Table 3 Description of included articles

Albert, 2012 [47]

USA

Clinic(s) (number not reported)

Cross-sectional study

Physicians who reported consistent use of standard order programs = 502

Age: Mean (SD) = 50.4 (10.1) years

Sex and Gender: Not reported

Physicians who consistently use SOPs for influenza vaccine only = 175

Age: Mean (SD) = 50.2 (9.4) years

Sex and Gender: Not reported

Physicians who consistently use SOPs for influenza and pneumococcal polysaccharide vaccine = 203

Age: Mean (SD) = 51.8 (9.9) years

Sex and Gender: Not reported

Innovation: Standard order programs are facility policies allowing non-physician health care providers to assess patient’s immunization status and administer vaccines without a physician order

Study outcome measurement

Measure: Single item asking how often non- physician staff utilize a standard order program for administering influenza, pneumococcal polysaccharide vaccine, or both types of vaccines at their clinic. Options range from: a) inexistence or lack of interest in implementing standard order programs; b) inexistence but interest in implementing standard order programs; c) existence but inconsistent use of standard order programs; or d) consistent use of standard order programs

Reliability: Not reported; Validity: Not reported

Alidina, 2018 [48]

USA

Hospital(s) (number not reported)

Cross-sectional study

Operating room staff = 368

Age: Not reported

Sex & Gender: Not reported

Professions: Anesthesiology = 311 (84.5%); Surgery = 13 (3.5%); operating room staff = 24 (6.5%); Other = 20 (5.4%)

Innovation: Operating room cognitive aids are tools (e.g. checklist or emergency operating procedures) that provide information to facilitate and standardize decision making, action and information sharing between health care providers during crises

Study outcome measurement

Measure: Single survey item asking operating room staff about the regular use of operating room cognitive aids at their facility on a 5-point Likert scale from “strongly disagree to strongly agree”

Reliability: Not reported

Validity: The survey was piloted survey with 21 operating room staff to assess readability and comprehensibility of questions

Anand, 2017 [49]

18 European countries

203 neonatal intensive care units

Prospective cohort study

Neonatal intensive care patients = 6648

Age: Mean (SD) = 35.0 (4.6) weeks

Not specified Sex or Gender:

Male = 3753 (56.5%); Female = 2895 (44.5%)

Interpreted as: Sex

Innovation: The use of measurement scales that measure continuous pain proceeding invasive procedures may enhance the quality pain management in neonatal patients (e.g. prevents untreated pain, under or overdosing of analgesics, or the development of drug tolerance)

Study outcome measurement

Measure: Chart audit to measure the use of pain assessments tools/scales designed to measure continuous pain (e.g. Echelle Douleur Inconfort Nouveau-ne (EDIN) scale, COMFORT scale) for 1 month in participating NICUs

Reliability: A random 10% of the data was double checked by a local data quality manager. If 1% or more errors is present, then another random 10% would be double checked. If 1% or more errors continued, then all data entries for that NICU would be double checked

Validity: Not reported

Ash, 1997 [50]

USA

65 academic health sciences centres

Cross-sectional study

Informatics professionals and library workers = 534^a

Age: Not reported

Sex and Gender: Not reported

Professions: Informatics professionals = 195 (31% of 629); library workers = 339 (48% of 706) ^a

Innovation: Electronic mail is a communication method whereby an individual sends a message to another individual via a computer or other technological devices

Study outcome measurement

Measures: Two single items scales measuring electronic mail infusion [81] and diffusion [82] on a 4-point scale (low to high). Infusion is the extent of which an innovation is implemented, while diffusion is the breadth of implementation within an organization

Reliability: Not reported; Validity: Not reported

Ben-David, 2019 [51]

Israel

24 medical surgical intensive care units

Cross-sectional study

Sample information not reported

Innovation: Central-line-associated bloodstream infection prevention practice bundles include measures that decreases risk of infection during insertion (e.g. hand hygiene and use of maximal sterile barriers) and measures that minimize infection risk during ongoing catheter use (e.g. aseptic technique for tubing and dressing changes and the prompt removal of central line catheters when no longer necessary)

Study outcome measurement

Measure: Monthly incidence rates of central-line-associated bloodstream infection collected as part of routine national surveillance in Israel hospitals

Reliability: Not reported; Validity: Not reported

Bentz, 2007 [52]

