Developing best practices for PPE Portraits across 25 sites: a systematic assessment of implementation and spread of adaptations using FRAME

Abstract

Background Adaptation, a form of modification that aims to improve an intervention’s acceptability and sustainability in each context, is essential to successful implementation in some settings. Due to the COVID-19 pandemic, clinicians have rapidly adapted how they deliver patient care. PPE Portraits are a form of adaptation, whereby health workers affix a postcard size portrait of themselves to the front of their personal protective equipment (PPE) to foster human connection during COVID-19. Methods We used the expanded framework for reporting adaptations and modifications to evidence-based interventions (FRAME) method to better understand the reasoning behind and results of each adaptation. We hypothesized that using the FRAME in conjunction with design-thinking would lead to emerging best practices and that we would find adaptation similarities across sites. Throughout multiple implementations across 25 institutions, we piloted, tracked, and analyzed adaptations using FRAME and design thinking. For each adaptation, we assessed the stage of implementation, whether the change was planned, decision makers involved, level of delivery impacted, fidelity to original intervention, and the goal and reasoning for adaptation. We added three crucial components to the FRAME: original purpose of the adaptation, unintended consequences, and alternative adaptations. Results When implementing PPE Portraits across settings, from a local assisted living center’s memory unit to a pediatric emergency department, several requests for adaptations arose during early development stages before implementation. Adaptations primarily related to (1) provider convenience and comfort, (2) patient populations, and (3) scale. Providers preferred smaller portraits and rounded (rather than square) laminated edges that could potentially injure a patient. Affixing the portrait with a magnet was rejected given the potential choking hazard the magnetic strip presented for children. Other adaptations, related to ease of dissemination, included slowing the process down during early development and providing buttons, which could be produced easily at scale. Conclusions The FRAME was used to curate the reasoning for each adaptation and to inform future dissemination. We look forward to utilizing FRAME including our additions and design thinking, to build out a range of PPE Portrait best practices with accompanying costs and benefits.

Improving patient experience by implementing an organisational culture model

“…The second step in improving the PX model aimed to improve empathy towards patients through education and a series of training programmes among all staff. This approach was consistent with previous studies, including systematic reviews examining the effectiveness of empathy in general practice, which found an association between clinician empathy and patient satisfaction 25–27. This research observed a direct positive relationship between increased patient support and lowered patient anxiety and distress, leading to significantly better clinical outcomes 24–26.…”

“…This approach was consistent with previous studies, including systematic reviews examining the effectiveness of empathy in general practice, which found an association between clinician empathy and patient satisfaction 25–27. This research observed a direct positive relationship between increased patient support and lowered patient anxiety and distress, leading to significantly better clinical outcomes 24–26. In addition, an earlier study in Korea among 550 outpatients found that physician-perceived patient empathy significantly influenced patient satisfaction and compliance through communication, perceived experience, interpersonal trust and partnership 26.…”

“…In addition, an earlier study in Korea among 550 outpatients found that physician-perceived patient empathy significantly influenced patient satisfaction and compliance through communication, perceived experience, interpersonal trust and partnership 26. Hence, as found in this research and supported by previous studies, empathy needs to be constantly assessed and improved among healthcare providers in order to improve their communication and patient care 25–27…”

“… 26 Hence, as found in this research and supported by previous studies, empathy needs to be constantly assessed and improved among healthcare providers in order to improve their communication and patient care. 25–27 …”

Adaptation of the collaborative care model to integrate behavioral health care into a low-barrier HIV clinic

“…To describe adaptations to the CoCM model, we used the FRAME ( Wiltsey Stirman et al, 2019 ), which supports systematic tracking and documentation of the rationale for modifications made to evidence-based interventions ( Albrecht et al, 2022 ; Ametaj et al, 2021 ; Baratta et al, 2021 ). In documenting the adaptation process, we considered both the structural elements of the CoCM intervention and the process-of-care elements relevant to the integration of BH with medical care ( McGinty & Daumit, 2020 ).…”