“…We did not prepare SUPPORT Summaries for the related reviews, and they did not contribute data to the summaries or the overview because of substantial overlap with one of the primary reviews. Following the screening of the subsequent searches of PDQ-Evidence, we identified five ongoing reviews of implementation strategies (Brennan 2009; Dudley 2009; Fønhus 2016; Pantoja 2014b; Rowe 2015); six additional systematic reviews of implementation strategies that are awaiting assessment (Baldwin 2011; Mauger Rothenberg 2012; Mundell 2013; Oluoch 2012; Rolfe 2014; Tannenbaum 2013; Appendix 5); and a number of other reviews that are awaiting classification and also need to be checked for relevance to this overview (Appendix 5). Figure 1Flow diagram…”
Section: Resultsmentioning
confidence: 99%
“…None of the included reviews assessed the effects of CQI strategies. One Cochrane Review on this topic is in progress (Brennan 2009). …”
BackgroundA key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness.ObjectivesTo provide an overview of the available evidence from up-to-date systematic reviews about the effects of implementation strategies for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on alternative implementation strategies and informing refinements of the framework for implementation strategies presented in the overview.MethodsWe searched Health Systems Evidence in November 2010 and PDQ-Evidence up to December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of implementation strategies on professional practice and patient outcomes and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the review findings. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries.Main resultsWe identified 7272 systematic reviews and included 39 of them in this overview. An additional four reviews provided supplementary information. Of the 39 reviews, 32 had only minor limitations and 7 had important methodological limitations. Most studies in the reviews were from high-income countries. There were no studies from low-income countries in eight reviews.Implementation strategies addressed in the reviews were grouped into four categories – strategies targeting:1. healthcare organisations (e.g. strategies to change organisational culture; 1 review);2. healthcare workers by type of intervention (e.g. printed educational materials; 14 reviews);3. healthcare workers to address a specific problem (e.g. unnecessary antibiotic prescription; 9 reviews);4. healthcare recipients (e.g. medication adherence; 15 reviews).Overall, we found the following interventions to have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects.1.Strategies targeted at healthcare workers: educational meetings, nutrition training of health worker...
“…We did not prepare SUPPORT Summaries for the related reviews, and they did not contribute data to the summaries or the overview because of substantial overlap with one of the primary reviews. Following the screening of the subsequent searches of PDQ-Evidence, we identified five ongoing reviews of implementation strategies (Brennan 2009; Dudley 2009; Fønhus 2016; Pantoja 2014b; Rowe 2015); six additional systematic reviews of implementation strategies that are awaiting assessment (Baldwin 2011; Mauger Rothenberg 2012; Mundell 2013; Oluoch 2012; Rolfe 2014; Tannenbaum 2013; Appendix 5); and a number of other reviews that are awaiting classification and also need to be checked for relevance to this overview (Appendix 5). Figure 1Flow diagram…”
Section: Resultsmentioning
confidence: 99%
“…None of the included reviews assessed the effects of CQI strategies. One Cochrane Review on this topic is in progress (Brennan 2009). …”
BackgroundA key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness.ObjectivesTo provide an overview of the available evidence from up-to-date systematic reviews about the effects of implementation strategies for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on alternative implementation strategies and informing refinements of the framework for implementation strategies presented in the overview.MethodsWe searched Health Systems Evidence in November 2010 and PDQ-Evidence up to December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of implementation strategies on professional practice and patient outcomes and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the review findings. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries.Main resultsWe identified 7272 systematic reviews and included 39 of them in this overview. An additional four reviews provided supplementary information. Of the 39 reviews, 32 had only minor limitations and 7 had important methodological limitations. Most studies in the reviews were from high-income countries. There were no studies from low-income countries in eight reviews.Implementation strategies addressed in the reviews were grouped into four categories – strategies targeting:1. healthcare organisations (e.g. strategies to change organisational culture; 1 review);2. healthcare workers by type of intervention (e.g. printed educational materials; 14 reviews);3. healthcare workers to address a specific problem (e.g. unnecessary antibiotic prescription; 9 reviews);4. healthcare recipients (e.g. medication adherence; 15 reviews).Overall, we found the following interventions to have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects.1.Strategies targeted at healthcare workers: educational meetings, nutrition training of health worker...
“…10 13 17 26 27 37 Local audits and measurements conducted on a regular basis relate to the organisation's structural capability, which strengthens the evidence for lean interventions. 36 37 39 40 A system-wide multifaceted approach, across functional divides, allows best practices to be learned and disseminated.…”
Section: Context: Situation and Organisationmentioning
confidence: 99%
“…Possible measures of outcomes could be related to the healthcare providers' performance (adherence to recommended practice), patient's outcome (as quality of life or mortality), surrogate outcomes (as re-admission) and organisational outcomes (such as resource use or sustainability). 36 At the University Hospital of North Norway, more than 5 years of lean experience and more than 20 implemented lean interventions leave us with a sufficient amount of empirically based cases to assess due to varying success.…”
Section: Context: Situation and Organisationmentioning
ObjectiveLean interventions aim to improve quality of healthcare by reducing waste and facilitate flow in work processes. There is conflicting evidence on the outcomes of lean thinking, with quantitative and qualitative studies often contradicting each other. We suggest that reviewing the literature within the approach of a new contextual framework can deepen our understanding of lean as a quality-improvement method. This article theorises the concept of context by establishing a two-dimensional conceptual framework acknowledging lean as complex social interventions, deployed in different organisational dimensions and domains. The specific aim of the study was to identify factors facilitating intended outcomes from lean interventions, and to understand when and how different facilitators contribute.DesignA two-dimensional conceptual framework was developed by combining Shortell's Dimensions of capability with Walshes’ Domains of an intervention. We then conducted a systematic review of lean review articles concerning hospitals, published in the period 2000–2012. The identified lean facilitators were categorised according to the intervention domains and dimensions of capability provided by the framework.ResultsWe provide a framework emphasising context by relating facilitators to domains and dimensions of capability. 23 factors enabling a successful lean intervention in hospitals were identified in the systematic review, where management and a supportive culture, training, accurate data, physicians and team involvement were most frequent.ConclusionsIn the absence of evidence, the two-dimensional framework, incorporating the context, may prove useful for future research on variation in outcomes from lean interventions. Findings from the review suggest that characteristics and local application of lean, in addition to strategic and cultural capability, should be given further attention in healthcare quality improvement.
“…Berwick (1989) states real change can only be achieved by system change. Quality improvement has been widely adopted in healthcare, particularly by hospital staff (Brennan et al, 2009). An early QI healthcare literature review found that success determinants included clinician participation, feedback to individual clinicians and a supporting organisation culture.…”
Section: Quality Improvement and Healthcarementioning
Structured Abstract: Purpose: Globally, healthcare managers continue to struggle with managing increasing demands for their services with limited or shrinking resources. It is therefore, clear that systems, processes and practices need to change to meet these challenges. We assess how integrating two improvement technologies, Lean and Integrated Care Pathways (ICPs) might help. Design/methodology/approach: Lean in healthcare and ICP provide a platform to develop conceptual frameworks for integrating two approaches. Findings: A conceptual integrated framework is provided to assist care pathway designers and implementers to consider the synergistic benefits of combining approaches to improvement.
Research limitations/implications:We provide a conceptual framework that requires empirically testing. Practical implications: This research provides a conceptual framework to aid practitioners to improve healthcare design and delivery. Originality/value: For the first time, we bring together two approaches to improving patient care pathway design and considers how these are linked in relation to improving the delivery of health care.
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