Skip to main content

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

From: A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project

Strategy Definitions
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