implementation

Blended education represents a new method in the field of medical education and relies on the unique advantages of both face-to-face and virtual education methods to increase the quality of learning. The aim of this study was to evaluate the feasibility study of blended education implementation based on the views of professors of Qom University of Medical Sciences.

The present study was a descriptive-survey study. The statistical population of the study included all faculty members of Qom University of Medical Sciences, 219 people in the academic year 2021-2022. The statistical sample consisted of 40 people who were selected by stratified random sampling method considering the appropriateness of university faculties. To collect research data, a researcher-made scale of blended education feasibility questionnaire was used, the reliability of which was 0.92 through Cronbach's alpha and its validity was 0.55 through convergent validity. Data analysis was performed using one-sample t-test and Friedman ranking test in SPSS version 26.

According to professors at Qom University of Medical Sciences, the establishment of a blended learning approach is statistically supported (p=0.0001). This feasibility is attributed to perceived strengths in implementation motivation (60.17), professor technical skills (46.35), and organizational culture (25.91) (p=0.0001). Conversely, the study revealed significant challenges in technical facilities (23.37), executive-administrative support (16.79), and financial-credit conditions (13.68), which were deemed insufficient for successful implementation (p=0.0001).

While blended learning is potentially viable, addressing these critical logistical and financial barriers is essential for successful implementation at the university.

 Monitoring and evaluation are crucial in ensuring the effective implementation of health priorities. This descriptive study examined the progress towards implementing Iran’s General Health Policies (IGHP) to illustrate how countries can effectively monitor and evaluate their national plans. Additionally, the study sought to identify factors that impede the full implementation of these policies.

 Available data sources, formal reports, and studies were examined to gather data on selected indicators. Then, documentary analysis and 21 semi-structured interviews were conducted to identify measures taken to materialize IGHP and factors that hindered the full implementation of IGHP. Data were analyzed using the content analysis method.

 The results showed that several indicators improved during these years, while there was no data for some indicators. There are some barriers to implementing the IGHP, including lack of full understanding of the policies, absence of necessary mechanisms and infrastructures, lack of coherency and alignment of national health plans and policies, absence of monitoring and evaluation framework, and lack of transparency and accountability in the health system. As countries continue to develop their health plans and policies, lack of clarity regarding the progress of these plans remains a concern.

 Countries need to strengthen their health planning systems and expedite the implementation of accountability mechanisms within the health system. Enhancing capacity building is essential to establish a comprehensive monitoring and evaluation framework. By fortifying these systems, countries will be better equipped to measure and track progress toward achieving their health objectives.

We aimed to identify and classify barriers and facilitators of implementation of research finding in healthcare.

A scoping review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR). Articles were extracted from online databases. The initial search was implemented on Jun, 2022, and updated until end of 2023. Two independent reviewers screened, selected, and extracted the data. Data were synthesized using thematic analysis.

Overall, 32 studies from 3,435 documents met the inclusion criteria. From which 60 barriers and 45 facilitators were identified. The main barriers and facilitators extracted were grouped into eight components: Organization, Collaboration to knowledge utilization, Researcher role, Methodology and technical aspect of research, Management, Cultural and social determinants, Training, and Government and community. Organizational barriers and facilitators were the most concerning with insufficient attention, methodology and technical aspects of research were salient barriers, and the other components had similar roles.

This study directly addresses a gap in implementing the research findings in organizations. The government would benefit from knowledge implementation with respect to evidence utilization. Additionally, implementation knowledge was not transferred to healthcare practice to a sufficient extent, thus restricting the systematic use of implementation knowledge in practice.

Knowledge translation and implementation science have made many advances in the last two decades. However, research is still not making expedient differences to practice, policy, and service delivery. It is time to evolve our approach to knowledge production and implementation. In this editorial we advance research coproduction as a neglected pathway to impact. Our starting point is that research impact is a function of how research is done and who is involved, arguing that researchers and non-researchers have an equal voice and role to play. We outline principles of coproduction including sharing power, valuing different sources of knowledge and viewpoints, equality, open communication, inclusivity, and mutuality. We consider implications at micro, meso, and macro system levels. In calling for this shift in the way knowledge is produced and applied, we anticipate it leading to inclusive research that more rapidly translates to better, more equitable health and care for all.

