Iowa Implementation for Sustainability Framework

Implementation Science

Heather Schacht Reisinger¹  Stephanie W. Edmonds²  Michele Wagner²  Kirsten Hanrahan²  Laura Cullen² 

[1]Department of Internal Medicine, University of Iowa, 200 Hawkins Dr., 52242, Iowa City, IA, USA

[2]Institute for Clinical and Translational Science, University of Iowa, 200 Hawkins Dr., 52242, Iowa City, IA, USA

[3]Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, 200 Hawkins Dr., 52242, Iowa City, IA, USA

关键词: Implementation;    Sustainability;    Framework;    Healthcare improvement;    Strategies;    Domain mapping;   

DOI  :  10.1186/s13012-021-01157-5

来源: Springer

【 摘 要 】

BackgroundAn application-oriented implementation framework designed for clinicians and based on the Diffusion of Innovations theory included 81 implementation strategies with suggested timing for use within four implementation phases. The purpose of this research was to evaluate and strengthen the framework for clinician use and propose its usefulness in implementation research.MethodsA multi-step, iterative approach guided framework revisions. Individuals requesting the use of the framework over the previous 7 years were sent an electronic questionnaire. Evaluation captured framework usability, generalizability, accuracy, and implementation phases for each strategy. Next, nurse leaders who use the framework pile sorted strategies for cultural domain analysis. Last, a panel of five EBP/implementation experts used these data and built consensus to strengthen the framework.ResultsParticipants (n = 127/1578; 8% response) were predominately nurses (94%), highly educated (94% Master’s or higher), and from across healthcare (52% hospital/system, 31% academia, and 7% community) in the USA (84%). Most (96%) reported at least some experience using the framework and 88% would use the framework again. A 4-point scale (1 = not/disagree to 4 = very/agree) was used. The framework was deemed useful (92%, rating 3–4), easy to use (72%), intuitive (67%), generalizable (100%), flexible and adaptive (100%), with accurate phases (96%), and accurate targets (100%). Participants (n = 51) identified implementation strategy timing within four phases (Cochran’s Q); 54 of 81 strategies (66.7%, p < 0.05) were significantly linked to a specific phase; of these, 30 (55.6%) matched the original framework. Next, nurse leaders (n = 23) completed a pile sorting activity. Anthropac software was used to analyze the data and visualize it as a domain map and hierarchical clusters with 10 domains. Lastly, experts used these data and implementation science to refine and specify each of the 75 strategies, identifying phase, domain, actors, and function. Strategy usability, timing, and groupings were used to refine the framework.ConclusionThe Iowa Implementation for Sustainability Framework offers a typology to guide implementation for evidence-based healthcare. This study specifies 75 implementation strategies within four phases and 10 domains and begins to validate the framework. Standard use of strategy names is foundational to compare and understand when implementation strategies are effective, in what dose, for which topics, by whom, and in what context.

【 授权许可】

CC BY