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E-book: Improving Patient Care: The Implementation of Change in Health Care

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  • Pub. Date: 26-Feb-2020
  • Publisher: Wiley-Blackwell
  • Language: eng
  • ISBN-13: 9781119488606
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Improving Patient Care: The Implementation of Change in Health CareLarger Image
  • Format: EPUB+DRM
  • Pub. Date: 26-Feb-2020
  • Publisher: Wiley-Blackwell
  • Language: eng
  • ISBN-13: 9781119488606
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Strategies for successfully updating and improving health care organizations of all kinds

Health care is always evolving and improving. However, the rapid speed of medical advancement can make the adoption of new technologies and practices a challenging process – particularly in large organizations and complex networks. Any projected impact upon quality and outcomes of care must be carefully evaluated so that changes may be implemented in the most efficacious and efficient manner possible.

Improving Patient Care equips professionals and policymakers with the knowledge required to successfully optimize health care practice. By integrating scientific evidence and practical experience, the text presents a cohesive and proven model for practice change and innovation, complete with analysis of innovation, target group and setting; selection and application of strategies; and evaluation of process, outcomes and costs. This new third edition also includes: 

  • Newly written chapters on clinical performance feedback, patient engagement, patient safety, evaluation designs, and methods for process evaluation
  • Increased emphasis on the role of contextual influences in implementation and improvement
  • New research examples from across the world and updated scientific literature throughout

Designed to help promote safer and more efficient, patient-centered care and better outcomes, Improving Patient Care is an essential resource for healthcare providers, quality assessors, and students of health services research, health management, and health policy.

List of Contributors xv
Introduction xix
Part I Principles of the Implementation of Change 1(86)
1 Implementation of Change in Healthcare: A Complex Problem
3(18)
Richard Grol
Michel Wensing
1.1 Introduction
3(2)
1.2 The Implementation Problem
5(4)
1.2.1 Effective Care
6(1)
1.2.2 Safe Care
6(1)
1.2.3 Efficient Care
7(1)
1.2.4 Access to Care
8(1)
1.2.5 Patient-Centered Care
8(1)
1.2.6 Variation in the Provision of Care
8(1)
1.3 Various Approaches to the Implementation of Change in Patient Care
9(3)
1.4 What Is Implementation?
12(3)
1.5 Which Recommended Practices Should Be Adopted?
15(1)
1.5.1 New Insights and Technologies
15(1)
1.5.2 Problems in Healthcare Practice
16(1)
1.6 A Systematic Approach to "Sustainable Change"
16(1)
References
17(4)
2 Theories on Implementation of Change in Healthcare
21(24)
Michel Wensing
Richard Grol
2.1 Introduction
21(2)
2.2 Theories on Factors Related to Individual Professionals
23(4)
2.2.1 Cognitive Theories
23(2)
2.2.2 Educational Theories
25(1)
2.2.3 Motivational Theories
26(1)
2.3 Theories on Social Processes
27(4)
2.3.1 Social Learning Theory
27(1)
2.3.2 Theories on Communication
27(1)
2.3.3 Social Network Theories
28(1)
2.3.4 Theories on Teamwork
29(1)
2.3.5 Theories on Professionalization
29(1)
2.3.6 Theories on Leadership
30(1)
2.4 Theories on Organizational Systems
31(5)
2.4.1 Theories of Effective Organizations
31(1)
2.4.2 Theory of Quality and Safety Management
31(2)
2.4.3 Theory of Operations Management
33(1)
2.4.4 Theory of Complex Systems
33(1)
2.4.5 Theory of Organizational Learning
34(1)
2.4.6 Theories of Organizational Culture
35(1)
2.5 Theories on Economic and Societal Structures
36(1)
