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Table 4 Policy-related strategies and examples of those strategies for implementation according to type of target

From: Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis

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)

[7, 12, 27,28,29,30,31, 38, 39, 45, 80, 100]

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

[7, 14, 26, 34, 37, 50, 53, 54, 73, 89, 96, 100]

With what supports service is provided (delivery arrangement)

• Create or change system-wide record systems or information and communication technologies to support implementation

[29, 94, 97, 100]

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

[7, 34, 72, 89, 97, 100]

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)

[12, 28, 29, 34, 35, 70, 72, 94, 96, 100, 103, 104, 111]

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)

[90, 100]

With what supports service is provided (delivery arrangement)

• Change organizational record systems or other information and communication technologies to support implementation

[97, 100]

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)

[7, 9, 28, 29, 35, 52, 53, 65, 82, 86, 100]

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

[27, 28, 34, 70, 72, 89, 95, 100]

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

[7, 45, 49, 54, 57, 66, 79, 89, 100]

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

[28,29,30, 34, 39, 65, 70, 83, 89, 100]

Consumer

Consumer and stakeholder involvement (governance arrangement)

• Consumer protection (laws, complaints management)

• Consumer, family, and stakeholder engagement in implementation and monitoring

[70, 72, 89, 100]

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

[29, 90, 100]

Consumer-targeted implementation supports (implementation-related supports)

• Information or education provision

• Behavior change support

• Skills and competencies development

• Communication and decision-making facilitation

[45, 54, 66, 70]

Innovation

Commercial authority (governance arrangement)

• Adjust licensure and registration requirements to support implementation

• Consider pricing and purchasing

• Establish voluntary agreements on advertising

[54, 66]

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

[32, 49, 70, 72, 79, 84, 89, 95, 100]