The challenges in implementing digital change

The challenges in implementing digital change
National Audit Office 21 July 2021

• This report sets out the lessons for the centre of government and departments to learn from the experience of implementing digital change. It sets out these lessons in six categories, which are essential to get right at the outset understanding aims, ambition and risk; engaging commercial partners; legacy systems and data; capability; delivery methods; and funding mechanisms. This report assesses good practice, following consultation with experts from industry, academia and think tanks to highlight the nature of the challenges and understand why government has found it hard to apply the lessons of experience.

Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (ADEPT): approaches to adopting implementation strategies.

Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (ADEPT): approaches to adopting implementation strategies.
Implementation Sci 15, 109 (2020). https://doi.org/10.1186/s13012-020-01069-w

• A cost-effectiveness analysis to identify the most cost-effective approach to deploying implementation strategies to enhance the uptake of Life Goals, a mental health EBP.

A systematic scoping review of change management practices used for telemedicine service implementations.

A systematic scoping review of change management practices used for telemedicine service implementations.
BMC Health Serv Res 20, 815 (2020). https://doi.org/10.1186/s12913-020-05657-w  

• Areview of the evidence identified 16 change management practices relating to either strategic or operational aspects of telemedicine implementations. The authors suggest that the slow rate of adoption of telemedicine may be due to a piecemeal approach to the change process, and a lack of understanding of how to plan, manage and reinforce change when implementing telemedicine services.

Guidance to support rapid successful changes to health and social care that will last during and beyond the COVID-19 pandemic

Guidance to support rapid successful changes to health and social care that will last during and beyond the COVID-19 pandemic
ARC South London 29 July 2020

• An interactive resource to support the rapid implementation and evaluation of health and social care innovations, interventions and new services during, and after, the Covid-19 pandemic.

Understanding decisions to scale up: a qualitative case study of three health service intervention evaluations

Understanding decisions to scale up: a qualitative case study of three health service intervention evaluations
Journal of Health Services Research & Policy 7 May 2020. https://doi.org/10.1177/1355819620921892

• A qualitative multiple case study was conducted to characterize the evaluation and scale-up efforts of three [Canadian] interventions. 
• Conclusions: Determining if an intervention is effective and should be scaled up is more complex in practice than described in the literature. Efforts are needed to explicitly include the role of social processes in the current frameworks guiding scaling-up efforts.

Abstract

Bridging the implementation gap of machine learning in healthcare

Bridging the implementation gap of machine learning in healthcare [Commentary]
BMJ Innovations 2020;6:45-47, 27 March 2020

• A recent systematic review of deep learning applications using electronic health records data highlighted the need to focus on the last mile of implementation: ‘for direct clinical impact, deployment and automation of deep learning models must be considered’. The typical life-cycle of an algorithm remains: train on historical data, publish a good receiver-operator curve and then collect dust in the ‘model graveyard’.
• User-experience design ought to be considered as a fundamental part of any health machine learning pipeline—the way to merge an algorithm into the ‘socio-technical’ milieu of the clinic. Safety Patient safety must also become a foundational part of model design. Moving forward, there will be much to learn from the rich field of implementation science, which has developed frameworks for the design of complex health service interventions.

Leading the acceleration of evidence into practice: a guide for executive nurses

Leading the acceleration of evidence into practice: a guide for executive nurses
NHS England 11 March 2020

• A guide to promote awareness and use of evidence in organisations across the system. It discusses creating the right settings for evidence informed practice, supporting staff to engage with evidence, translating evidence into practice, and assuring improvement. Includes case studies

Adapting rapid assessment procedures for implementation research using a team-based approach to analysis

Adapting rapid assessment procedures for implementation research using a team-based approach to analysis: a case example of patient quality and safety interventions in the ICU.
Implementation Sci 15, 12 (22 February 2020). https://doi.org/10.1186/s13012-020-0972-5

• Description of the adaptation of rapid assessment procedures and introduction of a rapid team-based analysis process using an example of an evaluation of an intensive care unit (ICU) redesign initiative aimed at improving patient safety in four academic medical centres across the USA. The report presents in-depth case summaries describing the overall implementation process for each site; implementation barriers and facilitators for all four sites are presented.

