You are viewing the site in preview mode

Skip to main content

Advertisement

Table 1 Themes, facilitators, and barriers to implementing medication reconciliation according to qualitative analysis of interviews with healthcare managers, and selected relevant Consolidated Framework for Implementation Research (CFIR) constructs [13]

From: Implementing medication reconciliation from the planner’s perspective: a qualitative study

Facilitator Barrier CFIR construct(s) with short definition [13]
Theme 1: Consensus that purpose of medication reconciliation is to improve patient safety; respondents also had a broader view of its value
Planners with a broad view of the process’ value   Individuals’ knowledge and beliefs about the intervention: “attitudes toward and value placed on the intervention as well as familiarity with facts, truths, and principles related to the intervention” [13]
External policy and incentives: “external strategies to spread interventions including policy and regulations (governmental or other central entity), external mandates, … and public or benchmark reporting” [13]
Theme 2: Planning team’s membership and functioning recognized as facilitators to a successful planning process
Planners who were or became champions of the process   Engaging champions: “’individuals who dedicate themselves to supporting, marketing, and “driving through” an [implementation]’, overcoming indifference or resistance that the intervention may provoke in an organization” [13]
Planners organizationally positioned to carry out the plan   Engaging individuals: “attracting and involving appropriate individuals in the implementation” [13]
Planners who were compelling leaders, who could get buy-in from front line staff   Engaging opinion leaders: “individuals in an organization who have formal or informal influence on the attitudes and beliefs of their colleagues with respect to implementing the intervention” [13]
Planners with openness to others’ perspectives and a willingness to compromise, to facilitate discussion and joint problem-solving   Learning climate: “climate in which leaders express their own fallibility and need for team members’ assistance and input; team members feel that they are essential, valued, and knowledgeable partners in the change process; individuals feel psychologically safe to try new methods; …sufficient time and space for reflective thinking and evaluation” [13]
Perseverance in obtaining resources Lack of resources, staffing and/or budgetary support Available resources: “the level of resources dedicated for implementation …including money, training, education, physical space, and time” [13]
Multi-departmental participation in planning   Process planning: “the degree to which scheme[s] … for implementing an intervention are developed in advance and the quality of those schemes” [13]
Communication among team members, in or out of meetings Poor team communication Networks and communications: “the nature and quality of formal and informal communications within an organization” [13]
Theme 3: Implementation facilitated by planners’ understanding of performance improvement, and fitting the new process into workflow
Planners with an understanding of the basic tenets of performance improvement   Individuals’ other personal attributes: “personal traits such as tolerance of ambiguity, intellectual ability, motivation, values, competence, capacity, and learning style” [13]
Fitting the process into each discipline’s workflow   Compatibility: “how the intervention fits with existing workflows and systems” [13]
Assigning roles to multiple disciplines Resistance to changing roles and/or scope of practice; enforcer is a negative role Implementation climate: “The absorptive capacity for change, shared receptivity of involved individuals to an intervention” [13]
Providing value to front-line providers to improve uptake   Relative advantage: “stakeholders’ perception of the advantage of implementing the intervention versus an alternative solution” [13]
Testing to optimize human-computer usability IT staff may not be available or able to do testing Trialability: “ability to test the intervention on a small scale in the organization, and to be able to reverse course” [13]
Recognition that intervention should be refined based on reevaluation   Trialability (see above for definition)
Theme 4: Training recognized as important to sustaining the process, but training has limited effect on some individuals or groups
Training all staff and tracking training Staff turnover high; non-compliance not always solved by retraining Available resources (see above for definition)
Marketing campaign with slogan   Networks and communications (see above for definition)
Successful training approaches: peer-to-peer training; didactic with real case examples   Individuals’ knowledge and beliefs about the intervention (see above for definition)
Self-efficacy: “individuals’ belief in their own capabilities to execute course of action to achieve implementation goals” [13]
Trainees’ experiencing first hand avoided errors to drive home importance Work and other activities compete for trainees’ attention Individual stage of change: “characterization of the phase an individual is in, as he or she progresses toward skilled, enthusiastic, and sustained use of the intervention” [13]
Relative priority: “Individuals’ perception of the importance of the implementation” [13]
Theme 5: Planners monitored compliance to help sustain the process, but this did not ensure achievement of reduced errors
Monitoring of completion rates Completion rates provide no data on health impact; lack of resources to gather such data Executing: “carrying out or accomplishing the implementation according to plan” [13]
Available resources (see above for definition)
Feedback of monitoring results to providers; fostering competition to increase compliance Dilemma that error reports could go up if the new process results in more recognition Reflecting and evaluating: “quantitative and qualitative feedback about the progress and quality of implementation accompanied with regular personal and team debriefing about progress and experience” [13]