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

Identify and prepare champion(s): identify and prepare individuals who dedicate themselves to supporting a new practice and overcoming indifference or resistance

11

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■

■

■

■

■

■

■

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Build an implementation coalition: recruit and cultivate relationships with partners in the implementation effort

10

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■

■

■

■

■

■

■

■

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

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■

■

■

■

■

■

■

Conduct local consensus discussions: include stakeholders in discussions about whether the clinical innovation appropriately addresses an important problem

5

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■

■

■

Conduct local needs assessment: collect and analyze data (e.g., baseline contraceptive counseling and use rates) related to the need for the innovation

3

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■

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

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■

Obtain stakeholder feedback about the implementation plan: formally and informally soliciting front-line workers’ opinions to refine the implementation plan

2

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■

Facilitation: a process of interactive problem-solving and support in the context of a recognized need for improvement and a supportive interpersonal relationship

9

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Assess and redefine workflow: map current work processes and plan for desired work processes, identifying changes necessary to routinize the clinical innovation

5

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Stage implementation scale up: phase implementation efforts by starting with small pilots or demonstration projects and gradually move to a system-wide rollout

10

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Access new funding: access money to facilitate implementation

11

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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

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Change record systems: change electronic medical records to allow better patient care or assessment of clinical outcomes

10

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■

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Change physical structure and equipment: adapt the physical structure/equipment to accommodate the intervention (e.g., adding a Pyxis^TM or device insertion supplies)

11

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■

■

■

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■

■

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Provide dynamic training and educational activities: use interactive methods to teach stakeholders (e.g., providers, operations staff) about the innovation

11

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■

■

■

■

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■

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■

Develop and distribute educational materials: disseminate manuals and toolkits

10

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Conduct ongoing training: offer follow-up training, advanced training, booster training, purposefully spaced training, training to competence, structured supervision

10

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Remind clinicians: develop reminder systems designed to help clinicians to recall information and/or prompt them to use the clinical innovation

10

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Provide clinical supervision: expert clinician offers ongoing supervision

4

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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

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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

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

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■

■

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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

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Plan for outcome evaluation: identify relevant outcomes, measures, and data sources

2

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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

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Evaluate the implementation: monitor progress and adjust clinical practices and implementation strategies to continuously improve the quality of care

8

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Audit and feedback: collect clinical performance data and give it to clinicians and administrators to monitor, evaluate, and modify provider behavior

0