Figure 2 - uploaded by Alison Kitson
Content may be subject to copyright.
Source publication
Background:
Multi-faceted approaches are generally recognised as the most effective way to support the implementation of evidence into practice. Audit and feedback often constitute one element of a multi-faceted implementation package, alongside other strategies, such as interactive education and facilitated support mechanisms. This paper describe...
Contexts in source publication
Context 1
... many of the internal facilita- tors, this would be their first experience of audit. A timetable was subsequently agreed that would enable each of the four recommendations to have a baseline audit, followed by an implementation/action plan, a period of spread to the wider nursing home, and re-audit, within the overall timescale of the study (see Fig. ...
Context 2
... two of the facilitators expressed concerns and said they would prefer to start with an audit of recommendation 1 only. In order to maintain a uniform approach across all of the nursing homes, it was then agreed that all the facilitators should proceed in this way, thus applying a staged approach to both audit and implementa- tion (see Fig. 2b). However, an unintended consequence of this decision was that once homes starting looking at the audit of the first recommendation (screening for problems with continence), they immediately started to act on their audit findings and introduce more comprehensive screening and assessment methods. The impact of this was that it was ...
Similar publications
Abstract State and local governments, businesses, community organizations, and the general public are taking an increasingly significant role in climate impact assessment. Driven by impacts to constituents and customers and threats to human health, essential services, and property values, local organizations are on the front lines of responding to...
Citations
... Clinical audit, as a quality improvement approach, has been advocated for many years to identify gaps and improve healthcare quality in clinics [37]. The JBI approach to evidence implementation, which is firmly grounded in the audit, feedback, and re-audit process, is successful in small or large-scale evidence implementation projects to change practice in the clinic [38][39][40], with seven stages as follows: ...
... Each hospital required at least two core members to attend the training. The training included: a) an overview of EBP and the process of the project; b) introduction to the JBI PACES and GRiP audit and feedback tool [39,44]; c) audit methods: describing the results of each audit cycle, interpreting audit criteria of the project and audit compliance methods. ...
Background
Chemotherapy, whilst treating tumours, can also lead to numerous adverse reactions such as nausea and vomiting, fatigue and kidney toxicity, threatening the physical and mental health of patients. Simultaneously, misuse of chemotherapeutic drugs can seriously endanger patients' lives. Therefore, to maintain the safety of chemotherapy for cancer patients and to reduce the incidence of adverse reactions to chemotherapy, many guidelines state that a comprehensive assessment of the cancer patient should be conducted and documented before chemotherapy. This recommended procedure, however, has yet to be extensively embraced in Chinese hospitals. As such, this study aimed to standardise the content of pre-chemotherapy assessment for cancer patients in hospitals and to improve nurses' adherence to pre-chemotherapy assessment of cancer patients by conducting a national multi-site evidence implementation in China, hence protecting the safety of cancer patients undergoing chemotherapy and reducing the incidence of adverse reactions to chemotherapy in patients.
Methods
The national multi-site evidence implementation project was launched by a JBI Centre of Excellence in China and conducted using the JBI approach to evidence implementation. A pre- and post-audit approach was used to evaluate the effectiveness of the project. This project had seven phases: training, planning, baseline audit, evidence implementation, two rounds of follow-up audits (3 and 9 months after evidence implementation, respectively) and sustainability assessment. A live online broadcast allowed all participating hospitals to come together to provide a summary and feedback on the implementation of the project.
Results
Seventy-four hospitals from 32 cities in China participated in the project, four withdrew during the project's implementation, and 70 hospitals completed the project. The pre-and post-audit showed a significant improvement in the compliance rate of nurses performing pre-chemotherapy assessments for cancer patients. Patient satisfaction and chemotherapy safety were also improved through the project's implementation, and the participating nurses' enthusiasm and belief in implementing evidence into practice was increased.
Conclusion
The study demonstrated the feasibility of academic centres working with hospitals to promote the dissemination of evidence in clinical practice to accelerate knowledge translation. Further research is needed on the effectiveness of cross-regional and cross-organisational collaborations to facilitate evidence dissemination.
... Of the publications identified, 30 were included in the final analysis ( Figure 1). This included seven systematic reviews [28][29][30][31][32][33][34] , 15 randomisedcontrolled trials (RCTs) [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] , seven quasi-experimental studies [50][51][52][53][54][55][56] and one retrospective cohort study 57 . The majority of intervention studies were from Europe (n=10, 43.6%), while the remaining studies were from the US (n=7, 30.5%), ...
