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Implementation Science at UW

Archives: UW Articles

✪ Middle managers’ role in implementing evidence-based practices in healthcare: A systematic review

Authors:

Sarah Birken, Alecia Clary, Amir Alishahi Tabriz, Kea Turner, Rosemary Meza, Alexandra Zizzi, Madeline Larson, Jennifer Walker & Martin Charns

University of Washington affiliated authors are displayed in bold.

Published: December 2018

Read the full text in the open access journal Implementation Science

Abstract:

Background

Middle managers are in a unique position to promote the implementation of evidence-based practices (EBPs) in healthcare organizations, yet knowledge of middle managers’ role in implementation and determinants (e.g., individual-, organizational-, and system-level factors) which influence their role remains fractured, spanning decades and disciplines. To synthesize understanding, we undertook a systematic review of studies of middle managers’ role in healthcare EBP implementation and determinants of that role.

Methods

We searched MEDLINE/PubMed and Business Source Complete (Ebsco) for literature on middle managers’ role in healthcare EBP implementation and its determinants. We abstracted data from records that met inclusion criteria (i.e., written in English, peer-reviewed, and reporting either a protocol or results of an empirical study) into a matrix for analysis. We summarized categorical variables using descriptive statistics. To analyze qualitative data, we used a priori codes and then allowed additional themes to emerge.

Results

One hundred five records, spanning across several countries and healthcare settings and relating to a range of EBPs, met our inclusion criteria. Studies of middle managers’ role in healthcare EBP implementation and its determinants substantially increased from 1996 to 2015. Results from included studies suggest that middle managers shape implementation climate in addition to fulfilling the four roles hypothesized in extant theory of middle managers’ role in implementation. However, extant studies offered little understanding of determinants of middle managers’ role.

Conclusions

Our findings suggest that middle managers may play an important role in facilitating EBP implementation. Included studies offered little understanding regarding the relative importance of various roles, potential moderators of the relationship between middle managers’ roles and EBP implementation, or determinants of middle managers’ role in EBP implementation. Future studies should seek to understand determinants and moderators of middle managers’ role. Clearer understanding may facilitate the translation of evidence into practice.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Operationalizing the ‘pragmatic’ measures construct using a stakeholder feedback and a multi-method approach

Authors:

Cameo F. Stanick, Heather M. Halko, Caitlin N. Dorsey, Bryan J. Weiner, Byron J. Powell, Lawrence A. Palinkas & Cara C. Lewis

University of Washington affiliated authors are displayed in bold.

Published: November 2018

Read the full text in the open access journal BMC Health Services Research

Abstract:

Context

Implementation science measures are rarely used by stakeholders to inform and enhance clinical program change. Little is known about what makes implementation measures pragmatic (i.e., practical) for use in community settings; thus, the present study’s objective was to generate a clinical stakeholder-driven operationalization of a pragmatic measures construct.

Evidence acquisition

The pragmatic measures construct was defined using: 1) a systematic literature review to identify dimensions of the construct using PsycINFO and PubMed databases, and 2) interviews with an international stakeholder panel (N = 7) who were asked about their perspectives of pragmatic measures.

Evidence synthesis

Combined results from the systematic literature review and stakeholder interviews revealed a final list of 47 short statements (e.g., feasible, low cost, brief) describing pragmatic measures, which will allow for the development of a rigorous, stakeholder-driven conceptualization of the pragmatic measures construct.

Conclusions

Results revealed significant overlap between terms related to the pragmatic construct in the existing literature and stakeholder interviews. However, a number of terms were unique to each methodology. This underscores the importance of understanding stakeholder perspectives of criteria measuring the pragmatic construct. These results will be used to inform future phases of the project where stakeholders will determine the relative importance and clarity of each dimension of the pragmatic construct, as well as their priorities for the pragmatic dimensions. Taken together, these results will be incorporated into a pragmatic rating system for existing implementation science measures to support implementation science and practice.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

The Pediatric Guideline Adherence and Outcomes (PEGASUS) programme in severe traumatic brain injury: A single-centre hybrid implementation and effectiveness study

Authors:

Monica S. Vavilala, Mary A. King, Jen-Ting Yang, Scott L. Erickson, Brianna Mills, Rosemary M. Grant, Carolyn Blayney, Qian Qiu, Randall M. Chesnut, Kenneth M. Jaffe, Bryan J. Weiner, & Brian D. Johnston

University of Washington affiliated authors are displayed in bold.

