Establishing Clinical Swallowing Assessment Services via Telepractice: A Multisite Implementation Evaluation

Purpose While research has confirmed the feasibility and validity of delivering clinical swallowing evaluations (CSEs) via telepractice, challenges exist for clinical implementation. Using an implementation framework, strategies that supported implementation of CSE services via telepractice within 18 regional/rural sites across five health services were examined. Method A coordinated implementation strategy involving remote training and support was provided to 18 sites across five health services (five hub and spoke services) that had identified a need to implement CSEs via telepractice. Experiences of all 10 speech-language pathologists involved at the hub sites were examined via interviews 1 year post implementation. Interview content was coded using the Consolidated Framework for Implementation Research (CFIR) and constructs were rated for strength and direction of influence, using published CFIR coding conventions. Results Services were established and are ongoing at all sites. Although there were site-specific differences, 10 CFIR constructs were positive influencing factors at all five sites. The telepractice model was perceived to provide clear advantages for the service, and clinicians were motivated by positive patient response. Strategies used to support implementation, including having a well-organized implementation resource and an external facilitator who worked closely with the local champions, were highly valued. Two CFIR constructs, Structural Characteristics and Available Resources , were challenges for all sites. Conclusions A complex interplay of factors influenced service implementation at each site. A strong local commitment to improving patient care, and the assistance of targeted strategies to support local implementation were viewed as central to enabling implementation.

Building Self-reliance: A Framework to Evaluate Smallholder Coffee Farmers’ Pursuit of Commercialization

his study examines the application of a self-reliance framework for practitioners and evaluators to better understand the capacities and intrinsic factors impacting smallholder coffee farmers’ commercialization behaviors. We surveyed 40 smallholder coffee producers in Peru using a quantitative instrument. Data were analyzed to determine if statistical relationships exist between farmers’ self-reliance (measured via knowledge and skills, attitudes, and aspirations) and their commercialization behaviors. Findings indicate the self-reliance framework effectively illustrates relationships between farmers’ aspirations, knowledge and skills and their commercialization behaviors, while future, additional studies are needed to better measure and understand the role of commercialization-related attitudes. Practitioners can leverage the study’s findings by using a self-reliance framework to infer farmers’ likeliness to pursue sustainable commercialization practices and align their trainings and design interventions based on evaluation findings. The conceptual self-reliance framework is the first of its kind applied for smallholder coffee commercialization. The findings demonstrate that self-reliance concepts employed recently in other contexts may potentially be used similarly by extension and development facilitators. Keywords: coffee, commercialization, external facilitator, Peru, self-reliance, smallholder

Podiatry as a career in the UK - what attracts Generation Z? A qualitative exploration with university and college students

Background Training for a career in podiatry is reported to provide graduates with excellent employability, alongside professional autonomy and suitable renumeration. Yet, there has been an ongoing decline in the number of those applying to study the subject. There is limited literature associated with this topic and we sought to explore the factors that attract ‘generation Z’ (those born 1995–2010) to a potential career in podiatry. Method A qualitative design framework underpinned by phenomenological principles used four focus groups over a two-year period to generate data from participants at University and in Further Education. Focus group conversations were led by external facilitator, recorded, independently transcribed verbatim and anonymised prior to thematic analysis. This was followed by external, independent verification of themes. Results Four main themes were determined from the analysis i) a lack of awareness of podiatry; ii) podiatry: accessible course, accessible career; iii) career status; iv) breadth/opportunity of the scope of practice. Both positive and negative experiences were reported and highlighted key gaps in how the attractiveness of a career in podiatry is portrayed. Conclusion The chronic lack of awareness of podiatry as a career clearly needs to be addressed, ideally with more positive role modelling in mainstream and popular media. The career status offered together with the breadth of, and opportunity associated with, the scope of practice should continue to be celebrated.

Undergraduate Accounts of the Impact of Lockdown on Their Self-Managed Reflective Development of Graduate Abilities

This account is mostly written by students in the first year of their discipline-based study of civil engineering. It features their self-managed development of graduate abilities in the second semester of an undergraduate Irish course in problem-based civil engineering. The principal abilities were creativity, problem-solving, presentations and teamwork. The case-study paper concentrates upon four students’ reports and reflections on their experiences concerning their second (partially locked-down) semester. Their accounts complement the review of the early weeks of their first semester experience, that has already been published elsewhere. They are joined by the tutor who was an external facilitator of their early drafts of reviews. He suggested the compilation and structure of this paper, and has assisted with the assembly of the condensed individual contributions.