USA

19 (10 intervention, 9 control) clinics

Cluster randomised trial

(1) Control clinic patients = Not reported

Age: Mean (SD) = 50.7 (5.6) years

Reported Gender: Male = 33.5%; Female = 76.5%

Interpreted as: Sex

(2) Physicians in control clinics = 55

Age: Not reported

Reported Gender: Male = 49.2%; Female = 50.8%

Interpreted as: Sex

3) Intervention clinic patients = Not reported

Age: Mean (SD) = 54.2 (6.7) years

Reported Gender: Male = 34%; Female = 76%

Interpreted as: Sex

4)Physicians in intervention clinics = 57

Age: Not reported

Reported Gender: Male = 51.6%; Female = 48.4%

Interpreted as: Sex

Innovation: The delivery of electronic health record generated feedback, rather than peer feedback to health care providers to increase the delivery of tobacco cessation assistance and referrals to the Oregon Tobacco Quitline

Study outcome measurement

Measure: Monthly rates of clients referred, reached, or counseled regarding tobacco cessation using the Oregon Tobacco Quitline according to electronic health records

Reliability: Not reported; Validity: Not reported

Bradley, 2012 [53]

USA

533 hospitals

Cross-sectional study

Hospitals’ chief executive officers = 533

Age: Not reported

Sex & Gender: Not reported

Professions: Not reported

Innovation: There was no specific innovation in this study. The purpose of this study was to identify and determine the relationships between hospital strategies and hospital risk-standardized mortality rates

Study outcome measurement

Measure: Thirty-day risk-standardized mortality rates: “predicted number of deaths within 30 days of admission at a hospital divided by the expected number of deaths within 30 days of admission at the same hospital multiplied by the overall 30-day mortality rate of the cohort” [53] (p.3)

Reliability: Not reported; Validity: Not reported

Campbell, 2008 [54]

USA

One hospital

Non-controlled before and after study

Intensive care unit patients = 120

Age: Range = 32–93 years old

Reported Gender: Male = 53%; Female = 47%

Interpreted as: Sex

Innovation: The Keystone ICU Sepsis project aims at improving the quality of care, decreasing length of stay, eliminating unnecessary cost and creating a culture centred on safety in participating Michigan hospital’s intensive care units. The Keystone ICU Sepsis project seeks to increase the identification of patients with or at risk of sepsis and the implementation of appropriate of sepsis protocols

Study outcome measurement

Measures: Chart documentation of (1) intensive care unit nurses’ compliance with sepsis-screening protocols and (2) the proportion of patients with severe sepsis that physicians initiated the sepsis protocol on

Reliability: Not reported; Validity: Not reported

Chang, 2012 [40]

USA

225 primary care practices

Cross-sectional study

Primary care directors: sample details not reported

Innovation: Depression care improvement models are evidence-based models that guides screening and management of common mental health disorders in a primary care setting. These models include the collocation of mental health specialists, the Translating Initiatives in Depression (TIDES) model and the Behavioural Health Laboratory (BHL) model

Study outcome measurement

Measure: Primary care directors’ responses to a single item in the 2007 VA Clinical Practice Organization Survey (CPOS) Primary Care [83]. This single item asks the degree of implementation of three depression care improvement models (collocation, TIDES and BHL). The authors dichotomized the responses into fully or partially implemented versus planned but not yet implemented or not implemented. Some clinics may have implemented multiple depression improvement models. The authors used a hierarchal coding system to assign each clinic to only a single model; prioritizing BHL, then TIDES, then collocation

Reliability: Not reported; Validity: Not reported

Ellerbeck, 2006 [55]

USA

44 hospitals

Cross-sectional study

Sample details not reported

Innovation: Consistent use of aspirin and beta-blockers during the hospitalization or at the time of discharge in patients with acute myocardial infarction

Study outcome measurement

Measures: Audit of hospital records and supplemental Medicare billing records of a random sample of Medicare patients admitted between April 1, 1998, and May 31, 2001, with a principal diagnosis of acute myocardial infarction. Outcome data was the use of aspirin and beta-blockers at admission and at discharge

Reliability: Not reported; Validity: Not reported

Foster, 2017 [56]

USA and Puerto Rico

1174 hospitals

Non-controlled before and after study

Sample details not reported

Innovation: Innovations were not clearly outlined in this paper. The purpose of the paper is to assess the relationships between engagement or knowledge translation strategies and the change in a composite measure of quality of care according to 10 harm topics (e.g. readmissions). Examples of these engagement or knowledge translation strategies includes improvement events targeted to staff, and improvement fellows (a subset of which comprises of champions)