2.5.1 Economic Theories
36(1)
2.5.2 Theories on Contracting
37(1)
2.6 Conclusions
37(2)
References
39(6)
3 Effective Implementation of Change in Healthcare: A Systematic Approach
45(28)
Richard Grol
Michel Wensing
3.1 Elements of Effective Implementation
45(7)
3.2 The Implementation of Change Model
52(1)
3.3 Developing a Proposal and Targets for Change
53(2)
3.4 Assessment of Performance
55(1)
3.5 Analysis of the Target Group and Setting
56(5)
3.5.1 Aims and Settings of the Implementation
57(1)
3.5.2 Segments within the Target Group and Stages of Change
57(1)
3.5.3 Phases in a Process of Change: A Summary of the Literature
58(1)
3.5.4 Orientation
59(1)
3.5.5 Insight
59(1)
3.5.6 Acceptance
59(1)
3.5.7 Change
60(1)
3.5.8 Maintenance
60(1)
3.5.9 Barriers and Facilitators to Changing Practice
60(1)
3.6 Selection and Development of Improvement Strategies
61(1)
3.7 Development, Testing, and Execution of an Implementation Plan
61(2)
3.8 Sustainable Change: Integration of Change into Practice Routines
63(1)
3.9 Evaluation and (Possible) Adaptations to the Plan
63(3)
3.10 Planning of the Implementation Process
66(2)
3.11 Conclusions
68(1)
References
68(5)
4 Planning and Organizing the Change Process
73(14)
Richard Grol
Michel Wensing
4.1 Introduction
73(2)
4.2 A Motivated Team Comprising All Relevant Expertise
75(1)
4.3 Creating a Context for Change
76(5)
4.3.1 The Central Role of Physicians
76(2)
4.3.2 Collaboration in Teams for Patient Care
78(3)
4.4 Involving the Target Group and Stakeholders in the Plan
81(1)
4.5 Leaders and Key Figures
81(1)
4.5.1 Medical Leadership
82(1)
4.6 Project Management: Time Schedule and Responsibilities
82(1)
4.7 Resources and Support
83(1)
4.8 Conclusions
84(1)
References
84(3)
Part II Guidelines and Innovations 87(44)
5 Characteristics of Successful Innovations
89(14)
Richard Grol
Michel Wensing
5.1 Introduction
89(2)
5.2 Various Types of Improvements Require Various Types of Change Proposals
91(3)
5.2.1 Scientific Literature, Guidelines, Decision Support, and Decision Aids
91(1)
5.2.2 Clinical Pathways
92(1)
5.2.3 Improved Care Processes
93(1)
5.2.4 Other Innovations
93(1)
5.3 Characteristics of Innovations That Promote Implementation
94(3)
5.4 Format and Presentation
97(2)
5.5 Involvement of the Target Group and Local Adaptation
99(1)
5.6 Conclusions
100(1)
References
100(3)
6 Clinical Practice Guidelines as a Tool for Improving Patient Care
103(28)
Jako Burgers
Trudy van der Weijden
Richard Grol
6.1 Introduction
103(1)
6.2 Aims of Guidelines
104(1)
6.3 Potential Benefits and Limitations of Guidelines
105(2)
6.3.1 Potential Benefits
106(1)
6.3.2 Possible Limitations
106(1)
6.4 Development of Effective Guidelines
107(14)
6.4.1 Topic Selection
107(3)
6.4.2 Composition of the Guideline Development Group
110(1)
6.4.3 Patient and Public Involvement
111(2)
6.4.4 Drafting the Scope
113(1)
6.4.5 Development of Draft Guideline
114(1)
6.4.6 Identifying and Reviewing Available Guidelines and Reviews
114(1)
6.4.7 Collection and Evaluation of Scientific Evidence
115(1)
6.4.8 Contribution of All Relevant Expertise and Experience
116(1)
6.4.9 Formulation of Recommendations
116(2)
6.4.10 Consultation and Authorization
118(1)
6.4.11 Consultation
118(1)
6.4.12 Pilot Testing
119(1)
6.4.13 Authorization
119(1)
6.4.14 Design of the Guideline and Related Products
119(1)
6.4.15 Evaluation
120(1)
6.4.16 Updating Guidelines
121(1)
6.5 Quality of Guidelines and Guideline Development Programs
121(2)
6.6 International Collaboration in Guideline Development
123(1)
6.7 Conclusion
124(1)
References
125(6)
Part III Assessment of Performance 131(24)
7 Indicators for Quality and Safety of Care
133(22)
Joze Braspenning
Rosella Hermens
Hilly Calsbeek
Stephen Campbell
Philip van der Wees
Richard Grol
7.1 Introduction
133(4)
7.1.1 Aim of the Assessment
135(2)
7.2 Indicators for Quality and Safety of Care
