Abstract:
BACKGROUND:Those attempting to implement changes in health care settings often find that intervention efforts do not progress as expected. Unexpected outcomes are often attributed to variation and/or error in implementation processes. We argue that some unanticipated variation in intervention outcomes arises because unexpected conversations emerge during intervention attempts. The purpose of this paper is to discuss the role of conversation in shaping interventions and to explain why conversation is important in intervention efforts in health care organizations. We draw on literature from sociolinguistics and complex adaptive systems theory to create an interpretive framework and develop our theory. We use insights from a fourteen-year program of research, including both descriptive and intervention studies undertaken to understand and assist primary care practices in making sustainable changes. We enfold these literatures and these insights to articulate a common failure of overlooking the role of conversation in intervention success, and to develop a theoretical argument for the importance of paying attention to the role of conversation in health care interventions. DISCUSSION:Conversation between organizational members plays an important role in the success of interventions aimed at improving health care delivery. Conversation can facilitate intervention success because interventions often rely on new sensemaking and learning, and these are accomplished through conversation. Conversely, conversation can block the success of an intervention by inhibiting sensemaking and learning. Furthermore, the existing relationship contexts of an organization can influence these conversational possibilities. We argue that the likelihood of intervention success will increase if the role of conversation is considered in the intervention process. SUMMARY:The generation of productive conversation should be considered as one of the foundations of intervention efforts. We suggest that intervention facilitators consider the following actions as strategies for reducing the barriers that conversation can present and for using conversation to leverage improvement change: evaluate existing conversation and relationship systems, look for and leverage unexpected conversation, create time and space where conversation can unfold, use conversation to help people manage uncertainty, use conversation to help reorganize relationships, and build social interaction competence.
journal_name
Implement Scijournal_title
Implementation science : ISauthors
Jordan ME,Lanham HJ,Crabtree BF,Nutting PA,Miller WL,Stange KC,McDaniel RR Jrdoi
10.1186/1748-5908-4-15subject
Has Abstractpub_date
2009-03-13 00:00:00pages
15issn
1748-5908pii
1748-5908-4-15journal_volume
4pub_type
杂志文章abstract:BACKGROUND:This study examined the effectiveness of seven different interventions designed to increase the proportion of general practitioners (GPs) accepting an offer of free access to an online evidence-based resource. METHODS:Australian GPs (n = 14,000) were randomly selected and assigned to seven intervention grou...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-4-68
更新日期:2009-10-20 00:00:00
abstract:BACKGROUND:Knowledge translation (KT) aims to close the research-practice gap in order to realize and maximize the benefits of research within the practice setting. Previous studies have investigated KT strategies in nursing and medicine; however, the present study is the first systematic review of the effectiveness of...
journal_title:Implementation science : IS
pub_type: 杂志文章,评审
doi:10.1186/1748-5908-7-70
更新日期:2012-07-25 00:00:00
abstract:BACKGROUND:Worksites are important locations for interventions to promote health. However, occupational programs with documented efficacy often are not used, and those being implemented have not been studied. The research in this report was funded through the American Reinvestment and Recovery Act Challenge Topic 'Path...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-5-73
更新日期:2010-10-08 00:00:00
abstract:BACKGROUND:Implementation researchers have typically studied organizational culture and climate by testing whether individual dimensions are linked to the implementation of evidence-based practices (EBPs) rather than examining how the overarching social context influences implementation. This approach may limit impleme...
journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究
doi:10.1186/s13012-019-0863-9
更新日期:2019-02-12 00:00:00
abstract:BACKGROUND:Adapting promising health care interventions to local settings is a critical component in the dissemination and implementation process. The Veterans Health Administration (VHA) rural transitions nurse program (TNP) is a nurse-led, Veteran-centered intervention designed to improve transitional care for rural ...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-017-0653-1
更新日期:2017-10-23 00:00:00
abstract:BACKGROUND:Health practice guidelines (HPGs) are important tools for the translation of evidence into practice. Reporting Items for Practice Guidelines in HealThcare (RIGHT) checklist provides guidance on reporting health practice guidelines (HPGs). We assessed the reporting completeness and quality of a set of nationa...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-018-0828-4
更新日期:2018-10-29 00:00:00
abstract:BACKGROUND:With the current funding climate and need for advancements in implementation science, there is a growing demand for grantsmanship workshops to increase the quality and rigor of proposals. A group-based implementation science-focused grantsmanship workshop, the Implementation Development Workshop (IDW), is on...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-016-0429-z
更新日期:2016-05-06 00:00:00
abstract:BACKGROUND:Considerable racial and socio-economic disparities exist in breast cancer. In spite of the existence of numerous evidence-based interventions (EBIs) aimed at reducing breast cancer screening barriers among the underserved, there is a lack of uptake or sub-optimal uptake of EBIs in community and clinical sett...