Study outcome measurement

Measure: A weighted composite score of quality of care calculated by adding a ratio of occurrence of the 10 harm topics for 1 month. A low score means higher quality. These measures are based on self-reports submitted by hospitals

Reliability: Not reported; Validity: Not reported

Goff, 2019 [57]

USA

80 pediatric primary care practices

Cross-sectional study

Practice leaders = 80

Age in years (n (%)): 26–35 = 8 (10%); 36–45 = 17 (21.3%); 46–55 = 17 (21.3%); 56–65 = 31 (38.8%); > 65 = 3 (3.75%); No response = 4 (5%)

Reported Gender: Female = 66 (82.5%); Male = 10 (12.5%); Non-binary = 1 (1.25%); No response = 3 (3.75%)

Interpreted as: Gender

Professions: Practice manager = 58 (72.5%); Nurse manager = 6 (7.5%); Physician owner = 1 (1.25%); Physician leader = 4 (5%); Other = 9 (11.3%); No response = 2 (2.5%)

Innovation: This study did not have an innovation, rather the study assessed the relationships between the organizational characteristics of primary care practices in the Massachusetts Health Quality Partners and their reported clinical quality and patient experience scores

Study outcome measurement

Measures: The authors translated clinical quality and patient experience scores from Massachusetts Health Quality Partners website to a scale from zero to three points. Average patient experience scores and clinical quality scores were calculated for practices reporting four or more patient experience or clinical quality scores

Reliability: Not reported; Validity: Not reported

Granade, 2020 [58]

USA

Primary care clinics and pharmacies (number not reported)

Cross-sectional study

(1) Clinicians = 4911

Age in years (n (%)): < 40 = 1497 (30.5%); 40–49 = 1503 (26.8%); 50–59 = 1156 (23.4%); ≥ 60 = 736 (19.3%)

Reported Sex: Male = 1858 (48.5%); Female = 3053 (51.5%)

Interpreted as: Sex

Professions: Physician = 2349 (71.5%); Nurse practitioner = 1293 (15.7%); Physician assistant = 1269 (12.8%)

(2) Pharmacists = 793

Age in years (n (%)): < 40 = 310 (45.3%); 40–49 = 194 (19.4%); 50–59 = 161 (17.5%); ≥ 60 = 125 (17.7%)

Reported Sex: Male = 1858 (48.5%); Female = 3053 (51.5%)

Interpreted as: Sex

Innovation: The Standards for Adult Immunization Practice emphasizes that health care providers should routinely perform assessments, strongly recommend, administer, or provide referrals, and document in electronic health care systems the administration of all necessary vaccines in adult patients

Study outcome measurement

Measure: A survey developed by Centers for Disease Control and Prevention and Abt Associates Inc. to assess primary care clinicians and pharmacists’ self reported adherence to the Standards for Adult Immunization Practice and factors (e.g. presence of champions) related to implementation of these standards. A composite score of vaccination process standard adherence was calculated by the authors

Reliability: Not reported

Validity: Survey question phrasing were revised for better readability and comprehension

Hsia, 2019 [59]

Taiwan

119 hospitals

Cross-sectional study

Top managers = 119

Age: Not reported

Sex and Gender: Not reported

Professions: Not reported

Innovation: E-Health innovations are forms of information technology that are designed to aid with the delivery of health care related activities. Examples of E-Health innovations are electronic health record computerized provider order entry, and picture archiving and communication systems

Study outcome measurement

Measure: A seven-item subscale within a 28-item questionnaire that is intended to measure the extent that hospital medical services and work processes are performed using E-Health technologies. The questionnaire was created by the authors. Scoring of items were on a five-point Likert scale ranging from strongly disagree to strongly agree

Reliability: Composite reliability = 0.95; α = 0.934

Validity: Factor loadings range = 0.728–1.053, which is above the 0.707 threshold

Hung, 2008 [60]

USA

57 primary care practice-based research networks

Cross-sectional study

Patients = 4735

Age in years (n (%)): 18–39 = 1348 (28.9%); 40–54 = 1476 (31.6%); 55–64 = 925 (19.8%); ≥ 65 = 921 (19.7%)

Reported Gender: Male = 1319 (27.9%); Female = 3377 (71.3%)

