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Promoting Action on Research Implementation in Health Services framework applied to TeamSTEPPS implementation in small rural hospitals
Journal article   Peer reviewed

Promoting Action on Research Implementation in Health Services framework applied to TeamSTEPPS implementation in small rural hospitals

Marcia M Ward, Jure Baloh, Xi Zhu and Greg L Stewart
Health care management review, Vol.42(1), pp.2-13
01/2017
DOI: 10.1097/HMR.0000000000000086
PMCID: PMC6893845
PMID: 26415078
url
https://www.ncbi.nlm.nih.gov/pmc/articles/6893845View
Open Access

Abstract

A particularly useful model for examining implementation of quality improvement interventions in health care settings is the PARIHS (Promoting Action on Research Implementation in Health Services) framework developed by Kitson and colleagues. The PARIHS framework proposes three elements (evidence, context, and facilitation) that are related to successful implementation. An evidence-based program focused on quality enhancement in health care, termed TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), has been widely promoted by the Agency for Healthcare Research and Quality, but research is needed to better understand its implementation. We apply the PARIHS framework in studying TeamSTEPPS implementation to identify elements that are most closely related to successful implementation. Quarterly interviews were conducted over a 9-month period in 13 small rural hospitals that implemented TeamSTEPPS. Interview quotes that were related to each of the PARIHS elements were identified using directed content analysis. Transcripts were also scored quantitatively, and bivariate regression analysis was employed to explore relationships between PARIHS elements and successful implementation related to planning activities. The current findings provide support for the PARIHS framework and identified two of the three PARIHS elements (context and facilitation) as important contributors to successful implementation. This study applies the PARIHS framework to TeamSTEPPS, a widely used quality initiative focused on improving health care quality and patient safety. By focusing on small rural hospitals that undertook this quality improvement activity of their own accord, our findings represent effectiveness research in an understudied segment of the health care delivery system. By identifying context and facilitation as the most important contributors to successful implementation, these analyses provide a focus for efficient and effective sustainment of TeamSTEPPS efforts.
Evidence-Based Practice Health Plan Implementation - methods Health Plan Implementation - organization & administration Health Services Research - organization & administration Hospitals, Rural Humans Interviews as Topic Patient Safety - standards Prospective Studies Qualitative Research Quality Improvement Quality of Health Care - standards

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