Week 5: Implementation Strategies Flashcards
Methods or techniques used to enhance the adoption, implementation, and sustainability of a clinical program, practice, or intervention.
Implementation Strategies
Types of Implementation Strategies
1) Discrete or Single Implementation Strategy
2) Multifaceted Implementation Strategy
Involves a single action or process. Example: Reminders to prompt the use of an intervention.
Challenge: Due to the numerous challenges and barriers involved in implementing new practices, a single strategy is often insufficient.
Discrete/Single Implementation Strategy
Is a research project aimed at addressing the challenges associated with identifying and selecting appropriate implementation strategies in healthcare.
Expert Recommendations for Implementing Change (ERIC) Study
They have unparalleled importance in implementation science.
It targets barriers and leveragesT facilitators to implementation.
Implementation Strategies
Used a Delphi process with a panel of experts to reach consensus on the strategies and definitions which resulted in a compilation of 73 discrete implementation strategies with clear labels and detailed definitions.
Expert Recommendations for Implementing Change (ERIC)
Involves the use of two or more discrete strategies.
Can address barriers at different levels, such as patient, provider, and organizational levels.
Example: Creating reminders and developing educational materials.
Multifaceted Implementation Strategy
Why was the ERIC study developed?
To address two major limitations:
- Lack of conceptual clarity: Terms and definitions are often used inconsistently, making it difficult to understand and compare strategies.
- Insufficient guidance: There’s limited guidance on how to choose the best strategies for a given situation.
Was identified as a discrete implementation strategy.
The action of collecting and summarising clinical performance data over a specified time period and giving it to clinicians and administrators to monitor, evaluate, and modify provider behavior’.
Audit and Provide Feedback Strategy (one of the 73 strategies from ERIC)
Is a structured technique for gathering and synthesizing expert opinions on a particular topic.
Delphi Process
Flexibility: The compilation is meant to provide a range of options, not a rigid list of requirements.
Tailoring: Researchers and practitioners should select strategies based on their specific needs and context.
The ERIC Compilation (a tool/list, not a checklist)
9 Categories of the 73 Implementation Strategies (ERIC)
1) Evaluative and Integrative Strategies (10)
2) Provide Interactive Assistance (4)
3) Adapt and Tailor to Context (4)
4) Develop Stakeholder Interrelationships (17)
5) Train and Educate Stakeholders (11)
6) Supporting Clinicians (5)
7) Engage Consumers (5)
8) Utilize Financial Strategies (9)
9) Change Infrastructure (8)
Providing clinicians with ongoing supervision, focusing on the innovation; provide training for clinical supervisors, who will supervise clinicians who provide the innovation.
Example: Provide clinical supervision
Provide Interactive Assistance (4)
Assessing 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.
Example: Assess for readiness and identify barriers and facilitators
Evaluative and Integrative Strategies (10 items)
Identifying the ways, a clinical innovation can be tailored to meet local needs and clarify which elements of the innovation must be maintained to preserve fidelity.
Example: Promote adaptability
Adapt and Tailor to Context (4)
Identifying and preparing individuals who dedicate themselves to supporting, marketing and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization.
Example: Identify and prepare champions and build partnerships with stakeholders
Develop Stakeholder Interrelationships (17)
Distribute educational materials, including guidelines, manuals, and toolkits in-person, by mail, or electronically.
Train and Educate Stakeholders (11)
Shifting and revising roles among professionals who provide care, and redesigning job characteristics.
Supporting Clinicians (5)
Developing strategies with patients to encourage and problem-solve around adherence.
Engage Consumers (5)
Access new or existing money to facilitate the implementation.
Utilize Financial Strategies (9)
Having leadership declared the priority of the innovation and the determination to have it implemented.
Example: Mandate change
Change Infrastructure (8)
Factors that could influence the effectiveness of an intervention.
Have been referred to as barriers, obstacles, enablers, and facilitators within the context in which the intervention occurs.
Determinants of Practice
This process is critical in identifying strategies to address and overcome intervention and setting specific barriers and leverage facilitators to implementation.
Assess factors that influence implementation processes and outcomes.
Are any obstacles or challenges that can hinder the successful adoption, implementation, or sustainability of a new healthcare practice, program, or intervention.
Implementation Barriers
4 Methods to Improve Selection and Tailoring Strategies
1) Concept-Mapping
2) Group Model Building
3) Conjoin Analysis
4) Intervention Mapping
Is a web-based tool that helps researchers and practitioners identify and select appropriate implementation strategies to address specific barriers to change.
Consolidated Framework for Implementation Research (CFIR) Tool
A widely used framework for understanding and studying implementation processes.
Consolidated Framework for Implementation Research
A collaborative process for developing and refining models.
Group Model-Building
A visual tool for organizing and understanding relationships between concepts.
Concept Mapping
A statistical technique for measuring preferences.
Conjoint Analysis
A systematic approach to designing and implementing health interventions.
Intervention Mapping
What: Conducts group reviews on implementation strategies
How: They provide evidence for the effectiveness of various strategies, including printed materials, meetings, outreach, opinion leaders, audit and feedback, computerized reminders, and tailored strategies.
Limitations: The evidence base is currently incomplete.
Cochrane Effective Practice and Organization of Care
