Table 5 List of selected implementation strategies, suggested practical applications, and target
Factor | Strategy (change method) | Practical applications (suggested) | Target (directed at) |
|---|---|---|---|
Leadership | 1. Persuasive communication | â–ª Organize meetings with organizational leaders to introduce the new TCI and deliver convincing arguments and important messages (e.g., evidence on the effects of TCIs, need for person-centeredness, etc.) â–ª Perform open discussions with organizational leaders to discuss objections, change their attitude/perspective, and guide them toward adopting the TCI | Leaders of organizations (including management staff) |
2. Public commitment | ▪ Obtain formal written commitments from organizational leaders to implement the TCI ▪ Make a public declaration/announcement expressing organizational leaders’ determination to implement the TCI (e.g., put proof on websites, or in a newsletter) | Leaders of organizations (including management staff) | |
3. Sense-making | â–ª Assess and analyze current care integration and care continuity practices, then reinterpret to signal shortcomings and the need to provide transitional care in a new or different way â–ª Recreate processes and redefine organizational ethos/culture to support innovations and new ideas for transitional care | Organizational board of directors, executives, Quality improvement department | |
4. Development of leadership skills | â–ª Identify formal and informal leaders and assess the need for leadership skills-building â–ª Train on the change effort (e.g., group-based interactive and didactic training sessions, following the leadership and organizational change for implementation LOCI training) â–ª Provide coaching on the job by an external expert to promote the leaders' readiness and skills | Leaders of organizations (including management staff) | |
Engagement | 5. Participation | â–ª Identify relevant key persons (stakeholders) â–ª Map stakeholders by their influence, power, authority, and importance in relation to implementing the TCI â–ª Activate stakeholder groups (e.g. older persons associations, long-term care lobbyists) â–ª Identify issues in suboptimal transitional care and involve stakeholders to take control and be accountable to resolve the problems jointly | Stakeholders |
6. Modeling | â–ª Identify role models within the local context (e.g., champions, early adopters, opinion leaders) â–ª Support the role models to lead the TCI and to help influence and motivate fellow colleagues to adopt the TCI and help drive the implementation â–ª Invite the role models to share their experiences with the TCI in practice (e.g., testimonials, informal meetings to share stories) | Healthcare professionals | |
7. Build a coalition | â–ª Organize meetings and information sessions across different care settings (e.g., hospital, homecare, social care) to increase mutual understanding about the TCI implementation workflow, i.e., align on common goals, values, and needs | Organizations, Healthcare professionals | |
8. Conduct local consensus discussions | â–ª Conduct discussions with staff of different care settings (e.g., hospital, homecare, social care) to agree on core problems, needs, and goals, and to assess the benefit of implementing the TCI to address issues in delivering transitional care | Organizations, Stakeholders | |
9. Use mass media | â–ª Spread information about the TCI and its benefits using media channels (e.g., a quick guide on the website, refresher sessions, newsletters, and social media) | Stakeholders | |
Information continuity | 10. Structural redesign | â–ª Develop a formal communication workflow, and a guide for healthcare professionals to integrate care collaboratively and to share information between different care settings (e.g., hospital, homecare, social care) involved â–ª Develop a standardized discharge letter to indicate the treatment plan upon transition from one care setting to another (e.g., hospital to home care) | Organizations, Healthcare professionals |
11. Change in communication between providers, including distant ones | â–ª Develop HIT systems interlinked between different organizations, or find ways to automatize information exchange between systems when possible â–ª Optimize communication links (e.g., smartphone communication apps, conferencing technology, web chat, email) | Organizations | |
12. Enhancing network linkages | â–ª Create inter-organizational networks (common platforms, regular conferences and meetings, collaborative learning sessions) to discuss issues and updates in transitional care delivery â–ª Conduct teams meetings for staff implementing the TCI to share experiences, problem-solving, and support one another | Organizations, Healthcare professionals | |
Financing of TCIs’ implementation | 13. Advocacy and Lobbying | ▪ Develop a proposal for new funding formulas supportive of healthcare providers to implement innovations in transitional care ▪ Draft a new policy brief and business case supportive of improving transitional care ▪ Identify key funders in the system and request discussions with them ▪ Identify the key TCIs’ leaders and prepare the advocacy and lobbying with them | National healthcare system, Ministry of health, Regional public health governance, Health insurers, Funding agencies |
Available resources and HIT systems | 14. Changes in Staffing models | â–ª Develop a proposal for new staffing arrangements (number, roles) â–ª Develop a proposal for retaining and attracting transitional care experts (e.g., care transition nurse) | Organizations, Policymakers, Funders |
15. Use of HIT systems | â–ª Assess existing/non-existing HIT systems â–ª Develop a proposal to use and potentially integrate HIT systems to share medical information in care transitions and to support TCI implementation | Organizations | |
16. Develop resource sharing agreements | â–ª Establish formal agreements (e.g., memorandum of understanding) between LTC organizations on resource sharing â–ª Create formal/informal networks between LTC organizations | Organizations | |
