The Stanford Lightning Report What a new methodological approach for - - PowerPoint PPT Presentation

The Stanford Lightning Report

What a new methodological approach for rapid qualitative synthesis can tell us about prospective evaluation of implementation in dynamic systems

Cati Brown-Johnson PhD, Nadia Safaeinili MPH, Dani Zionts MScPH, Laura Holdsworth PhD, Marcy Winget PhD Division of Primary Care and Population Health, Stanford University School of Medicine

Conflicts of Interest

2

None

Contents

3

• 1. Origin Story - The Lightning Report
• 2. How to Make a Lightning Report
• 3. Exploration - CFIR analysis of 14 Lightning Reports
• 4. Next Steps

Contents

4

1.

• 1. Or

Origin Story - The Lightn tning Report t

• 2. How to Make a Lightning Report
• 3. Exploration - CFIR analysis of 13 Lightning Reports
• 4. Next Steps

5

Contents

6

• 1. Origin Story - The Lightning Report

2.

• 2. Ho

How w to Mak Make e a a Lig Light htning ning Rep eport

• 3. Exploration - CFIR analysis of 13 Lightning Reports
• 4. Next Steps

• 1. Pre-planning with healthcare evaluation partners
• 1. Rapid synthesis

a) structured research notes b) two researchers discuss notes/memos c) synthesize findings using Plus/Delta/Insight debriefing

• 2. Lightning Report creation

Lightning Report Method

Positives Risks Insights

8

Contents

9

• 1. Origin Story - The Lightning Report
• 2. How to Make a Lightning Report

3.

• 3. Ex

Exploration n - CF CFIR analy analysis is of f 13 13 Lig Light htning ning Rep eports

• 4. Next Steps

CFIR Analysis

10

Objective: to assess which implementation outcomes this rapid synthesis approach (Lightning Report) best captures, and which implementation outcomes are not gathered Coding: Consolidated Framework for Implementation used to code findings from 13 Lightning Reports from 4 projects; 245 excerpts relevant to implementation science Additional barrier/facilitator coding for all excerpts

11

Readiness for Implementation (n=39)

• Availability of resources as facilitators (training): “Health coaching

interprofessional training provided” or barriers (space): “lack of penetration [due to] not being co-located” Implementation Climate (n=35)

• Compatibility: “Many aspects of the intervention already in place

at the new clinic” Patient needs/resources (n=34)

• Frequent patient relationship theme, likely due to major

interventions revolving around care coordination

Most frequent CFIR constructs cluster in Inner setting

12

• Is limited information about individuals attributable to the internal

audience?

• Single external intervention Lightning Report (where we did not

personally know on-the-ground implementing providers and staff) had the most information about characteristics of individuals (n=4)

Forgotten CFIR domain: Characteristics of Individuals (18 out of 245 excerpts)

13

Facilitators Patient needs and resources (17) Networks and communication (15) Adaptability (9) Available resources* (8) Themes of staff experience:

• intervention adaptation by front-

line staff

• staff training

Facilitators and Barriers

Barriers Patient needs and resources (11) Compatibility (11) Networks and communication (10) Access to knowledge & info (10) Complexity (10) Themes of role definition:

• lack of role definition,
• inappropriateness tasks for

non-clinical staff,

• miscommunication/

misunderstanding of new roles

Contents

14

• 1. Origin Story - The Lightning Report
• 2. How to Make a Lightning Report
• 3. Exploration - CFIR analysis of 14 Lightning Reports

4.

• 4. Nex

Next Step eps

Using the Lightning Report:

• Don’t be afraid to try this at home (you can always also record all

your interviews for back-up)

• Variations – cumulative reporting vs snapshot
• Ideal as partner in PDSA-like interventions

Research:

• Compare Lightning Report creation across groups/individuals
• Compare Lightning Report results to fully coded transcript results

Next steps

Thank you

Lightning Report method to prospectively evaluate dynamic system implementation

• Prompt communication with stakeholders (healthcare partners)
• Immediate, actionable insights
• Methodological rigor - standard methods

Questions? Cati Brown-Johnson PhD cbrojohnson@Stanford.edu