Time and Organizational Cost for Facilitating Implementation of Primary Care Mental Health Integration

Background Integrating mental health services into primary care settings is complex and challenging. Although facilitation strategies have successfully supported implementation of primary care mental health integration and other complex innovations, we know little about the time required or its cost. Objective To examine the time and organizational cost of facilitating implementation of primary care mental health integration. Design Descriptive analysis. Participants One expert external facilitator and two internal regional facilitators who helped healthcare system stakeholders, e.g., leaders, managers, clinicians, and non-clinical staff, implement primary care mental health integration at eight clinics. Intervention Implementation facilitation tailored to the needs and resources of the setting and its stakeholders. Main Measures We documented facilitators’ and stakeholders’ time and types of activities using a structured spreadsheet collected from facilitators on a weekly basis. We obtained travel costs and salary information. We conducted descriptive analysis of time data and estimated organizational cost. Key Results The external facilitator devoted 263 h (0.09 FTE), including travel, across all 8 clinics over 28 months. Internal facilitator time varied across networks (1792 h versus 1169 h), as well as clinics. Stakeholder participation time was similar across networks (1280.6 versus 1363.4 person hours) but the number of stakeholders varied (133 versus 199 stakeholders). The organizational cost of providing implementation facilitation also varied across networks ($263,490 versus $258,127). Stakeholder participation accounted for 35% of the cost of facilitation activities in one network and 47% of the cost in the other. Conclusions Although facilitation can improve implementation of primary care mental health integration, it requires substantial organizational investments that may vary by site and implementation effort. Furthermore, the cost of using an external expert to transfer facilitation skills and build capacity for implementation efforts appears to be minimal.

Implementation and development of guidelines in the emergency services in Kosovo – PARIHS framework

Background The aim of this project is to create understanding on the determinant factors enhancing adherence to treatment guidelines for the emergency medical services in Kosovo (EMSK). Focus is on barriers, and enablers while introducing the guidelines. It is aiming to create clearance and understanding of how and why the implementation outcomes are achieved. The factors influencing implementation will be mapped in three main domains. The domains are part of the determinant framework Promoting Action on Research Implementation in Health Services (PARIHS). Each of the domains is further divided into sub-constructs. Methods The process of implementing treatment guidelines into the emergency medical services in Kosovo was observed and documented by 4 researchers, using a participatory research design. The PARIHS framework that consists of three core components: evidence, context, and facilitation was applied to make clarity on what works better and why, in order to achieve the outcomes of the implemented guidelines. Results The preliminary results have shown that the three constructs have an important role in the process of implementation. The domain evidence determined the way the evidence based practice is conceived in this particular setting. The domain context concerns the organization and teamwork shaped challenges and possibilities for adherence to the guidelines. The role of an external facilitator was of specific importance. Conclusions The PARIHS framework serves in both practical and theoretical planning of an intervention. In the present project it provides clarity on planning of the process, while also offer understanding of the elements that contribute to the sustainability of the intervention. Finally the lessons from the approach can be replicated in similar context. Key messages Implementation projects can be more successful suing a framework to direct the effort. Such interventions should be premised with clarity on the evidence, the local context, and facilitation factors.

