Table 4 Implementation strategies, cluster assignments, definitions, and observed frequencies (descending)
From: Implementation strategies in suicide prevention: a scoping review
Implementation strategy | Cluster(s)a | Definitionb | Total studies |
|---|---|---|---|
Purposefully reexamine the implementation | Use evaluative and iterative strategies | Monitor progress and adjust clinical practices and implementation strategies to continuously improve the quality of care | 20 |
Conduct educational meetingsc | Train and educate stakeholders | Hold meetings targeted toward educating multiple stakeholder groups (i.e., providers, administrators, other organizational stakeholders, community members, patients/consumers, families) about the clinical innovation and/or its implementation | 19 |
Develop educational materialsc | Train and educate stakeholders, Messaging | Develop and format manuals, toolkits, and other supporting materials to make it easier for stakeholders to learn about the innovation and for clinicians to learn how to deliver the clinical innovation. This can include technology-delivered (e.g., online/smartphone-based static or dynamic) content and health messaging | 17 |
Distribute educational materials | Train and educate stakeholders, Messaging | Distribute educational materials (including guidelines, manuals, and toolkits) in person, by mail, and/or electronically | 17 |
Centralize technical assistance | Provide interactive assistance | Develop and use a centralized system to deliver technical assistance focused on implementation issues | 15 |
Conduct local needs assessment | Use evaluative and iterative strategies | Collect and analyze data related to the need for innovation | 13 |
Use advisory boards and workgroups | Develop stakeholder interrelationships | Create and engage a formal group of multiple kinds of stakeholders to provide input and advice on implementation efforts and to elicit recommendations for improvements | 12 |
Conduct ongoing trainingc | Train and educate stakeholders | Plan for and conduct training in the clinical innovation in an ongoing way for all individuals involved with the implementation and users of the clinical innovation, e.g., clinicians, implementation staff, practice facilitators | 12 |
Provide ongoing consultation | Train and educate stakeholders | Provide ongoing consultation with one or more experts in the strategies used to support implementing the innovation | 12 |
Conduct local consensus discussions | Use evaluative and iterative strategies | 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 | 11 |
Audit and provide feedbackc | Use evaluative and iterative strategies | Develop summaries of clinical performance over a specific time period, often including a comparator, and give it to clinicians and/or administrators. Summary content (e.g., nature of the data, choice of comparator) and their delivery (e.g., mode, format) are designed to modify specifically targeted behavior(s) or actions of individual practitioners, teams, or health care organizations | 11 |
Assess for readiness and identify barriers and facilitatorsc | Use evaluative and iterative strategies | Assess various aspects of an organization to determine its degree of readiness to implement and identify barriers that may impede implementation and strengths that can be leveraged to facilitate the implementation effort | 11 |
Develop and organize quality monitoring system | Use evaluative and iterative strategies | Develop and organize systems and procedures that monitor clinical processes and/or outcomes for the purpose of quality assurance and improvement | 10 |
Conduct educational outreach visitsc | Train and educate stakeholders | Have a trained person meet with individuals or teams in their work settings to educate them about the clinical innovation with the intent of changing behavior to reliably use the clinical innovation as designed | 9 |
Stage implementation scale up | Use evaluative and iterative strategies | Phase implementation efforts by starting with small pilots or demonstration projects and gradually move to a system-wide rollout | 8 |
Assess and redesign workflowc | Change infrastructure | Observe and map current work processes and plan for desired work processes, identifying changes necessary to accommodate, encourage, or incentivize the use of the clinical innovation as designed | 8 |
Promote adaptability | Adapt and tailor to context | Identify the ways a clinical innovation can be tailored to meet local needs and clarify which elements of the innovation must be maintained to preserve fidelity | 8 |
Change record systems | Change infrastructure | Change records systems to allow better assessment of implementation or clinical outcomes | 7 |
Involve executive boards | Develop stakeholder interrelationships | Involve existing governing structures (e.g., boards of directors, medical staff boards of governance) in the implementation effort, including the review of data on implementation processes | 7 |
Mandate change | Change infrastructure | Have leadership declare the priority of the innovation and their determination to have it implemented | 7 |
Make training dynamic | Train and educate stakeholders | Vary the information delivery methods to cater to different learning styles and work contexts, and shape the training in the innovation to be interactive | 6 |
Conduct cyclical small tests of change | Use evaluative and iterative strategies | Implement changes in a cyclical fashion using small tests of change before taking changes system-wide. Tests of change benefit from systematic measurement and results of the tests of change are studied for insights on how to do better. This process continues serially over time, and refinement is added with each cycle | 6 |
Involve patients/consumers and family members | Engage consumers, Messaging | Engage or include patients/consumers and families in the implementation effort | 6 |
Identify and prepare champions | Develop stakeholder interrelationships | Identify and prepare individuals who dedicate themselves to supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization | 6 |