journal_title:Implementation science : IS
pub_type: 临床试验,杂志文章
doi:10.1186/s13012-015-0334-x
更新日期:2015-10-14 00:00:00
abstract:BACKGROUND:It is challenging to interpret the results of multifaceted interventions due to complex program theories that are difficult to measure in a quantifiable manner. The aims of this paper were, first, to develop a model for a comprehensive quantitative implementation evaluation and, second, to operationalize it ...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/s13012-018-0720-2
更新日期:2018-02-08 00:00:00
abstract:BACKGROUND:Previous efforts to produce case descriptions have typically not focused on the organizations that produce research evidence and support its use. External evaluations of such organizations have typically not been analyzed as a group to identify the lessons that have emerged across multiple evaluations. Case ...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-3-56
更新日期:2008-12-17 00:00:00
abstract:BACKGROUND:Antiretroviral therapy (ART) for HIV-infected persons and pre-exposure prophylaxis (PrEP) for uninfected persons are extraordinarily effective strategies for HIV prevention. In Africa, the region which shoulders the highest HIV burden, HIV care is principally delivered through public health HIV care clinics,...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/s13012-018-0809-7
更新日期:2018-09-04 00:00:00
abstract:BACKGROUND:Patients with opioid use disorder (OUD) frequently present to the emergency department (ED) after overdose, or seeking treatment for general medical conditions, their addiction, withdrawal symptoms, or complications of injection drug use, such as soft tissue infections. ED-initiated buprenorphine has been sh...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-019-0891-5
更新日期:2019-05-07 00:00:00
abstract:BACKGROUND:Adapting interventions that have worked elsewhere can save resources associated with developing new interventions for each specific context. While a developing body of evidence shows benefits of adapted interventions compared with interventions transported without adaptation, there are also examples of inter...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-019-0956-5
更新日期:2019-12-17 00:00:00
abstract:BACKGROUND:More than a fifth of Australian children arrive at school developmentally vulnerable. To counteract this, the Healthy Kids Check (HKC), a one-off health assessment aimed at preschool children, was introduced in 2008 into Australian general practice. Delivery of services has, however, remained low. The Theore...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-9-60
更新日期:2014-05-23 00:00:00
abstract:BACKGROUND:To improve hypertension care for ethnic minority patients of African descent in the Netherlands, we developed a provider intervention to facilitate the delivery of culturally appropriate hypertension education. This pilot study evaluates how the intervention affected the attitudes and perceived competence of...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-5-35
更新日期:2010-05-14 00:00:00
abstract:BACKGROUND:Shared decision-making is not widely implemented in healthcare. We aimed to set a research agenda about promoting shared decision-making through continuing professional development. METHODS:Thirty-six participants met for two days. RESULTS:Participants suggested ways to improve an environmental scan that h...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-6-68
更新日期:2011-07-05 00:00:00
abstract:BACKGROUND:For early stage breast cancer, randomized controlled trials (RCTs) have shown that patient decision aids (PtDAs), when used by surgeons, result in increased patient knowledge about options and different patient treatment choices as compared to standard care. Yet, recent data suggests that PtDAs are used by l...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-014-0174-0
更新日期:2014-11-29 00:00:00
abstract:BACKGROUND:Violence against women (VAW) is a major public health problem. Translation of VAW research to policy and practice is an area that remains understudied, but provides the opportunity to examine knowledge translation and exchange (KTE) processes in a complex, multi-stakeholder context. In a series of studies in...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-6-102
更新日期:2011-09-06 00:00:00
abstract:BACKGROUND:Healthcare systems are challenged by a demand that exceeds available resources. One policy to meet this challenge is task substitution-transferring tasks to other professions and settings. Our study aimed to explore stakeholders' perceived feasibility of transferring hospital-based monitoring of stable glauc...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-8-14
