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Behavioral and Psychological Aspects of the Physician Experience with Deimplementation

INTRODUCTION: Deimplementation, or the structured elimination of non-evidence–based practices, faces challenges distinct from those associated with implementation efforts. These barriers may be related to intrinsic psychological factors, as perceptions and emotions surrounding the discontinuation of...

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Autores principales: McDaniel, Corrie E., House, Samantha A., Ralston, Shawn L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8782108/
https://www.ncbi.nlm.nih.gov/pubmed/35071960
http://dx.doi.org/10.1097/pq9.0000000000000524
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author McDaniel, Corrie E.
House, Samantha A.
Ralston, Shawn L.
author_facet McDaniel, Corrie E.
House, Samantha A.
Ralston, Shawn L.
author_sort McDaniel, Corrie E.
collection PubMed
description INTRODUCTION: Deimplementation, or the structured elimination of non-evidence–based practices, faces challenges distinct from those associated with implementation efforts. These barriers may be related to intrinsic psychological factors, as perceptions and emotions surrounding the discontinuation of established practices appear to differ from those associated with practice adoption. This study aims to explore barriers and facilitators experienced by pediatric clinicians engaging in deimplementation projects. METHODS: We used behavioral economics concepts to inform our qualitative study design following a theory-informed inductive approach. We conducted semistructured interviews with participants from two national quality improvement collaboratives where the primary outcomes were deimplementation measures. Using purposeful sampling, we recruited project leaders at institutions in the top and bottom quartiles from within each collaborative. Finally, we conducted a thematic analysis using a combination of inductive and deductive coding. RESULTS: In total, we interviewed participants from 12 high-performing sites and 7 low-performing sites. Participants identified nine concepts associated with successful deimplementation practice and three psychological barriers that impacted behavior change: (1) loss, (2) fear, and (3) action bias. Participants further identified four overarching strategies for mitigating the identified psychological barriers, including (1) making allowance for nonconformism; (2) permission to change; (3) normalizing; and (4) reframing. CONCLUSION: There is potential for more effective deimplementation through the proactive incorporation of an awareness of specific psychological barriers of loss, fear, and action bias, as well as specific mitigation strategies to address the psychocognitive experience.
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spelling pubmed-87821082022-01-21 Behavioral and Psychological Aspects of the Physician Experience with Deimplementation McDaniel, Corrie E. House, Samantha A. Ralston, Shawn L. Pediatr Qual Saf Multi-institutional collaborative and QI network research INTRODUCTION: Deimplementation, or the structured elimination of non-evidence–based practices, faces challenges distinct from those associated with implementation efforts. These barriers may be related to intrinsic psychological factors, as perceptions and emotions surrounding the discontinuation of established practices appear to differ from those associated with practice adoption. This study aims to explore barriers and facilitators experienced by pediatric clinicians engaging in deimplementation projects. METHODS: We used behavioral economics concepts to inform our qualitative study design following a theory-informed inductive approach. We conducted semistructured interviews with participants from two national quality improvement collaboratives where the primary outcomes were deimplementation measures. Using purposeful sampling, we recruited project leaders at institutions in the top and bottom quartiles from within each collaborative. Finally, we conducted a thematic analysis using a combination of inductive and deductive coding. RESULTS: In total, we interviewed participants from 12 high-performing sites and 7 low-performing sites. Participants identified nine concepts associated with successful deimplementation practice and three psychological barriers that impacted behavior change: (1) loss, (2) fear, and (3) action bias. Participants further identified four overarching strategies for mitigating the identified psychological barriers, including (1) making allowance for nonconformism; (2) permission to change; (3) normalizing; and (4) reframing. CONCLUSION: There is potential for more effective deimplementation through the proactive incorporation of an awareness of specific psychological barriers of loss, fear, and action bias, as well as specific mitigation strategies to address the psychocognitive experience. Lippincott Williams & Wilkins 2022-01-21 /pmc/articles/PMC8782108/ /pubmed/35071960 http://dx.doi.org/10.1097/pq9.0000000000000524 Text en Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Multi-institutional collaborative and QI network research
McDaniel, Corrie E.
House, Samantha A.
Ralston, Shawn L.
Behavioral and Psychological Aspects of the Physician Experience with Deimplementation
title Behavioral and Psychological Aspects of the Physician Experience with Deimplementation
title_full Behavioral and Psychological Aspects of the Physician Experience with Deimplementation
title_fullStr Behavioral and Psychological Aspects of the Physician Experience with Deimplementation
title_full_unstemmed Behavioral and Psychological Aspects of the Physician Experience with Deimplementation
title_short Behavioral and Psychological Aspects of the Physician Experience with Deimplementation
title_sort behavioral and psychological aspects of the physician experience with deimplementation
topic Multi-institutional collaborative and QI network research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8782108/
https://www.ncbi.nlm.nih.gov/pubmed/35071960
http://dx.doi.org/10.1097/pq9.0000000000000524
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