Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Abstract Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.http://deepblue.lib.umich.edu/bitstream/2027.42/78272/1/1748-5908-4-50.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/2/1748-5908-4-50-S1.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/3/1748-5908-4-50-S3.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/4/1748-5908-4-50-S4.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/5/1748-5908-4-50.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/6/1748-5908-4-50-S2.PDFPeer Reviewe

A dynamic systems engineering methodology research study. Phase 2: Evaluating methodologies, tools, and techniques for applicability to NASA's systems projects

A study of NASA's Systems Management Policy (SMP) concluded that the primary methodology being used by the Mission Operations and Data Systems Directorate and its subordinate, the Networks Division, is very effective. Still some unmet needs were identified. This study involved evaluating methodologies, tools, and techniques with the potential for resolving the previously identified deficiencies. Six preselected methodologies being used by other organizations with similar development problems were studied. The study revealed a wide range of significant differences in structure. Each system had some strengths but none will satisfy all of the needs of the Networks Division. Areas for improvement of the methodology being used by the Networks Division are listed with recommendations for specific action

Exploring the journey to services

Firms are increasingly providing services to complement their product offerings. The vast majority of studies on the service journey, also known as servitization or service transition, examine the challenges and enablers of the process of change through cases studies. Investigations that provide an in-depth longitudinal analysis of the steps involved in the service journey are much rarer. Such a detailed understanding is required in order to appreciate fully how firms can leverage the enablers while overcoming the challenges of servitization. This study investigates what does a service journey look like? It analyzes in some detail the actual service journeys undertaken by three firms in the well-being, engineering and learning sectors. The paper offers four contributions. First, in the change literature, there are two dominant theories: The punctuated equilibrium model and the continuous change model. This study demonstrates that servitization follows a continuous change rather than a punctuated equilibrium. It shows that such continuous change is neither logical nor structured but much more emergent and intuitive in nature. Second, the study provides empirical evidence to support a contingency view of the dominance and sequencing of the different process models of change across the change journey. Third, this research shows the pace of service development and when the coexistence of basic, intermediate and complex services occurs. Finally, it contributes to the literature in the service field by presenting three actual service journeys and the associated seven stages of the service strategy model that organizations should consider when managing their service journeys

Strategies for Improving the Organizational Value of Training in a Corporate Setting

Training departments and the products and services they provide are often viewed by organizational leaders as expenses rather than investments. As organizations struggle to remain competitive and viable, the money and effort spent on training comes under increased critical examination. This Organization Improvement Plan (OIP) focuses on a training department, Corporate University (CU), operating within a specific organizational context at the Insurance Institute (II). The OIP examines the organization through various critical lenses including structural, human resource, technological, and symbolic perspectives to assess and propose practical actions the CU can take to demonstrate how the products and services they provide contribute evidence based organizational value. The path-goal leadership theory, the prominent leadership approach practiced at II, will be leveraged as the leadership approach to lead the change management process. An authentic change model, Agile Broadband Change Model (ABCM), which is a hybrid of Kotter’s Eight Stage Process (Kotter & Cohen, 2002) and Cawsey, Deszca, and Ingols (2016) Change Path Model, will be used to guide the change process. The OIP recommends the adoption of the New World Kirkpatrick Model as an evaluation framework with the implementation of a standardized approach to training evaluation and reporting. The OIP could be adapted to fit the needs of other organizations struggling with challenges related to demonstrating the value of training and striving to align training outcomes to organizational goals. Key words: organizational value, path-goal leadership approach, Agile Broadband Change Model, Kotter’s Eight Stage Process, Change Path Model, New World Kirkpatrick Model, evaluation framework, standardized approach to training evaluation, aligning training

Use of the Silver-Level Arkansas Career Readiness Certificate as a Pre-hire Screening Tool

At a statewide level in Arkansas, the Arkansas Career Readiness Certificate (ACRC) is marketed as a means for assessing and exhibiting individual worker skill levels and as an additional aggregate credential to be presented alongside high school and college degree attainment levels. Employers from multiple sectors use the ACRC as a pre-hire screening tool and to determine incumbent worker eligibility for advancement. Despite having been in place in the state for nearly a decade with over 65,000 Arkansans earning an ACRC, prior to this study no research had been conducted to determine the effectiveness of the ACRC as a pre-hire screening tool. The research question of this study focused on the silver-level ACRC and the perception of human resource managers at manufacturing firms in Arkansas regarding the certificate’s influence on hiring higher-performing employees. The study sought out the managers’ perceptions related to employee safety, productivity, and retention. Data collection for this mixed methods study was conducted in two phases. The first phase included an online quantitative survey of 23 human resource managers at manufacturing firms in Arkansas. The second phase included in-person interviews of a subset of the original survey participants. Nine interviews were conducted to further explore the issues of employee safety, productivity, and retention as related to the ACRC. Findings from the study concluded that use of the silver-level Arkansas Career Readiness Certificate as a pre-hire screening tool does lead to hiring higher performing employees. This study further concluded that employee productivity is positively impacted more than safety or retention, and that overall performance of employees with the certificate was improved as compared to those without it

Initiating Leadership Development In a VUCA Environment

Organizations across the world are continuously undergoing change - some of which is by choice; the majority of this change is in response to the pressures the external environment. In today\u27s world, organizations need to be agile. They need to be able to meet the challenges and develop creative ways to attract and retain talent as part of their business strategy. When organizations are strong, their process and procedures are working well in support of their business operations, and their employees are engaged as healthy and constructive components of a high-functioning, complex, adaptable system. Organizational adaptation is imperative in the modern, volatile, unpredictable, complex and ambiguous (VUCA) environment, as without it a firm can become obsolete. Organizations represent and operate as complex adaptive systems. Accordingly, all of their systemic parts are connected and employees within these systems have the ability to influence the organizational and relational dynamics that are needed to successfully meet the adaptive challenges they and their organizations receive from their surrounding environment. This Organizational Improvement Plan (OIP) presents a possible solution by initializing leadership development through an engagement of complexity leadership theory and adaptive leadership within an organizational context unfamiliar with the value of investing in the leadership development of their employees as a form of competitive advantage. Utilizing a postmodern perspective, this OIP focuses on developing a theoretical framework through which a progressive, iterative solution can begin to gradually influence the evolution of largely transactional relationships between employees into increasingly collaborative exchanges through which adaptive work and innovative solutions can be enabled