... Of the 30 included publications, six evaluated toileting assistance programs 29,31,32,42,46,55 , four addressed exercise programs 29,34,47,48 , three addressed drug therapies 29,33,57 , and two described a technologybased intervention 37,56 . A total of 11 publications described the effects of education programs for nursing home staff [38][39][40][41]44,45,49,[51][52][53][54] and six evaluated multicomponent interventions 29,28,35,36,43,50 . There was considerable heterogeneity with respect to the types of interventions, how they were delivered (ie, duration, intensity, components), and how outcomes were evaluated. ...
... Of the 11 publications that evaluated the effects of education programs for nursing home staff, seven were RCTS [38][39][40][41]44,45,49 and four were quasi-experimental studies [51][52][53][54] . The nature of the educational interventions and the outcomes of interest varied considerably. ...
... Unauthorized reproduction of this article is prohibited. 5 studies, 55,56 before and after studies, pragmatic evidence implementation designs, and quality improvement studies. 51 Although the use of theory has increased in evidence implementation (which we view as a positive), the danger is that some theories remain stagnant (or ossified) in their development and do not evolve as the results of empirical research prove, disprove, or add nuance to elements of pre-existing theories. ...
There are many theories, models, and frameworks that have been proposed in the field of implementation science. Despite this, many evidence implementation or practice improvement projects do not consider these theories, models, or frameworks in their improvement efforts. The JBI approach is one example of an implementation theory, model, or framework. This approach has been developed particularly with health care professionals in mind and is designed to clearly guide pragmatic evidence implementation efforts based on the best available evidence. In this paper, we discuss how the JBI approach to evidence implementation can interact with and support theory-informed, pragmatic evidence implementation projects.
... This function requires that there are the right resources and mobilization capacity to allocate and mobilize resources for long-, medium-, and short-term initiatives [9]. JBI provides JBIC members with free access to its large suite of evidence-based practice (EBP) content (systematic reviews, evidence summaries, and recommended practices) and systematic review and clinical audit software [24,25]. The EBP content and software ensure that its 3,000þ individual members can access high-quality evidence, appraise diverse types of evidence, and apply evidence at the point of care. ...
Evidence-based healthcare is a worldwide movement with hundreds of organisations and thousands of individuals working to ensure that healthcare practice, policy, and decision-making is informed by rigorous research evidence, to improve health outcomes. The success of this global agenda however depends on individuals and organisations working together within a functioning evidence ecosystem. Collaborative evidence networks are a key mechanism to facilitate the synthesis, transfer and implementation of evidence into healthcare policy and practice. Using the Network Functions Approach as a framework for review, this paper explores the strategic functions and form of the JBI Collaboration to illustrate the role of a collaborative evidence network in promoting and supporting evidence-based healthcare globally. It illustrates how the functions of a collaborative evidence network enable the development, exchange and dissemination of knowledge, the building of social capital, mobilization of resources and amplification and advocacy of members work and ideas, which increase the capacity and effectiveness of members in achieving their unified purpose. Effective and sustainable collaborative evidence networks have innovative ways of relating and mobilising energy for action; and combine formal and informal structures and relationships to successfully work together to address complex global health issues and drive the evidence-based healthcare agenda forward.
... Essas ações resultaram no aumento do nível de conhecimento do usuário sobre sua doença, comportamento preventivo, menos internações hospitalares e consultas de emergência e, consequentemente, menor custo para os serviços de saúde e suas famílias (9,13) . Em pacientes in-Harvey G et al, 2012 (15) ternados tais práticas repercutiram em menores taxas de complicações, menor tempo de internação, menos reinternações e melhor recuperação, em especial quando direcionadas para o autocuidado após a alta (11). Neste sentido, estudos internacionais vêm discutindo a abordagem de pacientes por enfermeiros, seja para orientações de autocuidado domiciliar, seja para avaliação das necessidades de cuidados do paciente por telefone (9,(11)(12)(13) . ...
... Estudo realizado na Austrália investigou a aplicação do sistema de evidência clínica (PACES -Practical Application of Clinical Evidence System) do Instituto Joanna Briggs (JBI) para enfermeiros em lares de idosos. O programa compreende três fases: 1) pré-auditoria clínica; 2) implementação de boas práticas; 3) auditoria pós-implementação e concluiu ser preciso incentivo ao uso de novas tecnologias, informação e tempo estimado para adequação dos profissionais aos sistemas implantados (15) . ...
