Harnessing implementation science to improve care quality and patient safety: a systematic review of targeted literature

Braithwaite, Jeffrey; Marks, David H.; Taylor, Natalie

doi:10.1093/intqhc/mzu047

Cited by 139 publications

(168 citation statements)

References 66 publications

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“…Teaching within small groups facilitates active participation and allows for discussions of special cases and patient groups. This form of education therefore provides opportunities for answering questions and correcting misconceptions [25] and is in line with the adult learning approach that enables reflective learning and active participation [26]. Nevertheless, in our study, it is also possible that this method might have resulted in impaired knowledge transfer if the attention of nursing staff was more on their patients and their needs.…”

Section: Discussionsupporting

confidence: 54%

The effect of a short educational intervention on the use of urinary catheters: a prospective cohort study

Blöndal

Ingadóttir

Einarsdóttir

et al. 2016

Int J Qual Health Care

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Objective: To assess the effectiveness of implementation of evidence-based recommendations to reduce catheter-associated urinary tract infections (CAUTIs). Design: Prospective cohort study, conducted in 2010-12, with a before and after design. Setting: A major referral university hospital. Participants: Data were collected before (n = 244) and 1 year after (n = 255) the intervention for patients who received urinary catheters. Intervention: The intervention comprised two elements: (i) aligning doctors' and nurses' knowledge of indications for the use of catheters and (ii) an educational effort consisting of three 30-to 45-minute sessions on evidence-based practice regarding catheter usage for nursing personnel on 17 medical and surgical wards. Main Outcome Measures: The main outcome measures were the proportion of (i) admitted patients receiving urinary catheters during hospitalization, (ii) catheters inserted without indication, (iii) inpatient days with catheter and (iv) the incidence of CAUTIs per 1000 catheter days. Secondary outcome measures were the proportion of (i) catheter days without appropriate indication and (ii) patients discharged with a catheter. Results: There was a reduction in the proportion of inpatient days with a catheter, from 44% to 41% (P = 0.006). There was also a reduction in the proportion of catheter days without appropriate indication (P < 0.001) and patients discharged with a catheter (P = 0.029). The majority of catheters were inserted outside the study wards. Conclusions: A short educational intervention was feasible and resulted in significant practice improvements in catheter usage but no reduction of CAUTIs. Other measures than CAUTI may be more sensitive to detecting important practice changes.

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Section: Discussionsupporting

confidence: 54%

The effect of a short educational intervention on the use of urinary catheters: a prospective cohort study

Blöndal

Ingadóttir

Einarsdóttir

et al. 2016

Int J Qual Health Care

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“…118 These included the preparations made for the change, staff capacity for implementation, and resources. Obstacles to implementation were the opposite: 'for example, when people fail to prepare, have insufficient capacity for implementation or when the setting is resistant to change, then care quality is at risk, and patient safety can be compromised'.…”

Section: Literature Reviewmentioning

confidence: 99%

Evaluation of a national surveillance system for mortality alerts: a mixed-methods study

Aylin

Bottle

Burnett

et al. 2018

Health Serv Deliv Res

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BackgroundSince 2007, Imperial College London has generated monthly mortality alerts, based on statistical process control charts and using routinely collected hospital administrative data, for all English acute NHS hospital trusts. The impact of this system has not yet been studied.ObjectivesTo improve understanding of mortality alerts and evaluate their impact as an intervention to reduce mortality.DesignMixed methods.SettingEnglish NHS acute hospital trusts.ParticipantsEleven trusts were included in the case study. The survey involved 78 alerting trusts.Main outcome measuresRelative risk of mortality and perceived efficacy of the alerting system.Data sourcesHospital Episodes Statistics, published indicators on quality and safety, Care Quality Commission (CQC) reports, interviews and documentary evidence from case studies, and a national evaluative survey.MethodsDescriptive analysis of alerts; association with other measures of quality; associated change in mortality using an interrupted time series approach; in-depth qualitative case studies of institutional response to alerts; and a national cross-sectional evaluative survey administered to describe the organisational structure for mortality governance and perceptions of efficacy of alerts.ResultsA total of 690 mortality alerts generated between April 2007 and December 2014. CQC pursued 75% (154/206) of alerts sent between 2011 and 2013. Patient care was cited as a factor in 70% of all investigations and in 89% of sepsis alerts. Alerts were associated with indicators on bed occupancy, hospital mortality, staffing, financial status, and patient and trainee satisfaction. On average, the risk of death fell by 58% during the 9-month lag following an alert, levelling afterwards and reaching an expected risk within 18 months of the alert. Acute myocardial infarction (AMI) and sepsis alerts instigated institutional responses across all the case study sites, although most sites were undertaking some parallel activities at a more general level to address known problems in care in these and other areas. Responses included case note review and coding improvements, changes in patient pathways, changes in diagnosis of sepsis and AMI, staff training in case note write-up and coding, greater transparency in patient deterioration, and infrastructure changes. Survey data revealed that 86% of responding trusts had a dedicated trust-level lead for mortality reduction and 92% had a dedicated trust-level mortality group or committee in place. Trusts reported that mortality reduction was a high priority and that there was strong senior leadership support for mortality monitoring. The weakest areas reported concerned the accuracy of coding, the quality of specialty-level mortality data and understanding trends in specialty-level mortality data.LimitationsOwing to the correlational nature of our analysis, we could not ascribe a causal link between mortality alerts and reductions in mortality. The complexity of the institutional context and behaviour hindered our capacity to attribute locally reported changes specifically to the effects of the alerts rather than to ongoing institutional strategy.ConclusionsThe mortality alert surveillance system reflects aspects of quality care and is valued by trusts. Alerts were considered a useful focus for identifying problems and implementing interventions around mortality.Future workA further analysis of site visits and survey material, the application of evaluative framework to other interventions, a blinded case note review and the dissemination of findings.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…[12][13][14] For example, practitioners are alleged to lack the time, motivation and capacity to use evidence 15,16 or are purported to be overwhelmed by the quantity of diverse evidence. [17][18][19] Research reports may lack relevance, can be opaque and verbose 20 and it can be a long time before they are released. 21 Some argue that research output is dominated by a biomedical focus on drugs, tests and devices.…”

