This intervention analysis template focuses on improving discharge care after hospitalization for acute stroke. It includes the scope, target population, problem analysis, strategy mix, timeframes, logic model, outcomes, assumptions, and external factors. The goal is to enhance the overall quality of discharge plans for patients.
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INTERVENTION ANALYSIS TEMPLATE Intervention nametobringimprovementwithindischargeplan: Organisationalinterventiontoimprovedischargeafter hospitalisation for acute stroke, a controlled before-after pilot study SCOPINGScope of this intervention is to bring improvement within discharge of patients suffered from acute stroke after hospitalization Target populationTarget population of this organizational intervention are hospital clinicians or practitioners who are involved in discharge care of patients who had been hospitalized after suffering an acute stroke. Problem AnalysisIt has been analysed that due to poor interaction and poor healthcare management system discharge care of a patient is not planned in a proper manner. Discharge care pan of such patients is extremely poor because of various causes such as: due to poor discharge care plan hospitalization stay of patients within hospital is much longer, unmet needs of patients are not fulfilled in a proper manner. Patients are not educated about their condition are not provided with an education booklet for self-care planning. Less than 50 percent of patients receivebehaviouralpreventioneducationorprescriptionof prevention medicines form healthcare practitioners. Strategy mixIt is an important part of analysing intervention because it directly help evaluators and other stakeholders to identify what is being evaluated. Most of the hospitals do not focus upon development of individualized prevention management strategies for acute stroke patients. It is important to develop a high- quality discharge plan for such patients so that their hospital stay can be minimized. This interventionwillfurtherhelpinenhancingoverallqualityof discharge plan. Timeframesthisinterventionhasbeencompletedandpilotstudyofthis intervention carried out for approximately 5 months. But completion of this intervention took 12 months and was completed in 7 phases that were: Phase 1: baseline performance in which selection of hospitals were
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done. Phase 2: Intervention design was developed and finalized Phase 3: pre- intervention performance was analysed with the help of data completeness report Phase 4: delivery of intervention was done in order to review the process and data result quality Phase 5: 2ndworkshop of intervention was carried out in which education to leaders were given considering local opinion and action plan for behavioural change strategy was developed Phase 6: Post implementation performance was analysed after 3 months in which self- monitoring was done using Australian stroke clinical registry and through telephone support from project officer. Phase 7: Lastly sustainability assessment was done after 12 months. LOGIC MODELInput: In this what will be invested are identified. Some of the main things that were invested are: money, student and staff time, planning time. Expertise, knowledge base and material for decision making thatcanfurtherhelpindecisionmaking.Assistanceofteam members and technology with all the planning activities. Outputactivities:Inthiswhatisrequiredtobedeveloped, delivered, and conduct(Biggs and et. al., 2017). Develop an organizational intervention for improving discharge care by improving discharge after hospitalization To deliver an intervention that can help in enhancing overall quality of discharge plan Conduct 2 workshops in which review of progress gap analysis is to be done and education by local opinion leader is required to be takenand on the basis of it review of performance data is required to be done. On the bass of education taken by local opinion leaders, education other stakeholders would be given Conduction of extensive research was done in order to identify effectiveness of this intervention. Output participants: Here all the participants whom researcher reached were identified and specified. Some of the main participants
whowerereachedfordevelopmentofinterventionhavebeen identified below: Existingcontributorsorresearcherswhohavecarriedout researchinthisfield.Thedidnotparticipatedwithinthis intervention development directly. In fact, their research and knowledge were used for development of intervention program. Leader and new contributors were another important participant who participated in provision of their opinion or for educating other stakeholders in development of intervention program. Educators and decision makers patrocinated in taking important decisions and developing an educational workshop for providing educationtootherimportantstakeholdersinvolvedinthis intervention program development. Researcher and other team members directly participated in this intervention program development and in interacting with others for development of effective intervention program. Outcome of evaluation plan: Short outcome: In this results in terms of learning are shown and explained: Improved understanding of clinicians of ways in which they can work upon bringing improvement within discharge care plan Awareness of importance of high- quality discharge care plan willbeenhancedwithinallthestakeholdersofthis intervention Opinion of local leaders will be taken in order to ensure that intervention is being developed and implemented in a proper and appropriate manner. Feedback from all the stakeholders involved in development of intervention will be asked in order to identify scope of improvement. Medium outcome: Adoption of self-monitoring system using Australian stroke
clinicalregistryforanalysisofpostimplementationof organizational intervention in order to ensure that desired outcomes are being achieved with it. Monthly support from project officer in order to ensure success of organizational in order to keep a check on progress of intervention and ways in which it has brought changes within discharge care plan of hospital Develop action plan strategies on behaviour change strategies in order to retain participates participation within intervention program and in order to ensure that all the stakeholders are aware of their roles and responsibilities in discharge care plan in order to ensure success of the program. Process gap analysis data and results will be reviewed in order to identify gaps within developed intervention. Long outcome: Improved discharge care plan with the help of new organizational intervention. Development of organizational intervention for bring in improvement within discharge care plan after hospitalization for acute stroke patients Assumptions: Some of the main assumptions that were done during development of this intervention are:All the research findings were applied within defined time and at desired and appropriate space within hospital and all kinds of feedback provided by stakeholders wereusedasascopeofimprovementforenhancingoverall intervention External factors: Some of the external factors that could have impacted overall intervention development are: change in higher managementauthoritiesofhospitalscreatedsomeissuesin implementation of intervention of high- quality discharge care plan. THEORYOF CHANGE It is another important aspect of intervention that helps in explaining ways in which intervention will be bringing changes within current process, resources and activities that are required to be achieved (Gilissen and et. al., 2018). This theory of change will explain underpinning of intervention. This theory of change is interrelated to
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logic model.it directly helps in outlining linkage between different initiatives and all the three long, short and medium outcomes that will be achieved by the organization. theory of change for this intervention have been explained below in detailed manner: Figure1Theory of change Step 1: Identification of purpose of theory of change: the main purpose of this theory of change is to develop an organizational intervention program in order to bring improvement within discharge care after hospitalization for acute stroke patients. It is important to bring improvement within existing quality of discharge care for patients so that their duration of hospital stay can be reduced, unmet needs can be fulfilled and that can be educated about medicine precautions in an adequate manner. Step 2: Develop vision and define desired change: Desired change visionwhichisrequiredtobeachievedistodevelopan organizationalinterventionforhospitalssothatneedsand requirementofallthestakeholderscanbemeetespeciallyfor patients who get hospitalized after acute stroke. For them it is extremely important develop this intervention so that their after hospitalization discharge care plan quality can be enhanced and their all kinds of needs and requirements can be fulfilled.
