Implementation evidence-based in healthcare organizations management and policy

Framework design

The domain determinants are as follows: (determinant 1) an individual behavior, presented the perception of individuals and abilities; (determinant 2) implementing evidence-based strategies depend on the organizational needs and awareness; and (determinant 3) focus on organizational outcomes as an indicator for the change; (determinant 4) depends on the organizational culture; the main strategy of the organizations and the settings where the evidence-based management takes place. The comprehensive domain is the context (determinant 5) where the organization itself survives (Figure 1).

Figure 1. Perspective framework of implementation evidence-based management in healthcare organizations.

Theories on implementation/organizational theory and conceptual frameworks

Theories that are useful for the design and assessment of implementation science in healthcare apply to a variety of scientific purposes. Basic bases and processes of transition, which can be instrumentally used to develop strategies, are also proposed by certain strategies.²

New methods that incorporate outstanding psychological and organizational theories into a standardized model are required to make them available to researchers in implementation.⁵ In order to be clear about the predicted mechanisms of action at the organizational level, implementation researchers can draw on the input of organizational theories already donated by psychology, sociology, management science and other disciplines in the absence of such models.⁵

A variety of psychological theories concentrate on modifying human and organizational behavior and building on knowledge generated by previous research, theories can offer new perspectives that highlight the considered problems. The need for theory-based execution to describe, execute and then maintain any evidence is a multifaceted responsibility since implementation methods are generally (a) multi-dimensional and (b) the need to familiarize the contexts.

Institutional theory explores how environmental factors lead to organizations adopting similar processes and procedures. The theory refers to this as the “isomorphism” inclination, which is defined as an organization’s tendency to mimic other, comparable types of organizations in response to the matching set of environmental circumstances.⁶ Institutional theory describes three types of institutional pressures that promote isomorphism⁶ coercive pressures are the formal and informal pressures imposed by other organizations and institutions, including rules, guidelines, performance standards, and other external mandates or expectations of society mimetic pressures include the inclination for organizations to model what other peer organizations are doing, predominantly when the most effective or appropriate practice is unknown for organizations normative pressures are the mutual struggle of an occupation representatives to establish their working conditions and practices.⁶

The principle of contingency implies that the most productive way of structuring a task depends on the features of both the task and the environment. Prerequisite tasks should be well-defined to include service operation, result, and delivery. According to the theory, the mechanisms used to organize a mission differ from programmed to unprogrammed (i.e., new professional positions, teams, and communication processes that facilitate collective decision-making) on a spectrum (i.e., formal procedures, laws, hierarchical authority arrangements, and centralized decision making). The vital environment in contingency theory includes variables both within the organization (inner environment) and external to the organization (outer environment).⁷

The margin of error and the ability of adaptation

It is a complex enterprise to identify, incorporate and then maintain any approach. Because of various interaction levels (e.g., patients, caregivers, teams, service units), environments in which implementation attempts occur are themselves complex, with broad variation from one setting to another.⁸

Within evidence, which is a simplified representation of a more complex world with reasonably precise assumptions about cause and effect, it is possible to analyze each construct in the evidence and test it to support or disprove this course of transition. The evidence base could require refinement or be completely rejected based on performance. Through the use, for example, qualitative comparative analysis methods, consistent use of constructs across studies facilitates furthermore successful syntheses.⁹ The development of robust quantitative measures can also be driven by explicit operationalization of theoretical paradigms. Differences in quantitative measurements may be attributed to a number of contexts’ factors, i.e. the ability to adjust or the margins of error.

Implementation evidence-based management principles

Many implementation science experts have concluded that implementation methods need to be adapted to the target population, and its situation. Developing and choosing steps to transform information into results. This is analogous to patient care, where the option of treatment is normally followed by a diagnosis. There are a variety of steps in a systematic, organized approach to implementation: (a) simple definition of the information to be applied, (b) thorough review of the current situation, including information determinants-use differences, (c) alignment of procedures with intended management determinants, (d) implementation, assessment and adaptation of procedures. Obviously, this stepwise model for execution is often multifaceted and dynamic, such that deviations and repeated loops are needed.