Section: Knowledge Mobilisationmentioning

confidence: 99%

“…100 The organisational culture needs to be adaptive 142 or absorptive if it is to make use of knowledge, and increasing emphasis is given to organisational readiness. 18,82,138,143 The level of an organisation's 'absorptive capacity' [144][145][146][147] is defined as 'a firm's ability to recognise the value of new information, assimilate it, and apply it to commercial ends'. 146 This 'adaptive and responsive capacity' is important to knowledge use in practice and is affected by the organisation's 'prior related knowledge, a readiness to change, trust between partners, flexible and adaptable work organisations and management support'.…”

Section: Context Factorsmentioning

confidence: 99%

Getting the most out of knowledge and innovation transfer agents in health care: a qualitative study

Bullock

Barnes

Morris³

et al. 2016

Health Serv Deliv Res

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BackgroundKnowledge and innovation transfer (KIT) is recognised internationally as a complex, dynamic process that is difficult to embed in organisations. There is growing use of health service–academic–industry collaborations in the UK, with knowledge brokers linking producers with the users of knowledge and innovation.AimFocusing on KIT ‘agent’ roles within Academic Health Science Networks in England and Partnerships in Wales, we show how individual dispositions, processes and content contribute to desired outcomes.MethodsWe studied the KIT intentions of all Academic Health Science Networks in England, and the South East Wales Academic Health Science Partnership. Using a qualitative case study design, we studied the work of 13 KIT agents purposively sampled from five networks, by collecting data from observation of meetings, documentation, KIT agent audio-diaries, and semistructured interviews with KIT agents, their line managers and those they supported (‘Links’). We also used a consensus method in a meeting of experts (nominal group technique) to discuss the measurement of outcomes of KIT agent activity.FindingsThe case study KIT agents were predominantly from a clinical background with differing levels of experience and expertise, with the shared aim of improving services and patient care. Although outside of recognised career structures, the flexibility afforded to KIT agents to define their role was an enabler of success. Other helpful factors included (1) time and resources to devote to KIT activity; (2) line manager support and a team to assist in the work; and (3) access and the means to use data for improvement projects. The organisational and political context could be challenging. KIT agents not only tackled local barriers such as siloed working, but also navigated shifting regional and national policies. Board-level support for knowledge mobilisation together with a culture of reflection (listening to front-line staff), openness to challenges and receptivity to research all enabled KIT agents to achieve desired outcomes. Nominal group findings underscored the importance of relating measures to specific intended outcomes. However, the case studies highlighted that few measures were employed by KIT agents and their managers. Using social marketing theory helped to show linkages between processes, outcomes and impact, and drew attention to how KIT agents developed insight into their clients’ needs and tailored work accordingly.LimitationsLevel of KIT agent participation varied; line managers and Links were interviewed only once; and outcomes were self-reported.ConclusionsSocial marketing theory provided a framework for analysing KIT agent activity. The preparatory work KIT agents do in listening, understanding local context and building relationships enabled them to develop ‘insight’ and adapt their ‘offer’ to clients to achieve desired outcomes.Future workThe complexity of the role and the environment in which it is played out justifies more research on KIT agents. Suggestions include (1) longitudinal study of career pathways; (2) how roles are negotiated within teams and how competing priorities are managed; (3) how success is measured; (4) the place of improvement methodologies within KIT work; (5) the application of social marketing theory to comparative study of similar roles; and (6) patients as KIT agents.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Harnessing implementation science to improve care quality and patient safety: a systematic review of targeted literature

Abstract: This review of key studies in the quality and safety literature discusses the current state-of-play of implementation science applied to these domains.

Cited by 139 publications

References 66 publications

The effect of a short educational intervention on the use of urinary catheters: a prospective cohort study

The effect of a short educational intervention on the use of urinary catheters: a prospective cohort study

Evaluation of a national surveillance system for mortality alerts: a mixed-methods study

Getting the most out of knowledge and innovation transfer agents in health care: a qualitative study

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