137(3)
7.2.1 Aims of Measurement
137(1)
7.2.2 Domains and Perspectives
138(1)
7.2.3 Categories of Indicators
138(2)
7.3 Methods to Develop a Set of Indicators
140(1)
7.4 Selecting or Developing a Preliminary Set of Indicators
140(1)
7.4.1 Indicator Attributes
141(1)
7.4.2 Number of Indicators
141(1)
7.5 Finding Consensus among Target Users
141(3)
7.5.1 Delphi Technique
142(1)
7.5.2 RAND/UCLA Appropriateness Method
142(2)
7.6 Testing the Indicators Empirically
144(3)
7.6.1 Validity and Reliability
144(3)
7.7 Create a Feedback Report
147(1)
7.7.1 Calculating Indicators and Benchmarks
147(1)
7.7.2 Formulating Aims of Improvement
147(1)
7.8 Use and Effect of Quality Indicators
148(1)
7.8.1 Unintended Effects
148(1)
7.9 Conclusion
149(1)
References
150(5)
Part IV Problem Analysis 155(34)
8 Determinants of Implementation
157(16)
Michel Wensing
Richard Grol
8.1 Introduction
157(2)
8.2 Analysis of Stakeholders
159(2)
8.3 Determinants of Change
161(6)
8.3.1 Individual Health Professional Factors
161(1)
8.3.1.1 Cognitive Factors
161(1)
8.3.1.2 Motivational Factors
162(1)
8.3.1.3 Behavioral Factors (Routines)
163(1)
8.3.2 Patient Factors
163(1)
8.3.3 Professional Interactions
163(1)
8.3.3.1 Team Processes
163(1)
8.3.4 Professional Networks
164(1)
8.3.5 Organizational Factors
165(1)
8.3.5.1 Capacity for Organizational Change
165(1)
8.3.6 Organizational Structure
165(1)
8.3.7 Organizational Culture
166(1)
8.3.8 Availability of Necessary Resources
166(1)
8.3.9 Societal Factors
166(1)
8.3.9.1 Health Professions
166(1)
8.3.9.2 Financial Incentives and Disincentives
167(1)
8.3.9.3 Legislation
167(1)
8.4 Subgroups in the Target Population
167(1)
8.5 Conclusions
168(1)
References
168(5)
9 Methods to Identify and Analyze Determinants of Implementation
173(16)
Michel Wensing
Richard Grol
9.1 Introduction
173(2)
9.2 Interviews
175(2)
9.2.1 Individual Interviews
175(1)
9.2.2 Group Interviews
175(2)
9.3 Surveys
177(3)
9.3.1 Questionnaires about Clinical Guidelines
178(1)
9.3.2 Questionnaires on Theory-Based Determinants of Implementation
178(2)
9.4 Observation
180(1)
9.4.1 Routinely Collected Data
180(1)
9.4.2 Direct Observation
180(1)
9.5 Data Analysis
181(5)
9.5.1 Scientific Methods of Data Analysis
182(1)
9.5.2 Quality Improvement Methods
183(1)
9.5.3 Paretogram
183(1)
9.5.4 Fishbone Diagram
184(1)
9.5.5 Flow Chart
185(1)
9.6 Prioritization and Goal Setting
186(1)
9.7 Conclusions
186(1)
References
187(2)
Part V Strategies for Change 189(140)
10 Selection of Strategies for Improving Patient Care
191(16)
Richard Grol
Michel Wensing
10.1 Introduction
191(1)
10.2 Methods to Select and Develop Implementation Strategies
192(4)
10.2.1 Explorative Methods
194(2)
10.2.2 Theory-Based Methods
196(1)
10.3 Classification of Implementation Strategies
196(3)
10.4 Implementation Strategies in the Different Phases of Change
199(3)
10.4.1 Orientation
200(1)
10.4.2 Insight and Understanding
200(1)
10.4.3 Acceptance
201(1)
10.4.4 Change
201(1)
10.4.5 Maintenance
202(1)
10.5 Subgroups within the Target Group
202(1)
10.6 The Effectiveness of Different Strategies and Interventions
203(1)
10.7 Conclusions
204(1)
References
205(2)
11 Dissemination of Innovations
207(14)
Richard Grol
Michel Wensing
11.1 Introduction
207(3)
11.2 Mass Media Approach
210(3)
11.2.1 Written Materials
210(1)
11.2.2 Internet-Based Approaches
210(2)
11.2.3 Factors Associated with the Impact of Mass Media Strategies
212(1)
11.3 Personalized Approaches
213(4)
11.3.1 CME Courses and Conferences
214(1)
11.3.2 Social Networks
214(1)
11.3.3 Influential Individuals
215(1)
11.3.4 Personal Introduction in Practice
216(1)
11.4 Conclusion
217(1)
References
218(3)
12 Educational Implementation Strategies
221(14)
Michel Wensing
Cornelia Fluit
Jeremy Grimshaw
Richard Grol
12.1 Introduction
221(2)
12.2 Types of Educational Strategies
223(1)
