Table 2 CPG implementation facilitators: top five prioritized themes categorized by implementation strategy18 with NGT item examples
Facilitator theme | Examples of NGT items |
|---|---|
1. Organizational factors | |
Develop stakeholder interrelationships | Networking with others outside own institution |
Collaboration between and across disciplines | |
Commitment to strive for best practice | |
Convene teams | Dedicated team members to pediatric oncology |
Strong physician CPG champion | |
Designated person as implementation planner | |
Inclusion of all involved in guideline-related care | |
Utilize financial strategies | Adequate resources and time available |
Practice facilitation | CPGs are considered trustworthy as they are COG-endorsed |
Support practitioners | Commitment/advocacy from physician leadership |
Change infrastructure | Regular meetings to discuss CPGs |
Train and educate stakeholders | Formal presentation at staff meetings |
2. Individual factors | |
Develop stakeholder interrelationships | Eagerness/willingness for consensus toward implementation/use |
Convene teams | Goal of best patient care |
Engage consumers | Family buy-in |
Provide interactive assistance | Mentoring and education available among team members |
Use evaluative and interactive strategies | Good patient outcomes encourage CPG |
Support practitioners | Hospital/institution (upper management) supportive of change |
Change infrastructure | Consistent practitioner |
Train and educate stakeholders | Knowing the evidence to support the CPG |
Mentoring among team members | |
3. User needs/values | |
Develop stakeholder interrelationships | Commitment/advocacy from physician leadership |
Convene teams | Buy-in/engagement of all staff |
Provide interactive assistance | Mentorship within discipline |
Change infrastructure | Designated interdisciplinary committee to discuss and adopt guideline |
4. System factors | |
Develop stakeholder interrelationships | Patient-centered care—safety-focused |
Convene teams | Supportive staff |
Utilize financial strategies | Network that provides financial and administrative support (for example NCORP) |
Engage consumers | Education to families/materials |
Provide interactive assistance | EMR integration: standardized order sets, hard stops, prompting |
Use evaluative and interactive strategies | Organized systematic approach to implementation |
Support practitioners | Interdisciplinary functional team—good and open communication |
Change infrastructure | Staff huddles |
Train and educate stakeholders | Multidisciplinary rounds |
5. Implementation: strategies | |
Develop stakeholder interrelationships | Science-based approach |
Practice facilitation | Peer pressure |
Provide interactive assistance | Embedded in COG protocols with links |
Use evaluative and interactive strategies | Metrics/goals |
Support practitioners | Visible signs/reminders |
E-mail alerts regarding new CPG or updates | |
Change infrastructure | Negative reinforcement/monitoring board |
Train and educate stakeholders | External continuing education |
Journal club to share practice change | |
Regular tumor boards | |