Interpreted as: Sex

Innovation: The Chronic Care Model is a system-level framework consisting of six main areas with a focus on prevention and health behaviour counselling in primary care practices. These six main areas include (1) establishing a health system and organization of care centred on chronic care, (2) supporting patient participation in their own care, (3) a proactive delivery system that identifies and addresses health needs, (4) availability of evidence-based decision supports for health care providers, (5) implementing an electronic health care information system and (6) established networks with community resources to support continuity of care. This study was interested on understanding how the Chronic Care Model related to quality-of-life measures

Study outcome measurement

Measures: Three survey items based on the Center for Disease Control and Prevention’s Healthy Days core measures [84,85,86]: (1) number of unhealthy days in the past 30 days, (2) number limiting days in the past 30 days, (3) general health status. Number of unhealthy days and limiting days was measured on a three-point ordinal scale (0 days, 1–13 days and 14–30 days). General health status is rated on a five-point scale from poor to excellent

Reliability: Not reported; Validity: Not reported

Kabukye, 2020 [61]

Uganda

One tertiary oncology centre

Cross-sectional study

Survey Participants = 146

Age in years (n (%)): ≤ 30 = 47 (32.2%);31–40 = 58 (39.7%);41–50 = 20 (13.7%); ≥ 50 = 13 (8.9%); Missing = 8 (5.5%)

Reported Gender: Female = 86 (58.9%); Male = 53 (36.3%); Missing = 7 (4.8%)

Interpreted as: Sex

Profession(s): Oncologist = 9 (6.2%); Doctor = 27 (18.5%); Nurse = 24 (16.4%); Allied health worker (lab, imaging, pharmacy, medical records officers) = 61 (41.8%); Biostatistics/Data manager/IT = 13 (8.9%); Administrator = 12 (8.2%)

Innovation: Electronic health record is the use of information technology to assist with health care related processes

Study outcome measurement

Measure: A four-item subscale measuring organizational readiness in implementing electronic health records in low- and middle-income countries using a 5-point Likert scale ranging from strongly agree to strongly disagree adapted from a study by Paré et al. [68]

Reliability: Dillon- Goldstein’s rho = 0.79; α = 0.64

Validity: Convergent validity: Average variance extracted (AVE) = 0.48

Kenny, 2005 [62]

USA

Three army medical treatment facilities

Cross-sectional study

Registered nurses = 290

Age: Not reported

Reported Gender: Male = 60 (20.7%); Female = 229 (79.0%); Missing = 1 (0.3%)

Interpreted as: Sex

Innovation: This study did not have an explicit innovation. The purpose of this study was to examine individual and organization factors related to research use by nurses. Research use was defined as the use of research findings to guide nursing practice

Study outcome measurement

Measures: (1) Adapted Research Utilization survey by Estabrooks [87] to measure direct, persuasive and overall research use. All types of research use were single survey items scored using a 7-point Likert scale from "never" to "nearly every shift”

Reliability: α (range) = 0.77–0.91; Validity: Not reported

Khera, 2018 [63]

USA

108 transplant centres

Cross-sectional study

Physicians = 316

Age: Not reported

Sex and Gender: Not reported

Professions: Physicians = 230 (77.4); Program Medical Director = 67 (22.6)

Innovation: The findings of a phase three, multicentre randomized control trial titled Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 0201 [88] found that the use of bone marrow stem cells for unrelated donor hematopoietic cell transplantation is related to similar survival rates and less chronic graft versus host disease in patients with hematologic malignancies than the use of peripheral blood stem cells

Study outcome measurement

Measure: A 26-item survey developed by the authors according to the literature and key informant interviews with three researchers from BMT CTN 0201 study [88]. Outcome variables include physician reported personal and facility-level change in preference regarding unrelated donor graft use from peripheral blood source to bone marrow. These survey items were scored on a 5 -point Likert scale from very important to very unimportant

Reliability: Not reported; Validity: Not reported

Korall, 2017, 2018 [64, 65]

One study—two reports

Canada

13 long-term care homes

Cross-sectional study

Paid care providers = 529

Age in years (n (%)): 20–29 = 42 (7.9%); 30–39 = 87 (16.4%); 40–49 = 149 (28.2%); 50–59 = 187 (35.3%); 60–69 = 46 (8.7%); Missing/unknown = 18 (3.4%)

Reported Gender: Female = 474 (89.6%); Male = 40 (7.6%); Missing/unknown = 15 (2.8%)