Promote network weaving | Develop stakeholder interrelationships | Identify and build on existing high-quality working relationships and networks within and outside the organization, organizational units, teams, etc. to promote information sharing, collaborative problem-solving, and a shared vision/goal related to implementing the innovation | 5 |
Provide clinical supervision | Train and educate stakeholders | Provide clinicians with ongoing supervision focusing on innovation. Provide training for clinical supervisors who will supervise clinicians who provide the innovation. NOTE: This should only be coded when the supervisor/trainer is an external expert or local champion with knowledge of the intervention. Having someone who is not an expert in the intervention provide supervision would not count | 5 |
Provide local technical assistancec | Provide interactive assistance | Develop and use a system to deliver technical assistance within local settings that is focused on implementation issues | 5 |
Develop and implement tools for quality monitoring | Use evaluative and iterative strategies | Develop, test, and introduce into quality-monitoring systems the right input—the appropriate language, protocols, algorithms, standards, and measures (of processes, patient/consumer outcomes, and implementation outcomes) that are often specific to the innovation being implemented | 5 |
Develop a formal implementation blueprintc | Use evaluative and iterative strategies | Develop a formal implementation blueprint that includes all goals and strategies. The blueprint should include the following: (1) aim/purpose of the implementation; (2) scope of the change (e.g., what organizational units are affected); (3) timeframe and milestones; and (4) appropriate performance/progress measures. Use and update this plan to guide the implementation effort over time | 5 |
Implementation facilitationc | Provide interactive assistance | A multi-faceted interactive process of problem-solving, enabling and supporting individuals, groups, and organizations in their efforts to adopt and incorporate innovations into routine practices that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship | 5 |
Access new funding | Utilize financial strategies | Access new or existing money to facilitate the implementation | 4 |
Remind clinicians | Support clinicians | Develop reminder systems designed to help clinicians recall information and/or prompt them to use the clinical innovation | 4 |
Tailor strategies | Adapt and tailor to context | Tailor the implementation strategies to address barriers and leverage facilitators that were identified through earlier data collection | 4 |
Build a coalition | Develop stakeholder interrelationships | Recruit and cultivate relationships with partners in the implementation effort | 3 |
Create a learning collaborative | Train and educate stakeholders, Develop stakeholder interrelationships | Facilitate the formation of groups of providers or provider organizations and foster a collaborative learning environment to improve implementation of the clinical innovation. NOTE: This should have a specific focus on supporting implementation and not be part of the existing protocol for a given intervention (e.g., DBT consultation groups) | 3 |
Facilitate relay of clinical data to providers | Change infrastructure, Support clinicians, Messaging | Provide as close to real-time data as possible about key measures of process/outcomes using integrated modes/channels of communication in a way that promotes the use of the targeted innovation | 3 |
Intervene with patients/consumers to enhance uptake and adherence | Engage consumers, Messaging | Develop strategies with patients to encourage and problem-solve around adherence | 3 |
Use train-the-trainer strategies | Train and educate stakeholders | Train designated clinicians or organizations to train others in clinical innovation | 3 |
Create new clinical teams | Change infrastructure | Change who serves on the clinical team, adding different disciplines and different skills to make it more likely that the clinical innovation is delivered (or is more successfully delivered) | 2 |
Inform local opinion leaders | Develop stakeholder interrelationships, Messaging | Inform providers identified by colleagues as opinion leaders or “educationally influential” about the clinical innovation in the hopes that they will influence colleagues to adopt it | 2 |
Create online learning communitiesc | Train and educate stakeholders, Develop stakeholder interrelationships | Create an online portal for clinical staff members to share and access resources, webinars, and FAQs related to the specific evidenced-based intervention, and provide interactive features to encourage learning across settings and teams, e.g., regular blogs, facilitated discussion boards, access to experts, and networking opportunities | 2 |
Organize clinician implementation team meetingsc | Develop stakeholder interrelationships | Develop and support teams of clinicians, staff, patients, and other stakeholders who are implementing or may be users of the innovation. Provide protected time for teams to reflect on the implementation progress, share lessons learned, make refinements to plans, and support one another’s learning | 2 |
Revise professional roles | Change infrastructure | Shift and revise roles among professionals who provide care, and redesign job characteristics | 2 |
Capture and share local knowledge | Develop stakeholder interrelationships, Messaging | Capture local knowledge from implementation sites on how implementers and clinicians made something work in their setting and then share it with other sites | 1 |
Engage community resourcesc | Train and educate stakeholders, Develop stakeholder interrelationships | Connect practices and their patients to community resources outside the practice (e.g., state and county health departments; non-profit organizations; resources related to addressing the social determinants of health; and organizations focused on self-management techniques and support) | 1 |