  Healthy food store interventions (HFIs) are an important health-promotion tool, but face implementation and sustainment barriers. This paper aims to explore the underlying factors that produce these barriers using an innovative systems innovation perspective, through the case study of a multi-component HFI. The HFI was implemented in a minor, national, cooperative supermarket chain, in the Netherlands, a competitive market where price-based competition is the norm. 

The HFI was implemented for 6-12 months, in six stores. It was implemented by the researchers, and maintained by store employees. The study applied a Reflexive Monitoring in Action (RMA) approach, meaning that the researchers monitored stores’ adherence to the HFI, via store visits, to identify potential issues. Subsequently, the researchers interviewed the store managers responsible for the intervention, to have them reflect upon the barriers leading to these adherence issues, underlying systemic factors, and potential solutions. The stores implemented these solutions, and during the next monitoring visit the researchers evaluated whether the barrier had been resolved.

We found that the HFI often clashed with regular activities of the stores (eg, competing over the same spaces) and that store managers generally prioritized these regular activities. This prioritization was based on the greater commercial value of those regular activities (eg, selling unhealthy products) according to store managers, based on their beliefs and assumptions about commerce, health, and consumer preferences. Due to the limited resources of supermarkets (eg, people, time, space), and the HFI often not fitting within the existing structures of the stores as easily as traditional practices, store managers often neglected the HFI components in favor of regular store activities. 

Our findings illustrate the systemic factors that produce implementation barriers for HFIs, and the dynamics by which this production occurs. These insights help future researchers to anticipate and respond to such barriers.

Caddedu and colleagues’ paper “Employee-Driven Innovation in Health Organizations: Insights From a Scoping Review,” presents findings regarding the state of the literature around employee-driven innovation (EDI). In uncovering the who, what, and how of EDI in healthcare organizations the authors suggest that embracing EDI at an organizational level may be a key to supporting larger system transformation efforts. This commentary builds on this contention suggesting that to help realize that broader vision, attention should be paid to the overlapping implementation mechanisms around empowerment, adaptability, learning, and meaning and value that drive both processes. Finally, it is suggested that what may be most powerful about EDI is its ability to bring joy and vitality back to a healthcare workforce that is currently in crisis.

Growing evidence supports the integration of occupational health and safety and workplace health promotion approaches. However, the triggers and the methods for planning and implementing such approaches remain vastly unclear. This scoping review aimed to address this gap in the literature.

This review searched 43 databases (e.g. PubMed, Web of Science Core Collection, all EBSCOhost databases). Of the 7,142 results identified initially, systematic screening protocols led to the inclusion of 13 articles meeting the objectives of this review.

Of the 13 articles included, five focused on physical activity interventions. Ten articles first set specific work-related issues to be addressed. Five articles highlighted the necessity of understanding the influence of pre-existing knowledge in the interventions of integrated approaches and the heterogeneity of mental perceptions among workers. Five articles acknowledged that tailoring and flexibility of integrated approaches were key success factors, and nine articles reported the benefits of utilizing online platforms to implement integrated approaches.

Future integrated interventions should consider not only tailoring, flexibility, and delivery modality but also the appropriate level of outcome changes to suit the actual needs of workers. Intervention researchers should consider more consistently how to enhance intervention sustainability and scalability. Further research is also required on work-related issues other than physical activity.

