Table 8 Key factors influencing synoptic reporting tool (SRT) implementation and use and their relationship to the theoretical perspectives (1 = Promoting Action on Research Implementation in Health Services; 2 = Organizational framework of innovation implementation; 3 = Systems thinking / change)

Common factors

Stakeholder involvement

3; local autonomy, (re)negotiation, resources

Key stakeholder involvement influenced SRT implementation and use, with high involvement critical to navigating the healthcare system, building a sense of local ownership, and acquiring moral and material support for implementation.

Managing the change process

2; implementation policies and practices, implementation climate

Employing policies and practices to manage resistance and other barriers to SRT implementation and use, communicate about the SRT and its implementation, and provide training and support were important parts of managing the change process.

Administrative and managerial support^a

2; management support

In organizations wherein administrative and managerial support were high, implementation went smoother and the experience tended to be better for end users; where support was low, the reverse occurred.

Champions and respected colleagues

2; innovation champions

Respected colleagues who championed the SRT were instrumental to clinicians’ decisions to use the SRTs and to continue using, even in settings wherein ongoing challenges and frustrations were prevalent.

Innovation attributes

2; innovation-values fit

Innovation-values fit is akin to one of the concepts-compatibility-encompassed in the key factor innovation attributes. High compatibility or `fit’ existed between SRTs and individual, organizational, and system values, interests, and priorities.

3; nature of knowledge

Implementation and use was influenced by the way in which participants understood the SRTs. Individuals’ understandings of the nature and characteristics of the SRTs were depicted as attributes of the innovation, specifically complexity, relative advantage, and compatibility. When individuals believed that the SRT held value and would (at least eventually) be better than the practice it replaced, they were much more apt to support its implementation and use.

Distinct factors

Implementation approach

Neither

In the endoscopy and cancer surgery cases, SRT implementation and use were influenced by the tool’s positioning in the healthcare system (i.e., part of a screening program; pilot project) and the related implementation approach (i.e., top-down, policy driven; ground-up). Neither of the theoretical perspectives specifically addresses how these factors might affect innovation implementation.

Project management

Neither

In the endoscopy case, SRT implementation was impeded by suboptimal project management, specifically related to the tool’s implementation. Neither of the theoretical perspectives specifically addresses project management as an important influence on moving knowledge into practice, though task-based `facilitation’ [64] may include some of the project management practices encompassed in this factor.

Resources

2; financial resource availability

Limited financial resources, including financially dependent resources (e.g., acquiring personnel), was deemed a key constraining factor in the mammography and cancer surgery cases. Limited resources affected change management practices (mammography) as well as information technology work to update/refine the SRT (mammography) and adapt the SRT to the Nova Scotia environment (cancer surgery).

Culture

1; context (culture)

In the mammography case, SRT implementation and use were facilitated by the program’s strong quality improvement culture.

Leadership

1; context (leadership)

In the mammography case, SRT implementation and use were facilitated by consistent and effective leadership; the leaders, who have largely remained stable over two decades, were effective at building a dedicated team and acquiring the resources for SRT implementation.

Monitoring and feedback mechanisms

1; context (evaluation)

SRT implementation and use in the mammography case were facilitated by ongoing monitoring and feedback mechanisms at multiple levels of the healthcare system (e.g., clinicians, health districts, government).

Components of the healthcare system

3; no specific construct

In the endoscopy and cancer surgery cases, SRT implementation was impeded by structural, infrastructural, and/or socio-historical components of the healthcare system. `Systems’ thinking / change views the healthcare system as an interdependent, social system wherein the movement of knowledge into practice is impacted by the larger system’s characteristics (e.g., relationships across the system, historical interactions, and so on).