Table 3 ERIC discrete implementation strategy compilation (n = 73)

Access new funding

Access new or existing money to facilitate the implementation

Alter incentive/allowance structures

Work to incentivize the adoption and implementation of the clinical innovation

Alter patient/consumer fees

Create fee structures where patients/consumers pay less for preferred treatments (the clinical innovation) and more for less-preferred treatments

Assess for readiness and identify barriers and facilitators

Assess various aspects of an organization to determine its degree of readiness to implement, barriers that may impede implementation, and strengths that can be used in the implementation effort

Audit and provide feedback

Collect and summarize clinical performance data over a specified time period and give it to clinicians and administrators to monitor, evaluate, and modify provider behavior

Build a coalition

Recruit and cultivate relationships with partners in the implementation effort

Capture and share local knowledge

Capture local knowledge from implementation sites on how implementers and clinicians made something work in their setting and then share it with other sites

Centralize technical assistance

Develop and use a centralized system to deliver technical assistance focused on implementation issues

Change accreditation or membership requirements

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

Change liability laws

Participate in liability reform efforts that make clinicians more willing to deliver the clinical innovation

Change physical structure and equipment

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

Change record systems

Change records systems to allow better assessment of implementation or clinical outcomes

Change service sites

Change the location of clinical service sites to increase access

Conduct cyclical small tests of change

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

Conduct educational meetings

Hold meetings 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

Conduct educational outreach visits

Have a trained person meet with providers in their practice settings to educate providers about the clinical innovation with the intent of changing the provider’s practice

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

Conduct local needs assessment

Collect and analyze data related to the need for the innovation

Conduct ongoing training

Plan for and conduct training in the clinical innovation in an ongoing way

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

Create new clinical teams

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)

Create or change credentialing and/or licensure standards

Create an organization that certifies clinicians in the innovation or encourage 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 the innovation

Develop a formal implementation blueprint

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

Develop academic partnerships

Partner with a university or academic unit for the purposes of shared training and bringing research skills to an implementation project

Develop an implementation glossary

Develop and distribute a list of terms describing the innovation, implementation, and stakeholders in the organizational change

Develop and implement tools for quality monitoring

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

Develop and organize quality monitoring systems

Develop and organize systems and procedures that monitor clinical processes and/or outcomes for the purpose of quality assurance and improvement

Develop disincentives

Provide financial disincentives for failure to implement or use the clinical innovations

Develop educational materials

Develop and format 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

Develop resource sharing agreements

Develop partnerships with organizations that have resources needed to implement the innovation

Distribute educational materials

Distribute educational materials (including guidelines, manuals, and toolkits) in person, by mail, and/or electronically

Facilitate relay of clinical data to providers

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 use of the targeted innovation

Facilitation

A process of interactive problem solving and support that occurs in a context of a recognized need for improvement and a supportive interpersonal relationship

Fund and contract for the clinical innovation

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

Identify and prepare champions

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

Identify early adopters

Identify early adopters at the local site to learn from their experiences with the practice innovation

Increase demand

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

Inform local opinion leaders

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

Intervene with patients/consumers to enhance uptake and adherence

Develop strategies with patients to encourage and problem solve around adherence

Involve executive boards

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

Involve patients/consumers and family members

Engage or include patients/consumers and families in the implementation effort

Make billing easier

Make it easier to bill for the clinical innovation

Make training dynamic

Vary the information delivery methods to cater to different learning styles and work contexts, and shape the training in the innovation to be interactive

Mandate change

Have leadership declare the priority of the innovation and their determination to have it implemented

Model and simulate change

Model or simulate the change that will be implemented prior to implementation

Obtain and use patients/consumers and family feedback

Develop strategies to increase patient/consumer and family feedback on the implementation effort

Obtain formal commitments

Obtain written commitments from key partners that state what they will do to implement the innovation

Organize clinician implementation team meetings

Develop and support teams of clinicians who are implementing the innovation and give them protected time to reflect on the implementation effort, share lessons learned, and support one another’s learning

Place innovation on fee for service lists/formularies

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)

Prepare patients/consumers to be active participants

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 about available evidence-supported treatments

Promote adaptability

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

Promote network weaving

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

Provide clinical supervision

Provide clinicians with ongoing supervision focusing on the innovation. Provide training for clinical supervisors who will supervise clinicians who provide the innovation

Provide local technical assistance

Develop and use a system to deliver technical assistance focused on implementation issues using local personnel

Provide ongoing consultation

Provide ongoing consultation with one or more experts in the strategies used to support implementing the innovation

Purposely reexamine the implementation

Monitor progress and adjust clinical practices and implementation strategies to continuously improve the quality of care

Recruit, designate, and train for leadership

Recruit, designate, and train leaders for the change effort

Remind clinicians

Develop reminder systems designed to help clinicians to recall information and/or prompt them to use the clinical innovation

Revise professional roles

Shift and revise roles among professionals who provide care, and redesign job characteristics

Shadow other experts

Provide ways for key individuals to directly observe experienced people engage with or use the targeted practice change/innovation

Stage implementation scale up

Phase implementation efforts by starting with small pilots or demonstration projects and gradually move to a system wide rollout

Start a dissemination organization

Identify or start a separate organization that is responsible for disseminating the clinical innovation. It could be a for-profit or non-profit organization

Tailor strategies

Tailor the implementation strategies to address barriers and leverage facilitators that were identified through earlier data collection

Use advisory boards and workgroups

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

Use an implementation advisor

Seek guidance from experts in implementation

Use capitated payments

Pay providers or care systems a set amount per patient/consumer for delivering clinical care

Use data experts

Involve, hire, and/or consult experts to inform management on the use of data generated by implementation efforts

Use data warehousing techniques

Integrate clinical records across facilities and organizations to facilitate implementation across systems

Use mass media

Use media to reach large numbers of people to spread the word about the clinical innovation

Use other payment schemes

Introduce payment approaches (in a catch-all category)

Use train-the-trainer strategies

Train designated clinicians or organizations to train others in the clinical innovation

Visit other sites

Visit sites where a similar implementation effort has been considered successful

Work with educational institutions

Encourage educational institutions to train clinicians in the innovation