Identify early adopters | Use evaluative and iterative strategies | Identify early adopters at the local site to learn from their experiences with the practice innovation | 1 |
Model and stimulate change | Use evaluative and iterative strategies | Model or simulate the change that will be implemented prior to implementation | 1 |
Prepare patients/consumers to be active participants | Engage consumers, Messaging | Prepare patients/consumers to be active in their care, to ask questions, and specifically to inquire about care guidelines, the evidence behind clinical decisions, or available evidence-supported treatments | 1 |
Recruit, designate, and train for leadership | Develop stakeholder interrelationships | Recruit, designate, and train leaders for the change effort | 1 |
Shadow other experts | Train and educate stakeholders | Provide ways for key individuals to directly observe experienced people engage with or use the targeted practice change/innovation | 1 |
Use data expertsc | Adapt and tailor to context | Involve, hire, and/or consult experts to acquire, structure, manage, report, and use data generated by implementation efforts | 1 |
Use mass media | Engage consumers, Train and educate stakeholders, Messaging | Use media to reach large numbers of people to spread the word about the clinical innovation | 1 |
Change physical structure and equipment | Change infrastructure | Evaluate current configurations and adapt, as needed, the physical structure and/or equipment (e.g., changing the layout of a room, adding equipment) to best accommodate the targeted innovation | 1 |
Develop academic partnerships | Develop stakeholder interrelationships | Partner with a university or academic unit for the purposes of shared training and | 1 |
Increase demand | Engage consumers, Train and educate stakeholders, Messaging | Attempt to influence the market for the clinical innovation to increase competition intensity and to increase the maturity of the market for the clinical innovation | 1 |
Obtain formal commitments | Develop stakeholder interrelationships | Obtain written commitments from key partners that state what they will do to implement the innovation | 1 |
Use an implementation advisorc | Develop stakeholder interrelationships | Seek guidance from experts in implementation, including providing support and training for the implementation work force | 1 |
Work with educational institutions | Develop stakeholder interrelationships | Encourage educational institutions to train clinicians in innovation | 1 |
Alter incentive/allowance structures | Utilize financial strategies | Work to incentivize the adoption and implementation of clinical innovation | 0 |
Alter patient/consumer fees | Utilize financial strategies | Create fee structures where patients/consumers pay less for preferred treatments (the clinical innovation) and more for less-preferred treatments | 0 |
Change accreditation or membership requirements | Change infrastructure | Strive to alter accreditation standards so that they require or encourage use of the clinical innovation. Work to alter membership organization requirements so that those who want to affiliate with the organization are encouraged or required to use the clinical innovation | 0 |
Change liability laws | Change infrastructure | Participate in liability reform efforts that make clinicians more willing to deliver clinical innovation | 0 |
Change service sites | Change infrastructure, Adapt and tailor to context | Change the location of clinical service sites to increase access | 0 |
Create or change credentialing and/or licensure standards | Change infrastructure | Create an organization that certifies clinicians in the innovation or encourages an existing organization to do so. Change governmental professional certification or licensure requirements to include delivering the innovation. Work to alter continuing education requirements to shape professional practice toward innovation bringing research skills to an implementation project | 0 |
Develop an implementation glossary | Train and educate stakeholders, Messaging | Develop and distribute a list of terms describing the innovation, implementation, and stakeholders in the organizational change | 0 |
Develop disincentives | Utilize financial strategies | Provide financial disincentives for failure to implement or use the clinical innovations | 0 |
Develop resource-sharing agreements | Support clinicians | Develop partnerships with organizations that have the resources needed to implement the innovation | 0 |
Fund and contract for the clinical innovation | Utilize financial strategies | Governments and other payers of services issue requests for proposals to deliver the innovation, use contracting processes to motivate providers to deliver the clinical innovation and develop new funding formulas that make it more likely that providers will deliver the innovation | 0 |
Make billing easier | Utilize financial strategies | Make it easier to bill for the clinical innovation | 0 |
Place innovation on fee-for-service lists/ formularies | Utilize financial strategies | Work to place the clinical innovation on lists of actions for which providers can be reimbursed (e.g., a drug is placed on a formulary, a procedure is now reimbursable) | 0 |
Start a dissemination organization | Engage consumers, Train and educate stakeholders, Messaging | Identify or start a separate organization that is responsible for disseminating the clinical innovation. It could be a for-profit or non-profit organization | 0 |
Use capitated payments | Utilize financial strategies | Pay providers or care systems a set amount per patient/consumer for delivering clinical care | 0 |
Use data warehousing techniques | Adapt and tailor to context | Integrate clinical records across facilities and organizations to facilitate implementation across systems | 0 |
Use other payment schemes | Utilize financial strategies | Introduce payment approaches (in a catch-all category) | 0 |
Visit other Sites | Develop stakeholder interrelationships | Visit sites where a similar implementation effort has been considered successful | 0 |