Interpreted as: Sex

Professions: Health care assistant/resident care aide = 290 (54.8%); Licensed practical nurse = 84 (15.9%); Registered nurse = 40 (7.6%) Resident care coordinator = 13 (2.4%); Manager = 14 (2.6%); Recreational/occupational/ physiotherapist = 24 (4.5%); Unit/program clerk = 18 (3.4%); Missing/unknown = 49 (9.3%)

Innovation: Hip protectors are protective undergarments with either a hard shield or soft pads sewn into its sides to cover the skin over the lateral aspects of the proximal femur. The purpose of hip protectors is to minimize the injury to the hip resulting from a fall

Study outcome measurement

Measures: A 15-item questionnaire titled as C-Hip Index, developed and tested for psychometric properties by authors [64] to measure affective and cognitive, behavioural and overall hip protector commitment

Reliability: α (range) = 0.87–0.97

Validity:

(1) Construct validity: Authors reported a two-factor structure as the result of an exploratory factor analysis: Factor 1 (affective and cognitive commitment) and Factor 2 (behavioural commitment) which loaded to a higher order factor called "commitment to hip protectors" with an eigen value of 1.386. R² = 0.693. Both subscales had a factor matrix coefficient of 0.833

(2) Content validity index (CVI): Twelve items in C-Hip index had a CVI = 0.79 for both clarity and relevance. Range of item CVI = 0.55–0.82

(3) Convergent validity: Increase in self reported championing is associated with increase scores for the affective/cognitive, behavioural subscales and the entire C-Hip index (p < 0.01)

(4) Concurrent validity: Significant lower median responses for individual subscales or entire C-Hip index amongst participants that responded that they were aware of a resident breaking a hip while wearing a hip protector (p < 0.01). Significant higher median responses for individual subscales or entire C-Hip index amongst individuals who responded that there was a champion at their long-term care home

Lago, 2013 [66]

Italy

103 neonatal intensive care units

Cross-sectional study

Sample details not reported

Innovation: The implementation of effective neonatal pain prevention programs according to best practice guidelines. These programs should include training and strategies to routinize the assessment of pain and the appropriate use of pharmacological and non-pharmacological therapies to prevent and treat pain

Study outcome measurement

Measure: A 58- item questionnaire created by the authors assessing neonatal intensive care units’ characteristics, availability pain control guidelines and neonatal intensive care units’ routine use of non-pharmacological and pharmacological pain-relieving interventions during invasive procedures. Frequency of pain-relieving interventions was measured on 4-point Likert scale from never (0–15%) to always (> 90%)

Reliability: Not reported; Validity: Not reported

Papadakis, 2014 [67]

Canada

40 family health team clinics

Cross-sectional study

(1) Health care providers = 288

Age: Mean (SD) = 39.5 (17.3) years

Sex and Gender: Not reported

Profession(s): Practising physician = 80.7%; Medical resident = 5%; Nurse practitioner = 12.7%

(2) Patient = 2501

Age: Mean (SD) = 47.7 (14.7) years

Reported Sex: Male = 952 (38.1%); Female = 1549 (61.9%)

Interpreted as: Sex

Innovation: Evidence-based smoking cessation treatments is composed of five strategies (denoted as 5 As): ask patients about their smoking status, advise patients to quit smoking, assess patient’s readiness to quit, assist with a quitting attempt using behavioural counselling or smoking cessation medications, and to arrange follow-up pertaining to smoking cessation

Study outcome measurement

Measures: (1) A health care provider survey created by the authors to assess family health teams characteristics and providers’ attitudes and believes towards evidence-based smoking cessation treatments

(2) A patient evaluation survey created by the authors asking on a binary scale (yes or no) if the patient’s physician or other health care providers asked, advised, or assessed readiness to quit, and if the provider assisted, or arranged follow-up regarding smoking cessation

Reliability: Not reported; Validity: Not reported

Paré, 2011 [68]

Canada

(1) Study 1: 11 home care organizations

(2) Study 2: one hospital

Cross-sectional study

(1) Study 1: Registered nurses = 134

Age in years (%): ≤ 29: 14%; 30–39 = 23%; 40–49 = 35%; 50–59 = 26%; ≥ 60 years = 2%

Reported Gender: Male = 2%; Female = 98%

Interpreted as: Sex

(2) Study 2: Clinicians = 237

Age (%): ≤ 29 years = 10%; 30 to 39 years = 21%; 40 to 49 years = 28%

50 to 59 years = 34%; ≥ 60 years = 7%

Reported Gender: Male = 32%; Female = 68%

Interpreted as: Sex

Professions: Registered nurse = 57%; Social worker = 9%; Occupational therapist = 4%; Clinician (others) = 19%; Physicians = 12%

