Table 2.
Summary of Each Implementation Project
Project | Problem | Innovation | Facilitation | Recipients | Context |
---|---|---|---|---|---|
1 BHIP | Limited delivery of anticipatory, patient-centred, and coordinated outpatient mental health care. | Collaborative Chronic Care Model (CCM) for interdisciplinary team-based care in general mental health clinic settings. | Internal-external model of facilitation adapted from Kirchner et al. (2014) and based on i-PARIHS | Interdisciplinary general mental health care team members (e.g. clerk, nurse, psychiatrist, psychologist, social worker) at nine U.S. Department of Veterans Affairs (VA) medical centres. | Outpatient mental health care setting |
Outer context | |||||
In 2013, VA leadership launched a nationwide initiative to establish interdisciplinary teams in each VA medical centre throughout the United States. In 2015, the VA adopted the CCM and partnered with the study team to develop CCM implementation support. | |||||
Inner context | |||||
The inner context varied by medical centre. | |||||
2 CHERISH | High prevalence of geriatric complications (e.g. delirium, functional decline) in older inpatients | A multicomponent intervention to reduce complications and improve outcomes | Internal-external model of facilitation based on i-PARIHS | Interdisciplinary acute care team members (nurses, allied health professionals, medical staff) | Acute care setting |
Outer context | |||||
New national standard on comprehensive care and delirium clinical care standard created an impetus for improving care of older patients. | |||||
Inner context | |||||
The inner context varied by hospital and ward. | |||||
3 SIMPLE | Suboptimal and inefficient management of malnutrition in hospitals | Systematised Interdisciplinary Malnutrition Program Implementation and Evaluation – for enabling a system and team approach to better management of malnutrition | Internal-external model of facilitation based on i-PARIHS | Multidisciplinary teams and dietetics departments in six publicly funded hospitals in Australia | Acute care setting |
Outer context | |||||
State-wide roll-out of electronic medical | |||||
records exposed gaps in systems of malnutrition care and unsustainable demand on dietetics services. | |||||
Inner context | |||||
The inner context varied by hospital, ward and dietetics department. | |||||
4 REACH | Inconsistent cleaning practices in hospitals despite detailed cleaning guidelines | An environmental cleaning bundle – a bundle of evidence-based practices to improve cleaning performance and reduce infections | External facilitation with local champions | Environmental services staff members employed in a role that included ward cleaning across 11 hospitals (public and private) in Australia. | Acute care setting |
Outer context | |||||
National accreditation requirements and infection control guidelines required hospitals to have a comprehensive cleaning program. | |||||
Inner context | |||||
The inner context varied by ward. |