From research to practice: Factors affecting implementation of prospective targeted injury-detection systems

RTI International, Research Triangle Park, NC 27709-2194, USA.
BMJ quality & safety (Impact Factor: 3.99). 02/2011; 20(6):527-33. DOI: 10.1136/bmjqs.2010.045039
Source: PubMed


AIM This paper describes key factors that shaped implementation of prospective targeted injury-detection systems (TIDS) for adverse drug events (ADEs) and nosocomial pressure ulcers (PrU). METHODS Using case-study methodology, the authors conducted semistructured interviews with implementation champions and TIDS users at five hospitals. Interviews focused on implementation experiences, assessment of TIDS' effectiveness and utility, and plans for sustainability. The authors used content analysis techniques to compare implementation experiences within and across organisations and triangulated data for explanation and confirmation of common themes. FINDINGS Participating hospitals were more successful in implementing the low-complexity PrU-TIDS, as compared with high-complexity ADE-TIDS. This pattern reflected the greater complexity of ADE-TIDS, its higher costs and poorer alignment with existing workflows. Complexity affected the innovations' perceived usability, the time needed to learn and install the trigger systems, and their costs. Local factors affecting implementation and sustainability of both innovations included turnover affecting champions and other staff, shifting organisational priorities, changing information infrastructures, and institutional constraints on adapting existing IT to the electronic TIDS. CONCLUSIONS To facilitate implementation of complex healthcare innovations such as ADE-TIDS, staff in adopting organisations should give high priority to innovation implementation; allocate sufficient resources; effectively communicate with and involve local champions and users; and align innovations with workflows and information systems. In addition, they should monitor local factors, such as changes in organisational priorities and IT, availability of implementation staff and champions, and external regulations and constraints that may pose barriers to innovation implementation and sustainability.

9 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: /st>Getting greater levels of evidence into practice is a key problem for health systems, compounded by the volume of research produced. Implementation science aims to improve the adoption and spread of research evidence. A linked problem is how to enhance quality of care and patient safety based on evidence when care settings are complex adaptive systems. Our research question was: according to the implementation science literature, which common implementation factors are associated with improving the quality and safety of care for patients? /st>We conducted a targeted search of key journals to examine implementation science in the quality and safety domain applying PRISMA procedures. Fifty-seven out of 466 references retrieved were considered relevant following the application of exclusion criteria. Included articles were subjected to content analysis. Three reviewers extracted and documented key characteristics of the papers. Grounded theory was used to distil key features of the literature to derive emergent success factors. /st>Eight success factors of implementation emerged: preparing for change, capacity for implementation-people, capacity for implementation-setting, types of implementation, resources, leverage, desirable implementation enabling features, and sustainability. Obstacles in implementation are the mirror image of these: for example, when people fail to prepare, have insufficient capacity for implementation or when the setting is resistant to change, then care quality is at risk, and patient safety can be compromised. /st>This review of key studies in the quality and safety literature discusses the current state-of-play of implementation science applied to these domains.
    International Journal for Quality in Health Care 05/2014; 26(2). DOI:10.1093/intqhc/mzu047 · 1.76 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To determine the feasibility of implementing a clinical observation method for adverse event detection. Methods: Prospective adverse event surveillance was conducted from February to April 2012. We implemented this adverse event prospective surveillance system on the general internal medicine units of five sites within two teaching institutions and one community hospital. Following surveillance, we assembled provider and decision-maker focus groups to understand the barriers and success factors related to our implementation. We used a structured interview guide with facilitated discussion. Results: We performed six focus group interviews in June and July 2012. In total, 31 individual participated including senior executives (15), managers (7) and care providers (9). We identified the following success factors: the overall design of the system including the clinical observer and clinical reviewer functions; the credibility of the data and the opportunity to make changes to practice in 'real-time'. We identified the following opportunities for improvement: the need for clear guidelines on the type of information to collect for each event trigger, and for an action plan to ensure accountability and follow through on improvement efforts once the adverse event data have been analyzed. Conclusions: This work supports a conclusion that prospective surveillance is viewed as beneficial and acceptable. For this reason, healthcare organizations should consider adopting prospective adverse event surveillance to support their local quality improvement methods. © The Author 2014. Published byOxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
    International Journal for Quality in Health Care 05/2014; 26(4). DOI:10.1093/intqhc/mzu052 · 1.76 Impact Factor