Objective Structured Practical Examination (OSPE) has gained popularity as an objective assessment tool. Traditional assessment methods such as video and semester practical examinations are better suited to assessing the cognitive domain in pharmacology. The competency-based medical education curriculum has shifted to the psychomotor and attitude communication domains (hands-on demonstration on manikins, criticism of prescription and medical literature, hands-on demonstration on manikins, computer-assisted learning), and assessing these domains calls for more objective methods of assessment, such as the OSPE. This study aimed to design and implement the OSPE as an assessment tool for practical pharmacology for Phase II MBBS students. We also evaluated the perception, acceptability, and usefulness of OSPE for the students and the faculty.

The faculty was sensitized. Group discussions with the head of the department and faculty were held regarding the content of the OSPE stations and the design, planning, implementation, and feasibility checks. The OSPE was scheduled to be held at the upcoming formative examination with a set of 8 OSPE stations and 2 rest stations. The OSPE stations were set up in the department and were initially piloted by faculty. The OSPE was carried out in the formative examination of Phase II students. Feedback questionnaires for both students and faculty members were prepared and validated prior to administration.

Of the ninety-eight students in the batch, 96 participated. The average OSPE score obtained by the students was 22.23 ± 5.74 (the total OSPE score was 35). Ninety-six percent of the students enjoyed the OSPE, 99% of whom were satisfied (Likert scale 3-5). All the faculty agreed that the OSPE was unbiased and structured, although it required more effort, and manpower and preparation were time consuming.

The key to a successful OSPE is careful planning. A well-designed OSPE can drive learning and have a positive impact on education.

 Blood wastage leads to additional costs and reduced blood availability to patients. Above all is the moral issue of wasting donor gifts. This study aimed to determine the rate of blood wastage before and after implementing a new standard operating procedure (SOP) in Iran.

 In this interventional study, a SOP for wastage management was prepared and implemented in all blood centers throughout the country. Data were extracted from the integrated software of the Iranian Blood Transfusion Organization (IBTO). The wastage rate of blood components in the post-intervention years (2016-2017) was then compared with that in the pre-intervention years (2013-2015) using the Z test.

 The overall wastage rate decreased by 36.86% (P<0.001, 95% CI [36.84-36.88]) after the intervention. Red blood cell (RBC) wastage decreased from 2.6% to 2.5%, platelet wastage from 19.5% to 10.6% and plasma wastage from 15.5% to 7.3% (P<0.001). The highest percentage of waste reduction pertained to plasma components, which decreased by 52.90% (P<0.001, 95% CI [52.86-52.94]). Expiration was the most common cause of RBC and platelet wastage. The most common causes of plasma wastage were RBC contamination and rupture or leakage of the bags. The intervention resulted in a drop of over 250000 discarded components each year, equal to approximately thirty-six million dollars in savings.

 This intervention effectively reduced waste and increased efficiency. Ongoing blood wastage reviews, auditing, and receiving feedback from the central headquarters were powerful tools in following the compliance of blood centers. Further studies are recommended, especially concerning blood wastage in hospital blood banks and various wards.

Mobile-based self-care applications can help patients with hepatitis increase their awareness about various aspects of the disease. This study aimed to develop and evaluate a self-care mobile app for viral hepatitis.

This study was conducted in three steps. In the first step, a questionnaire containing 24 topics in four sections was used to determine the potential app contents. In the second step, the app was developed using the Android Studio 3 development environment and Kotlin programming language. In the third step, the quality of the app was evaluated using mobile app rating scale (MARS). The Questionnaire for User Interface Satisfaction (QUIS) was used to evaluate user satisfaction.

A high priority was given to the following contents of the medical and health information section; describing ways of transmitting hepatitis (81.7%), dealing with high-risk behaviors (80.6%), and methods of preventing hepatitis (79.6%). The MARS and QUIS evaluations’ results showed that the quality of the app and the user satisfaction with it were at a good level.

Since according to the participants, the topics related to the “medical and health information” section were the most important contents, we recommend addressing this part in designing other self-care apps.

