All teach, all learn, all improve?

Nembhard, Ingrid M.

doi:10.1097/hmr.0b013e31822af831

Cited by 59 publications

(31 citation statements)

References 37 publications

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“…By sharing both successes and failures, teams were able to learn valuable dos and don’ts and consider practices that might be worthy of adopting as part of their QI efforts [6]. In our study, participants identified that value of having opportunities to provide and receive both formal, structured and informal feedback.…”

Section: Discussionmentioning

confidence: 99%

“…Fundamental to a collaborative approach is interorganizational learning whereby organizations acquire, share and combine knowledge with other organizations and have the opportunity to learn from the successes and failures of their peers in improvement areas [6]. This learning approach aims to create the conditions for collaborative, reflective, and innovative experiential systems that enable collective discussions regarding daily practice issues and finding solutions for improvement by integrating tacit-explicit knowledge [9, 10].…”

Section: Introductionmentioning

confidence: 99%

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Contextualizing learning to improve care using collaborative communities of practices

Jeffs

McShane

Flintoft

et al. 2016

BMC Health Serv Res

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BackgroundThe use of interorganizational, collaborative approaches to build capacity in quality improvement (QI) in health care is showing promise as a useful model for scaling up and accelerating the implementation of interventions that bridge the “know-do” gap to improve clinical care and provider outcomes. Fundamental to a collaborative approach is interorganizational learning whereby organizations acquire, share, and combine knowledge with other organizations and have the opportunity to learn from their respective successes and challenges in improvement areas. This learning approach aims to create the conditions for collaborative, reflective, and innovative experiential systems that enable collective discussions regarding daily practice issues and finding solutions for improvement.MethodsThe concepts associated with interorganizational learning and deliberate learning activities within a collaborative ‘Communities-of-practice’(CoP) approach formed the foundation of the of an interactive QI knowledge translation initiative entitled PERFORM KT. Nine teams participated including seven teams from two acute care hospitals, one from a long term care center, and one from a mental health sciences center. Six monthly CoP learning sessions were held and teams, with the support of an assigned mentor, implemented a QI project and monitored their results which were presented at an end of project symposium. 47 individuals participated in either a focus group or a personal interview. Interviews were transcribed and analyzed using an iterative content analysis.ResultsFour key themes emerged from the narrative dataset around experiences and perceptions associated with the PERFORM KT initiative: 1) being successful and taking it to other levels by being systematic, structured, and mentored; 2) taking it outside the comfort zone by being exposed to new concepts and learning together; 3) hearing feedback, exchanging stories, and getting new ideas; and 4) having a pragmatic and accommodating approach to apply new learnings in local contexts.ConclusionsStudy findings offer insights into collaborative, inter-organizational CoP learning approaches to build QI capabilities amongst clinicians, staff, and managers. In particular, our study delineates the need to contextualize QI learning by using deliberate learning activities to balance systematic and structured approaches alongside pragmatic and accommodating approaches with expert mentors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Contextualizing learning to improve care using collaborative communities of practices

Jeffs

McShane

Flintoft

et al. 2016

BMC Health Serv Res

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“…As health reform unfolds and primary care practices are expected to integrate routine health behavior assessment, practices will be faced with a need to revamp their patient-reported data collection processes. Technical assistance in the form of training on the use of behavioral health assessments, practice facilitation (Nutting et al 2010), structured rapid cycle quality improvement support (Rubenstein et al 2010), and interorganizational learning opportunities (Nembhard 2012) may aid practices in using PRO data and disseminating best practices in supporting patient health behavior change in low-resource settings. Unless implementation support is provided to practices, the routine collection and meaningful use of behavioral health data will likely flounder, particularly in low resource practices that serve the most vulnerable patient populations.…”

Section: Discussionmentioning

confidence: 99%

Real-World Implementation and Outcomes of Health Behavior and Mental Health Assessment