Objective:
To know the resources used and the necessary skills to the nurse for the management of educational practices in health services.
Method:
This is an integrative literature review, carried out in the Latin American and Caribbean databases on Health Sciences Information (BIREME), PubMed Central (PMC), Scopus and Web of Science (WoS). After analysis resulted in 18 studies, published between the period 2011 to 2017, which were presented in three categories.
Results:
The results were presented in the categories: instrumental resources used in health education, technological resources applied to educational practices and competencies for management of educational practices.
Conclusion:
This study brings as a contribution to the practice of nurses subsidies for the development of management of educational practices in health services through technological and instrumental resources and professional skills that aim at team development, user autonomy and institutional growth.
... Given the paucity of implementation research within palliative care and the recognition that a lack of facilitation is a major barrier to the implementation of clinical guidelines in practice, this study provides important new information for palliative care practice, in particular a more detailed understanding of facilitation processes. The majority of studies on facilitation within healthcare to date have also focused on implementation of guidelines or interventions for patients [39][40][41][42]. Improved understanding of (i) facilitation of person-centred interventions across many different contexts, and (ii) interventions designed for family carers, is an important and unique contribution to palliative care practice. ...
Background
An understanding of how to implement person-centred interventions in palliative and end of life care is lacking, particularly for supporting family carers. To address this gap, we investigated components related to successful implementation of the Carer Support Needs Assessment Tool (CSNAT) intervention, a person-centred process of carer assessment and support, using Promoting Action on Research Implementation in Health Services (PARIHS) as a theoretical framework. This study identifies how the PARIHS component of ‘facilitation’ and its interplay with the components of ‘context’ and ‘evidence’ affect implementation success.
Methods
MRC Framework Phase IV study to evaluate implementation of the CSNAT intervention at scale, over six months, in 36 UK palliative care services. 38 practitioners acting as internal facilitators in 35/36 services were interviewed. Field notes were collected during teleconference support sessions between the external and internal facilitators.
Results
Successful implementation was associated with internal facilitators’ ‘leverage’ including their positioning within services, authority to change practice, and having a team of supportive co-facilitators. Effective facilitation processes included a collaborative approach, ongoing communication, and proactive problem solving to address implementation barriers. Facilitators needed to communicate the evidence and provide legitimacy for changing practice. Contextual constraints on facilitation included having to adjust recording systems to support implementation, organisational changes, a patient-focused culture and lack of managerial support.
Conclusions
The CSNAT intervention requires attention to both facilitation processes and conducive organisational structures for successful implementation. These findings are likely to be applicable to any person-centred process of assessment and support within palliative care.
... However, difficulties arose related to the IFs' ability to use the online system, limited computer access and skills. This slowed down the planned audit process, such that none of the 8 sites reached the point of re-auditing (as originally planned) within the 12 months [26]. ...
Background
The ‘Facilitating Implementation of Research Evidence’ study found no significant differences between sites that received two types of facilitation support and those that did not on the primary outcome of documented compliance with guideline recommendations. Process evaluation highlighted factors that influenced local, internal facilitators’ ability to enact the roles as envisaged. In this paper, the external facilitators responsible for designing and delivering the two types of facilitation intervention analyse why the interventions proved difficult to implement as expected, including the challenge of balancing fidelity and adaptation.
Methods
Qualitative data sources included notes from monthly internal-external facilitator teleconference meetings, from closing events for the two facilitation interventions and summary data analyses from repeated interviews with 16 internal facilitators. Deductive and inductive data analysis was led by an independent researcher to evaluate how facilitation in practice compared to the logic pathways designed to guide fidelity in the delivery of the interventions.
Results
The planned facilitation interventions did not work as predicted. Difficulties were encountered in each of the five elements of the logic pathway: recruitment and selection of appropriate internal facilitators, preparation for the role, ability to apply facilitation knowledge and skills at a local level, support and mentorship from external facilitators via monthly teleconferences, working collaboratively and enabling colleagues to implement guideline recommendations. Moreover, problems were cumulative and created tensions for the external facilitators in terms of balancing the logic pathway with a more real-world, flexible and iterative approach to facilitation.
