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Using Implementation Science to Effectively Implement Evidence-Based Practices Heather J. Gotham, PhD Mid-America ATTC UMKC School of Nursing Health Literacy:

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Presentation on theme: "Using Implementation Science to Effectively Implement Evidence-Based Practices Heather J. Gotham, PhD Mid-America ATTC UMKC School of Nursing Health Literacy:"— Presentation transcript:

1 Using Implementation Science to Effectively Implement Evidence-Based Practices Heather J. Gotham, PhD Mid-America ATTC UMKC School of Nursing Health Literacy: A prescription for Patient Engagement February 12, 2013

2 “As clinicians, what we say does not matter unless patients are able to understand the information we give them well enough to use it to make good health-care decisions. Otherwise we didn’t reach them, and that is the same as if we didn’t treat them.” United States Surgeon General; Benjamin, 2010

3 Objectives 1.Define implementation and implementation science 2.Describe the implementation gap and its effects on evidence-based practices 3.Describe 4 strategies from implementation science research to assist with organizational changes and promote the best patient outcomes


5 Implementation Incorporating an innovation into routine practice. Includes a range of strategies to address individual, organizational, and systemic characteristics (e.g., skills training, administrative buy-in, policy changes). ATTC Technology Transfer Workgroup, 2010

6 Implementation Science Combines research across fields –Rural sociology –Medical sociology –Communication & marketing –Evidence-based medicine –Organizational change Studies how evidence-based practices are used in the real world Studies what strategies can help most efficiently implement evidence-based practices Greenhalgh et al., 2004

7 Grei “Passive approaches are generally ineffective and unlikely to result in behavior change.” (Grimshaw 2001)

8 “Train and hope” doesn’t work either. (Stilen 2013)

9 Effective Intervention X Ineffective or Insufficient Implementation = Inconsistent; Not Sustainable; Poor Outcomes The Implementation Gap

10 Assertive Community Treatment –Patients with mental health and substance use disorders –Treatment using multi-disciplinary team Strong Implementation (High Fidelity) ACT team Weak Implementation (Low Fidelity) ACT team Treatment Drop-outs 15%30% Substance Use in Remission 55%13% Hospital Admissions McHugo et al., 1999

11 Patient medication adherence Health professional adherence to EBPs Better patient health The Implementation Gap in Healthcare

12 What Works EffectiveNOT Effective Effective NOT Effective IMPLEMENTATION INTERVENTION Performance Implementation (High Fidelity) Paper Implementation Procedure Implementation (Low Fidelity) Copyright © Dean L. Fixsen and Karen A. Blase, 2008

13 Difficult to Change Practice and Make it Stick (Routine)

14 Use Implementation Science to Create Successful Change

15 Create a Successful Implementation Team Organizational Sponsor –Leads implementation effort, appoints the Change Agent –Acts as a mentor to maintain enthusiasm –Problem-solver, assists Change Agent and Team

16 Change Agent –Overall responsibility for implementation and plan –Supervisory position with responsibility and authority to implement policy and programmatic changes –Recognized/respected for leadership, organizational savvy, and persistence Create a Successful Implementation Team

17 Implementation Team –Comprised of staff from all levels/roles Administrative, Supervisory, Support, Technical and/or IT Patients –Meet regularly –Review implementation planning Create a Successful Implementation Team

18 Implementation Drivers Key elements of capacity and infrastructure that influence a program’s success

19 OUTCOMES (% of Participants) TRAINING COMPONENTS Knowledge Skill Demonstration Use in the Classroom Theory and Discussion 10% 5%0%..+Demonstration in Training 30% 20% 0%..+ Practice & Feedback in Training 60% 5%..+ Coaching in Classroom 95% Joyce and Showers (2002) study of implementing new education practices in the classroom Implementation Drivers: Training alone is never enough


21 Use Implementation Drivers to Develop an Implementation Plan Implementation Driver Implementation Steps Staff Person(s) Deadline Comments Recruitment/ Staff Selection Implementation Team 1.Finalize Implementation TeamChange Agent 11/11Completed 2. Meet every 2 weeks through March, then re- evaluate Team11/18 Facil. Admin. Supports Screening Process 1.What is currently done? Are nurses already doing EMR Screening? Change agent, head nurse 11/18 Decision Support Data Systems EMR 1.Determine issues and system limits with EMR What if only some items are completed? Can all staff complete the screener? Admin staff with IT staff 11/15 initial report Review at 11/18 meeting Training Targeted training needed for all levels of staff 1.Education for nurses on all shiftsHealth coach supervisor 11/18

22 Improvement Cycles Improvement cycles and other quality improvement strategies help you to manage the changes being implemented and to keep the focus on what is working.

23 Improvement Cycles Plan: Plan the change using the implementation plan Do:Make the change Study:Evaluate what happened Act:Continue or go back to planning

24 Implementation Stages Every change in clinical practice goes through multiple stages from exploring the options for change through fully implementing the change. The whole process takes several months to years.

25 Implementation Stages Initial Implementation drivers Manage change & expectations Improvement cycles Learn from mistakes Celebrate progress Full Implementation drivers Monitor outcomes Improvement cycles Components integrated Fully functioning Sustainability Installation Acquire resources Create implementation plan Develop infrastructure Prepare staff Exploration Assess needs Examine innovations Assess fit Promote “buy in” From:

26 Use Implementation Science to Create Successful Change Teams –Build an implementation team Drivers –Training alone is never enough –Detailed implementation plan Improvement Cycles –PDSA cycles Stages –Implementing new practices takes months to years –Recognize the change process

27 Practices are Abandoned….

28 Five warning signs for De-adoption of EBPs Massatti et al., 2008

29 Lack of ongoing resources Massatti et al., 2008

30 Lack of support from external groups of the effort to change Massatti et al., 2008

31 Attitudes about the new practice – think we do it already versus open to learning and changing Massatti et al., 2008

32 Beliefs that the new practice does not fit with our knowledge/skills or the agency’s mission/philosophy Massatti et al., 2008

33 Beliefs that the new practice is neither easy to implement nor a permanent part of the agency’s services Massatti et al., 2008

34 Sustainability Plan for sustainability as you’re writing the grant/planning the project Prepare for turnover –Develop expertise in the agency –What are your re-training plans? Plan for continued resources where needed Outcome data/continuous quality improvement

35 Contact Heather J. Gotham, PhD Associate Research Professor Mid-America ATTC UMKC School of Nursing direct (816)

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