![]() ![]() Quality improvement collaboratives are designed to improve healthcare quality and outcomes among multiple organizations by using a structured, temporary approach. Īchieving large-scale implementation of innovations and new guidelines across intra-organizational boundaries is even more complex. There has been increased awareness of the role of such contextual factors on the effectiveness of implementation interventions in healthcare. In their review article, Weiner and colleagues conclude that both motivation and capability are essential components of readiness for change. Studies have shown that organizational readiness facilitates the successful implementation of innovations and new guidelines. Orientation, insight, and acceptance are necessary before actual change can begin in practice. Grol described several specific steps and related barriers involved in the process of change. These considerations have the potential to influence health organizations’ choices regarding the execution of implementation interventions. Moreover, the process of change requires the investment of considerable financial and personal resources. Whether beneficial implementation effects on health outcome or quality measures will occur and to what extent is difficult to predict in advance. Their effectiveness in optimizing patient outcomes and healthcare quality has been addressed across different contexts, but further evaluations are still required in order to explore the practical implications of different strategies. ![]() These implementation interventions are specified activities designed to enhance adoption of clinical practice with the goal to improve healthcare outcomes. Several single and multifaceted implementation interventions have been used to improve the translation of knowledge and guidelines into medical practice. Insight into the trends of nonparticipants is valuable to existing implementation effectiveness research. Despite the statistically significant improvement in overall evidence-based perioperative care, the awareness raised by recruitment activities alone was not enough to reduce time to functional recovery and length of hospital stay in nonparticipating hospitals. No differences in perioperative outcomes between the nonparticipating and participating hospitals were identified at baseline. None of these hospitals managed to reduce time to functional recovery or length of hospital stay significantly. Linear regression models revealed no statistically significant or clinically relevant differences in time to functional recovery (mean difference − 0.2 days, 95% CI -0.7 to 0.2, p = 0.319) or length of hospital stay (mean difference − 0.4 days, 95% CI -1.3 to 0.5, p = 0.419) in the nonparticipating hospitals. In three of the five nonparticipating hospitals, adherence to the selected evidence-based perioperative elements increased significantly after awareness of the trial (overall mean difference 9.7%, 95% CI 6.9 to 12.5%, p < 0.001). In retrospect, nonparticipating and participating hospitals did not differ in baseline characteristics, functional recovery, and length of hospital stay. Multivariable regression models, adjusted for baseline characteristics, were used for analysis. Outcome measures for the subsequent pre-post awareness study in the five nonparticipating hospitals were: (1) overall adherence to predefined evidence-based perioperative elements and (2) change in functional recovery and length of hospital stay. Baseline data of participating hospitals’ ( N = 19) characteristics, time to functional recovery, and length of hospital stay were compared. Of the seven gynecology departments of nonparticipating Dutch hospitals, five agreed to participate in a retrospective analysis. A secondary objective was to explore how perioperative practice changed among nonparticipants. The objective of this multiphase observational study was to identify differences between organizations that participated in a large-scale implementation project aiming to improve perioperative care, functional recovery, and length of hospital stay after gynecologic surgery and organizations that did not participate. The recruitment of participants for a quality improvement collaborative increases awareness of the specific innovation. The scope of implementation research is often restricted to the analysis of organizations that participate voluntarily in implementation interventions. ![]()
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