Table 5 Champions’ effectiveness in increasing patient, provider and system/facility’s innovation use

Conceptual innovation use (knowledge/enlightenment)

Provider (n = 4)

Conclusion: Across four studies, there are mixed findings with respect to use of champions and improvement in providers’ conceptual innovation use

Implementation of new technology or equipment

(n = 4)

One study two reports:

Korall, 2017, 2018 [64, 65]

Cross-sectional study

Existence of a champion of hip protectors

(single item scored on a 5-point Likert scale)

Overall commitment to hip protectors

Bayesian Model Averaging logistic model

Logistic regression coefficient (95% CI) = 0.24 (0.17–0.31)

 < .05

Kabukye, 2020 [61]

Cross-sectional study

Presence of an effective champion (3-item survey scale by Paré et al.[68]

Organizational readiness in a low-resource setting

Structural equation model using a partial least square method

Path coefficient = 0.15

.0299

Paré, 2011 [68]

Cross-sectional study

Presence of an effective champion

(3-item survey scale)

Organizational readiness in a large teaching hospital

Structural equation model using a partial least squares method

Path coefficient = 0.23

 < .05

Organizational readiness in implementing a mobile computing system for home care

Path coefficient = 0.05

 > .05

One study, two reports: Weiler, 2012, 2013 [77, 78]

Interrupted time series

Endorsed by champions (three items rated at a 6-point Likert scale based on Mullins et al. [98]

Intention to use transfer boards 2 months post-introduction of transfer boards

Stepwise logistic regression

Partial R²a = 0.036

C(p) =  − .041

F = 16.25

 < .0001

Structural equation model using a maximum likelihood method

Path coefficients (95 CI) = 0.27 (− .0156–.5556)

 > 0.05^a

System/Facility (n = 1)

Conclusion: There is a study suggesting that the use of champions is related to system/facility’s conceptual innovation use

Implementation of best practices related to vaccination processes

(n = 1)

Tierney, 2003 [75]

Mixed study (generic qualitative and cross-sectional)

Presence of a champion lead (“Yes/No” survey item)

Pediatrician practices’ likelihood or intent to adopt reminder and recall system in their practice in a year

Multivariable linear regression

Test statistic not reported

 < .03

Pediatrician practices’ likelihood or intent to adopt immunization coverage rates assessments in their practice in a year

Test statistic not reported

.002

Instrumental Innovation Use (adherence in using the innovation (evidence-based practice or technology))

Patient (n = 1)

Conclusion: There is a study suggesting that the use of champions is related to improving patients’ instrumental innovation use

Implementation of Kangaroo-Mother Care

(n = 1)

Soni,2016 [73]

Interrupted time series

Absence of champions

(two champion were present from January 5, 2010–July 31, 2011; transition period from August 1, 2011, to July 31, 2012; champion was absent from August 1, 2012, to October 7, 2014)

Initiation rate of skin to skin by mothers of neonatal intensive care unit (NICU) patients

Competing-risks regression model and observation-weighted linear polynomial test

Subhazard rate ratios (SHR)^c (95 CI) = 0.62 (0.47 − 0.82)

 < .001^b

Overall use of skin to skin by mothers of NICU patients

Multivariate logistic regression and observation-weighted linear polynomial test

OR (95 CI) = 0.49 (0.34–0.70)

.004^b

Average duration of skin to skin provided by mothers of NICU patients

Multivariate linear regression and observation-weighted linear polynomial test

β (95 CI) =  − 1.47 (− 2.07 to − 0.86)

 < .001^b

Initiation rate of breastfeeding by mothers of NICU patients

Competing-risks regression model and observation-weighted linear polynomial test

SHR (95 CI) = 0.88 (0.68–1.14)

.30^b

Overall use of “breastfeeding” by mothers of NICU patients

Multivariate logistic regression and observation-weighted linear polynomial test

OR (95 CI) = 0.89 (0.55–1.44)

