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Understanding Mis-Implementation in U.S. State Health Departments: An Agent-Based Model
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4 2023
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Source: Am J Prev Med. 64(4):525-534
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Alternative Title:Am J Prev Med
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Description:Introduction:
The research goal of this study is to explore why mis-implementation occurs in public health agencies and how it can be reduced. Mis-implementation is ending effective activities prematurely or continuing ineffective ones, which contributes to wasted resources and sub-optimal health outcomes.
Methods:
The study team created an agent-based model (ABM) that represents how information flow, filtered through organizational structure, capacity, culture, and leadership priorities shapes continuation decisions. This ABM used survey data and interviews with state health department personnel across the U.S. between 2014 and 2020; model design and analyses were conducted with substantial input from stakeholders between 2019 and 2021. The model was used experimentally to identify potential approaches for reducing mis-implementation.
Results:
Simulations showed that increasing either organizational evidence-based decision-making capacity or information-sharing could reduce mis-implementation. Shifting leadership priorities to emphasize effectiveness resulted in the largest reduction, while organizational restructuring did not reduce mis-implementation.
Conclusions:
The model identifies for the first time a specific set of factors and dynamic pathways most likely driving mis-implementation, and suggests a number of actionable strategies for reducing it. Priorities for training the public health workforce include evidence-based decision-making and effective communication. Organizations will also benefit from an intentional shift in leadership decision-making processes. Based on this initial, successful application of ABM to mis-implementation, this work provides a framework for further analyses.
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Pubmed ID:36509634
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Pubmed Central ID:PMC10033358
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Volume:64
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Issue:4
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