Using Health Systems Engineering Approaches to Prepare for Tailoring of Implementation Interventions

Area of Science:

• Healthcare quality improvement
• Health systems engineering
• Implementation science

Background:

• Evidence-based practice implementation requires adapting strategies to local contexts like resources and culture.
• Health systems engineering (HSE) methods can identify system-level variations impacting broad implementation.
• Understanding these variations is crucial before scaling up new practices.

Purpose of the Study:

• To describe current processes for pre-endoscopy antithrombotic medication management.
• To identify variations in these processes across different healthcare systems.
• To develop an assessment tool for tailoring future implementation strategies.

Main Methods:

• A multi-disciplinary team used HSE methods within a quality improvement initiative.
• Stakeholder focus groups were conducted across four healthcare systems.
• Workflow maps were developed, analyzed, and integrated to identify key steps and variations.

Main Results:

• Five key process steps were identified in pre-endoscopy antithrombotic management.
• Significant variation was observed in how each step was executed across health systems.
• Variation was influenced by health system integration and staff roles/training.

Conclusions:

• HSE tools effectively identify key workflow steps, execution variations, and contextual factors.
• This approach and an associated assessment tool can aid in tailoring implementation strategies.
• Understanding system-level variation is essential for successful, widespread adoption of evidence-based practices.