Table 4 List of selected implementation strategies, description, and relevant theory and/or evidence on effectiveness
Factor | Strategy (change method) | Description | Relevant theory and/or evidence from literaturea |
|---|---|---|---|
Leadership | 1. Persuasive communication | Guiding individuals and environmental agents toward the adoption of an idea, attitude, or action by using arguments or other means | Communication-Persuasion Matrix, Elaboration Likelihood Model, Diffusion of Innovations Theory [23, 28] ➣ The use of persuasive, novel, relatable, and important arguments and communication with leaders can be effective to achieve change |
|  | 2. Public commitment | Stimulating pledging, promising or engaging oneself to perform the healthful behavior, and announcing that decision to others | Theories of Automatic, Impulsive and Habitual Behavior [23, 28] ➣ Indications for positive effect: organizational leaders committed to implementing an intervention to reduce hospitalization from a nursing home directly increased the staff commitment to implementation [42] |
3. Sense-making | Leaders reinterpret and relabel processes in organization, create meaning through dialogue, and model and redirect change | Organizational Development Theory [23, 28] ➣ Indications for positive effect: a committed organizational leadership who created an encouraging environment within healthcare organizations (e.g., supportive policies and practices, allocation of funds and resources) to implement an innovation increased directly the staff commitment to implementation [43] | |
4. Development of leadership skills | Development of strong leadership skills in clinical leaders to align and sustain evidence-based practice implementation efforts | ➣ Indications for positive effect: demonstrated as useful to build leadership skills to support the implementation of evidence-based practices in community-based mental health organizations [44] | |
Engagement | 5. Participation | Assuring high level engagement of the participants’ group in problem solving, decision making, and change activities; with highest level being control by the participants’ group | Diffusion of Innovations Theory, Theories of Power, Organizational Development Theories, Models of Community Organization [23, 28] ➣ Indications for positive effect: engaging stakeholders (e.g., managers, local providers) through meetings, briefings, and consultations increased the reach and adoption of a mental health intervention in primary care clinics [45] ➣ Patient activation improved health-related outcomes suggesting substantial positive effects [46] |
6. Modeling | Providing an appropriate model being reinforced for the desired action | Social Cognitive Theory [47] ➣ Providing models (similar persons) that can do the same tasks and demonstrate steps to attain a complex objective can be effective to motivate and increase self-efficacy ➣ Indications for positive association: champions were related to increased use of innovations in healthcare organizations [48] / identifying early adopters and learning from their experiences was associated with the uptake of a new evidence-based treatment in a clinical care setting [49, 50] ➣ Indications for positive effect: opinion leaders can probably improve healthcare professionals' compliance with evidence-based practice (effect sizes are modest and varied) [51] | |
7. Build a coalition | Recruit and cultivate relationships with partners in the implementation effort | ➣ Indications for positive association: building local teams to address challenges were associated with the uptake of a new evidence-based treatment in a clinical care setting [49, 50] | |
8. Conduct local consensus discussions | Include local providers and other stakeholders in discussions that address whether the chosen problem is important and whether the clinical innovation to address it is appropriate | ➣ Indications for positive effect: local consensus discussions proved effective to improve adherence to a new guideline in a nursing home (used in combination with other strategies) [52] | |
9. Use mass media | Use media to reach large numbers of people to spread the word about the clinical innovation | ➣ Indications for positive effect: evidence showed that these channels of communication may have an important role in influencing the use of healthcare interventions and services [53] | |
Information continuity | 10. Structural redesign | Change organizational elements such as formal statements of organizational philosophy, communication flow, reward systems, job descriptions, and lines of authority | Organizational Development Theory [23, 28] ➣ Planned development, improvement, or reinforcement of structures and processes can promote organizational effectiveness and help deal with resistance to change |
11. Change in communication between providers, including distant ones | Systems to improve the communication between healthcare providers, including establishment of any type of telecommunication link for implementation (e.g., use of information and communication technology) | ➣ Indications for positive effect: the use of HIT communication systems improved adherence to a new guideline in a nursing home (used in combination with other strategies) [54] | |