Applying Design Thinking in Revising Data Curation of Taiwanese Herbaria

Herbaria in Taiwan face critical data challenges: Different taxonomic views prevent data exchange; There is a lack of development practices to keep up with standard and technological advances; Data is disconnected from researchers’ perspective, thus it is difficult to demonstrate the value of taxonomists’ activities, even though a few herbaria have their specimen catalogue partially exposed in Darwin Core. Different taxonomic views prevent data exchange; There is a lack of development practices to keep up with standard and technological advances; Data is disconnected from researchers’ perspective, thus it is difficult to demonstrate the value of taxonomists’ activities, even though a few herbaria have their specimen catalogue partially exposed in Darwin Core. In consultation with the Herbarium of the Taiwan Forestry Research Institute (TAIF), the Herbarium of the National Taiwan University (TAI) and the Herbarium of the Biodiversity Research Center, Academia Sinica (HAST), which together host most important collections of the vegetation on the island, we have planned the following activities to address data challenges: Investigate a new data model for scientific names that will accommodate different taxonomic views and create a web service for access to taxonomic data; Refactor existing herbarium systems to utilize the aforementioned service so the three herbaria can share and maintain a standardized name database; Create a layer of Application Programming Interface (API) to allow multiple types of accessing devices; Conduct behavioral research regarding various personas engaged in the curatorial workflow; Create a unified front-end that supports data management, data discovery, and data analysis activities with user experience improvements. Investigate a new data model for scientific names that will accommodate different taxonomic views and create a web service for access to taxonomic data; Refactor existing herbarium systems to utilize the aforementioned service so the three herbaria can share and maintain a standardized name database; Create a layer of Application Programming Interface (API) to allow multiple types of accessing devices; Conduct behavioral research regarding various personas engaged in the curatorial workflow; Create a unified front-end that supports data management, data discovery, and data analysis activities with user experience improvements. To manage these developments at various levels, while maximizing the contribution of participating parties, it is crucial to use a proven methodological framework. As the creative industry has been leading in the area of solution development, the concept of design thinking and design thinking process (Brown and Katz 2009) has come to our radar. Design thinking is a systematic approach to handling problems and generating new opportunities (Pal 2016). From requirement capture to actual implementation, it helps consolidate ideas and identify agreed-on key priorities by constantly iterating through a series of interactive divergence and convergence steps, namely the following: Empathize: A divergent step. We learn about our audience, which in this case includes curators and visitors of the herbarium systems, about what they do and how they interact with the system, and collate our findings. Define: A convergent step. We construct a point of view based on audience needs. Ideate: A divergent step. We brainstorm and come up with creative solutions, which might be novel or based on existing practice. Prototype: A convergent step. We build representations of the chosen idea from the previous step. Test: Use the prototype to test whether the idea works. Then refine from step 3 if problems were with the prototyping, or even step 1, if the point of view needs to be revisited. Empathize: A divergent step. We learn about our audience, which in this case includes curators and visitors of the herbarium systems, about what they do and how they interact with the system, and collate our findings. Define: A convergent step. We construct a point of view based on audience needs. Ideate: A divergent step. We brainstorm and come up with creative solutions, which might be novel or based on existing practice. Prototype: A convergent step. We build representations of the chosen idea from the previous step. Test: Use the prototype to test whether the idea works. Then refine from step 3 if problems were with the prototyping, or even step 1, if the point of view needs to be revisited. The benefits by adapting to this process are: Instead of “design for you”, we “design together”, which strengthens the sense of community and helps the communication of what the revision and refactoring will achieve; When put in context, increased awareness and understanding of biodiversity data standards, such as Darwin Core (DwC) and Access to Biological Collections Data (ABCD); As we lend the responsibility of process control to an external facilitator, we are able to focus during each step as a participant. Instead of “design for you”, we “design together”, which strengthens the sense of community and helps the communication of what the revision and refactoring will achieve; When put in context, increased awareness and understanding of biodiversity data standards, such as Darwin Core (DwC) and Access to Biological Collections Data (ABCD); As we lend the responsibility of process control to an external facilitator, we are able to focus during each step as a participant. We illustrate how the planned activities are conducted by the five iterative steps.

Corporate board decision-making: applying collective versus personal values

Purpose This paper aims to offer a solution to the dilemma of board members using their personal values to drive decision-making and strategy. Board members are asked to discuss the collective values at the onset of strategy planning. Design/methodology/approach Six questions, developed over a 15-year period of working in the area of strategy and governance, unite research on values in organizations, and provide a guide for arriving at a set of agreed-upon values for decision-making. Findings Two examples from practice showcase how agreeing on values before beginning the strategy process has assisted boards with better decision-making. Research limitations/implications The questions and process are meant to be a reflective tool for board members to consider when discussing values and decision-making rather than predicting behaviour or explaining outcomes. The process is most effective for boards whose culture supports a desire for improvement and therefore a willingness to experiment with new processes. The process can be enhanced by using an external facilitator having the ability to extrapolate meaning as the discussion unfolds. Practical implications This work empowers board members to be more effective in assessing strategic options and in communicating the inner logic and meaning of the strategy throughout the organization and to the external stakeholders. Originality/value Advocating that boards engage in focused discussion around values at the beginning of the strategic process improves decision-making and provides a litmus test for evaluating the strategic options. Agreeing on a set of values also makes board members more aware of the implications of each option in the long term.