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Table 2 Discrete strategies and specifications identified by stakeholders across interviews and workshops

From: A stakeholder-driven method for selecting implementation strategies: a case example of pediatric hypertension clinical practice guideline implementation

Strategy category Discrete strategy Actor(s) Action(s) Temporality Dosage
Training Asynchronous training of MA/nurses Trainers: video (School of Medicine, available materials with pediatric standardized patient)
Trainees: MAs/nurses
• Training in BP measurement techniques and context (refreshers)
• Training in EHR strategies for EBP
• New hires
• Transfers/inter-departmental changes to pediatrics (within 1 week of starting)
• 20–30 min
Synchronous training of MA/nurses Trainers: BP champion(s), MA trainer or lead MA
Trainees: MAs/nurses
• In vivo BP measurement technique and context training
• Training in EHR strategies for EBP
• BP measurement spot-checks
• Immediately following asynchronous training (above)
• Spot-checks: ongoing
• 15–20 min (total)
• Spot-checks: quarterly, 5–10 min
Training of MA/nurses in manual BP reading Trainers: BP champion(s), Video (School of Medicine, available materials with pediatric standardized patient)
Trainees: MAs/nurses
• Training in manual BP measurement techniques
• Manual BP measurement spot-checks
• New hires
• Transfers/inter-departmental changes to pediatrics (within 1 week of starting)
• Spot-checks: ongoing
• 20–30 min
Asynchronous training of pediatric clinicians Trainer: video
Trainees: pediatric clinicians
• Training in BP measurement techniques and context (particularly for pediatric practices)
• How to address EBP, etc.
• Training in EHR strategies
• Annually • One training for diagnosis
• One training for treatment/management (~15 min each)
Synchronous training of pediatric clinicians Trainer: specialist (e.g., pediatric nephrologist)
Trainees: pediatric clinicians
• Psychoeducation (grand rounds, in-service, counseling strategies, case presentations) • Annually • 50–60 min
Audit and feedback Feedback reports • Data team
• Alliance-generated report
• Targets: pediatric clinicians, (support staff)
• Dashboard report
• Practice-level comparisons,
• Individual clinician performance (combined with annual review)
• Report generation and review: as needed (recommended: monthly to quarterly, combined with other data reports/reviews)
• To providers: 6 months (combined with incentive structure)
• ~10 min per meeting
Workflow changes Workflow changes Operations director (to MAs) • Specification and dissemination of new workflow • Within 1 month of implementation launch • 1–2 h
Staffing changes Develop new position • Operations director/practice manager
• Residency/intern manager
• Describe the position and hire; develop a business plan to justify position • Within 1 month of implementation launch • 6–8 h
Shift tasks among existing positions • Operations director/practice manager
• Residency/intern manager
• Specify new expectations (population health tool)
• Relieve other duties and reassign as needed
• Within 1 month of the launch of the population health tool • 1–2 h
Visual reminders/materials (non-digital) Visual reminders for staff • Operations director/practice manager
• Marketing team
• Make materials available and accessible • Within 1 month of implementation launch
• Refresh as needed
• 2–5 min per patient, as needed (to use materials)
• May require time to create materials
Materials for patients/families • Operations director (for workflow change)
• MAs (sending messages)
• Send email or snail mail to indicated patients/families • Within 1 month of implementation launch
• Refresh as needed
• 1–2 h/week
HIT solutions/features EHR reminders and features • Alliance, individual health center’s EHR department
• Target: pediatric clinicians, support staff
• Programming EHR (order sets, clinical decision tree quick-link) • Within 1 month of implementation launch, use with every patient as necessary • 1–2 min/patient
Population builder (population health tool) Identify at-risk patients/populations • BP champion(s)
• Trainees
• Data team
• Case managers
• Run population queries and review
• Flag at-risk patients (scheduled or need follow-up)
• Weekly to monthly • 5–20 min/week (highly variable)
Patient care huddles • Care team (pediatric clinicians and support staff, case managers) • Meeting to review results of population health tool query • Daily • 5–10 min, 1–2 times/day
Leadership support Engaging leadership • Pediatric clinicians
• Quality Improvement team
• External actors from relevant interest groups (AAP, AllianceChicago)
• Meetings
• Materials to make the case
• Prioritization within strategic plan/quality improvement plan
• Highly variable per CHC (more effort up front, with ongoing time commitment) • Variable, dependent on the current stage of change
Financial support Provider incentives • Leadership: COO, CEO, CFO
• HRSA,
• UDS measures
• Insurance companies
• Integrate within existing pediatric provider incentive structure plan and financial model • 6 months (performance review schedule) • Requires 2–3 h up front, minimal time once integrated
Accessing funding (positions, equipment) • Leadership: COO, CEO, CFO • Add/integrate into yearly budget
• Clinic space: work with facilities
• Ongoing (e.g., replace broken equipment, as needs arise) • 30–60 min for budget planning
  1. Notes. Actor indicates “Who does this?”; Action(s) indicate “what do the actors do?”; Temporality specifies “When was the strategy used?”; and Dosage refers to frequency of use and time involved in each use. We do not include “action target,” “implementation outcome,” or “justification”, which are elements of the Proctor et al. (2013) suggestions for specifying strategies. This is because some of these appear elsewhere in the IRLM. For example, superscripts in Fig. 2 indicate linkages between strategy and determinant (which is often part of “action target”), and potential mechanisms are described as well, which are part of both “action target” and “justification”; implementation outcomes are also included in the IRLM