0.61^b

Provider (n = 17)

Conclusion: Across 17 studies, there are mixed findings with respect to use of champions and improvement in providers’ instrumental innovation use

Implementation of best practices for smoking cessation

(n = 3)

Bentz, 2007 [52]

Cluster randomised trial

Presence of a champion (“Yes/No” item determined through structured interviews with clinic managers or lead nurses)

Monthly rates of documented clients connected by health care providers to the Oregon Tobacco Quitline

Generalized estimating equations

OR (95 CI) = 3.44 (2.35–5.03)

 < .05

Papadakis, 2014 [67]

Cross-sectional study

Presence of physician champion

(“Yes/No” survey item)

Frequency of evidence-based smoking cessation treatments delivered by health care providers

Multivariable logistic regression

OR (95 CI) = 2.0 (1.1–3.6)

 < .01

Strasser, 2003 [74]

Cross-sectional study

Presence of a designated champion (single item rated on a 6-point Likert scale)

Extent that health care providers apply smoking cessation guideline to help parents of cystic fibrosis patients quit smoking

Multivariable logistic regression

β (SE) =  − .7570 (0.2110)

OR (95 CI) = 0.469 (0.310–0.709)

0.0003

Implementation of best practices related to vaccination processes

(n = 3)

Albert, 2012 [47]

Cross-sectional study

Presence of an immunization champion on site

(“Yes/No” survey item)

Consistent use of standard orders for influenza vaccines only by non-physician staff

Multivariable logistic regression

OR (95% CI) = 1.12 (0.72–1.76)

 > .05

Consistent use of standard orders for both influenza vaccine and PPV by non-physician staff

OR (95% CI) = 1.67 (1.01–4.54)

.046

Granade, 2020 [58]

Cross-sectional study

Presence of immunization champions

(“Yes/No” survey item)

Primary care clinicians’ adherence to adult vaccination standards

Multivariable logistic regression

APR (95% CI) = 1.40 (1.26–1.54)

 < .05

Pharmacist’s adherence to adult vaccination standards

APR (95% CI) = 1.20 (0.96–1.49)

 > .05

Slaunwhite, 2009 [72]

Case–control study

23 champions randomly allocated to 23 hospital units versus 23 matched units with no champion

Difference in overall health care providers vaccination rates between champion and non champion units

t -test

t (22) = 2.86

(11% higher vaccination rate in champion units)

 < .03

Percentage change in health care provider vaccination rates from previous year in champion units

t (21) = 4.38

(increase from 44 to 54%)

 < .001

Implementation of new technology/equipment (n = 2)

Alidina, 2018 [48]

Cross-sectional study

Presence of an implementation champion for cognitive aids (selected as an important facilitator from a list of facilitators)

Regular use of operating cognitive aids during applicable clinical events

Chi square

Test statistic not reported

0.8968

Absence of an implementation champion for cognitive aids (selected as important barrier from a list of barriers)

Regular use of operating cognitive aids during applicable clinical events

Multivariable logistic regression

OR (95% CI) = 0.44 (0.23–0.84)

.0126

Shea, 2016 [70]

Cross-sectional study

Presence of nurse champions (“Yes/No” survey item)

Percentage of providers in a clinic demonstrating Stage 1 meaningful use of electronic health records

Multivariable logistic regression

OR (95 CI) = 0.99 (0.60–1.65)

.983

Implementation of best practices related to pain management in neonatal intensive care units (n = 2)

Anand, 2017 [49]

Prospective cohort study

Presence of a nurse^d champion

(“Yes/No” survey item)

Number of continuous pain assessments performed and documented by nurses per day for 1 month in neonatal intensive care units

Generalized estimating equations

OR (95 CI) = 2.54 (1.27–5.11)

0.009

Lago, 2013 [66]

Cross-sectional study

Presence of a local champion (single item asking whether a physician champion, a nurse champion, both types of champions, or no champion was present)

