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Table 3 Implementation strategies for immediate postpartum contraceptive services and frequency of utilization by study sites

From: Implementing immediate postpartum contraception: a comparative case study at 11 hospitals

Strategiesa Sites utilizing strategy
Total 1 2 3 4 5 6 7 8 9 10 11
Strategies to plan and lead implementation
Identify and prepare champion(s): identify and prepare individuals who dedicate themselves to supporting a new practice and overcoming indifference or resistance 11
Build an implementation coalition: recruit and cultivate relationships with partners in the implementation effort 10  
Promote network weaving: cultivate high-quality working relationships within and across organizational units to promote information sharing, collaborative problem-solving, and a shared vision related to implementing the innovation 9   
Conduct local consensus discussions: include stakeholders in discussions about whether the clinical innovation appropriately addresses an important problem 5       
Conduct local needs assessment: collect and analyze data (e.g., baseline contraceptive counseling and use rates) related to the need for the innovation 3         
Assess for readiness; identify barriers and facilitators: assess various aspects of an organization to determine its readiness to implement, barriers that may impede implementation, and strengths that can be used in the implementation effort 0            
Tailor strategies: tailor the implementation strategies to address barriers and leverage facilitators that were identified through earlier data collection 0            
Develop a formal or informal implementation blueprint: Develop a description of the (1) aim/purpose of the implementation, (2) scope of the change (e.g., units affected), (3) timeframe and milestones, and (4) appropriate performance measures 4        
Obtain stakeholder feedback about the implementation plan: formally and informally soliciting front-line workers’ opinions to refine the implementation plan 2          
Facilitation: a process of interactive problem-solving and support in the context of a recognized need for improvement and a supportive interpersonal relationship 9   
Assess and redefine workflow: map current work processes and plan for desired work processes, identifying changes necessary to routinize the clinical innovation 5       
Stage implementation scale up: phase implementation efforts by starting with small pilots or demonstration projects and gradually move to a system-wide rollout 10  
Strategies to optimize financial environment
Access new funding: access money to facilitate implementation 11
Place innovation on FFS lists/inpatient formulary: work to place the clinical innovation on lists of actions for which providers can be reimbursed (e.g., a drug is placed on a formulary, a procedure is now reimbursable) 11
Strategies to optimize for infrastructure change
Change record systems: change electronic medical records to allow better patient care or assessment of clinical outcomes 10  
Change physical structure and equipment: adapt the physical structure/equipment to accommodate the intervention (e.g., adding a PyxisTM or device insertion supplies) 11
Strategies to train, educate, and support clinicians and staff
Provide dynamic training and educational activities: use interactive methods to teach stakeholders (e.g., providers, operations staff) about the innovation 11
Develop and distribute educational materials: disseminate manuals and toolkits 10  
Conduct ongoing training: offer follow-up training, advanced training, booster training, purposefully spaced training, training to competence, structured supervision 10  
Remind clinicians: develop reminder systems designed to help clinicians to recall information and/or prompt them to use the clinical innovation 10  
Provide clinical supervision: expert clinician offers ongoing supervision 4        
Organize clinician and staff team meetings: support the teams implementing the innovation and protect time to reflect on their efforts and share lessons learned 5       
Engage local opinion leaders: activate individuals identified by colleagues as “influential” to motivate colleagues to adopt the clinical innovation; dampen resistance among opinion leaders, if needed 0            
Strategies to engage patients
Prepare patients to be active participants: prepare patients to inquire about care guidelines and available treatment options and request the clinical innovation from their providers desired 6      
Involve patients in implementation planning: solicit and use patient feedback 0            
Engage community resources: utilize health departments, non-profits, resources for addressing social determinants of health, and reproductive justice experts 1           
Strategies to evaluate Implementation
Plan for outcome evaluation: identify relevant outcomes, measures, and data sources 2          
Develop processes and tools for quality monitoring: develop, test, and utilize systems and procedures to monitor clinical processes or outcomes related to the innovation 5       
Evaluate the implementation: monitor progress and adjust clinical practices and implementation strategies to continuously improve the quality of care 8    
Audit and feedback: collect clinical performance data and give it to clinicians and administrators to monitor, evaluate, and modify provider behavior 0            
  1. aAdapted from the Expert Recommendations for Implementing Change (Powell, et al., Implementation Science, 2015)
  2. NOTE: Strategies used by sites but not clearly linked to implementation outcomes include: conduct cyclical small tests of change (n=1), use advisory boards and work groups (n=2), use train the trainer strategies (n=1), and revise professional roles (n=1)
  3. LARC Long-acting reversible contraception