Conclusion
Evaluating an intervention that is fluid and dynamic within the methodology of a randomised controlled trial is complex and challenging. At a practical level, relational aspects of facilitation are critically important. It is essential to recruit and retain individuals with the appropriate set of skills and characteristics, explicit support from managerial leaders and accessible mentorship from more experienced facilitators. At a methodological level, there is a need for attention to the balance between fidelity and adaptation of interventions. For future studies, we suggest a theoretical approach to fidelity, with a focus on mechanisms, informed by prospective use of process evaluation data and more detailed investigation of the context-facilitation dynamic.
... The facilitator role can be filled by clinical professionals, researchers or managers (Harvey and Kitson 2015). The performance goals of facilitation projects can be specified in a top-down fashion by senior managers, clinicians and researchers external to the practice setting or can be collectively determined by clinical teams themselves (Harvey, Kitson, and Munn 2012). It can be designed as a pre-planned and monitored sequence of stages (Dogherty, Harrison, and Graham 2010) or remain deliberately fluid from the outset, allowing for greater flexibility and emergence (Tierney, Kislov, and Deaton 2014). ...
When applied to solving real-world problems in organisational settings, service improvement techniques are likely to evolve over time in response to the context of their implementation. However, the temporal dynamics of this evolution and its underlying microprocesses remain underresearched. To address this gap, we present a qualitative longitudinal case study of facilitation as a service improvement technique utilised by a UK-based collaborative knowledge mobilisation programme to improve the detection and management of Chronic Kidney Disease in primary care organisations. We argue that an uncritical and uncontrolled adaptation of facilitation may undermine its promise to positively affect organisational learning processes and mask the unsustainable nature of the resulting improvement outcomes captured by conventional performance measurement.
... This evidence implementation project utilised the Joanna Briggs Institute Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) audit and feedback tool. 27,28,29 The PACES and GRiP framework for promoting evidence based health care involved three phases of activity: 1. Establishing a team for the project and undertaking a baseline audit based on criteria informed by the evidence. 2. Analysing the results of the baseline audit and designing and implementing strategies to address non-compliance found in the baseline audit informed by the GRiP framework. ...
Background:
Pain management is a significant issue in health facilities in Ghana. For burn patients, this is even more challenging as burn pain has varied facets. Despite the existence of pharmacological agents for pain management, complaints of pain still persist.
Objectives:
The aim of this project was to identify pain management practices in the burns units of Komfo Anokye Teaching Hospital, compare these approaches to best practice, and implement strategies to enhance compliance to standards.
Methods:
Ten evidence-based audit criteria were developed from evidence summaries. Using the Joanna Briggs Institute Practical Application of Clinical Evidence Software (PACES), a baseline audit was undertaken on a convenience sample of ten patients from the day of admission to the seventh day. Thereafter, the Getting Research into Practice (GRiP) component of PACES was used to identify barriers, strategies, resources and outcomes. After implementation of the strategies, a follow-up audit was undertaken using the same sample size and audit criteria.
Results:
The baseline results showed poor adherence to best practice. However, following implementation of strategies, including ongoing professional education and provision of assessment tools and protocols, compliance rates improved significantly. Atlhough the success of this project was almost disrupted by an industrial action, collaboration with external bodies enabled the successful completion of the project.
Conclusion:
Pain management practices in the burns unit improved at the end of the project which reflects the importance of an audit process, education, providing feedback, group efforts and effective collaboration.
... The facilitator role can be filled by clinical professionals, researchers or managers (Harvey and Kitson 2015). The performance goals of facilitation projects can be specified in a top-down fashion by senior managers, clinicians and researchers external to the practice setting or can be collectively determined by clinical teams themselves (Harvey, Kitson, and Munn 2012). It can be designed as a pre-planned and monitored sequence of stages (Dogherty, Harrison, and Graham 2010) or remain deliberately fluid from the outset, allowing for greater flexibility and emergence (Tierney, Kislov, and Deaton 2014). ...
When applied to solving real-world problems in the public sector, managerial techniques are likely to evolve over time in response to the context of their implementation. The temporal dynamics of this evolution and its underlying processes, however, remain under-researched. To address this gap, we present a qualitative longitudinal case study of a UK-based knowledge mobilization programme utilizing “facilitation” as a service improvement approach. We describe the processes underpinning the distortion of facilitation over time and argue that an uncritical and uncontrolled adaptation of managerial techniques may mask the unsustainable nature of the resulting improvement outcomes captured by conventional performance measurement. © 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
