Background
The WHO Surgical Safety Checklist improves surgical outcomes, but evidence and theoretical frameworks for successful implementation in low‐income countries remain lacking. Based on ...previous research in Madagascar, a nationwide checklist implementation in Benin was designed and evaluated longitudinally.
Methods
This study had a longitudinal embedded mixed‐methods design. The well validated Consolidated Framework for Implementation Research (CFIR) was used to structure the approach and evaluate the implementation. Thirty‐six hospitals received 3‐day multidisciplinary training and 4‐month follow‐up. Seventeen hospitals were sampled purposively for evaluation at 12–18 months. The primary outcome was sustainability of checklist use at 12–18 months measured by questionnaire. Secondary outcomes were CFIR‐derived implementation outcomes, measured using the WHO Behaviourally Anchored Rating Scale (WHOBARS), safety questionnaires and focus groups.
Results
At 12–18 months, 86·0 per cent of participants (86 of 100) reported checklist use compared with 31·1 per cent (169 of 543) before training and 88·8 per cent (158 of 178) at 4 months. There was high‐fidelity use (median WHOBARS score 5·0 of 7; use of basic safety processes ranged from 85·0 to 99·0 per cent), and high penetration shown by a significant improvement in hospital safety culture (adapted Human Factors Attitude Questionnaire scores of 76·7, 81·1 and 82·2 per cent before, and at 4 and 12–18 months after training respectively; P < 0·001). Acceptability, adoption, appropriateness and feasibility scored 9·6–9·8 of 10. This approach incorporated 31 of 36 CFIR implementation constructs successfully.
Conclusion
This study shows successfully sustained nationwide checklist implementation using a validated implementation framework.
Implementation works
Cultivating a more dynamic relationship between science and policy is essential for responding to complex social challenges such as sustainability. One approach to doing so is to “span the ...boundaries” between science and decision making and create a more comprehensive and inclusive knowledge exchange process. The exact definition and role of boundary spanning, however, can be nebulous. Indeed, boundary spanning often gets conflated and confused with other approaches to connecting science and policy, such as science communication, applied science, and advocacy, which can hinder progress in the field of boundary spanning. To help overcome this, in this perspective, we present the outcomes from a recent workshop of boundary-spanning practitioners gathered to (1) articulate a definition of what it means to work at this interface (“boundary spanning”) and the types of activities it encompasses; (2) present a value proposition of these efforts to build better relationships between science and policy; and (3) identify opportunities to more effectively mainstream boundary-spanning activities. Drawing on our collective experiences, we suggest that boundary spanning has the potential to increase the efficiency by which useful research is produced, foster the capacity to absorb new evidence and perspectives into sustainability decision-making, enhance research relevance for societal challenges, and open new policy windows. We provide examples from our work that illustrate this potential. By offering these propositions for the value of boundary spanning, we hope to encourage a more robust discussion of how to achieve evidence-informed decision-making for sustainability.
Theories of everything, Frank Close argues, can be described as those which draw on all relevant branches of knowledge to explain everything known about the universe. Such accounts may reign supreme ...for centuries. Then, often as a result of the advances they themselves have enabled, a new discovery is made which the current theory cannot explain. A new theory is needed which inspiration, sometimes, supplies. Moving from Isaac Newton's work on gravity and motion in the seventeenth century to thermodynamics and James Clerk Maxwell's laws of electromagnetism in the nineteenth to Max Planck's and Paul Dirac's quantum physics in the twentieth, Professor Close turns finally to contemporary physics and the power and limitations of the current theory of everything.
In August 2017, 100 million will gather across the USA to watch a total solar eclipse. This book, written by the widely read popular science author Frank Close, describes the spellbinding allure of ...this most beautiful natural phenomenon, taking the reader to a war zone in the Western Sahara, to the South Pacific, and to the African bush.
Recent data on charmonium production in B-meson decays suggest that charmonium hybrid mesons with mass ∼4 GeV may be produced in B-decay via cc̄ colour octet operators. Some of these states are ...likely to be narrow with clean signatures to J/ψπ+π− and J/ψγ final states. Experimental signatures and search strategies for existing B-factories are described.
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