Background: In implementation science, vast gaps exist between theoretical and practical knowledge. These gaps prevail in the process of getting from problem analysis to selecting implementation strategies while engaging stakeholders including care users. Objective: To describe a process of how to get from problem analysis to strategy selection, how to engage stakeholders, and to provide insights into stakeholders’ experiences. Design: A qualitative descriptive design. Setting and participants: The setting was a care organization providing long-term care to people with acquired brain injuries who are communication vulnerable. Fourteen stakeholders (care users, professionals and researchers) participated. Data were collected by a document review, five interviews and one focus group. Inductive content analysis and deductive framework analysis were applied. Intervention: Stakeholder engagement. Main outcome measures: A three-step process model and stakeholders experiences. Results and conclusion: We formulated a three-step process: (a) reaching consensus and prioritizing barriers; (b) categorizing the prioritized barriers and idealization; and (c) composing strategies. Two subthemes continuously played a role in how stakeholders were engaged during the process: communication supportive strategies and continuous contact. The experiences of stakeholder participation resulted in the following themes: stakeholders and their roles, use of co-creation methods and communication supportive strategies, building relationships, stimulus of stakeholders to engage, sharing power, empowerment of stakeholders, feeling a shared responsibility and learning from one another. We conclude that the inclusion of communicationvulnerable care users is possible if meetings are prepared, communication-friendly presentations and reports are used, and relationship building is prioritized.
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Over the past few years, there has been an explosion of data science as a profession and an academic field. The increasing impact and societal relevance of data science is accompanied by important questions that reflect this development: how can data science become more responsible and accountable while also responding to key challenges such as bias, fairness, and transparency in a rigorous and systematic manner? This Patterns special collection has brought together research and perspective from academia, the public and the private sector, showcasing original research articles and perspectives pertaining to responsible and accountable data science.
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Abstract Despite the numerous business benefits of data science, the number of data science models in production is limited. Data science model deployment presents many challenges and many organisations have little model deployment knowledge. This research studied five model deployments in a Dutch government organisation. The study revealed that as a result of model deployment a data science subprocess is added into the target business process, the model itself can be adapted, model maintenance is incorporated in the model development process and a feedback loop is established between the target business process and the model development process. These model deployment effects and the related deployment challenges are different in strategic and operational target business processes. Based on these findings, guidelines are formulated which can form a basis for future principles how to successfully deploy data science models. Organisations can use these guidelines as suggestions to solve their own model deployment challenges.
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Background: Although principles of the health promoting school (HPS) approach are followed worldwide, differences between countries in the implementation are reported. The aim of the current study was (1) to examine the implementation of the HPS approach in European countries in terms of different implementation indicators, that is, percentage of schools implementing the HPS approach, implementation of core components, and positioning on so‐called HPS‐related spectra, (2) to explore patterns of consistency between the implementation indicators across countries, and (3) to examine perceived barriers and facilitators to the implementation of the HPS approach across countries. Methods: This study analyzed data from a survey that was part of the Schools for Health in Europe network's Monitoring Task 2020. The survey was completed by HPS representatives of 24 network member countries. Results: Large variations exist in (the influencing factors for) the implementation of the HPS approach in European countries. Observed patterns show that countries with higher percentages of schools implementing the HPS approach also score higher on the implementation of the core components and, in terms of spectra, more toward implementing multiple HPS core components, add‐in strategies, action‐oriented research and national‐level driven dissemination. In each country a unique mix of barriers and facilitators was observed. Conclusion: Countries committed to implementing the HPS approach in as many schools as possible also seem to pay attention to the quality of implementation. For a complete and accurate measurement of implementation, the use of multiple implementation indicators is desirable.
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From the article This paper describes a joint effort by two educational and scientific institutes, the HU University of Applied Sciences and Utrecht University, in designing a BPM course that not only transfers theoretical knowledge but lets students also experience real life BPM-systems and implementation issues. We also describe the implementation of the developed module with an indication of its success: it is now running for the fifth time, and although there continue to be points for improvement, over the years several scientific papers in the BPM domain resulted from the course, as well as a reasonable amount of students started their final thesis project in the BPM-domain.