12. Enhancing network linkages | Training network members to provide support and members of the target group to mobilize and maintain their networks | Theories of Social Networks and Social Support [23, 28] ➣ Indications for positive association: promoting working relationships and networks inside/outside the organization was associated with the uptake of a new evidence-based treatment in a clinical care setting [49, 50] | |
Financing of TCIs’ implementation | 13. Advocacy and Lobbying | Arguing and mobilizing resources on behalf of a particular change, giving aid to a cause, active support for a cause or position | Stage Theory of Organizational Change; Models of Community Organization; Agenda-Building Theory; Multiple Streams Theory [23, 28] ➣ Is a primary method to achieve change at the environmental/community level and highlights the role of community activism to support important issues |
Available resources and HIT systems | 14. Changes in Staffing models | Interventions to achieve an appropriate level and mix of staff, recruitment and retention of staff, and transitioning of healthcare workers from one environment to another, for example interventions to increase the proportion of healthcare workers in underserved areas | ➣ Indications for positive association: forming new interdisciplinary teams was associated with the uptake of a new evidence-based treatment in a clinical care setting [49, 50] |
15. Use of HIT systems | Health record and health management systems to store and manage patient health information, for example electronic patient records, or systems for recalling patients for follow-up or prevention | ➣ Indications for positive effect: the use of HIT communication systems improved adherence to a new guideline in a nursing home (used in combination with other strategies) [54] | |
16. Develop resource sharing agreements | Develop partnerships with organizations that have resources needed to implement the innovation | Organizational theories – Resource dependency theory [55] ➣ Indications for positive association: partnering with other resourceful organizations can help implement changes and was associated with the uptake of a new evidence-based treatment in a clinical care setting [49, 50] | |
Access to knowledge and information | 17. Facilitation | Creating an environment that makes the action easier or reduces barriers to action | Social Cognitive Theory [47] ➣ Indications for positive effect: improved the adoption of evidence-based guidelines in various clinical areas that focused on prevention, system-level improvements, and outcomes associated with chronic disease management within clinical practice settings [56] |
18. Develop and distribute educational materials | Develop guidebooks, manuals, toolkits, and other supporting materials in ways that make it easier for stakeholders to learn about the innovation and for clinicians to learn how to deliver the clinical innovation, and distribute it in person, by mail, and/or electronically | ➣ Indications for positive effect: can probably improve healthcare professionals' practice but slightly, and electronic versions have little or no difference compared to printed versions (effect sizes are small and variable) [57] | |
19. Conduct educational meetings and ongoing trainings | Hold meetings and trainings (e.g., courses, workshops, conferences) in an ongoing way targeted toward different stakeholder groups (e.g., providers, administrators, other organizational stakeholders, and community, patient/consumer, and family stakeholders) to teach them about the clinical innovation | ➣ Indications for positive effect: can probably improve compliance with desired practice, and interactive formats are more effective than didactic ones (effect sizes are modest) [58] | |
20. Create a learning collaborative | Facilitate the formation of groups of providers or provider organizations and foster a collaborative learning environment to improve implementation of the clinical innovation | ➣ Indications for positive association: improvement in the adoption and implementation quality of expanding new clinical services in primary care settings were moderately associated with the engagement of clinicians in learning collaboratives [59] | |
Sense of urgency | 21. Consciousness raising & | Providing information, feedback, or confrontation about the causes, consequences, and alternatives for a problem or a problem behavior | Health Belief Model, Precaution-Adoption Process Model, Trans-Theoretical Model [23, 28] ➣ Providing cues for action or information about risk is important and can be effective to change perceptions and implement change |
22. Scenario-based risk information | Providing information that may aid the construction of an image of the ways in which a future loss or accident might occur | ||
23. Organizational diagnosis and feedback | Assessing of organizational structures and employees’ beliefs and attitudes, desired outcomes and readiness to take action, using surveys and other methods | Organizational Development Theory, Organizational Readiness for Change [23, 28, 41] ➣ Assessing an organization's readiness and accordingly fostering its capacity, capabilities, commitment, and efficacy to change are key drivers to developing readiness to implement change within an organization | |