Innovation: The innovations in the two studies pertain to the implementation of clinical information system. In study 1, the innovation was a mobile computing project. The mobile computing project contains home care nursing policies and procedures and allows home care nurses to create individualized care plans for their clients and to document the care they provided. The innovation in study two was the electronic medical record. The purpose of this study was to determine the factors related to the readiness of the staff in implementing these technological innovations

Study outcome measurement

Measures: The authors created a survey according to Holt and colleagues’ conceptual model of organizational readiness [89]. The questionnaire has 39 items. Organizational readiness was measured on 4- item subscale, scored on a 5-point Likert scale ranging from strongly agree to strongly disagree adopted two studies [90, 91]

Reliability: (1) Organizational readiness—α: Study 1 = 0.89; Study 2 = 0.88

Validity:

(1) Construct validity: exploratory factor analyses showed that all scale items loaded highly (> 0.68) on a single factor

(2) Convergent validity: Average variance extracted (study 1 = 0.88; study 2 = 0.86) was higher than inter-construct correlations

(3) Discriminant validity: Cross-loadings (study 1 range = 0.85–0.91; study 2 range = 0.78–0.89) loaded more highly on their own factor than on other factors

Patton, 2013 [69]

England

153 emergency departments

Cross-sectional study

Lead clinicians = 153

Age: Not reported

Sex and Gender: Not reported

Professions: Not reported

Innovation: The assessment of alcohol consumption and provision of advice to decrease alcohol use by health care providers in the emergency department is an effective and cost-effective way of decreasing alcohol consumption and alcohol related harm

Study outcome measurement

Measure: A follow-up survey based on questions from a national emergency survey distributed in England in 2006 [92].The dependent variables were two survey items asking about emergency staff's access to training for screening and brief advice regarding alcohol consumption

Reliability: Not reported; Validity: Not reported

Sharkey, 2013 [39]

USA

14 nursing homes

Non-controlled before and after study

Sample details were not reported

Innovation: The On-Time pressure ulcer quality improvement based on the integration of health information technology tools has three primary objectives: (1) utilize the knowledge and train certified nursing assistants to document and communicate their assessments to licensed staff through an electronic health system; (2) support collaborative and multidisciplinary clinical decision making through clinical decision support systems that summarize resident data from daily staff documentations; and (3) to establish a proactive practice focused on prevention and early treatment of pressure ulcers

Study outcome measurement

Measures: On-Time facilitators’ reports tracked implementation milestones achieved every 9 months and documented facility team characteristics, team skills and capacity. Milestones were tracked according to three levels: levels 1 to 3. The level equates to the number of process improvements implemented facility wide

Reliability: Not reported; Validity: Not reported

Shea, 2016 [70]

USA

37 ambulatory clinics

Cross-sectional study

Health care providers = 596

Age: Not reported

Sex and Gender: Not reported

Professions: Not reported

Innovation: The innovation in this study was the meaningful use of electronic health records, or the ability to maximize the capacity of the electronic health record to improve quality, safety and efficiency of health care services. Meaningful use of the electronic health records is implemented in three stages. However, the authors were interested in the Stage 1 meaningful use because Medicare services must attest to this level of meaningful use 90 days post implementation of the electronic health records to receive monetary incentives. Stage 1 meaningful objective criteria includes 14 required core objectives (e.g. having an updated medication lists for patients) and 5 menu objectives selected from a set of 10 options (e.g. providing patient- specific educational materials)

Study outcome measurement

Measure: Survey created and administered by authors to clinics’ senior leaders. Meaningful use of electronic health records was quantified as the percentage of eligible providers in each clinic demonstrating all Stage 1 meaningful use objective criteria

Reliability: Not reported; Validity: Not reported

Sisodia, 2020 [71]

USA

205 medical, surgical and mental and behavioural health clinics

Retrospective cohort study

Sample details not reported

Innovation: Patient-reported outcomes are questionnaires that is distributed to patients to assess their general health, quality of life, or health/symptoms pertaining to a specific disease

Study outcome measurement

Measure: Patient-reported outcomes collection rates were extracted from project logs within an enterprise data warehouse. These logs contained the number and type of patient related questionnaires administered to collect patient related outcomes by participating clinics in the most recent 6 months

Reliability: Not reported; Validity: Not reported

Slaunwhite, 2009 [72]