Development of an Academic-Service Alliance to address New Graduate Registered Nurses’ Practice Readiness

New Graduate Registered Nurses’ (NGRN) lack of practice readiness is a Problem of Practice (PoP) impacting hospitals. Stemming from the evolving complexity of today’s healthcare environment and the generalist nature of the baccalaureate nursing program, the lack of NGRN practice readiness increases hospital-based orientation costs, patient safety risks, and NGRN attrition. There is currently no formal structure in which key stakeholders can address the NGRN lack of knowledge, skills and judgment and the associated implications for the safety and quality of patient care. This Organizational Improvement Plan (OIP) examines NGRN practice readiness within the organizational context of the Health Centre (HC), a Canadian academic health sciences center, and explores possible solutions. Nadler and Tushman’s (1980) Congruence Model of Organizational Behavior is used to perform a critical analysis of the HC’s current state and determine needed change. Consideration is given to the political, economic, social, cultural and historical influences shaping this PoP The Change Leader (CL) draws on authentic leadership, collaboration theory, principles of influence and inclusion, and adaptive leadership theory to develop a comprehensive change plan. Viewing the disempowered position of nursing students, NGRN, and patients through a critical theory lens highlights the need to remove structural barriers and enable equitable participation of all stakeholders in the change process. The HC operates as a complex adaptive system (CAS) and, in light of complexity theory, the proposed emergent change is guided by broad, system-level goals. Three possible solutions to this PoP are reviewed. Based on Kotter’s eight-stage process of major change, a plan to establish an Academic-Service Partnership (referred to as the ‘Alliance’) is described. Throughout the change plan attention is given to the empowerment of key stakeholders: nursing students, NGRN, and patients. The evaluation component of the change plan incorporates a Return-on-Investment (ROI) methodology to identify both the monetary and intangible benefits of the proposed change. A multi-strategy communication plan designed to align with and support the corresponding stages of the planned change is outlined. This OIP proposes a model which provides the structure required to address NGRN practice readiness. In future, this solution has potential application for other healthcare professions and their transition into professional practice

Research on technology entrepreneurship and accelerators

The last few years, accelerators are quickly proliferating across the globe. To illustrate, the F6S-platform for founders indicates that the worldwide number of accelerators has grown from 194 in 2012 to 793 in 2015; an increase of 308%. However, there is quite some confusion about what an accelerator is and what its impact is on early-stage technology ventures. To add to the confusion, many programs are continuously evolving their models. Understanding the organizational design of accelerators, its effectiveness, and its role in the startup ecosystem is key if we want to properly advise policy makers, investors, and corporates looking for new ways to spur the development of innovative ventures. Furthermore, focusing on accelerators provides an opportunity to extend the learning and experimentation literature as it offers a natural lab setting. Accordingly, the overarching research question of this dissertation is: what do accelerators do and how do they impact the entrepreneurial trajectory of ventures? This study uses theory elaboration methods to suggest how accelerators are configured and what happens within an accelerator program. The research setting is 40 accelerators across Europe—cohort-based startup support programs that accelerate learning and are seen as problem solvers for various actors in the entrepreneurial ecosystem such as venture capitalists, governments, corporates and even incubators. For instance, setting up an accelerator benefits venture capitalists by facilitating investments in a larger number of early-stage ventures at relatively low cost. It also benefits governments and corporates to streamline technology commercialization efforts. Thus, accelerators are an important phenomenon and this study provides several insights. On the one hand, it opens the ‘black box’ by highlighting the design and practices of the accelerator. By recognizing the heterogeneity among accelerators, it is clear that more robust metrics have to be developed in order to monitor the effectiveness of the different models. Although classifications of accelerator programs based on their relative performance (e.g. the Seed Accelerators Ranking Project) could be of importance to startups, it may also provide a distorted view considering programs can differ in their strategic objectives. On the other hand, it explains to policy makers, accelerators and early-stage technology ventures the boundary conditions of acceleration. First, policy makers need to take a long-term budget view when they consider to support startups through accelerator programs. Second, many ventures may not be investor-ready or commercially viable at the end of an accelerator program. Therefore, a systematic policy approach is needed for startups to thrive. Third, both early-stage technology ventures and individuals interested in setting up an accelerator should take into account the specific program components such as the selection process and the learning approach when respectively considering to apply for a program or configure one. Taken together, these essays demonstrate that accelerators occur in various forms, are constantly evolving and can differently impact the development of early-stage ventures

Paper Session III-A - Artificial Expertise in Systems Engineering

As technology development and engineering problems have grown in complexity, technical systems have evolved to meet these challenges. This evolution has occurred within a foundation of traditional engineering analysis and work processes originating prior to current computer technology. These processes were designed to improvise and compensate for ambiguous design or analysis information. Systems engineering optimization of computer technology applications can eliminate or redesign engineering processes such that the unified system function focuses on innovation, flexibility, speed, and quality. Artificial Expertise for systems engineering refers to the application of artificial intelligence expert systems and shared data bases to promote the integration of cross-functional engineering groups through technical interchange and control mechanisms. This paper presents some conceptual applications and examples for implementing artificial expertise in system development