Braithwaite Jeffrey, Marks Danielle, Taylor Natalie
Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW 2052, Australia.
Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW 2052, Australia Bradford Institute for Health Research, Bradford, UK.
Int J Qual Health Care. 2014 Jun;26(3):321-9. doi: 10.1093/intqhc/mzu047. Epub 2014 May 5.
Getting greater levels of evidence into practice is a key problem for health systems, compounded by the volume of research produced. Implementation science aims to improve the adoption and spread of research evidence. A linked problem is how to enhance quality of care and patient safety based on evidence when care settings are complex adaptive systems. Our research question was: according to the implementation science literature, which common implementation factors are associated with improving the quality and safety of care for patients?
We conducted a targeted search of key journals to examine implementation science in the quality and safety domain applying PRISMA procedures. Fifty-seven out of 466 references retrieved were considered relevant following the application of exclusion criteria. Included articles were subjected to content analysis. Three reviewers extracted and documented key characteristics of the papers. Grounded theory was used to distil key features of the literature to derive emergent success factors.
Eight success factors of implementation emerged: preparing for change, capacity for implementation-people, capacity for implementation-setting, types of implementation, resources, leverage, desirable implementation enabling features, and sustainability. Obstacles in implementation are the mirror image of these: for example, when people fail to prepare, have insufficient capacity for implementation or when the setting is resistant to change, then care quality is at risk, and patient safety can be compromised.
This review of key studies in the quality and safety literature discusses the current state-of-play of implementation science applied to these domains.
将更高水平的证据应用于实践是卫生系统面临的一个关键问题，研究成果的数量又加剧了这一问题。实施科学旨在提高研究证据的采用率和传播率。一个相关问题是，当护理环境是复杂适应系统时，如何基于证据提高护理质量和患者安全。我们的研究问题是：根据实施科学文献，哪些常见的实施因素与改善患者护理质量和安全相关？
我们对关键期刊进行了有针对性的检索，以应用PRISMA程序研究质量和安全领域的实施科学。在应用排除标准后，检索到的466篇参考文献中有57篇被认为相关。纳入的文章进行了内容分析。三位评审员提取并记录了论文的关键特征。采用扎根理论提炼文献的关键特征，以得出新出现的成功因素。
出现了八个实施成功因素：为变革做准备、实施能力——人员、实施能力——环境、实施类型、资源、影响力、理想的实施促进特征和可持续性。实施中的障碍是这些因素的反面：例如，当人们没有做好准备、实施能力不足或环境抵制变革时，护理质量就会受到威胁，患者安全可能会受到损害。
本次对质量和安全文献中关键研究的综述讨论了应用于这些领域的实施科学的现状。