12.3 Effectiveness of Education
224(3)
12.3.1 Educational Materials
225(1)
12.3.2 Educational Meetings
225(1)
12.3.3 Outreach Visits
226(1)
12.3.4 E-learning
226(1)
12.4 Determinants of the Effectiveness of Education
227(3)
12.4.1 Targets for Education
228(1)
12.4.2 Active Participation
229(1)
12.4.3 Duration of Education
229(1)
12.4.4 Opinion Leaders
229(1)
12.4.5 Assessment and Feedback
230(1)
12.5 Discussion and Conclusions
230(1)
References
231(4)
13 Clinical Performance Feedback and Decision Support
235(18)
Noah Ivers
Benjamin Brown
Jeremy Grimshaw
13.1 Introduction
235(3)
13.2 Definitions, Characteristics, and Components
238(1)
13.2.1 Feedback
238(1)
13.2.2 Decision Support
238(1)
13.3 Effectiveness of Feedback and Decision Support
239(2)
13.4 Factors Associated with Effects
241(5)
13.4.1 Underlying Assumptions, Relevant Theories, and Mechanisms
241(1)
13.4.2 Factors Associated with Effects
242(4)
13.5 Discussion and Conclusions
246(2)
References
248(5)
14 Engaging Patients in Healthcare Improvement and Innovation
253(10)
Glyn Elwyn
Amy Price
14.1 Introduction
253(1)
14.2 Impact of Patient Engagement on Direct Care
254(3)
14.2.1 Well-Established Conceptual Frameworks
254(1)
14.2.2 Persistent Theory-Practice Gap
255(1)
14.2.3 Broader Impacts
256(1)
14.3 Impact of Patient Engagement on Organizational Design and Governance
257(2)
14.4 Impact of Patient Engagement in Policy Making
259(1)
14.5 Conclusion
260(1)
References
260(3)
15 Organizational Implementation Strategies
263(12)
Michel Wensing
Miranda Laurant
Richard Grol
15.1 Introduction
263(1)
15.2 Revision of Professional Roles
264(2)
15.3 Enhanced Patient Care Teams
266(1)
15.4 Knowledge Management (Use of IT)
267(2)
15.5 Integrated Care Systems
269(2)
15.6 Quality and Safety Management
271(1)
15.7 Conclusions
272(1)
References
272(3)
16 Patient Safety Strategies
275(24)
Marieke Zegers
Mirelle Hanskamp-Sebregts
Hub Wollersheim
Charles Vincent
16.1 Introduction
275(1)
16.2 Definition of Patient Safety Concepts
276(1)
16.3 Strategies to Measure Patient Safety
277(3)
16.4 Patient Safety Improvement Strategies
280(9)
16.4.1 Teamwork Training
280(1)
16.4.2 Improved Handovers
280(5)
16.4.3 Rapid Response Team
285(1)
16.4.4 Infection Prevention
285(1)
16.4.5 Delirium Prevention
286(1)
16.4.6 Fall Prevention
287(1)
16.4.7 Pressure Ulcers
287(1)
16.4.8 Pain Management
287(1)
16.4.9 Interventions to Prevent Adverse Drug Events
288(1)
16.5 Strategies to Assure Patient Safety
289(3)
16.5.1 Leadership
289(1)
16.5.2 Safety Culture
290(1)
16.5.3 Governance
290(2)
16.6 Conclusions
292(1)
References
292(7)
17 Health System Strategies for Implementation
299(14)
Michel Wensing
Holger Pfaff
Richard Grol
17.1 Introduction
299(1)
17.2 Strategies to Enhance Evidence-Based Policy Making
300(3)
17.3 Scaling Up Interventions and Practices
303(1)
17.4 Changes in the Financial Reimbursement of Healthcare Providers
304(2)
17.5 Changes in the Financial Risk for Patients
306(1)
17.6 Changes in the Healthcare System
307(2)
17.7 Conclusions
309(1)
References
309(4)
18 Multifaceted Implementation Strategies
313(16)
Marlies Hulscher
Michel Wensing
18.1 Introduction
313(1)
18.2 Strategies in Multifaceted Implementation Strategies
314(6)
18.3 Effectiveness of Multifaceted Implementation Strategies
320(1)
18.4 Tailoring in Multifaceted Strategies
320(1)
18.5 Volume and Classification of Strategies
321(1)
18.6 Combinations of Specific Strategies
322(2)
18.7 Conclusions
324(1)
References
325(4)
Part VI Organization and Evaluation 329(80)
19 Planning of Implementation
331(14)
Richard Grol
19.1 Introduction
331(3)
19.1.1 Planning of the Implementation Process
334(1)
19.2 Development of the Plan According to Phases in the Change Process
334(2)
19.3 Planning of Activities for Different Levels of Care
336(1)
19.4 Planning of Activities over Time
337(1)
