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Implementation and de-implementation: two sides of the same coin?

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Summary
This summary is machine-generated.

Leaders in healthcare implementation and de-implementation share some traits but are not the same individuals. De-implementation faces unique motivational and economic barriers, unlike implementation.

Keywords:
Implementation scienceQuality improvementSurgery

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Area of Science:

  • Health Services Research
  • Medical Practice Management
  • Evidence-Based Medicine

Background:

  • Avoiding low-value care is a global priority, exemplified by initiatives like Choosing Wisely.
  • While implementation of evidence-based practices is well-studied, de-implementation of existing low-value care is less understood.
  • Understanding the differences between implementation and de-implementation is crucial for optimizing healthcare delivery.

Purpose of the Study:

  • To explore the differences between the processes of care implementation and de-implementation.
  • To identify characteristics of leaders and laggards in both implementation and de-implementation.
  • To understand the barriers and facilitators unique to or shared between implementation and de-implementation.

Main Methods:

  • Literature review on implementation and de-implementation processes.
  • Analysis of data from two published studies involving the same orthopaedic surgeons (one implementation, one de-implementation).
  • Definition and comparison of 'leaders' (those who implemented/de-implemented) and 'laggards' (those who did not).

Main Results:

  • Leaders in both implementation and de-implementation tended to be younger, less experienced, and more open to new evidence compared to laggards.
  • Leaders in implementation and de-implementation were not the same individuals, suggesting intervention-specific leadership.
  • De-implementation faced motivational, economic, and political barriers, while implementation was more associated with organizational factors.
  • Outcome expectancy (perceived patient benefit) was the sole common barrier/facilitator for both processes.

Conclusions:

  • Leadership in healthcare change (implementation or de-implementation) depends on both personal characteristics and intervention type.
  • De-implementation requires addressing specific motivational and economic factors beyond those for implementation.
  • Further research is needed to validate findings and deepen the understanding of leading and resisting change in healthcare.