Consulting activities for OT services implementation in the emergency department

By “implementation”, we mean the setting up of a concrete intervention within a precise context that can be defined by its symbolic, organizational and physical dimensions (Brousselle, A., 2009).

Within the scope of my research, in particular regarding knowledge transfer, different clinical settings have approached me to assist them in setting up occupational therapy services in their emergency departments. It is my conviction that providing services to the community is part of the role of a university professor; I have therefore tried to counsel and better equip these settings to bring them closer to reaching their goals.

In order to do so, I based my work on implementation assessment theories that make it possible to document the various aspects of an intervention that one might want to implement, define its functioning, its implementation process as well as making it possible to define the factors that support or jeopardize it. Moreover, this approach aims to harness the expertise of care providers who are involved in the process that we wanted to implement and it encourages an appropriation of results and produces knowledge transfer within the practice setting.

Klein and Sorra’s "Model of Implementation Effectiveness"

Different aspects of the implementation process were addressed using Klein and Sorra’s “Model of Implementation Effectiveness”. Applying Klein and Sorra’s model encourages an intervention’s implementation process. Moreover, their model identifies the factors that need to be acted upon to ensure a successful implementation.

According to these authors, an effective intervention implementation rests on two main factors: 1) the implementation climate and 2) the concordance between the values of the implementation environment and the intervention’s targeted goals.

  1. The implementation climate corresponds to the perception whereby the implementation of an intervention is recognized by the setting and is supported and expected within the organization. Several elements are related to a favourable implementation climate were described in the literature (access to training and help after the initial training, the time required for learning and the putting into practice, the answers to worries and the complaints made, the resources and the incentives).
  2. The concordance between the values of the implementation setting and the intervention’s targeted goals centers around the organizational culture of the implementation setting (the values, beliefs, perceptions and standards of behaviour). For example, if the perceptions of emergency department care providers are that the intervention is an additional task, over and above already too numerous tasks, it could negatively affect participation in the implementation process.

Implementation assessment model

Arnold Love proposed another implementation analysis approach. According to Love, the implementation assessment answers questions from four broad categories related to:

  1. Needs and feasibility assessments (What are the needs of the target clientele? What has been done to meet the needs of the target clientele? What are the hurdles to implementation? What are the resources required to implement an effective program?)
  2. Program planning and design (How was the program’s theory designed to meet the goals? Does the implementation context encourage the implementation of the planned program, and if so how? Which aspects of the program need to be modified to obtain the targeted results?)
  3. Operationalization (Does the program reach the target clientele? Do clients reject or leave the program? Has the program been implemented according to plan? What are the hurdles to implementation?)
  4. Improvement of the program (Does the program meet the implementation goals and targets? Do clients benefit from the program? What are the program’s strengths and weaknesses? What are the differences between the various implementation settings?)

In brief, implementation analysis consists of the study of the relationship between an intervention and its start-up context.

The implementation of a systematic process for functional status assessment in seniors at risk for functional decline who visit emergency departments would be made easier by taking into consideration certain aspects. It is by taking the time to 1) engage in discussions with the different actors involved in the change to be introduced and 2) explain the role of the OT professional, as well as 3) what the addition of such expertise can offer in terms of client service in the emergency department and, more importantly, 4) how the OT’s expertise can complement that of other members of the emergency department’s interdisciplinary team, that the probability of encouraging the implementation of such a service increases.

What follows is a description of factors linked to the organization and functioning in the hospital setting and more particularly the influence of the active implication of geriatric interdisciplinary teams in emergency departments, in hospitals and in the territories covered:

In the particular clinical setting of the CSSS Pierre-de-Saurel, the implementation of a systematic process of functional status assessment of seniors who visit the emergency department was documented.

The specific goals were to: (1) promote awareness in emergency department teams regarding the importance of considering functional status when planning discharges from the ED, (2) train professionals to use the FSAS-ED tool, (3) document the functional status of seniors using the FSAS-ED to identify the factors surrounding a return home versus admission to a care unit, (4) describe the implementation of the functional status assessment of seniors in the emergency department and (5) document the elements that facilitate or hinder the implementation of the functional status assessment process in the emergency department.

Références

  • Brousselle, A. (2009). L'évaluation : concepts et méthodes. Montréal: Les Presses de l'Université de Montréal.
  • Klein, K. J. & Sorra, J. S. (1996). The Challenge of Innovation Implementation. The Academy of Management Review, 21(4), 1055–1080. Retrieved from http://www.jstor.org/stable/259164
  • Love, A. (2004). Implementation evaluations, in Wholey, J. S., Hatry, H. P. et Newcomber, K. E., (dir), Handbook of practical program evaluation, (2nd edition, 63-98), San Francisco: Jossey-Bass.