Enhancing Learning, Innovation, Adaptation, and Sustainability in Health Care Organizations

Persaud, D. David

doi:10.1097/hcm.0000000000000014

Cited by 18 publications

(17 citation statements)

References 141 publications

(499 reference statements)

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“…Sustainability can only be achieved with reliable systems that become part of the organizational culture. [9][10][11] Once the early NINJA results were shared with hospital physicians and administrative leadership, we were supported to develop reliable automated processes to identify nephrotoxic medication-exposed patients in near real time, 12 inculcate nephrotoxic medication exposure and AKI assessment discussions and education as part of the daily ward rounds, and empower pharmacists to make screening and nephrotoxic medication adjustment recommendations. We now report on the 3-year sustainability of our project and examine any potential epidemiological shifts that could explain the improved outcomes we observed.…”

mentioning

confidence: 99%

A sustained quality improvement program reduces nephrotoxic medication-associated acute kidney injury

Goldstein

Mottes

Simpson

et al. 2016

Kidney International

197

153

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Exposure to nephrotoxic medication is among the most common causes of acute kidney injury (AKI) in hospitalized patients. Here we conducted a prospective quality improvement project implementing a systematic Electronic Health Record screening and decision support process (trigger) in our quaternary pediatric inpatient hospital. Eligible patients were noncritically ill hospitalized children receiving an intravenous aminoglycoside for more than 3 days or more than 3 nephrotoxins simultaneously (exposure) from September 2011 through March 2015. Pharmacists recommended daily serum creatinine monitoring in exposed patients after appearance on the trigger report and AKI was defined by the Kidney Disease Improving Global Outcomes AKI criteria. A total of 1749 patients accounted for 2358 separate hospital admissions during which a total of 3243 episodes of nephrotoxin exposure were identified with 170 patients (9.7%) experiencing 2 or more exposures. A total of 575 individual AKI episodes occurred over the 43-month study period. Overall, the exposure rate decreased by 38% (11.63-7.24 exposures/1000 patient days), and the AKI rate decreased by 64% (2.96-1.06 episodes/1000 patient days). Assuming initial baseline exposure rates would have persisted without our project implementation, we estimate 633 exposures and 398 AKI episodes were avoided. Thus, systematic surveillance for nephrotoxic medication exposure and near real-time AKI risk can lead to sustained reductions in avoidable harm. These interventions and outcomes are translatable to other pediatric and nonpediatric hospitalized settings.

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mentioning

confidence: 99%

A sustained quality improvement program reduces nephrotoxic medication-associated acute kidney injury

Goldstein

Mottes

Simpson

et al. 2016

Kidney International

197

153

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“…Five articles were derived from special settings such as construction [ 176 ], education [ 101 ], pharmacies [ 135 ], urban planning [ 383 ], and public health institutions [ 32 ]. In 44 articles [ 2 , 3 , 13 , 33 , 124 , 126 , 127 , 179 , 206 , 211 , 220 , 237 , 239 , 247 , 297 , 316 , 317 , 322 , 324 , 325 , 328 , 339 , 341 – 343 , 346 – 350 , 354 , 356 , 358 , 364 , 369 , 372 , 374 , 375 , 377 , 378 , 380 , 381 , 384 , 385 ], the setting was not reported or not applicable (e.g., opinion/theoretical articles). For empirical studies and published protocols, about 28% were derived from research in the USA, 22% from Canada, 10% from Sweden, and 10% from the UK.…”

Section: Resultsmentioning

confidence: 99%

“…An alternative use of PARIHS in empirical studies involved focusing on one of the three PARIHS elements (n = 17) and investigating them in greater depth, most notably context (n = 10) (e.g., [155,232]) and facilitation (n = 7) (e.g., [307,312]). A total of 25 opinion/theoretical articles [144,351,[359][360][361][366][367][368][369][370][371][372][373][374][375][376][377][378][379][380][381][382][383][384][385] reported using the PARIHS framework in some other way, including a discussion about PARIHS as part of presenting a general overview of theories and frameworks to inform implementation (e.g., [369,376,378,384]), using PARIHS to augment, develop, or evaluate other implementation models and frameworks (e.g., [318,359,367,374,382]), and informing education and learning and teaching initiatives [144,372]. Empirical review articles (n = 11) included reviews of implementation frameworks [3,313,…”

Section: The Application Of Parihs In Any Other Waymentioning

confidence: 99%

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

et al. 2020

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Background: The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. Methods: This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/ countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. Results: The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. Conclusions: In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.

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“…Organizations that have this capacity have been dubbed learning organizations 8 and have comparatively greater success in improving their effectiveness and efficiency. 9 - 11 Whereas the concept of cultivating a learning organization has been applied in many different types of organizations, it is a relatively new idea in health systems, particularly in health systems that serve LMICs. 12 …”

Section: Introductionmentioning

confidence: 99%

Effective Project Management of a Pan-African Cancer Research Network: Men of African Descent and Carcinoma of the Prostate (MADCaP)

Odiaka

Lounsbury²,

Jalloh

et al. 2018

JGO

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PurposeHealth research in low- and middle-income countries can generate novel scientific knowledge and improve clinical care, fostering population health improvements to prevent premature death. Project management is a critical part of the success of this research, applying knowledge, skills, tools, and techniques to accomplish required goals. Here, we describe the development and implementation of tools to support a multifaceted study of prostate cancer in Africa, focusing on building strategic and operational capacity.MethodsApplying a learning organizational framework, we developed and implemented a project management toolkit (PMT) that includes a management process flowchart, a cyclical center-specific schedule of activities, periodic reporting and communication, and center-specific monitoring and evaluation metrics.ResultsThe PMT was successfully deployed during year one of the project with effective component implementation occurring through periodic cycles of dissemination and feedback to local center project managers. A specific evaluation was conducted 1 year after study initiation to obtain enrollment data, evaluate individual quality control management plans, and undertake risk log assessments and follow-up. Pilot data obtained identified areas in which centers required mentoring, strengthening, and capacity development. Strategies were implemented to improve project goals and operational capacity through local problem solving, conducting quality control checks and following compliancy with study aims. Moving forward, centers will perform quarterly evaluations and initiate strengthening measures as required.ConclusionThe PMT has fostered the development of both strategic and operational capacity across project centers. Investment in project management resources is essential to ensuring high-quality, impactful health research in low- and middle-income countries.

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Enhancing Learning, Innovation, Adaptation, and Sustainability in Health Care Organizations

Cited by 18 publications

References 141 publications

A sustained quality improvement program reduces nephrotoxic medication-associated acute kidney injury

A sustained quality improvement program reduces nephrotoxic medication-associated acute kidney injury

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

Effective Project Management of a Pan-African Cancer Research Network: Men of African Descent and Carcinoma of the Prostate (MADCaP)

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