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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]