Access to knowledge and information | 17. Facilitation | â–ª Use change agents/facilitators to build a relationship with healthcare professionals â–ª Provide practical support, relevant materials and means, and information to enhance the use of TCIs (e.g., helpdesk, outreach support, information zone) | Healthcare professionals |
18. Develop and distribute educational materials | â–ª Develop supporting educational materials (e.g., manual, toolkit, brochures, guidebook, reminders, videos) to inform about the TCI and how to implement it, including technology-delivered content (e.g., online, smartphone applications) | ||
19. Conduct educational meetings and ongoing training | â–ª Conduct training, workshops, conferences, lectures, and meetings to inform about the TCI and how to implement it (use both didactic and interactive formats) | ||
20. Create a learning collaborative | â–ª Foster the formation of a long-term network group of healthcare professionals for learning and exchanging ideas on how to provide optimal transitional care â–ª Organize educational outreach visits by a trained person to meet with healthcare professionals in their work settings to educate them about the TCI and provide support in using it â–ª Establish academic partnerships with a university or academic unit to share research skills on implementing the TCI â–ª Use video stories from other organizations that implemented a TCI | ||
Sense of urgency | 21. Consciousness raising & 22. Scenario-based risk information | â–ª Use media to spread testimonials of what went wrong during care transitions â–ª Conduct informational meetings to raise awareness and highlight the need for the TCI (use a real case to discuss risks and adverse outcomes of poor care transitions) â–ª Provide stories or videos depicting alternative courses of events as told by care staff healthcare workers can identify with | Leaders of organizations (including management staff), Healthcare professionals |
23. Organizational diagnosis and feedback | ▪ Assess the various organizational aspects that should be in place and the organization’s degree of readiness to implement the TCI (e.g., use surveys, and focus groups) ▪ Establish a list of barriers and facilitators in the organization that can influence the implementation of the TCI and how to overcome/leverage them ▪ Enter into discussions with organizational leaders on the above and explore solutions | Organizations | |
Relative priority | 24. Belief selection & 25. Persuasive communication | â–ª Provide information and testimonials about the positive/negative consequences of implementing/not implementing the TCI (e.g., cases, stories) â–ª Share findings of needs assessment (e.g., case report) and describe the priority to implement the TCI within the organization | Leaders of organizations (including management staff), Healthcare professionals |
26. Organizational diagnosis and feedback | â–ª Conduct a survey to collect perspectives on implementing the TCI â–ª Discuss the results with organizational and operational leaders and explore solutions with them | Organizations | |
Reflecting and evaluating | 27. Audit and feedback | â–ª Prepare and perform audits for assessing the quality of transitional care â–ª Develop a summary of performance regarding the TCI implementation (key measures on process /outcomes) over a specific period â–ª Organize regular implementation team meetings to relay data on performance (provide feedback), reflect on implementation effort (get feedback), and share lessons learned | Organizations, Healthcare professionals |
28. Monitoring the performance of the delivery of healthcare | â–ª Develop tools/systems for quality monitoring with measures specific to the TCI implemented (e.g., processes, patient outcomes, implementation outcomes) â–ª Assess continuously the progress of the TCI implementation and adjust clinical practices when needed | ||
Targeted groups | 29. Tailoring | â–ª Asses the local care and social needs of the target population of older persons â–ª Develop an adaptable TCI (clarify the core and modular components) to meet the local needs | Older persons |
Transition roles | 30. Structural redesign, 31. Role expansion or task shifting, & 32. Revise professional roles | â–ª Map current inter-organizational interactions, work processes, and staff roles and identify changes necessary to accommodate the TCI implementation â–ª Expand, shift, or revise job descriptions, roles, and tasks of staff to include implementing the TCI | Organizations, Healthcare professionals |
Knowledge, beliefs, and personal attributes of healthcare professionals | 33. Active learning | â–ª Conduct interactive lectures, group discussions, and teach-back sessions (e.g., exercises with a workbook, case study solving) about the TCI components and features | Healthcare professionals |
34. Chunking & 35. Advance organizers | â–ª Use labels, color-coding, index in the educational materials about the TCI â–ª Structure and write texts in the most accessible way | ||
36. Shifting perspective, 37. Arguments, & 38. Belief selection | ▪ Challenge organizations and healthcare professionals to take the perspective of an older person facing a care transition and ask them to consider what they would find important ▪ Organize meetings with healthcare professionals to introduce the new TCI and deliver convincing arguments and important messages (e.g., evidence on the effects of TCIs, need for person-centeredness, etc.) ▪ Perform open discussions with healthcare professionals to discuss objections, and ways to overcome them, and provide guidance towards adopting the TCI (e.g., integrate new beliefs about the TCI) | ||
39. Direct experience 40. Guided practice | â–ª Assign to a care setting where a TCI is implemented to obtain direct observation â–ª Bring experts on innovations in transitional care to model tasks and skills required and to provide ongoing implementation support on-site â–ª Bring TCI coaches to support on innovations, transitional care, and implementation | Healthcare professionals |