Indicators of retention in remote digital health studies

Indicators of retention in remote digital health studies: a cross-study evaluation of 100,000 participants.
npj Digital Medicine 3, 21 (2020). 17 February 2020 https://doi.org/10.1038/s41746-020-0224-8

• Analysis of findings regarding recruitment and retention from eight remote digital health studies conducted between 2014–2019 provided individual-level study-app usage data from more than 100,000 participants. 
• Factors which were significantly associated with increase in participant retention time, including (i) referral by a clinician to the study (ii) compensation for participation; (iii) having the clinical condition of interest in the study; and (iv) older age.

Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence-based practice:

Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence-based practice: a 5-year panel analysis.
Implementation Sci 15, 10 (2020). https://doi.org/10.1186/s13012-020-0970-7

• Using data collected from 30 outpatient children’s mental health clinics in US hospitals across a 5-year period, this study shows that when first-level leaders increase their use of specific implementation leadership behaviours, they contribute to improvements in their organisation's evidence based practice implementation climate, which in turn contributes to increased use of evidence-based practice by clinicians.

How-to guide: non face-to-face clinics

How-to guide: non face-to-face clinics
UCL Partners 28 January 2020

• This website includes a range of resources aimed at supporting colleagues / partners in the planning and implementation of non face-to-face models of care.
• News release: UCL Partners launch new guide on how to set-up non face-to-face clinics

NIHR - Delivering complex and innovative trials

Delivering complex and innovative trials

• NIHR has launched a new web resource to showcase their expertise and share best practice around making Complex Innovative Design (CID) studies ‘business as usual’.
• Complex and innovative trial design includes the trial methodology or design but also complexity which may also exist in the set-up, recruitment, delivery or the statistical analysis and mathematics which underpin the trial. See the case study library.

Identifying relevant concepts and factors for the sustainability of evidence-based practices within acute care contexts:

Identifying relevant concepts and factors for the sustainability of evidence-based practices within acute care contexts: a systematic review and theory analysis of selected sustainability frameworks
Implementation Science 2019, 14:108. 19 December 2019

• Understanding why a particular evidence based practice (EBP) might be sustained in one setting and not another remains unclear. This review sought to identify existing frameworks/models/theories that focus solely on the sustainability of EBPs in acute care settings. It identified 37 core factors which could be grouped into 7 main themes: innovation, adopters, leadership and management, inner context, inner processes, outer context, and outcomes.

Exploring the sustainability of quality improvement interventions in healthcare organisations

Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the 10-year impact of the ‘Productive Ward: Releasing Time to Care’ programme in English acute hospitals
BMJ Quality & Safety 2020;29:31-40. 12 December 2019
As an ongoing QI approach Productive Ward, which has been around for 10 years, has not been sustained. Resource constraints and a managerial desire for standardisation meant that, over time, there was a shift away from the original vision of empowering ward staff to take ownership of Productive Ward towards a range of implementation ‘short cuts’.  However the approach has informed contemporary organisational QI practices and strategies.

Abstract

NIHR Applied Research Collaborations (ARCs)

NIHR Applied Research Collaborations (ARCs) (launched October 2019)

• NIHR ARCs (previously NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRCs), support applied health and care research that responds to, and meets, the needs of local populations and local health and care systems. 
• The 15 local partnerships between NHS providers, universities, charities, local authorities, Academic Health Science Networks and other organisations also undertake implementation research to increase the rate at which research findings are implemented into practice. 
• Research priorities for the different ARCs.

Accessing sexual health testing online

Accessing sexual health testing online
PHE 21 August 019

• Description of a new sexual health testing service in London which makes it simpler and more convenient for people - including those in the groups more at risk of sexually transmitted infections (STIs) - to get tested regularly, encouraging early identification of STIs and avoiding onward transmission. Clients access the service directly through the web or via clinic websites.
• Supporting resources.

Do no harm: a roadmap for responsible machine learning for health care

Do no harm: a roadmap for responsible machine learning for health care
Nature Medicine v25, p1337–1340 (2019) 19 August 2019

• Interest in machine-learning applications within medicine has been growing, but few studies have progressed to deployment in patient care. We present a framework, context and ultimately guidelines for accelerating the translation of machine-learning-based interventions in health care. To be successful, translation will require a team of engaged stakeholders and a systematic process from beginning (problem formulation) to end (widespread deployment).

[Not available on NHS OpenAthens til August 2020]

NHS Scotland’s Decision Support Platform: a formative qualitative evaluation

NHS Scotland’s Decision Support Platform: a formative qualitative evaluation
BMJ Health & Care Informatics 2019;26:e100022. 2 June 2019
A formative evaluation of NHS Scotland's Decision Support Platform to inform plans for its national roll-out in primary care.


Abstract