W5-T2 Implementation Strategies

Question 1

define implementation strategies

Answer 1

methods or techniques used to enhance the adoption, implementation, and sustainability of a clinical programme, practice or intervention

Proctor et al., 2013)

—> have unparalleled importance in implementation science

—> target barriers and leverage facilitators to implementation

Question 2

what are two types of implementation strategies

Answer 2

Discrete implementation strategy
–> Involve single action or process (i.e. reminders)

Multi-faceted implementation strategy
–> involve two or more discrete implementation strategies (i.e. reminders and educational materials)

Question 3

why ERIC (expert recommendation for implementing change) was developed

Answer 3

to address two major limitations:

lack of conceptual clarity surrounding terms and
definitions for implementation strategies

insufficient guidance regarding how best to identify and select appropriate implementation strategies

Question 4

Define how ERIC works

Answer 4

it describes over 70 discrete implementation strategies that can be used to enhance evidence-based intervention in healthcare system

Question 5

implementation strategy taxonomy

Answer 5

Strategy and Definition

Access new funding - access new or existing money to facilitate the implementation

After incentive/ allowance structures - work to incentive the adoption and implementation of the clinical innovation

Assess for readiness and identify barriers and facilitators - assess various aspects of an organization to determine its degree of readiness to implement, barriers that may impede implementation, and strengths that can be used in the implementation effort

audit and provide feedback - collect and summarise clinical performance data over a specified time period and give it to clinicians and admins to monitor, evaluate and modify provider behaviour

Question 6

how implementation strategy used

Answer 6

as a list, not checklist

Question 7

define the relationship among implementation strategies from the Second Eric study

Answer 7

use the concept of mapping

73 discrete strategies organized into 9 categories

Question 8

9 categories within ERIC and example of strategy in it

Answer 8

1. use evaluative and integrative strategies (n=10)
   i.e. assess for readiness and identify barriers and facilitators
2. provide interactive assistance (n=4)
   i.e. provide clinical supervision
3. adapt and tailor to context (n=4)
   i.e. promote adaptability
4. develop stakeholder interrelationship (n=17)
   i.e. identify and prepare champions
5. train and educate stakeholders (n=11)
   i.e. distribute educational materials
6. supporting clinicians (n=5)
   i.e. revise professional roles
7. engage consumers (n=5)
   i.e. intervene with patients to enhance uptake and adherence
8. utilize financial strategies (n=9)
   i.e. access new funding
9. change infrastructure (n=8)
   i.e. mandate change

Question 9

define the objective of the development process

Answer 9

1. the development and testing of implementation strategies are top priorities
2. implementation strategies should be tailored to the local context

Question 10

define the development process

Answer 10

tailoring strategies to implementation barriers
(the first step involves assessing the factors that influence the implementation processes and outcomes)

Example

1. barriers to implementation: knowledge and skills
   barrier (lack of knowledge/skills to implement intervention = implementation strategies (distribute educational materials)
2. infeasibility
   barrier (some intervention components are perceived to be infeasible = implementation strategy (promote adaptability)
3. High cost
   barrier ( high cost associated with implementing intervention) = implementation strategies (access new funding)

Question 11

what other value in implementing strategy besides identify the barrier

Answer 11

identify the facilitator (leverage factors)

1. motivation
   facilitator (individuals motivated and committed to implementing intervention) = implementation strategy (identify and prepare champion)

Question 12

develop an awareness of the key steps, and factors to consider, when developing an implementation strategy

Question 13

define the process of matching strategies to barriers

Answer 13

CFIR - ERIC Implementation Strategy Matching Tool

choose implementation strategies to address contextual barriers, diversity in the recommendation and future directions

Question 14

what are the methods proposed by Powell to improve the selection and tailoring of implementation strategies

Answer 14

1. concept mapping
2. group model building
3. conjoint analysis
4. intervention mapping

each method proposed to provide
–> step-by-step process for selecting and tailoring implementation strategies
–> emphasis on stakeholder participation

Question 15

evidence-based the effective implementation strategies

Answer 15

1. printed educational materials
2. educational meeting
3. educational outreach
4. local opinion leaders
5. audit and feedback
6. computerized reminders
7. tailored implementation strategies

Question 16

what are the findings from the number of discrete strategies used

Answer 16

the sites that use a greater number of implementation strategies were more likely to implement the evidence-based treatment

(the correlation was only moderate and does not explain all variants in implementation success)

—> How strategies were selected was not clear

—> Sequencing intensity and fidelity to each implementation strategy is also unknown

Question 17

define the findings from the research of the selection of implementation strategies based on their importance and feasibility

Answer 17

most strategies were either deemed highly important and highly feasible or were deemed low importance and not feasible (strong correlation between importance and feasibility).

—> A number of strategies were viewed as important but not feasible.
—> A number of strategies were viewed as feasible but less important.

Question 18

what are the three most important discrete implementation strategies

Answer 18

– assessing readiness and identifying barriers and facilitators
– auditing and provide feedback
– purposely re-examine implementation

Question 19

what are the three least important implementation strategies

Answer 19

– changing liability laws
– using capitated payments
– Start a dissemination organisation

Question 20

what are three least feasible strategies

Answer 20

– changing liability laws
– change or create credentialing and/or licensure standards
–make billing easier

Question 21

what are the three most feasible strategies

Answer 21

– develop educational materials
– distribute educational materials
– assess for readiness and identify barriers and
facilitators

Question 22

what can be summarize from the factors to consider when choosing the implementation strategies

Answer 22

there are a number that could and should be considered including:

evidence for the effectiveness of the strategy
the number of strategies
strategy importance and feasibility