Canada

46 units within one acute care facility

23 units with champions

23 units with no champions

Case–control study

Sample details not reported

Innovation: The introduction of unit champions can facilitate the uptake of the influenza vaccine amount hospital staff

Study outcome measurement

Measure: Annual influenza vaccination rates in matched hospital units (matched according to previous years influenza vaccination rates, physical size and primary function). Secondly, the authors assessed the change in annual influenza vaccination rates from the previous year for each hospital unit

Reliability: Not reported; Validity: Not reported

Soni, 2016 [73]

India

One neonatal intensive care unit (NICU)

Interrupted time series

NICU patients = 648

Percentage of sample when KMC champions were absent in the NICU = 43.1%

Age: Not reported

Not specified Sex and Gender: Female % = 37.3%; Male % = 62.7%

Interpreted as: Sex

Innovation: Kangaroo mother care has two main components: skin-to-skin care and breastfeeding. Kangaroo mother care is a safe and low-cost measure to reduce neonatal mortality

Study outcome measurement

Measures: Chart audits to determine overall use and initiation rate (neonates/30 days) of skin-to-skin care and breastfeeding documented on standardized forms. Average duration (hours/day) was only measured for skin-to-skin care because of the difficulty in differentiating between breastfeeding attempts and successful breastfeeding

Reliability: Not reported; Validity: Not reported

Strasser, 2003 [74]

USA

203 cystic fibrosis care centres

Cross-sectional study

Clinic directors and coordinators of CF care centres = 289

Age: Not reported

Reported Gender: Male: 114 (39.6%); Female: 174 (60.4%); Missing = 1 (0.3%)

Interpreted as: Sex

Profession(s): Director = 150 (52.1%); Nurse coordinator = 112 (38.9%); Nurse practitioner = 20 (6.9%); Nurse health educator = 6 (2.1%)

Innovation: The Agency for Healthcare Research and Quality (AHRQ) 5A Smoking Cessation Clinical Practice Guideline refers to five steps: ask, advise, assess readiness to quit, assist patients with quitting and to arrange follow-up regarding smoking cessation

Study outcome measurement

Measure: A survey developed by authors to examine factors reported by directors and coordinators of cystic fibrosis centres that may affect smoking cessation guideline implementation. The AHRQ 5 A (ask, advise, assess, assist and arrange follow-up) model smoking cessation guideline was the guideline assessed by the survey. The outcome variable was measured with a dichotomous (yes/no) question asking whether the AHRQ 5 A has been implemented to address cystic fibrosis patient’s parentals smoking behaviours

Reliability: Test–retest survey reliability (n = first 30 respondents): Kendall’s tau = 1.00, p < .01; Spearman’s r = 1.00, p < .01

Validity: The survey was approved for content validity by an expert panel (a pulmonologist and two doctoral trained researchers in medical education and health behaviour)

Tierney, 2003 [75]

USA

Public health clinics and pediatrician practices (number not reported)

Mixed study (generic qualitative and cross-sectional)

(1) Public Health Clinics providers = 440

(2) Pediatricians = 434

Age: Not reported

Sex and Gender: Not reported

Profession(s): Not reported

Innovation: Reminder and recall immunization systems are routine communication processes (via telephone or mail) with children’s parents at preselected ages to remind them of an upcoming or past-due immunization or wellness check up. Routine immunization assessments refer to the measurement of immunization coverage rates at least every 2 years

Study outcome measurement

Measure: A 21-item survey created by the authors to assess five domains: messages to parents, barriers to implementation of reminder or recall messaging systems, other immunization practices (assessments, feedback), practice attitudes about immunization and characteristics and demographics

Reliability: Not reported; Validity: Not reported

Ward, 2004 [76]

USA

109 Veterans Affairs medical centres

Cross-sectional study

Quality managers = 109

Age: Not reported

Sex and Gender: Not reported

Profession(s): Not reported

Patients = not reported

Age: Mean (range) = 66 (59 - 73) years

Gender: Males: 96% Females: 4%; Range of males in all centres = 90–99%

Interpreted as: Sex

Innovation: The implementation and health care providers' adherence to diabetes guidelines pertains to glycemic, lipid and blood pressure screening and control

Study outcome measurement

Measures: (1) A 31-item questionnaire distributed to quality managers assessing organizational context related to diabetes guideline implementation. Provider process measures in the survey included performing the following: HbA_1c screen (annually), foot screening (annually), lipid screening (biannually), renal screening (biannually), eye screen (annually)