19.5 Incorporating the Implementation Plan into Existing Activities
337(1)
19.6 Testing of the Implementation Strategies
338(1)
19.7 Setting Goals for Evaluation
339(1)
19.8 Integration and Embedding of New Practice into Routines and Organization
340(2)
19.9 Conclusions
342(1)
References
343(2)
20 Experimental Designs for Evaluation of Implementation Strategies
345(12)
Michel Wensing
Jeremy Grimshaw
20.1 Introduction
345(2)
20.2 Experimental Study Designs
347(4)
20.2.1 Pragmatic versus Explanatory Trials
348(1)
20.2.2 Cluster Randomization
348(1)
20.2.3 Options for Choice of Study Groups
349(1)
20.2.4 Block Designs
349(1)
20.2.5 Allocation of Participants to Study Arms
350(1)
20.3 Outcome Measures and Data-Collection Methods
351(2)
20.4 Statistical Power and Data Analysis
353(1)
20.5 Regulatory and Ethical Considerations
354(1)
20.6 Conclusion
354(1)
References
355(2)
21 Observational Evaluation of Implementation Strategies
357(12)
Michel Wensing
Jeremy Grimshaw
21.1 Introduction
357(1)
21.2 Designs for Observational Evaluations
358(1)
21.3 Cross-Sectional Studies
359(1)
21.4 Before-After Comparisons
359(2)
21.5 Controlled Before-After Comparisons
361(2)
21.6 Multiple Case Studies
363(1)
21.7 Developmental Research
364(1)
21.8 Data Analysis in Observational Evaluation Designs
365(1)
21.9 Conclusions
366(1)
References
366(3)
22 Process Evaluation of Implementation Strategies
369(20)
Marlies Hulscher
Michel Wensing
22.1 Introduction
369(1)
22.2 Frameworks for Process Evaluation
370(2)
22.3 Process Evaluation and Implementation Strategies
372(2)
22.3.1 Evaluation of Pilots and Small Improvement Projects
373(1)
22.3.2 Evaluation of Strategies in Experimental Designs
373(1)
22.3.3 Evaluation of Improvement Programs in Observational Designs
374(1)
22.4 Assessing the Fidelity of Implementation Strategies
374(4)
22.5 Framing Process Evaluations
378(3)
22.6 A Practical, Step-wise Approach to Process Evaluation
381(4)
22.6.1 Step 1: Analysis of Implementation Strategy as Planned
381(1)
22.6.2 Step 2: Assessment of Intervention Fidelity
382(1)
22.6.3 Step 3: Assessment of Participant Experiences
383(1)
22.6.4 Step 4: Exploration of Working Mechanisms
384(1)
22.7 Conclusions
385(1)
References
386(3)
23 Economic Evaluation of Implementation Strategies
389(20)
Johan L. Severens
Ties Hoomans
Eddy Adang
Michel Wensing
23.1 Introduction
389(1)
23.2 The Basics of Economic Evaluation
390(2)
23.2.1 Definition of Cost-Effectiveness
391(1)
23.3 Types of Economic Evaluation
392(3)
23.4 Policy Cost-Effectiveness
395(1)
23.5 Framing Economic Evaluations
396(2)
23.5.1 Choice of Comparator
396(1)
23.5.2 Time Horizon of a Study
396(1)
23.5.3 Study Perspective
396(2)
23.6 Cost Analysis
398(4)
23.6.1 Directly Attributable, Indirectly Attributable, Fixed, and Variable Costs
398(1)
23.6.2 Categories of Costs
399(1)
23.6.3 Volumes and Cost Prices
400(2)
23.7 Sensitivity Analysis, Quantitative Modeling, and Budget Impact
402(3)
23.7.1 Sensitivity Analysis
402(1)
23.7.2 Quantitative Modeling
403(1)
23.7.3 Budget Impact Analysis
404(1)
23.8 Ex Post Evaluation of the Efficiency of Implementation
405(1)
23.9 Conclusions
405(1)
References
406(3)
Index 409
MICHEL WENSING, Full Professor of Health Services Research and Implementation Science, University of Heidelberg, Heidelberg; Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany; Department IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.

RICHARD GROL, Emeritus Professor, Radboud University, Nijmegen; and Maastricht University, Maastricht, The Netherlands.

JEREMY GRIMSHAW, Senior Scientist, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario; Full Professor, Department of Medicine, University of Ottawa, Ottawa, Ontario; Canada Research Chair in Health Knowledge Transfer and Uptake, Ottawa, Ontario, Canada.
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