PDF(Pubmed)
Abstract：
BACKGROUND: Introducing new working methods is common in healthcare organisations. However, implementation of a new method is often suboptimal. This reduces the effectiveness of the innovation and has several other negative effects, for example on staff turnover. The aim of the current study was to implement the ABC method in residential departments for brain injured patients and to assess the quality of the implementation process. The ABC method is a simplified form of behavioural modification based on the concept that behaviour operates on the environment and is maintained by its consequences.
METHODS: Four residential departments for brain injured patients introduced the ABC method sequentially as healthcare innovation using a stepped-wedge design. A systematic process evaluation of the implementation was carried out using the framework of Saunders et al. Descriptive statistics were used to analyse the quantitative data; open questions were clustered.
RESULTS: The training of the ABC method was well executed and the nursing staff was enthusiastic and sufficiently involved. Important aspects for successful implementation had been addressed (like a detailed implementation plan and implementation meetings). However, facilitators and barriers that were noted were not addressed in a timely manner. This negatively influenced the extent to which the ABC method could be properly learned, implemented, and applied in the short and long term.
CONCLUSIONS: The most challenging part of the introduction of this new trained and introduced method in health care was clearly the implementation. To have a successful implementation serious attention is needed to tailor-made evidence-based implementation strategies based on facilitators and barriers that are identified during the implementation process. Bottlenecks in working with the ABC method have to be addressed as soon as possible. This likely requires \'champions\' who are trained for the job, next to an organisation\'s management that facilitates the multidisciplinary teams and provides clarity about policy and agreements regarding the training and implementation of the new method. The current process evaluation and the recommendations may serve as an example for the implementation of new methods in other healthcare organisations.
METHODS: Four residential departments for brain injured patients introduced the ABC method sequentially as healthcare innovation using a stepped-wedge design. A systematic process evaluation of the implementation was carried out using the framework of Saunders et al. Descriptive statistics were used to analyse the quantitative data; open questions were clustered.
RESULTS: The training of the ABC method was well executed and the nursing staff was enthusiastic and sufficiently involved. Important aspects for successful implementation had been addressed (like a detailed implementation plan and implementation meetings). However, facilitators and barriers that were noted were not addressed in a timely manner. This negatively influenced the extent to which the ABC method could be properly learned, implemented, and applied in the short and long term.
CONCLUSIONS: The most challenging part of the introduction of this new trained and introduced method in health care was clearly the implementation. To have a successful implementation serious attention is needed to tailor-made evidence-based implementation strategies based on facilitators and barriers that are identified during the implementation process. Bottlenecks in working with the ABC method have to be addressed as soon as possible. This likely requires \'champions\' who are trained for the job, next to an organisation\'s management that facilitates the multidisciplinary teams and provides clarity about policy and agreements regarding the training and implementation of the new method. The current process evaluation and the recommendations may serve as an example for the implementation of new methods in other healthcare organisations.
摘要：
背景：在医疗机构中，引入新的工作方法很常见。然而,一种新方法的实现往往是次优的。这降低了创新的有效性，并产生了其他一些负面影响，例如员工更替。本研究的目的是在住院部门对脑损伤患者实施ABC方法，并评估实施过程的质量。ABC方法是一种简化的行为修改形式，基于行为对环境起作用并由其后果维持的概念。
方法：四个脑损伤患者的住宅部门采用阶梯式楔形设计，将ABC方法作为医疗保健创新。使用Saunders等人的框架对实施进行了系统的过程评估。描述性统计用于分析定量数据；对开放性问题进行聚类。
结果：ABC方法的培训执行良好，护理人员热情且充分参与。已经解决了成功执行的重要方面（例如详细的执行计划和执行会议）。然而,注意到的促进者和障碍没有得到及时解决。这对正确学习ABC方法的程度产生了负面影响，已实施，并适用于短期和长期。
结论：在医疗保健中引入这种新的经过培训和引入的方法，最具挑战性的部分显然是实施。为了成功实施，需要认真注意根据实施过程中确定的促进者和障碍制定基于证据的实施战略。必须尽快解决使用ABC方法的瓶颈。这可能需要接受过这项工作培训的“冠军”，接下来是一个组织的管理，促进多学科团队，并提供有关培训和实施新方法的政策和协议的明确性。当前的过程评估和建议可以用作在其他医疗保健组织中实施新方法的示例。
方法：四个脑损伤患者的住宅部门采用阶梯式楔形设计，将ABC方法作为医疗保健创新。使用Saunders等人的框架对实施进行了系统的过程评估。描述性统计用于分析定量数据；对开放性问题进行聚类。
结果：ABC方法的培训执行良好，护理人员热情且充分参与。已经解决了成功执行的重要方面（例如详细的执行计划和执行会议）。然而,注意到的促进者和障碍没有得到及时解决。这对正确学习ABC方法的程度产生了负面影响，已实施，并适用于短期和长期。
结论：在医疗保健中引入这种新的经过培训和引入的方法，最具挑战性的部分显然是实施。为了成功实施，需要认真注意根据实施过程中确定的促进者和障碍制定基于证据的实施战略。必须尽快解决使用ABC方法的瓶颈。这可能需要接受过这项工作培训的“冠军”，接下来是一个组织的管理，促进多学科团队，并提供有关培训和实施新方法的政策和协议的明确性。当前的过程评估和建议可以用作在其他医疗保健组织中实施新方法的示例。