Subscription Required for Full Text Access

Published: November 2018

Read the full text in the subscription access journal Lancet Child and Adolescent Health
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✪ Results-based aid with lasting effects: Sustainability in the Salud Mesoamérica Initiative

Authors:

Charbel El Bcheraoui, Aruna M Kamath, Emily Dansereau, Erin B Palmisano, Alexandra Schaefer, Bernardo Hernandez and Ali H Mokdad
University of Washington affiliated authors are displayed in bold.
Published: October 2018

Read the full text in the open access journal Globalization and Health

Abstract:

Background

The Salud Mesoamérica Initiative is a public-private partnership aimed at reducing maternal and child morbidity and mortality for the poorest populations in Central America and the southernmost state of Mexico. Currently at the midpoint of implementation and with external funding expected to phase out by 2020, SMI’s sustainability warrants evaluation. In this study, we examine if the major SMI components fit into the Dynamic Sustainability Framework to predict whether SMI benefits could be sustainable beyond the external funding and to identify threats to sustainability.

Methods

Through the 2016 Salud Mesoamérica Initiative Process Evaluation, we applied qualitative methods including document review, key informant interviews, focus group discussions, and a social network analysis to address our objective.

Results

SMI’s design continuously evolves and aligns with national needs and objectives. Partnerships, the regional approach, and the results-based aid model create a culture that prioritizes health care. SMI’s sector-wide approach and knowledge-sharing framework strengthen health systems. Evidence-based practice promotes policy dialogue and scale-up of interventions.

Conclusion

Most SMI elements fit within the Dynamic Sustainability Framework, suggesting a likelihood of sustainability after external funding ceases, and subsequent application of lessons learned by the global community. This includes a flexible design, partnerships and a culture of prioritizing healthcare, health systems strengthening mechanisms, policy changes, and scale-ups of interventions. However, threats to sustainability, including possible transient culture of prioritizing health care, dissipation of reputational risk and financial partnerships, and personnel turnover, need to be addressed.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Implementation Climate and Time Predict Intensity of Supervision Content Related to Evidence Based Treatment

Authors:

Michael D. Pullmann, Leah Lucid, Julie P. Harrison, Prerna Martin, Esther Deblinger, Katherine S. Benjamin and Shannon Dorsey
University of Washington affiliated authors are displayed in bold.
Published: October 2018

Read the full text in the open access journal Frontiers in Public Health

Abstract:

Objective

Children infrequently receive evidence-based treatments (EBTs) for mental health problems due to a science-to-practice implementation gap. Workplace-based clinical supervision, in which supervisors provide oversight, feedback, and training on clinical practice, may be a method to support EBT implementation. Our prior research suggests that the intensity of supervisory focus on EBT (i.e., thoroughness of coverage) during workplace-based supervision varies. This study explores predictors of supervisory EBT intensity.

Methods

Participants were twenty-eight supervisors and 70 clinician supervisees. They completed a baseline survey, and audio recorded supervision sessions over 1 year. Four hundred and thirty eight recordings were coded for supervision content. We chose to explore predictors of two EBT content elements due to their strong evidence for effectiveness and sufficient variance to permit testing. These included a treatment technique (“exposure”) and a method to structure treatment (“assessment”). We also explored predictors of non-EBT content (“other topics”). Mixed-effects models explored predictors at organizational/supervisor, clinician, and session levels.

Results

Positive implementation climate predicted greater intensity of EBT content coverage for assessment (coefficient = 0.82, p = 0.004) and exposure (coefficient = 0.87, p = 0.001). Intensity of exposure coverage was also predicted by more time spent discussing each case (coefficient = 0.04, p < 0.001). Predictors of greater non-EBT content coverage included longer duration of supervision sessions (coefficient = 0.05, p < 0.001) and lower levels of supervisor EBT knowledge (coefficient = −0.17, p = 0.013). No other supervisor- or clinician-level variables were significant predictors in the mixed effects models.

Conclusion

This was the first study to explore multi-level predictors of objectively coded workplace-based supervision content. Results suggest that organizations that expect, support and reward EBT are more likely to have greater intensity of EBT supervision coverage, which in turn may positively impact clinician EBT fidelity and client outcomes. There was evidence that supervisor knowledge of the EBT contributes to greater coverage, although robust supervisor and clinician factors that drive supervision are yet to be identified. Findings highlight the potential effectiveness of implementation strategies that simultaneously address organizational implementation climate and supervisor practices. More research is needed to identify mechanisms that support integration of EBT into supervision.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

Measuring Constructs of the Consolidated Framework for Implementation Research in the Context of Increasing Colorectal Cancer Screening in Federally Qualified Health Center

Authors:

Michelle C. Kegler, Shuting Liang, Bryan J. Weiner, Shin Ping Tu, Daniela B. Friedman, Beth A. Glenn, Alison K. Herrmann, Betsy Risendal, Maria E. Fernandez

University of Washington affiliated authors are displayed in bold.

Published: September 2018

Read the full text in the subscription access journal Health Services Research