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      Enhancing inter-organisational partnerships in integrated care models for older adults: a multiple case study


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          The purpose of this paper was to develop deeper insights into the practices enacted by entrepreneurial healthcare managers to enhance the implementation of a partnership logic in integrated care models for older adults.


          A multiple case study design in two urban centres in two jurisdictions in Canada, Ontario and Quebec. Data collection included 65 semi-structured interviews with policymakers, managers and providers and analysis of key policy documents. The institutional entrepreneur theory provided the theoretical lens and informed a reflexive iterative data analysis.


          While each case faced unique challenges, there were similarities and differences in how managers enhanced a partnership’s institutional logic. In both cases, entrepreneurial healthcare managers created new roles, negotiated mutually beneficial agreements and co-located staff to foster inter-organisational partnerships between public, private and community organisations in the continuum of care for older adults. In addition, managers in Ontario secured additional funding, while managers in Quebec organised biannual meetings and joint training to enhance inter-organisational partnerships.


          This study has two main implications. First, efforts to enhance inter-organisational partnerships should strategically include institutional entrepreneurs. Second, successful institutional changes may be supported by investing in integrated implementation strategies that target roles of staff, co-location and inter-organisational agreements.

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          A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project

          Background Identifying, developing, and testing implementation strategies are important goals of implementation science. However, these efforts have been complicated by the use of inconsistent language and inadequate descriptions of implementation strategies in the literature. The Expert Recommendations for Implementing Change (ERIC) study aimed to refine a published compilation of implementation strategy terms and definitions by systematically gathering input from a wide range of stakeholders with expertise in implementation science and clinical practice. Methods Purposive sampling was used to recruit a panel of experts in implementation and clinical practice who engaged in three rounds of a modified Delphi process to generate consensus on implementation strategies and definitions. The first and second rounds involved Web-based surveys soliciting comments on implementation strategy terms and definitions. After each round, iterative refinements were made based upon participant feedback. The third round involved a live polling and consensus process via a Web-based platform and conference call. Results Participants identified substantial concerns with 31% of the terms and/or definitions and suggested five additional strategies. Seventy-five percent of definitions from the originally published compilation of strategies were retained after voting. Ultimately, the expert panel reached consensus on a final compilation of 73 implementation strategies. Conclusions This research advances the field by improving the conceptual clarity, relevance, and comprehensiveness of implementation strategies that can be used in isolation or combination in implementation research and practice. Future phases of ERIC will focus on developing conceptually distinct categories of strategies as well as ratings for each strategy’s importance and feasibility. Next, the expert panel will recommend multifaceted strategies for hypothetical yet real-world scenarios that vary by sites’ endorsement of evidence-based programs and practices and the strength of contextual supports that surround the effort. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0209-1) contains supplementary material, which is available to authorized users.
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            An introduction to implementation science for the non-specialist

            Background The movement of evidence-based practices (EBPs) into routine clinical usage is not spontaneous, but requires focused efforts. The field of implementation science has developed to facilitate the spread of EBPs, including both psychosocial and medical interventions for mental and physical health concerns. Discussion The authors aim to introduce implementation science principles to non-specialist investigators, administrators, and policymakers seeking to become familiar with this emerging field. This introduction is based on published literature and the authors’ experience as researchers in the field, as well as extensive service as implementation science grant reviewers. Implementation science is “the scientific study of methods to promote the systematic uptake of research findings and other EBPs into routine practice, and, hence, to improve the quality and effectiveness of health services.” Implementation science is distinct from, but shares characteristics with, both quality improvement and dissemination methods. Implementation studies can be either assess naturalistic variability or measure change in response to planned intervention. Implementation studies typically employ mixed quantitative-qualitative designs, identifying factors that impact uptake across multiple levels, including patient, provider, clinic, facility, organization, and often the broader community and policy environment. Accordingly, implementation science requires a solid grounding in theory and the involvement of trans-disciplinary research teams. Summary The business case for implementation science is clear: As healthcare systems work under increasingly dynamic and resource-constrained conditions, evidence-based strategies are essential in order to ensure that research investments maximize healthcare value and improve public health. Implementation science plays a critical role in supporting these efforts.
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              Critical Analysis of Strategies for Determining Rigor in Qualitative Inquiry.

              Criteria for determining the trustworthiness of qualitative research were introduced by Guba and Lincoln in the 1980s when they replaced terminology for achieving rigor, reliability, validity, and generalizability with dependability, credibility, and transferability. Strategies for achieving trustworthiness were also introduced. This landmark contribution to qualitative research remains in use today, with only minor modifications in format. Despite the significance of this contribution over the past four decades, the strategies recommended to achieve trustworthiness have not been critically examined. Recommendations for where, why, and how to use these strategies have not been developed, and how well they achieve their intended goal has not been examined. We do not know, for example, what impact these strategies have on the completed research. In this article, I critique these strategies. I recommend that qualitative researchers return to the terminology of social sciences, using rigor, reliability, validity, and generalizability. I then make recommendations for the appropriate use of the strategies recommended to achieve rigor: prolonged engagement, persistent observation, and thick, rich description; inter-rater reliability, negative case analysis; peer review or debriefing; clarifying researcher bias; member checking; external audits; and triangulation.

                Author and article information

                Journal of Health Organization and Management
                Emerald Publishing
                27 May 2022
                31 August 2022
                : 36
                : 6
                : 781-795
                [1] Faculté de Medecine et des Sciences de la Santé , Universite de Sherbrooke - Campus de Longueuil , Longueuil, Canada
                [2]Département de sciences de la santé communautaire, University of Sherbrooke , Sherbrooke, Canada
                [3] Dalla Lana School of Public Health , University of Toronto , Toronto, Canada
                [4] Bridgepoint Collaboratory for Research and Innovation , Lunenfeld-Tanenbaum Research Institute , Sinai Health System , Toronto, Canada
                [5] Institute for Health System Solutions and Virtual Care , Women's College Hospital , Toronto, Canada
                Author notes
                Paul Wankah can be contacted at: paul.wankah.nji@usherbrooke.ca
                686505 JHOM-02-2022-0055.pdf JHOM-02-2022-0055
                © Paul Wankah, Mylaine Breton, Carolyn Steele Gray and James Shaw

                Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

                : 15 February 2022
                : 24 April 2022
                : 27 April 2022
                Page count
                Figures: 0, Tables: 1, Equations: 0, References: 42, Pages: 15, Words: 8246
                Self URI (journal-page): http://www.emeraldinsight.com/journal/jhom
                research-article, Research paper
                cat-HSC, Health & social care
                , Healthcare management
                Custom metadata

                Health & Social care
                Implementation,Case study,Institutional entrepreneurship,Older adults,Integrated care


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