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Background: In recent years, the effectiveness and cost-effectiveness of digital health services for people with musculoskeletal conditions have increasingly been studied and show potential. Despite the potential of digital health services, their use in primary care is lagging. A thorough implementation is needed, including the development of implementation strategies that potentially improve the use of digital health services in primary care. The first step in designing implementation strategies that fit the local context is to gain insight into determinants that influence implementation for patients and health care professionals. Until now, no systematic overview has existed of barriers and facilitators influencing the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. Objective: This systematic literature review aims to identify barriers and facilitators to the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. Methods: PubMed, Embase, and CINAHL were searched for eligible qualitative and mixed methods studies up to March 2024. Methodological quality of the qualitative component of the included studies was assessed with the Mixed Methods Appraisal Tool. A framework synthesis of barriers and facilitators to implementation was conducted using the Consolidated Framework for Implementation Research (CFIR). All identified CFIR constructs were given a reliability rating (high, medium, or low) to assess the consistency of reporting across each construct. Results: Overall, 35 studies were included in the qualitative synthesis. Methodological quality was high in 34 studies and medium in 1 study. Barriers (–) of and facilitators (+) to implementation were identified in all 5 CFIR domains: “digital health characteristics” (ie, commercial neutral [+], privacy and safety [–], specificity [+], and good usability [+]), “outer setting” (ie, acceptance by stakeholders [+], lack of health care guidelines [–], and external financial incentives [–]), “inner setting” (ie, change of treatment routines [+ and –], information incongruence (–), and support from colleagues [+]), “characteristics of the healthcare professionals” (ie, health care professionals’ acceptance [+ and –] and job satisfaction [+ and –]), and the “implementation process” (involvement [+] and justification and delegation [–]). All identified constructs and subconstructs of the CFIR had a high reliability rating. Some identified determinants that influence implementation may be facilitators in certain cases, whereas in others, they may be barriers. Conclusions: Barriers and facilitators were identified across all 5 CFIR domains, suggesting that the implementation process can be complex and requires implementation strategies across all CFIR domains. Stakeholders, including digital health intervention developers, health care professionals, health care organizations, health policy makers, health care funders, and researchers, can consider the identified barriers and facilitators to design tailored implementation strategies after prioritization has been carried out in their local context
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Aims and objectives: To describe the process of implementing evidence-based practice (EBP) in a clinical nursing setting. Background: EBP has become a major issue in nursing, it is insufficiently integrated in daily practice and its implementation is complex. Design: Participatory action research. Method: The main participants were nurses working in a lung unit of a rural hospital. A multi-method process of data collection was used during the observing, reflecting, planning and acting phases. Data were continuously gathered during a 24-month period from 2010 to 2012, and analysed using an interpretive constant comparative approach. Patients were consulted to incorporate their perspective. Results: A best-practice mode of working was prevalent on the ward. The main barriers to the implementation of EBP were that nurses had little knowledge of EBP and a rather negative attitude towards it, and that their English reading proficiency was poor. The main facilitators were that nurses wanted to deliver high-quality care and were enthusiastic and open to innovation. Implementation strategies included a tailored interactive outreach training and the development and implementation of an evidence-based discharge protocol. The academic model of EBP was adapted. Nurses worked according to the EBP discharge protocol but barely recorded their activities. Nurses favourably evaluated the participatory action research process. Conclusions: Action research provides an opportunity to empower nurses and to tailor EBP to the practice context. Applying and implementing EBP is difficult for front-line nurses with limited EBP competencies. Relevance to clinical practice: Adaptation of the academic model of EBP to a more pragmatic approach seems necessary to introduce EBP into clinical practice. The use of scientific evidence can be facilitated by using pre-appraised evidence. For clinical practice, it seems relevant to integrate scientific evidence with clinical expertise and patient values in nurses’ clinical decision making at the individual patient level.
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Background Literature on self-management innovations has studied their characteristics and position in healthcare systems. However, less attention has been paid to factors that contribute to successful implementation. This paper aims to answer the question: which factors play a role in a successful implementation of self-management health innovations? Methods We conducted a narrative review of academic literature to explore factors related to successful implementation of self-management health innovations. We further investigated the factors in a qualitative multiple case study to analyse their role in implementation success. Data were collected from nine self-management health projects in the Netherlands. Results Nine factors were found in the literature that foster the implementation of self-management health innovations: 1) involvement of end-users, 2) involvement of local and business partners, 3) involvement of stakeholders within the larger system, 4) tailoring of the innovation, 5) utilisation of multiple disciplines, 6) feedback on effectiveness, 7) availability of a feasible business model, 8) adaption to organisational changes, and 9) anticipation of changes required in the healthcare system. In the case studies, on average six of these factors could be identified. Three projects achieved a successful implementation of a self-management health innovation, but only in one case were all factors present. Conclusions For successful implementation of self-management health innovation projects, the factors identified in the literature are neither necessary nor sufficient. Therefore, it might be insightful to study how successful implementation works instead of solely focusing on the factors that could be helpful in this process.
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REducing Delay through edUcation on eXacerbations (REDUX) shows promise in reducing exacerbation recognition and action delays for chronic lung diseases in the Netherlands. However, factors influencing its successful implementation in China remain unclear. To identify the perceived factors influencing nurse-led self-management implementation of REDUX in China, stakeholder analysis using qualitative and quantitative approaches was conducted. A qualitative approach assessed support for REDUX, perceived influencing factors, and referred intervention delivery mode among patients, healthcare professionals, and policymakers. A quantitative approach identified necessary conditions for developing and implementing a digital-version intervention, involving app developers and cyber-security officers. The study followed COREQ and stakeholder analysis guidelines. Thirty-five patients, healthcare professionals, and policymakers highly supported REDUX. Perceived influencing factors included facilitators (e.g., easy-to-use design, perceived benefits) and barriers (e.g., patients’ affordability, lack of policy support). Preferred intervention delivery modes varied among stakeholders. Eighty-seven app developers and cyber-security officers completed quantitative surveys. The quantitative data showed that the work process of developing the health apps and protecting the users’ security and privacy mostly aligned with the related international guideline recommendations. The study identified key interdependent factors that were perceived as crucial for REDUX implementation success. Healthcare policies should prioritize self-management intervention, and minor action plan adjustments are needed.
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In this study, a data feedback program to improve teachers’ science and technology (S&T) teaching skills was designed and tested. The aim was to understand whether and how the four design principles underlying this program stimulated the intended teacher support. We examined how teachers in different phases of their career applied and experienced the employed design principles’ key aspects. Eight in-service teachers and eight pre-service teachers attended the data feedback program and kept a logbook in the meantime. Group interviews were held afterwards. Findings show that applying the four employed design principles’ key aspects did support and stimulate in- and pre-service teachers in carrying out data feedback for improving their S&T teaching. However, some key aspects were not applied and/or experienced as intended by all attending teachers. The findings provide possible implications for the development and implementation of professional development programs to support in - and pre-service teachers’ S&T teaching using data feedback.
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