRIDE: a Complexity Science-Informed Qualitative Study

Bruening, Rebecca; Sperber, Nina; Wang, Virginia; Mahanna, Elizabeth; Choate, Ashley; Tucker, Matthew; Zullig, Leah L.; Houtven, Courtney Harold Van; Allen, Kelli D.; Hastings, S. Nicole

doi:10.1007/s11606-022-07482-9

Cited by 3 publications

(5 citation statements)

References 29 publications

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“…Self-organisation of individual staff is seen as one of the key features explaining why evidence is not implemented in practice, as well as leading to differences in implementation both within and across settings. 16 Ludlow et al 26 conducted a study on how staff prioritise their work in residential aged care. Their study showed that tasks deemed outside of the scope of the staff roles were given a lower priority.…”

Section: Discussionmentioning

confidence: 99%

“…This means that including new tasks and non-routine tasks such as research, can be challenging. 16 Complexity science suggests that even when agreements on data collection or interventions are reached, research may not be implemented correctly even within a single location; for example, across different dining rooms. 14 Research utilising a complexity-informed approach to implementation is required for systems change within residential aged care.…”

Section: Discussionmentioning

confidence: 99%

“…15 A deductive theoretical approach was used based on the researchers' initial ideas on the challenges through a complexity science lens and was researcherdriven. [13][14][15][16] This was followed by an inductive approach where the data were coded without trying to fit within the existing coding framework and was data-driven. 15 This methodology required the lead researchers to read and re-read the transcribed data to further develop initial ideas, determine new ideas, and then code and develop these into themes.…”

Section: Discussionmentioning

confidence: 99%

“…There is a clear need for staff to self‐organise for evidence to be implemented into practice or to implement practice changes. This means that including new tasks and non‐routine tasks such as research, can be challenging 16 …”

Section: Discussionmentioning

confidence: 99%

“…A deductive theoretical approach was used based on the researchers’ initial ideas on the challenges through a complexity science lens and was researcher‐driven 13–16 . This was followed by an inductive approach where the data were coded without trying to fit within the existing coding framework and was data‐driven 15 .…”

Section: Methodsmentioning

confidence: 99%

See 4 more Smart Citations

The challenges facing residential aged care homes to participate in quality food and nutrition research

Cave

Abbey

Capra

2023

J Human Nutrition Diet

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Background There is a clear need for food and nutrition research to lead to pragmatic and sustainable solutions to the ongoing problems in residential aged care, particularly within foodservices. The present study aimed to identify systemic challenges for residential aged care homes in Australia to participate in quality food and nutrition research, using a complexity science lens. Methods Qualitative data from three studies in residential aged care were gathered, which included 28 participants across 21 aged care homes. Qualitative data consisted of in‐depth interviews, field notes and email communications with aged care staff. Thematic analysis was undertaken using both inductive and deductive approaches. Results Four themes were identified: (1) complex staffing issues deter or impede participation in research; (2) external pressure on the aged care system leads to research not being a priority; (3) funding issues are variable and pose a barrier for some aged care homes; and (4) research processes and requirements can lead to biased samples. Conclusions Several challenges to undertaking quality empirical research in residential aged care in Australia were identified. Research needs to be part of usual business, similar to hospitals, and operate independently of staffing and funding issues. Issues within foodservices are system issues and there is a need for quality empirical research to determine solutions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The challenges facing residential aged care homes to participate in quality food and nutrition research

Cave

Abbey

Capra

2023

J Human Nutrition Diet

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Enhancing team communication to improve implementation of a supervised walking program for hospitalized veterans: Evidence from a multi‐site trial in the Veterans Health Administration

Drake,

Wang,

Stechuchak

et al. 2024

PM&R

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IntroductionThe timely translation of evidence‐based programs into real‐world clinical settings is a persistent challenge due to complexities related to organizational context and team function, particularly in inpatient settings. Strategies are needed to promote quality improvement efforts and implementation of new clinical programs.ObjectiveThis study examines the role of CONNECT, a complexity science‐based implementation intervention to promote team readiness, for enhancing implementation of the ‘Assisted Early Mobility for Hospitalized Older Veterans’ program (STRIDE), an inpatient, supervised walking program.DesignWe conducted a stepped‐wedge cluster randomized trial using a convergent mixed‐methods design. Within each randomly assigned stepped‐wedge sequence, Veterans Affairs Medical Centers (VAMCs) were randomized to receive standardized implementation support only or additional training via the CONNECT intervention. Data for the study were obtained from hospital administrative and electronic health records, surveys, and semi‐structured interviews with clinicians before and after implementation of STRIDE.SettingEight U.S. VAMCs.ParticipantsThree hundred fifty‐three survey participants before STRIDE implementation and 294 surveys after STRIDE implementation. Ninety‐two interview participants.InterventionCONNECT, a complexity‐science–based intervention to improve team function.Main Outcome MeasuresThe implementation outcomes included STRIDE reach and fidelity. Secondary outcomes included validated measures of team function (i.e., team communication, coordination, role clarity).ResultsAt four VAMCs randomized to CONNECT, reach was higher (mean 12.4% vs. 3.8%), and fidelity was similar to four non‐CONNECT VAMCs. VAMC STRIDE delivery teams receiving CONNECT reported improvements in team function domains, similar to non‐CONNECT VAMCs. Qualitative findings highlight CONNECT's impact and the influence of team characteristics and contextual factors, including team cohesion, leadership support, and role clarity, on reach and fidelity.ConclusionCONNECT may promote greater reach of STRIDE, but improvement in team function among CONNECT VAMCs was similar to improvement among non‐CONNECT VAMCs. Qualitative findings suggest that CONNECT may improve team function and implementation outcomes but may not be sufficient to overcome structural barriers related to implementation capacity.

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The STRIDE Program: Getting Hospitalized Veterans Back on Their Feet

Hastings,

Choate,

Kappler

et al. 2024

Geriatrics Models of Care

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Self-Organization of Interprofessional Staff to Improve Mobility of Hospitalized Patients with STRIDE: a Complexity Science-Informed Qualitative Study

Cited by 3 publications

References 29 publications

The challenges facing residential aged care homes to participate in quality food and nutrition research

The challenges facing residential aged care homes to participate in quality food and nutrition research

Enhancing team communication to improve implementation of a supervised walking program for hospitalized veterans: Evidence from a multi‐site trial in the Veterans Health Administration

The STRIDE Program: Getting Hospitalized Veterans Back on Their Feet

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