Routine use (> 90% of the time) of non-pharmacological and pharmacological pain management interventions during invasive procedures in neonatal intensive care units

Stepwise logistic regression

Six out of 11 interventions:

(1) Heel prick: OR (95 CI) = 2.78 (1.2–6.43)

(2) Venipuncture: OR (95 CI) = 2.59 (1.13–5.96)

(3) PICC insertion: OR (95 CI) = 3.33 (1.38–8.02)

(4) Tracheal intubation: OR (95 CI) = 2.68 (1.17–6.16)

(5) Mechanical ventilation: OR (95 CI) = 3.74 (1.5–9.32)

(6) Chest tube insertion: OR (95 CI) = 3.26 (1.31–8.1)

 < 0.05

Five out of 11 interventions:

(1) Tracheal Aspiration: OR (95 CI) = 1.96 (0.82–4.66)

(2) Nasal CPAP: OR (95 CI) = 1.98 (0.87–4.53)

(3) Lumbar puncture: OR (95 CI) = 1.99 (0.86–4.59)

(4) ROP screening: OR (95 CI) = 2.35 (0.96–5.8)

(5) Postoperative pain: OR (95 CI) = 1.58 (0.56–4.43)

 > 0.05

Implementation of best practices related to prevention, identification and management of infections

(n = 2)

Campbell, 2008 [54]

Non-controlled before and after study

Appointment of six nurses (two for each shift) champions for 4 weeks

Intensive care unit nurses’ compliance with sepsis-screening protocols

Chi square

χ² = 30.86

 < .001

Physician’s initiation of sepsis protocol for patients with severe sepsis

χ² = 0.563

.453

Zavalkoff, 2015 [80]

Interrupted time series

Appointment of a single physician champion to lead projects decreasing catheter associated urinary tract infections

Urinary catheter-use ratio in a pediatric intensive care

Binomial regression (PROC GENMOD, binomial distribution, canonical link)

OR (95% CI) = 0.83 (0.77–0.90)

 < .05

Generic implementation of best research evidence

(n = 2)

Kenny, 2005 [62]

Cross-sectional study

Presence of a champion

(“Yes/No” survey item)

Nurses’ direct (instrumental) research use

Pearson’s correlation coefficient

r = .250

.001

Goff, 2019 [57]

Cross-sectional study

Presence of a designated quality champion

(“Yes/No” survey item)

Average clinical quality scores (adherence of providers to best practices in prescribing treatments for diseases (e.g. asthma, diabetes)

ANOVA

Test statistics not reported (Mean difference = 0.2 favouring presence of a champion)

.03

Implementation of diabetes guideline

(n = 1)

Ward, 2004 [76]

Cross-sectional

study

Presence of champion

(single item rated on a 5-point Likert scale)

Provider process measures relative to guideline-based diabetes management

Multivariable predictor generalized estimating equation

β (SE) = 1.24 (0.51)

.02

Implementation of best practices related to medications prescribed during or after an acute myocardial infarction

(n = 1)

Ellerbeck, 2006 [55]

Cross-sectional study

Presence of a physician champion

(“Yes/No” survey item)

Aspirin use at admission

Generalized estimating equations

OR (95% CI) = 1.31 (0.87–2.01)

 > .05

Aspirin use at discharge

OR (95% CI) = 1.17 (0.69–2.02)

 > .05

Beta-blockers use at admission

OR (95% CI) = 1.45 (0.91–2.31)

 > .05

Beta-blockers use at discharge

OR (95% CI) = 4.14 (1.66–11.66)

 < .05

Implementation of the findings of a phase III, multicentre randomized control trial (BMT CTN 0201) [88] study (n = 1)

Khera, 2018 [63]

Cross-sectional study

Engagement of local champions

(single item scored on a 5-point Likert scale)

Physician reported personal change in preferred unrelated donor graft source for patients with hematologic malignancies from peripheral blood source to bone marrow

