Factor | Case A: Mammography case | Case B: Endoscopy case | Case C: Cancer surgery case |
---|---|---|---|
Common factors | Â | Â | Â |
Stakeholder involvement | +/− Initial implementation and use were facilitated by stakeholder involvement; subsequent expansion was impeded by low stakeholder (i.e., radiologist) involvement | - Implementation was impeded by limited stakeholder involvement | + Implementation was facilitated by early, ongoing, and collaborative stakeholder involvement |
Managing the change process | - Implementation and use were impeded by sub-optimal change management practices | - Implementation and use were impeded by sub-optimal change management practices, though user training was well conducted | + Implementation and use were facilitated by high-quality change management practices |
Administrative and managerial supporta | +/− Implementation was facilitated by high administrative support and high managerial support in some hospitals; implementation was impeded by low managerial support in other hospitals | +/− Implementation was facilitated by high administrative support; implementation was impeded by low managerial support in many hospitals | + Implementation was facilitated by high administrative and managerial support |
Champions and respected colleagues | +/− Implementation and use were facilitated by clinical and administrative champions; lack of clinical champions in some districts impeded use | + Implementation and use were facilitated by clinical champions and respected clinical colleagues | + Implementation and use were facilitated by clinical champions and respected clinical colleagues |
Innovation attributes | +/- Implementation and use were facilitated by alignment with individuals’ and organizations’ values, interests, and needs; use was impeded by perceived tool (and final report) deficiencies and its relative (dis)advantage in practice | +/− Use was facilitated by the tool’s perceived ease of use, but impeded by IT and other technical issues; implementation and use were facilitated by alignment with individuals’ and organizations’ values, priorities, and interests | +/− Use was facilitated by the tool’s perceived ease of use, but impeded by accessibility and IT issues; implementation and use were facilitated by alignment with individuals’ and organizations’ values, priorities, and interests |
Distinct factors | Â | Â | Â |
Implementation approach | NA | + Implementation and use were facilitated by the tool’s positioning in the provincial screening program (however, the top-down, policy driven approach was met with much resistance) | +/− Implementation was facilitated by the tool’s positioning as a pilot project; use was impeded by its positioning since the team had no authority to influence use (e.g., through policy) |
Project management | NA | - Implementation was impeded by suboptimal project management, specifically related to the tool’s implementation | NA |
Resources | - Implementation and use were impeded by insufficient resources for SRT development/updates, implementation, and expansion | NA | - Implementation was impeded early in the project by insufficient IT resources |
Culture | + Implementation and use were facilitated by the program’s strong quality improvement culture; however, this strong culture was viewed negatively by some users, possibly influencing expansion | NA | NA |
Leadership | + Implementation and use were facilitated by consistent, effective leadership | NA | NA |
Monitoring and feedback mechanisms | + Implementation and use were facilitated by ongoing monitoring and feedback mechanisms | NA | NA |
Components of the healthcare system | NA | - Implementation was impeded by structural, infrastructural, and socio-historical components of the healthcare system | - Implementation was impeded by relational and infrastructural components of the healthcare system |