Reliable effectiveness: a theory on sustaining and replicating worthwhile innovations.
ABSTRACT While many health and human service innovations are sustained and replicated, it has been a puzzle how to sustain and replicate the performance of the better ones. What knowledge, skills, and conditions are required to reproduce across space and time the effectiveness of those innovations that are the most worthwhile? An extensive body of literature and experience is reviewed to suggest a comprehensive conceptual framework of programmatic, organizational, and environmental factors that may shape the circumstances for sustaining and replicating effectiveness.
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ABSTRACT: Application of Sustainability Principles to the Healthcare System The definition of sustainability appeared in 2006 at the UK Journal Nutrition Practitioner: "A complex system of interacting approaches to the restoration, management and optimization of human health that has an ecological base, that is environmentally, economically and socially viable indefinitely, that functions harmoniously both with the human body and the non-human environment, and which does not result in unfair or disproportionate impacts on any significant contributory element of the healthcare system." Generally, definitions of sustainability refer to those approaches that provide the best outcomes for both the human and natural environments, both now, and in the indefinite future. Sustainability is a robust concept that has proven its worth across a range of different industries including energy, agriculture, forestry and even construction and tourism. Contemporary healthcare in western countries is presently dominated by use of pharmaceutical drugs—and most indicators would suggest that these approaches have had very limited value in dealing with some of the greatest scourges facing human health, including chronic diseases, psychiatric diseases and even certain infectious diseases. The term should apply also to the conduct of medical practices, which should emphasize preventative healthcare in order to reduce the future burden on the healthcare sector, particularly by largely or partially preventable, chronic diseases such as heart disease, cancer, obesity, diabetes and osteoporosis, which currently represent the greatest burden.03/2013, Degree: Maters of Science in Health Administration (MHA), Supervisor: Prof. E Barsoum
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ABSTRACT: Background: Implementation science and knowledge translation have developed across multiple disciplines with the common aim of bringing innovations to practice. Numerous implementation frameworks, models, and theories have been developed to target a diverse array of innovations. As such, it is plausible that not all frameworks include the full range of concepts now thought to be involved in implementation. Users face the decision of selecting a single or combining multiple implementation frameworks. To aid this decision, the aim of this review was to assess the comprehensiveness of existing frameworks. Methods: A systematic search was undertaken in PubMed to identify implementation frameworks of innovations in healthcare published from 2004 to May 2013. Additionally, titles and abstracts from Implementation Science journal and references from identified papers were reviewed. The orientation, type, and presence of stages and domains, along with the degree of inclusion and depth of analysis of factors, strategies, and evaluations of implementation of included frameworks were analysed. Results: Frameworks were assessed individually and grouped according to their targeted innovation. Frameworks for particular innovations had similar settings, end-users, and ‘type’ (descriptive, prescriptive, explanatory, or predictive). On the whole, frameworks were descriptive and explanatory more often than prescriptive and predictive. A small number of the reviewed frameworks covered an implementation concept(s) in detail, however, overall, there was limited degree and depth of analysis of implementation concepts. The core implementation concepts across the frameworks were collated to form a Generic Implementation Framework, which includes the process of implementation (often portrayed as a series of stages and/or steps), the innovation to be implemented, the context in which the implementation is to occur (divided into a range of domains), and influencing factors, strategies, and evaluations. Conclusions: The selection of implementation framework(s) should be based not solely on the healthcare innovation to be implemented, but include other aspects of the framework’s orientation, e.g., the setting and end-user, as well as the degree of inclusion and depth of analysis of the implementation concepts. The resulting generic structure provides researchers, policy-makers, health administrators, and practitioners a base that can be used as guidance for their implementation efforts.Health Research Policy and Systems 03/2015; 13(16). DOI:10.1186/s12961-015-0005-z · 1.86 Impact Factor