Using the Internet to build community capacity for healthy public policy.

An interactive Web site and e-mail campaign became the primary focus of a coalition's community mobilization strategy to advocate for changes to the local smoking bylaw in a large Canadian urban center. This article presents the findings of an Internet survey of 2,200 Internet mailing list recipients in which 26% (n=605) submitted responses. Findings from four focus groups of the survey respondents (n=28) are also reported. The survey found that a majority of the mailing list respondents (66.1%) contacted the city council during the campaign. Only 35.8% of respondents had contacted a city council member prior to this campaign. As a result of their participation in the Internet campaign, 50.6% stated that they were more likely to get involved in future civic issues. These findings were confirmed by focus groups that found increased capacity for political involvement on this issue as well as capacity for future social and political action.

Using systems thinking to support clinical system transformation.

Purpose - The British Columbia Ministry of Health's Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC's health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings. Design/methodology/approach - Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers and board members were validated through an online survey. Findings - The functional themes for managing large-scale clinical change included: creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system. Research limitations/implications - The action research methodology was designed to guide continuing improvement of implementation. A sample of initiatives was selected; it was not intended to compare and contrast facilitators and barriers across all initiatives and regions. Similarly, evaluating the results or process of guideline implementation was outside the scope; the methods were designed to enable conversations at multiple levels - policy, management and practice - about how to improve implementation. The study is best seen as a case study of LSC, offering a possible model for replication by others and a tool to shape further dialogue. Practical implications - Recommended action-oriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing change fatigue; ensuring adequate resources; providing consistent communication especially for front-line care providers; and supporting local teams to demonstrate the clinical value of the guidelines to their colleagues. Originality/value - Bringing a complex systems perspective to clinical guideline implementation resulted in a clear understanding of the challenges involved in LSC.