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Identification of promising strategies to sustain improvements in hospital practice: a qualitative case study

Overview of attention for article published in BMC Health Services Research, December 2014
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  • Good Attention Score compared to outputs of the same age (70th percentile)
  • Above-average Attention Score compared to outputs of the same age and source (56th percentile)

Mentioned by

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5 tweeters

Citations

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28 Dimensions

Readers on

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82 Mendeley
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Title
Identification of promising strategies to sustain improvements in hospital practice: a qualitative case study
Published in
BMC Health Services Research, December 2014
DOI 10.1186/s12913-014-0641-y
Pubmed ID
Authors

Stephanie MC Ament, Freek Gillissen, Albine Moser, José MC Maessen, Carmen D Dirksen, Maarten F von Meyenfeldt, Trudy van der Weijden

Abstract

BackgroundA quality improvement collaborative is an intensive project involving a combination of implementation strategies applied in a limited ¿breakthrough¿ time window. After an implementation project, it is generally difficult to sustain its success. In the current study, sustainability was described as maintaining an implemented innovation and its benefits over a longer period of time after the implementation project has ended. The aim of the study was to explore potentially promising strategies for sustaining the Enhanced Recovery After Surgery (ERAS) programme in colonic surgery as perceived by professionals, three to six years after the hospital had successfully finished a quality improvement collaborative.MethodsA qualitative case study was performed to identify promising strategies to sustain key outcome variables related to the ERAS programme in terms of adherence, time needed for functional recovery and hospital length of stay (LOS), as achieved immediately after implementation. Ten hospitals were selected which had successfully implemented the ERAS programme in colonic surgery (2006¿2009), with success defined as a median LOS of 6 days or less and protocol adherence rates above 70%. Fourteen semi-structured interviews were held with eighteen key participants of the care process three to six years after implementation, starting with the project leader in every hospital. The interviews started by confronting them with the level of sustained implementation results. A direct content analysis with an inductive coding approach was used to identify promising strategies. The mean duration of the interviews was 37 minutes (min 26 minutes ¿ max 51 minutes).ResultsThe current study revealed strategies targeting professionals and the organisation. They comprised internal audit and feedback on outcomes, small-scale educational booster meetings, reminders, changing the physical structure of the organisation, changing the care process, making work agreements and delegating responsibility, and involving a coordinator. A multifaceted self-driven promising strategy was applied in most hospitals, and in most hospitals promising strategies were suggested to sustain the ERAS programme.ConclusionsJoining a quality improvement collaborative may not be enough to achieve long-term normalisation of transformed care, and additional investments may be needed. The findings suggest that certain post-implementation strategies are valuable in sustaining implementation successes achieved after joining a quality improvement collaborative.

Twitter Demographics

The data shown below were collected from the profiles of 5 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 82 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United States 2 2%
Brazil 1 1%
Malaysia 1 1%
United Kingdom 1 1%
Colombia 1 1%
Unknown 76 93%

Demographic breakdown

Readers by professional status Count As %
Researcher 16 20%
Student > Doctoral Student 12 15%
Student > Bachelor 10 12%
Student > Ph. D. Student 9 11%
Other 9 11%
Other 20 24%
Unknown 6 7%
Readers by discipline Count As %
Medicine and Dentistry 36 44%
Nursing and Health Professions 12 15%
Social Sciences 9 11%
Agricultural and Biological Sciences 3 4%
Business, Management and Accounting 3 4%
Other 9 11%
Unknown 10 12%

Attention Score in Context

This research output has an Altmetric Attention Score of 4. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 23 May 2015.
All research outputs
#4,644,706
of 15,045,928 outputs
Outputs from BMC Health Services Research
#2,372
of 5,161 outputs
Outputs of similar age
#88,708
of 302,126 outputs
Outputs of similar age from BMC Health Services Research
#215
of 498 outputs
Altmetric has tracked 15,045,928 research outputs across all sources so far. This one has received more attention than most of these and is in the 68th percentile.
So far Altmetric has tracked 5,161 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.8. This one has gotten more attention than average, scoring higher than 53% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 302,126 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 70% of its contemporaries.
We're also able to compare this research output to 498 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 56% of its contemporaries.