The choice of implementation methods or frameworks for any given initiative relies on the context , local knowledge and experience with implementation science , and the resources available to support the effort . Numerous frameworks combine implementation principles and tools to help organizations facilitate sustainable improvements .” equipment at the right time . It ’ s useful to understand how to make sure that vendors are supplying what they say they will deliver , but you also need to understand the nuances , to react to inevitable changes . How often do they happen ? How do you respond to them ? How do you track them ? IP & C professionals appreciate the workings of the supply chain overall and have the connections to understand details . They combine what happens in materials management with what happens on the floor with patient care to help other stakeholders synthesize the information and find a way forward .”
Once an improvement project is identified , a framework should be selected . As Trivedi and Schaffzin , et al . ( 2023 ) explain ,” The choice of implementation methods or frameworks for any given initiative relies on the context , local knowledge and experience with implementation science , and the resources available to support the effort . Numerous frameworks combine implementation principles and tools to help organizations facilitate sustainable improvements . An organization may utilize a particular implementation framework for its relevance to a specific intervention , setting , and / or need , and another for a different initiative . As a starting point when choosing a framework , an organization may review published evidence to understand what and how framework ( s ) were used successfully and compare them to their local context .”
Commonly used in healthcare , the 4 Es model ( Engage , Educate , Execute , and Evaluate ), as outlined by Pronovost , et al . ( 2008 ) is suited for large-scale projects that include multiple sites . As Trivedi and Schaffzin , et al . ( 2023 ) note , “ Its cyclical nature allows for formative work and feedback to drive modifications and adaptations , and it provides a guide for resolving knowledge gaps through education . However , it does not include targeted strategies to address multilevel barriers that hinder putting knowledge into practice .”
“ I have had the most exposure to and experience with the 4E ’ s , CUSP and PDSA ,” Pettis says . “ One size never fits all and sometimes you may need to use more than one framework to achieve success . In my experience the 4Es resonate best with staff .”
The following 4 E strategies guide organizational change efforts :
➊ Engagement : To motivate key working partners to take ownership and support the proposed interventions .
➋ Education : To ensure key working partners understand why the proposed interventions are important .
➌ Execution : To embed the intervention into standardized care processes .
➍ Evaluation : To understand whether the intervention is successful .
Trivedi and Schaffzin , et al . ( 2023 ) say the 4Es “ guide improvement teams in planning to address key partners for the implementation process : senior hospital leaders , improvement team leaders , and frontline staff . Planning for and utilization of multifaceted interventions that address the 4Es , coupled with explicit efforts to improve teamwork and safety culture , have been associated with reductions in HAIs and mortality and increased cost savings .”
Authors of the SHEA / IDSA / APIC practice recommendation say that future needs include establishing models for underperforming hospitals and units : “ Although national implementation studies have succeeded in preventing several different HAIs , investigators have not seen the same success when focused on facilities most in need of help — hospitals underperforming with respect to HAI prevention .”
With a preponderance of resources and frameworks to help institutions improve , why do some facilities and systems still struggle ?
“ Like any like anyone in my field , I hate speculating , so I will say upfront that I really don ’ t know ,” Schaffzin says . “ That ’ s why we included it in our paper – because it ’ s a nagging problem . And I , along with everyone else , wish I knew what would make a difference . If I were to speculate , it could be something that we haven ’ t appreciated about a given context or that we tried to do a horizontal intervention or the same intervention across the board , but we really need to vary it based on local context . Or it might be something that we haven ’ t identified yet , like there are some factors that we don ’ t understand or haven ’ t identified that will lead to an ‘ Aha !’ moment . And so , oftentimes , what that might entail is more evaluation early on , more determinant work of why something is occurring . It doesn ’ t mean that that achieving a goal is not possible ; if one model doesn ’ t work , it doesn ’ t mean that no model will work — it simply means we need to conduct additional analysis , or further experimentation with another model , another framework , or we could take a step back and ask , what are the system determinants , what are the individual determinants ? Looks for the bright stars , the champions , the ones who are overachieving , and then identify the gaps , the black holes which are underachieving , and you ask what ’ s missing , what are the differences between the two .”
Sustaining system change over the long-term is challenging , the experts acknowledge . As Trivedi and Schaffzin , et al . ( 2023 ) observe , “ A long-term goal of any implementation effort is to sustain and advance short-term gains . Ideally , sustaining gains occurs with less intensity than initial efforts , maintaining gains or improving at a slower rate and allowing resources to be directed to another effort . Characteristics of successfully sustained interventions have included those that are incorporated into the standard workflow , have effective champions to shepherd the effort and re-engage when necessary , can be modified over time , fit with an organization ’ s mission and procedures , provide easily perceived benefits to staff members and / or clients , and are supported by partner organizations . It can be difficult to meet those criteria in healthcare , where changes in workflows and staff are frequent .”
20 september 2023 • www . healthcarehygienemagazine . com