(2) Patient outcome measures include glycemic control (HbA_1c < 9.5%), non-smoker status, Lipid control (LDL ≤ 130 md/dL) and hypertension control < 140/90 mm Hg). These data were extracted from the 1999 Veterans Health Survey and the 2001 Veterans Satisfaction Survey

Reliability: Not reported; Validity: Not reported

One study, two reports:

Weiler, 2012, 2013 [77, 78]

USA

3 private ambulance companies and 3 public fire departments

Interrupted time series

Emergency Medical Service workers = 190 [77]; 221 [78]

Age: Range = 18–65 years old

Sex and Gender: Not reported

Professions: Not reported

Innovation: Patient transfer board or slide board is a foldable board that aids with lateral transfers by bridging the gap between the bed and hospital stretcher and facilitate sliding of the patient from the stretcher to the bed and vice versa

Study outcome measurement

Measures: This study used scales that the authors formulated according to existing validated instruments:

(1) “Intention to use the transfer board” scale (3 item scale) was based on Dishaw and Strong [93]

(2) Ergonomic advantage of transfer boards (5 item scale) was based on Moore and Benbasat [94]

Reliability: Not reported

Validity: Ergonomic advantage- Factor loadings ranged from 0.62 to 0.81. Validity not reported for intention to use scale

Westrick, 2009 [79]

USA

104 community pharmacies

Cross-sectional study

Pharmacy staff = 104

Age: Not reported

Reported Sex: Male = 65 (64.0%); Female = 35 (36.0%)

Interpreted as: Sex

Professions: Staff pharmacist = 13 (14.1%); Manager = 67 (72.8%);

Owner/partner = 12 (13%)

Innovation: Pharmacy-based in-house immunization services is the administration of vaccines by pharmacists at their designated health care setting

Study outcome measurement

Measure: A questionnaire created by the authors that assesses pharmacy staff’s perspectives regarding the following criteria relevant to the sustainability of an in-house pharmacy immunization services (5 subscales): champion effectiveness (strategic and operational), formal evaluation, degree of modification, compatibility and sustainability of immunization services. The sustainability scale was based on Goodman and colleagues [95]. The subscales composed of either 4 to 6 items or scored on a 5-point Likert scale except for formal evaluation, which is a single dichotomous item.

Reliability: α (range for all five subscales except formal evaluation) = 0.71–0.85. Formal evaluation was not assessed for reliability

Validity: Not reported

Whitebird, 2014 [41]

USA

42 clinics from 14 medical groups

Mixed study (Generic qualitative and prospective cohort)

Patients in the Depression Improvement Across Minnesota: Offering a New Direction (DIAMOND) program at 6 months follow-up = 5258

Age: Not reported

Sex and Gender: Not reported

Innovation: The DIAMOND program aims to provide collaborative depression care and consultive support to primary care clinics throughout Minnesota and Western Wisconsin. The DIAMOND program is composed of six aspects: (1) the use of the Patient Health Questionnaire-9 (PHQ-9) [96] to assess and monitor patient’s condition and progress; (2) systematic tracking of patients; (3) use of evidence-based guidelines to guide treatment; (4) dissemination of relapse prevention education to health care staff; (5) the presence of a care manager whose role is to educate, coordinate and support care services; and (6) the presence of a consulting psychiatrist collaborating with the care manager to review cases and provide treatment change recommendations

Study outcome measurement

Measure: Standardized monthly data reports regarding the number of eligible patients enrolled into the DIAMOND program (patients with a PHQ-9 ≥ 10) and remission rates (patients with a PHQ-9 < 5) every 6 months

Reliability: Not reported; Validity: Not reported

Zavalkoff, 2015 [80]

Canada

1 pediatric intensive care unit (PICU)

Interrupted time series

Sample: Pediatric patients = 3100

Age: Not reported

Sex and Gender: Not reported

Innovation: The introduction of a champion lead and an interdisciplinary policy dictating health care teams to systematically assess and discuss daily the appropriateness of continued use and/or removal of urinary catheters in patients

Study outcome measurement

Measures: Secondary data analysis of urinary catheter device utilization ratio in children admitted to the PICU between April 1, 2009, and June 29, 2013, according to hospital acquired surveillance database. Urinary catheter device utilization ratio was calculated by taking the number of days that a patient was exposed to a urinary catheter divided by the number of days that the patient was admitted in the PICU

Reliability: Not reported; Validity: Not reported