Step 3: Identify domain of change: Domain of change where change is required to be brought most importantly is within process ofdischargingpatients,performanceofcliniciansinvolvedin discharge process, and within overall behaviour of professionals involved in discharge care plan so that they can fulfil their roles and responsibilities in an adequate manner. Step 4: Identify strategic priorities: Strategic priorities that are required to be focused upon that can influence success of this interventionplanare:feedbackfromhospitalstaffmembers, feedback from patients of acute stroke hospitalized within hospital, conduct process gap analysis for identification of gap within current dischargecareplan,adoptionofdifferentbehaviourchange strategies,usageofAustralianStrokeclinicalregistryforself- monitoring of intervention successful implementation. Step 5: Develop pathway of change: pathway of change have been explained below as per the strategic priorities and complexities of process. Selection of hospital in which discharge care plan organizational intervention is required to be developed Collection of feedback from all the main stakeholders Pre- intervention performance evaluation though pre-workshop survey data Process gap analysis review for identification of gap within current process Provision of education by local pinion leaders Monthly support from project officer and self- monitoring of process though Australian stroke clinical registry. Step 6: Review and adopt theory of change: in this review of changesdoneisdoneanditwillbedonewiththehelpof Sustainabilityassessmentofinterventionimplementedwithin hospital though Australian stroke clinical registry self- monitoring process. ReflectionsThere are various kinds of theories that can be used for evaluation of
program logic and theory of change. Results chain theory will be used for evaluation of both program logic and theory of change. But for evaluation of theory of change short cycle logic will be used in which after every output evaluation will be done (Brousselle and Buregeya, 2018). Whereas, for evaluation of program logic, logic cycle logic will be used in which evaluation of logic will be done at the end. In order to implement intervention within hospital in a successful manner it is important for organization to adopt an appropriate change management model. For this intervention implementation Lewin’s change management model will be adopted and with the help of gathering feedback from employees or staff and patients suffering from acute stroke and has been hospitalized members of hospital program logic and theory of change will be evaluated (Smith, Li and Rafferty, 2020). Gathering feedback will directly help inevaluatingchangeswithindischargeplanofpatientsafter hospitalization have been brought or not. This provision of feedback from patients, staff members of hospital will directly help in gaining an understanding of whether the new program logic have been successfully implemented or not. As a part of evaluation pair for development of program logic was a difficulttaskto work upon. But thisexperiencehelpedme in understanding importance of discharge care plan quality and ways in whichimplementationofinterventioncanhelpinenhancing achievement of desired quality of discharge care plan which is required to be provided to patients and ways in which desired goals and objectives can be achieved.
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Logic model Money studentand stafftime, Planning time Expertise Knowledge baseand material Assistance of team members and technology Developan organizational intervention Conduct2 workshops Researcher and otherteam members deliveran intervention Leaderand new contributors Educatorsand decision makers Existing contributors Improved understanding of clinicians InputsOutputs ActivitiesParticipation Outcomes ShortMediumLong educationby localopinion leader Conductionof extensive research Develop action plan strategieson behaviourchange strategies Feedbackfrom allthe stakeholders Opinion of local leaders Awarenessof importanceof dischargecare plan enhanced Review of process gap analysis Assumptions All the research findings were applied within defined time and at desiredandappropriatespacewithinhospitalandallkindsof feedbackprovidedbystakeholderswereusedasascopeof improvement for enhancing overall intervention External Factors change in higher management authorities of hospitals created some issues in implementation of intervention of high- quality discharge care plan Monthlysupportfrom project officer in order toensuresuccessof organizational Adoptionofself- monitoringsystem usingAustralian strokeclinical registry Improved dischargecare planwiththe helpofnew organizational intervention
REFERENCES Books and Journals Biggs, D., and et. al., 2017. Developing a theory of change for a community‐based response to illegal wildlife trade.Conservation Biology.31(1). pp.5-12. Brousselle, A. and Buregeya, J.M., 2018. Theory-based evaluations: Framing the existence of a new theory in evaluation and the rise of the 5th generation.Evaluation.24(2). pp.153-168. Gilissen, J., and et. al., 2018. How to achieve the desired outcomes of advance care planning in nursing homes: a theory of change.BMC geriatrics.18(1). pp.1-14. Smith, J.D., Li, D.H. and Rafferty, M.R., 2020. The Implementation Research Logic Model: a method for planning, executing, reporting, and synthesizing implementation projects.Implementation Science.15(1). pp.1-12.