The ICU liberation campaign helping improve quality of intensive care and reduces post-intensive care syndromes through the release of ABCDEF bundle, which utilizes an interprofessional approach. Evidence has shown barriers to proper bundle implementation (such as complexity and multiplicity of bundle interventions, limited bundle understanding by staff, poor interprofessional collaboration, shortage of staff) may play an important role. A multistage study was conducted to localize the ABCDEF bundle.
 Firstly, the ABCDEF bundle was translated into Persian using the WHO protocol. The initial Persian translation was performed by both a nonmedical and medical individual. After combining and enhancing the translations, it was transformed into a checklist comprising 6 elements and 53 items, which were directed to experts to evaluate its face validity and qualitative content validity. After adjustment, the first expert panel validated the checklist, and a 5-point Likert rating system for assessment of importance, relevance, and feasibility were scored by them. Based on the results of descriptive analysis by SPSS, the experts' consensus led to elimination of one item and inclusion of other 52 items. Next, the second expert panel was held.
The final ABCDEF bundle was prepared with 52 items and, the plan, the proper time and implement responsible, for its management is proposed.
 Due to absence of the Iranian version of the ABCDEF bundle, our study provided a fluent and eloquent translation, to be both comprehensible and practical for the intensive care team members. The expert panel's opinion, adapted the bundle for implementation in the ICUs of Iran. We recommend that the localized ABCDEF bundle be implemented in specialized intensive fields (such as medical, surgical, trauma, etc). The contents of the bundle could not only be incorporated into ongoing training of staff, but also into the curriculum of undergraduates and medical residents.

Holmström et al provide an interesting and thought-provoking contribution to a perennial problem: why, despite a vast number of applications of simulation modelling in healthcare over the past 70 years, there is still remarkably little evidence of successful implementation of model results. Their paper is a retrospective analysis of five case studies, all undertaken as consultancy, that used a blend of system dynamics (SD) modelling and action research (AR). This commentary assesses the effectiveness of this approach in achieving implementation, based on the evidence presented, and discusses some of the issues raised. These issues include a comparison of Holmström’s approach with group model building (GMB) in SD, the differences between healthcare modelling projects undertaken by (a) business consultants and (b) academics, and the challenges of undertaking ‘systematic’ reviews of the grey literature.

Hospital strategies aimed at increasing quality of care and simultaneously reducing costs show potential to improve healthcare, but knowledge on real-world effectiveness is limited. In 2014, two Dutch hospitals introduced such quality-driven strategies. Our aim was to evaluate contexts, mechanisms, and outcomes of both strategies using multiple perspectives.

We conducted a mixed methods evaluation. Four streams of data were collected and analysed: (1) semistructured interviewing of 62 stakeholders, such as medical doctors, nurses, managers, general practitioners (GPs), and consultants; (2) financial statements of both organisations and other hospitals in the Netherlands (counterfactual); (3) national database of quality indicators, and patient-reported experiences; and (4) existing material on strategy development and effects.

Both strategies resulted in a relative decrease in volume of care within the hospital, while quality of care has not been affected negatively. One hospital failed to cut operating costs sufficiently, resulting in declining profit margins. We identified six main mechanisms that impacted these outcomes: (1) Quality-improvement projects spur change and commitment; (2) increased coordination between hospital and primary care leads to substitution of care; (3) insufficient use of data and support hinder quality improvement; (4) scaling down hospital facilities is required to convert volume reductions to cost savings; (5) shared savings through global budgets lead to shared efforts between payer and hospital; and (6) financial security for physicians facilitates shift towards quality-driven care.

This integrated analysis of mixed data sources demonstrated that the institution-wide nature of the strategies has induced a shift from a focus on production towards quality of care. Longer-term (financial) sustainability of hospital strategies aimed at decelerating production growth requires significant efforts in reducing fixed costs. This strategy poses financial risks for the hospital if operating costs are insufficiently reduced or if payer alignment is compromised. Keywords: Hospital Strategy, Quality Improvement, Cost Reduction, Implementation, The Netherlands Copyright: © 2023 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/ by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.