Although customized implementation is recommended, little is known about the legitimacy of various methods of tailoring. For example, it is uncertain what the most suitable level is for tailoring (geographic area, hospital or particular behaviors), which stakeholders should be involved in the tailoring process (clinicians, patients, health insurers), and which approaches are best used to gather information on obstacles to change.⁴ The discussion would serve as a method of disseminating research results directly to study participants as a review and some recommendations related to teamwork techniques for more successful sensemaking. The three foundations for ensuring the implementation of the evidence-based management are a) confirmability: unrecognized biases are monitored by researchers, b) reliability: candidate output remains consistent over time and c) credibility: findings are plausible and authentic.¹⁰

An approach led to prompting recognition that evidence should be chosen or created on the basis of a detailed understanding of context, an evaluation of determinants of execution, and an understanding of the factors required to implement them.¹¹ In order to improve the effect of implementation evidence-based management in healthcare organizations, five targets need to be addressed: (1) developing methods for designing and tailoring; (2) defining and evaluating processes; (3) performing more productive research; (4) increasing economic assessments; and (5) developing monitoring and reporting.

Organizational culture in healthcare organizations

The definition of organizational culture derives from different fields, including anthropology, sociology, and management. The value of culture for key results has begun recently to be addressed prominently in the healthcare organizations. As Schein¹² suggested: “Organizational culture is the pattern of shared fundamental assumptions that have worked well enough to be considered true and therefore to be taught to new members as the correct way to interpret, think and feel in relation to those members as conceived, discovered or formed by a given group as it learns to deal with its problems of external adaptation and internal integration”. There is a range of qualitative and quantitative methods that assess organizational culture, depending on each study’s aim and objectives.

If the evidence-based management is not related to successful organizational settings, an extremely honest decision on the standard of management is unlikely to be made, while culture is defined as a significant variable influencing the degree to which the evidence is focused on “reasonable” healthcare selections. A detailed research on the prevalent values in healthcare organizations has been conducted, and while the literature on the relation between culture and achievement is growing, a slight emphasis is put on decision-making either as an endpoint or as an adaptable evidence.

Clearly, culture is the form of decision-making that can be assumed, but there is a need for evidence to indicate how this happens. The literature emphasizes the value of the culture of research as a precondition for evidence-based management policymaking. Given the existing organizational and administrative culture of the healthcare system, if the service’s major capacity boundaries are limited, significant improvements in the operations of the healthcare system¹³ will be involved.

Outcome indicators in healthcare organizations

By systematic use of outcome records and implementers, outcomes can be strengthened over time. Compared to research that did not use outcome results, outcome indicators and their interpretations help to change results over time even more quickly.¹⁴ It was noted that the findings were not only used to identify potential interventions for change, but also to track and secure long-term improvements.¹⁴ The production of evidence-based management can enhance the use of investigative criteria, creation of result reliability, checklists, patient empowerment and change leadership for the further usage of data for evidence outcome improvement.

Outcomes are the product of treatment over time in terms of the welfare of the patient. The overall aim for patient care should be to advance patient outcomes. The targeted outcomes of healthcare are true indicators of the system quality. The outcomes of healthcare should focus on the patient and on the specific units or specialist facilities that provide care. In addition, the outcome assessment should include the entire continuum of care for the disease, as well as follow-up care.¹⁵

Highly productive organizations provide a method to track, examine patterns and measure outcomes across key areas of efficiency. The use of data to control key short- and long-term processes is integrated into management and running frameworks and is a characteristic of day-to-day work at all levels. The scope of results involving monitoring and review of healthcare includes the following: outcomes in healthcare (i.e. clinical and patient care outcomes); outcomes based on patients and other consumers (i.e. patient consumer experience using the delivery system)¹⁶; outcomes of staff and work system (i.e. staff satisfaction, staff growth, and performance and quality of work system measures); outcomes of organizational efficiency (i.e. efficiency, productivity, performance enhancement, cycle time, innovation spread); and governance and social responsibility processes that are needed for communicating and learning from these findings up and down the organization.

Adaptation of evidence-base for using in healthcare organizations

Healthcare evidence-based management that are effective in one context may not be effective elsewhere. For that, to ensure it suits a new context, an intervention can involve adaptation. To date, no general guideline is available to assist researchers in adapting and assessing approaches in new contexts, and no guidelines are available to help research funders or publications in evaluating proposed or documented adaptations or assessments. Policymakers and managers have limited assistance in determining if evidence-based approaches are suitable for their context, or whether adaptation and further assessment are needed. That can help to establish recommendations for these professionals to facilitate the adaptation, application and/or re-evaluation in new contexts of healthcare.

There are currently no overarching standards for adapting healthcare organizations’ evidence-based management procedures for application and assessment in other organizations or contexts. Such guidelines should help health professionals and policymakers in determining if complicated health evidence-based management are suitable for their context, help researchers in adapting procedures to new contexts, and assist research funders in deciding on the case for funding adaptation trials. Table 1 shows conditions of the adaptability (margin of accepted defect) characteristics that needed for evidence-based management implementations in healthcare organizations.