更新日期:2013-01-25 00:00:00
abstract:BACKGROUND:Service development innovation in health technology and practice is viewed as a pressing need within the field of mental health yet is relatively poorly understood. Macro-level theories have been criticised for their limited explanatory power and they may not be appropriate for understanding local and fine-g...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-6-120
更新日期:2011-10-26 00:00:00
abstract:BACKGROUND:Escalation of commitment is the tendency that (innovation) projects continue, even if it is clear that they will not be successful and/or become extremely costly. Escalation prevention potential (EPP), the capability of an organization to stop or steer implementation processes that do not meet their expectat...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-016-0435-1
更新日期:2016-05-20 00:00:00
abstract:BACKGROUND:Translation of evidence-based interventions into hospital systems can provide immediate and substantial benefits to patient care and outcomes, but successful implementation is often not achieved. Existing literature describes a range of barriers and facilitators to the implementation process. This systematic...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-018-0726-9
更新日期:2018-02-23 00:00:00
abstract:BACKGROUND:Use of direct oral anticoagulants (DOAC) is rapidly growing for treatment of atrial fibrillation and venous thromboembolism. However, incorrect dosing of these medications is common and puts patients at risk of adverse drug events. One way to improve safe prescribing is the use of population health tools, in...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-020-01044-5
更新日期:2020-09-21 00:00:00
abstract:BACKGROUND:The ethical argument that shared decision-making is "the right" thing to do, however laudable, is unlikely to change how healthcare is organized, just as evidence alone will be an insufficient factor: practice change is governed by factors such as cost, profit margin, quality, and efficiency. It is helpful, ...
journal_title:Implementation science : IS
pub_type: 杂志文章,评审
doi:10.1186/s13012-016-0480-9
更新日期:2016-08-08 00:00:00
abstract:BACKGROUND:In 2011, Manitoba implemented a province-wide program of physician detailing and free sampling for generic atorvastatin to increase use of this generic statin. We examined the impact of this unique combined program of detailing and sampling for generic atorvastatin on the use and cost of statin medicines, ma...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-017-0671-z
更新日期:2017-11-25 00:00:00
abstract:BACKGROUND:Teaching the content of clinical practice guidelines (CPGs) is important to both clinical care and graduate medical education. The objective of this study was to determine the characteristics of curricula for teaching the content of CPGs in family medicine and internal medicine residency programs in the Unit...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-4-59
更新日期:2009-09-21 00:00:00
abstract:BACKGROUND:In knowledge translation, complex interventions may be implemented in the attempt to improve uptake of research-based knowledge in practice. Traditional evaluation efforts that focus on aggregate effectiveness represent an oversimplification of both the environment and the interventions themselves. However, ...
journal_title:Implementation science : IS
pub_type: 杂志文章,评审
doi:10.1186/s13012-014-0115-y
更新日期:2014-09-05 00:00:00
abstract:BACKGROUND:The fields of implementation and improvement sciences have experienced rapid growth in recent years. However, research that seeks to inform health care change may have difficulty translating core components of implementation and improvement sciences within the traditional paradigms used to evaluate efficacy ...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-018-0770-5
更新日期:2018-05-29 00:00:00
abstract:BACKGROUND:In 2004, Gabbay and le May showed that clinicians generally base their decisions on mindlines-internalised and collectively reinforced tacit guidelines-rather than consulting written clinical guidelines. We considered how the concept of mindlines has been taken forward since. METHODS:We searched databases f...
journal_title:Implementation science : IS
pub_type: 杂志文章,评审
doi:10.1186/s13012-015-0229-x
更新日期:2015-04-09 00:00:00
abstract:BACKGROUND:Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy-makers. Using a psychosocial theoretical framework, this study aimed at exploring the factors affecting physician intention to adopt HTA recommendations. T...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-1-8
更新日期:2006-03-31 00:00:00