Multivariable logistic regression

OR (95 CI) = 1.91 (0.87–4.19)

.11

Physician reported transplant centre change in preferred unrelated donor graft source for patients with hematologic malignancies from peripheral blood source to bone marrow

OR (95 CI) = 3.18 (1.29–7.85)

.01

System/Facility (n = 7)

Conclusion: Across seven studies, the use of champions was reported to be related to increase in system/facility instrumental innovation use

Implementation of technology /equipment

(n = 3)

Ash, 1997 [50]

Cross-sectional study

Champion scale formulated from existing measures (unknown number of items and lack of detail on items reported (rated on a 5-point Likert scale)

Infusion of electronic mail

Multivariable linear regression

β = 0.09

.52

Diffusion of electronic mail

β = 0.34

.01

Hsia, 2019 [59]

Cross-sectional study

Presence of leadership's e-health championing behaviour (6-item survey scale)

Extent of hospital medical services and work processes are performed by health care providers using E-health technologies

Structural equation model using a partial least square method

Path Coefficient = 0.280

 < .05

Sharkey, 2013 [39]

Non-controlled before and after study

Presence of an internal champion (“Yes/No” question in facilitator reports)

Facility-wide implementation of at least two process improvements focused on using health information technology as a medium for clinical decision support to prevent pressure ulcers in nursing homes (labelled as “Level 2 outcome” by authors)

Nonparametric Spearman correlation

ρ = 0.65

.013

Facility-wide implementation of three or more process improvements focused on using health information technology as a medium for clinical decision support to prevent pressure ulcers in nursing homes (labelled as “Level 3 outcome” by authors)

ρ = 0.75

0.002

Implementation of a depression care programs (n = 2)

Chang, 2012 [40]

Cross-sectional study

Presence of clinical champion (“Yes/No” survey item)

Collocation model implemented

Multivariable logistic regression models

OR (95 CI) = 2.36 (1.14–4.88)

 < .05

TIDES model implemented

Bivariate regression analysis

OR (95 CI) = 0.59 (0.20–1.78)

 > .05

BHL model implemented

OR (95 CI) = 0.65 (0.14–2.98)

 > .05

No depression care improvement model implemented

OR (95 CI) = 0.63 (0.31–1.29)

 > .05

Whitebird, 2014 [41]

Mixed study (Generic qualitative and prospective cohort)

Presence of a strong primary care provider champion

(“Yes/No” extracted from quality improvement narrative reports)

Average monthly activation rate (patients entering the program per number of full-time health care provider)

Pearson’s correlation coefficient

r (95 CI) = 0.60 (0.10–0.86)

 < .05

Implementation of patient-reported outcomes collection program

(n = 1)

Sisodia, 2020 [71]

Retrospective cohort study

Presence of a clinician champion

(“Yes/No” survey item)

Patient-reported outcomes (PRO) collection rate per clinic in the most recent 6 months

Multivariable linear regression

Collection rate change (95 CI) = 11.2 (2.5–20.0)

.01

PRO successful collection rate (50% or greater) in a 6-month period

Multivariable logistic regression

OR (95 CI) = 3.36 (1.06–10.61)

.04

Implementation of best practices related to vaccination processes

(n = 1)

Tierney, 2003 [75]

Mixed study (generic qualitative and cross-sectional)

Presence of a champion lead (“Yes/No” survey item)

Pediatrician practices’ current use of reminder and recall systems

Multivariable logistic regression

OR (95% CI) = 1.85 (1.08–3.18)

 < .05

Public health clinic’s current use reminder and recall systems

Multivariable logistic regression

OR (95% CI) = 3.01 (1.34–6.73)

 < .05

Pediatrician practices’ current use of immunization coverage rates assessments

OR (95% CI) = 1.38 (0.89–2.13)

 < .05

Public health clinic’s current use of immunization coverage rates assessments

OR (95% CI) = Not reported

 > .05