Table 1Key elements of the CalNOC coaching intervention to reduce patient falls

Phase 1:
Conceptual fociCoaching interventionReciprocal site activitiesDeliverables
Catalyzed awareness of potential for improvement and establish preliminary organizational commitmentEngage sites in strategic vision of improvement potential related to falls/fall preventionAffirm preliminary interestSite confirmation(s) of commitment
Identify designated site “linker(s)”Develop linker networkDesignate key clinical opinion leader as “linker”Linker roster and active network – conference calls
Focus organizational self-assessment; determine capacity for changeCollaborate with linkers and CNOs to conduct organizational self-assessmentConduct organizational self-assessmentAnalysis and validation of organizational self-assessment findings
Linker role developmentEngage linkers in systematic education and coaching, self-directed study, supportive coachingLinkers actively participate in ongoing role developmentLinker role development with observable evidence of role implementation
Organization-specific self-query re: falls data integrity, practice consistency, and implications for improvement vis-à-vis literature and litigationIdentify elements of database self-query and coach linkers in data capture, descriptive analysis, and implicationsConduct, analyze and synthesize self-query as basis for mounting systematic improvement effortSelf-query initiated
Organizational capacity developmentProvide expert assistance and referrals to build organizational capacity for data-driven improvement project to reduce fallsSite-specific activities are reported that reflect capacity development efforts based on self-assessment findingsCapacity development tactics are reported and shared across sites
Linkers engage a site specific team in falls-improvement effortCoach linkers within context of their setting quality improvement model, stakeholders, and infrastructure; coach evolving project managementSite-specific teams mobilized with organizational buy-in; confirm project management roles and resourcesSite-specific teams identified and activated
Phases 2–4
Knowledge synthesisProvide linkers with general literature/references re: falls risk assessment and interventions; key indicators for falls quality monitoring and benchmarks.Site teams review, translate, and adapt literature; critique current practices and integrate potential innovations into a “pilot” evaluation; build consensusKnowledge synthesis products for Web-based delivery; knowledge access tactics observed.
Strategic planning for practice changeCoach linkers in developing systematic strategic plans for implementing and evaluating selected practice changesLinkers and teams develop systematic strategic plansStrategic plans documented and strategies shared among sites
Knowledge transferCoach linkers in process of research use, translation, and local adaptationLinkers and teams engage in research; use processes and local adaptation; preliminary adoption of selected practice changes.Research use tactics documented and shared among sites
Practice change implementation and evaluationCoach linkers in implementing and evaluating preliminary practice changesLinkers and teams implement and evaluate preliminary practice changes; refine plans as neededChanges are documented and preliminary evaluation data analyzed and reported
Analyze results of preliminary change; refine plan or decide abandon strategyMonitor/review results of work-in- progress; celebrate successes; and coach in revising plans, interpreting results and options for next steps; provide technical assistance as neededSustain implementation and evaluation; maintain gains; refine strategies; celebrate; provide qualitative data to aid in formative evaluation of project processes, tactics, and effectiveness.Measurable results
Sustain validated improvementsMonitor organizational change over time; analyze falls risk assessment, incidence, and injury trends per unit per site using CalNOC data; feedback with reports, project conferencesOngoing CalNOC data collection; sustained change; check inter-clinician reliability in adopting practice change(s)Evidence of improved falls prevention; conferences reach target audiences, provide preliminary reports to sites and stakeholders

From: Role of the External Coach in Advancing Research Translation in Hospital-Based: Performance Improvement

Cover of Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 2: Culture and Redesign)
Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 2: Culture and Redesign).
Henriksen K, Battles JB, Keyes MA, et al., editors.

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