Target | Strategy | Examples | References |
---|---|---|---|
System | Policy authority (governance arrangement) | • Centralization/decentralization of policy authority (e.g., creating a regional infrastructure with some policy authority to oversee implementation) • Accountability of the state sector’s role in implementation (e.g., develop system-wide performance indicators or targets, monitor performance and fidelity, evaluate, report results publicly, consider enforcement strategies) • Leadership for implementation (through the appointment of state sector leaders, dedicated resources, garnering support for innovation and its implementation) • Stewardship of the non-state sector’s role in implementation (e.g., constructing formal opportunities for non-state sector in oversight of implementation, contracting with non-state sector for implementation-related activities, fostering networks and linkages across different types of organizations who are engaged in implementation) | |
Funding system infrastructure (financial arrangement) | • Dedicate resources for system infrastructure to support implementation (e.g., intermediaries, technical assistance centers, backbone organizations, facilitators) • Create funding sources that align with time needed for effective implementation and scaling | [9, 27, 28, 31, 32, 35, 39, 49, 74, 82, 83, 94, 97, 100, 101] | |
Re-designing system to meet needs (delivery arrangement and implementation-related supports) | • Consider impacts of implementation on availability of care/service and plan for scaling-up across the geographical area or population • Assess possible impacts on other services (e.g., wait times) in response to implementing innovation | ||
With what supports service is provided (delivery arrangement) | • Create or change system-wide record systems or information and communication technologies to support implementation | ||
Organization | Organizational authority (governance arrangement) | • Management approaches in support of optimal implementation, including: developing data collection systems, developing and monitoring performance indicators, quality improvement plans, use of scorecards, or public reporting • Develop and deploy appropriate organizational leadership for implementation oversight and engagement • Include innovation as part of accreditation processes • Engage in networks/multi-institutional arrangements in support of implementation | |
Funding organizations (financial arrangement) | • Provide service grants or contract with organizations to support implementation or to offset additional administrative costs of implementing an innovation (e.g., training, data infrastructure changes, workforce stability impacts) • Prospective payments to cover lag-time costs when beginning to implement an innovation • Targeted payments or penalties based on organizational performance related to innovation (e.g., changing reimbursement rate structure so that providers of high fidelity receive modestly higher per unit rate) • Targeted payments or penalties based on client outcomes • Shift organizational funding models to support implementation (e.g., from fee-for-service to no-risk managed care arrangements) | ||
Where service is provided (delivery arrangement) | • Adjust sites of service delivery in response to an innovation • Consider how the physical structure, facilities, and equipment can support innovation during implementation and ensure appropriate supply (supply chain management) • Adjustments to the organizational scale in response to an innovation (e.g., number of beds, units of service) | ||
With what supports service is provided (delivery arrangement) | • Change organizational record systems or other information and communication technologies to support implementation | ||
Organization-targeted implementation supports (Implementation-related supports) | • Develop educational materials, hosting educational meetings, training, or outreach visits tailored to organizations • Develop and disseminate program or organizational service standards • Provision of technical assistance and other forms of implementation support • Support development and maintenance of inter-organizational collaboratives, communities of practice, and other forms of inter-organizational communication/learning • Consider non-monetary awards, incentives, and disincentives for organizations (e.g., exemplary program award) | ||
Workforce/service provider | Professional authority (governance arrangement) | • Create or alter training and licensure requirements • Change scope of practice to reflect innovation • Alter where providers can practice geographically and in what systems (public vs private) • Continuing competence (e.g., provide training and continuing education unit credits for innovation or disallow certain courses for credit) • Professional liability (e.g., change liability laws) • Alter university curricula to include knowledge of innovation | |
Remunerating providers (financial arrangement) | • Reimbursement for program participation, extra efforts in applying the innovation, or lost time due to training • Increase reimbursement rate • Changing the way providers are reimbursed to encourage implementation (e.g., from fee-for-service to capitation) • Loan forgiveness • Targeted payments or penalties for performance • Targeted payments or penalties based on outcomes • Review and align fiscal and billing policies and incentives for providers • Make billing easier for providers | [7, 27, 32, 34, 47, 52, 65, 69, 70, 73, 80, 82, 88, 90, 100, 104] | |
By whom service is provided (delivery arrangement) | • Assess and improve workplace conditions for providers to foster implementation • Extend the role of a particular provider within their existing scope of practice • Shift tasks between types of providers • Optimize the performance of the workforce in their current roles by creating, disseminating, and monitoring guidelines or standards of care for service providers | ||
Workforce-targeted implementation supports (implementation-related supports) | • Develop educational materials, hosting educational meetings, training, or outreach visits • Engage local opinion leaders • Reminders and prompts • Audit and feedback • Coaching • Develop either tailored or multi-faceted interventions to support implementation • Consider non-monetary awards, incentives, and disincentives for workforce | ||
Consumer | Consumer and stakeholder involvement (governance arrangement) | • Consumer protection (laws, complaints management) • Consumer, family, and stakeholder engagement in implementation and monitoring | |
Incentivizing consumers (financial arrangement) | • Alter consumer/patient fees • Consider disincentives that may exist for consumers to be successful (e.g., some employment programs) • Subsidies for private health insurance | ||
Consumer-targeted implementation supports (implementation-related supports) | • Information or education provision • Behavior change support • Skills and competencies development • Communication and decision-making facilitation | ||
Innovation | Commercial authority (governance arrangement) | • Adjust licensure and registration requirements to support implementation • Consider pricing and purchasing • Establish voluntary agreements on advertising | |
Purchasing products and services (financial arrangement) | • Changes to the scope and nature of insurance plans: extending or ending insurance coverage • Adjust list of covered/reimbursed services and products • Change restrictions or caps on coverage/reimbursement for innovation and related supports • Change mechanisms for billing • Prior approval requirements |