Relative priority | 24. Belief selection | Using messages designed to strengthen positive beliefs, weaken negative beliefs, and introduce new beliefs | Theory of Planned Behavior, Reasoned Action Approach [23, 28] ➣ Identifying the beliefs and awareness level of the receiver regarding the problem and its negative outcomes, then providing a relevant positive evaluation for a recommended behavior can be effective to achieve change |
25. Persuasive communication | Guiding individuals and environmental agents toward the adoption of an idea, attitude, or action by using arguments or other means | Communication-Persuasion Matrix, Elaboration Likelihood Model, Diffusion of Innovations Theory [23, 28] ➣ The use of persuasive, novel, relatable, and important arguments and communication with leaders can be effective to achieve change | |
26. Organizational diagnosis and feedback | Assessing of organizational structures and employees’ beliefs and attitudes, desired outcomes and readiness to take action, using surveys and other methods | Organizational Development Theory, Organizational Readiness for Change [23, 28, 41] ➣ Assessing an organization's readiness and accordingly fostering its capacity, capabilities, commitment, and efficacy to change are key drivers to developing readiness to implement change within an organization | |
Reflecting and evaluating | 27. Audit and feedback | A summary of health workers’ performance over a specified period of time, given to them in a written, electronic or verbal format. The summary may include recommendations for clinical action | Theories of Learning, Goal-Setting Theory, Social Cognitive Theory [23, 28] ➣ Indications for positive effect: can probably lead to important improvements in professional practice (effect sizes are small), yet is most effective when the performance is low, provided regularly by supervisors or colleagues, and includes clear targets/action plans [60] |
28. Monitoring the performance of the delivery of healthcare | Monitoring of health services by individuals or healthcare organizations, for example by comparing with an external standard | ➣ Indications for positive effect: improved adherence to a new guideline in a nursing home (used in combination with other strategies) [52, 54] | |
Targeted groups | 29. Tailoring | Matching the intervention or components to previously measured characteristics of the participant | Trans-Theoretical Model, Precaution Adoption Process Model, Protection Motivation Theory, Communication-Persuasion Matrix [23, 28] ➣ Indications for positive effect: suggested as important and essential to design evidence-based treatments in mental health [61] / can probably lead to the successful implementation of innovations in long-term residential care [62] |
Transition roles | 30.Structural redesign | Change organizational elements such as formal statements of organizational philosophy, communication flow, reward systems, job descriptions, and lines of authority | Organizational Development Theory [23, 28] ➣ Planned development, improvement, or reinforcement of structures and processes can promote organizational effectiveness and help deal with resistance to change |
31. Role expansion or task shifting & | Expanding tasks undertaken by a cadre of health workers or shifting tasks from one cadre to another, to include tasks not previously part of their scope of practice | ➣ Indications for positive effect: showed improvements in the process of care outcomes [56] / was associated with the uptake of a new evidence-based treatment in a clinical care setting [49, 50] | |
32. Revise professional roles | Shift and revise roles among professionals who provide care, and redesign job characteristics | ||
Knowledge, beliefs, and personal attributes of healthcare professionals | 33. Active learning | Encouraging learning from goal-driven and activity-based experience | Elaboration Likelihood Model, Social Cognitive Theory, Theories of Information Processing, Theories of Stigma and Discrimination, Communication-Persuasion Matrix, Theories of Learning, Theory of Planned Behavior, Reasoned Action Approach [23, 28] ➣ All these methods can help improve the individual’s capabilities and aptitude to implement change |
34. Chunking | Using stimulus patterns that may be made up of parts but that one perceives as a whole | ||
35. Advance organizers | Presenting an overview of the material that enables a learner to activate relevant schemas so that new material can be associated | ||
36. Shifting perspective | Encouraging taking the perspective of the other | ||
37. Arguments | Using a set of one or more meaningful premises and a conclusion | ||
38. Direct experience | Encouraging a process whereby knowledge is created through the interpretation of experience | ||
39. Belief selection | Using messages designed to strengthen positive beliefs, weaken negative beliefs, and introduce new beliefs | ||
40. Guided practice | Prompting individuals to rehearse and repeat the behavior various times, discuss the experience, and provide feedback | Social Cognitive Theory; Theories of Self-Regulation [23, 28] ➣ Indications for positive effect: coaching can lead to the implementation of more quality improvement interventions for cardiovascular health [63] |