Rodríguez

Glenn²,

Olmos

et al. 2014

The Journal of the American Board of Family Medicine

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Background Assessing patient-reported health behaviors is a critical first step to prioritizing prevention in primary care. We assessed the feasibility of point-of-care behavioral health assessment in nine diverse primary care practices, including four federally-qualified health centers (FQHCs), four Practice-based Research Network (PBRN) practices, and a Department of Veterans Affairs (VA) practice. Methods In this prospective mixed-methods study, practices were asked to integrate a standardized paper-based health behavior and mental health assessment into their workflow for 50 or more patients. We used three data sources to examine the implementation process: 1) patient responses to the health assessment, 2) patient feedback surveys about how assessments were used during encounters, and 3) post-implementation interviews. Results Most (71%) non-urgent patients visiting the participating practices during the implementation period completed the health assessment, but reach varied by practice (range: 59-88%). Unhealthy diet, sedentary lifestyle, and stress were the most common patient problems with similar frequencies observed across practices. The median number of “positive screens” per patient was similar across FQHCs (3.7-positives, SD=1.8), PBRN practices (3.8-positives, SD=1.9), and the VA clinic (4.1-positives, SD=2.0). Primary care clinicians discussed assessment results with patients about half of the time (54%), with considerable between practice variation (range: 13%-66% with lowest use among FQHC clinicians). Although clinicians were interested in routinely implementing assessments, many reported not feeling confident of having resources or support to address all patients’ behavioral health needs. Conclusions Primary care practices will need to revamp their patient-reported data collection processes in order to integrate routine health behavior assessments. Implementation support will be required if health assessments are to be actively used as part of routine primary care.

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“…This process allows teams to refine new practices within the local setting, identify implementation barriers, field test solutions to identified challenges, and share experiences across sites (Pinto, Benn, Burnett, Parand, & Vincent, 2011). At the organizational and systems level, LCs have potential to strengthen social networks and interorganizational learning (Bunger et al, 2014; Nembhard, 2012; Palinkas et al, 2011), leverage the influence of key opinion leaders towards improving the implementation climate for innovative practices (Wilson, Berwick, & Cleary, 2004), and foster a public and tanglible commitment from leadership (Wilson et al, 2004). By establishing mutli-disciplinary, cross-hierarchical teams, LCs may also promote increased team effectiveness (Nembhard, 2009), and can potentially build organizations’ capacity for innovation use and continuous improvement (e.g., using data to drive change and promote accountability) (Nembhard, 2012; Singer, Moore, Meterko, & Williams, 2012).…”

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confidence: 99%

Using a Theory-Guided Learning Collaborative Model to Improve Implementation of EBPs in a State Children’s Mental Health System: A Pilot Study

Nadeem

Weiss

Olin

et al. 2016

Adm Policy Ment Health

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Learning collaboratives (LCs) are used widely to promote implementation of evidence-based practices (EBPs). However, there has been limited research on the effectiveness of LCs and models vary widely in their structure, focus and components. The goal of the present study was to develop and field test a theory-based LC model to augment a state-led, evidence-based training program for clinicians providing mental health services to children. Analysis of implementation outcomes contrasted LC sites to matched comparison sites that participated in the clinical training program alone. Results suggested that clinicians from sites participating in the LC were more highly engaged in the state-led clinical training program and were more likely to complete program requirements.

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All teach, all learn, all improve?

Abstract: Background-Quality improvement collaboratives are an increasingly common strategy for implementing evidence-based practices in health care. However, research shows that many participating organizations do not achieve the level of performance improvement desired.

Cited by 59 publications

References 37 publications

Contextualizing learning to improve care using collaborative communities of practices

Contextualizing learning to improve care using collaborative communities of practices

Real-World Implementation and Outcomes of Health Behavior and Mental Health Assessment

Using a Theory-Guided Learning Collaborative Model to Improve Implementation of EBPs in a State Children’s Mental Health System: A Pilot Study

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