title: Reliable implementation of evidence: a qualitative study of antenatal corticosteroid administration in Ohio hospitals.
abstract: BACKGROUND
  Antenatal corticosteroids (ANCS) reduce complications of preterm birth; however, not all eligible women receive them. Many hospitals and providers do not have the right processes and conditions to enable ANCS administration with high reliability. The objective of this study was to understand conditions that enable delivery of ANCS with high reliability among hospitals participating in an Ohio Perinatal Quality Collaborative (OPQC) ANCS project.
  
  
  METHODS
  We conducted focus groups and semistructured interviews with members of the OPQC project team (n=27) and other care providers (n=70) using a purposeful sample of 6 sites involved in the OPQC ANCS project. Participants including nurses (n=57), attending obstetricians (n=17), physician trainees (n=21) and certified nurse midwives (n=2) were asked to reflect on their experiences and to identify factors contributing to optimal use of ANCS. Focus groups and interviews were transcribed verbatim and were analysed by a multidisciplinary team using an iterative approach that combined inductive and deductive methods to identify and categorise themes.
  
  
  RESULTS
  Six major themes supporting reliable implementation of ANCS at these hospitals emerged including: (1) presence of a high reliability culture, (2) processes that emphasise high reliability, (3) timely and efficient administration process, (4) multiple disciplines are involved, (5) evidence of benefit supports ANCS use and (6) benefit is recognised at all levels of the care team.
  
  
  CONCLUSIONS
  Our findings identify the key processes and supports needed to ensure delivery of ASCS with high reliability and are reinforced by implementation and reliability science. They are useful for foundation of the successful implementation of other evidence-based practices at high levels of reliability.
authors.affiliation: Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Heather C
authors.initials: HC
authors.lastname: Kaplan
authors.affiliation: SNS Research, Cincinnati, Ohio, USA.
authors.forename: Susan N
authors.initials: SN
authors.lastname: Sherman
authors.affiliation: James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Charlena
authors.initials: C
authors.lastname: Cleveland
authors.affiliation: James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Goldenhar
authors.affiliation: James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Carole M
authors.initials: CM
authors.lastname: Lannon
authors.affiliation: Division of Maternal Fetal Medicine and Center for Health Care Research and Policy, Metro Health Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bailit
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D055317:Evidence-Based Practice; D005260:Female; D017144:Focus Groups; D006284:Health Plan Implementation / Q000592:standards*; D006785:Hospitals, University; D006801:Humans; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D009820:Ohio; D010348:Patient Care Team / Q000458:organization & administration; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods; D036301:Qualitative Research; D017749:Total Quality Management
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Healthcare quality improvement; Human factors; Implementation science; Obstetrics and gynecology; Qualitative research