Table 2 Rapid-cycle approach to incorporating multi-level stakeholder economic perspectives when adopting an evidence-based practice. Adapted from Johnson et al. [35]

Preparation (pre-condition)

Identifying multiple stakeholder types

When implementing a new EBP, identify multiple stakeholders across levels who will be impacted by the costs of the implementation.

The inclusion of more stakeholder types initially will set the stage for adopting a multi-level perspective

Problem exploration (pre-implementation)

Understand cost and benefit issues across identified stakeholder levels

Identify costs and priorities across multiple levels of stakeholder groups. Include a rough estimate of costs and discuss with all stakeholder groups involved.

Facilitate meetings to discuss cost data and priorities among different stakeholder groups

Such exploration will aid in developing a deeper understanding of costs and priorities across groups and how they influence adoption, implementation, and sustainment

Knowledge exploration (pre-implementation)

Identify areas of cost (and benefit) congruence and conflict across stakeholder levels

Provide key cost information related to priorities of each stakeholder group

Investigate organizations that have faced similar issues and have successfully resolved them.

Information summaries using visual displays and emphasizing issues prioritized by that group, should aid in identifying areas where conflicts in priorities need to be resolved

Solution development (pre-implementation)

Identify pragmatic solutions to areas of cost conflict

Facilitate meetings to discuss cost data and priorities, including identifying solutions or reallocation of resources that can be reasonably applied to create win-win scenarios across stakeholder levels

Identifying solutions to resolve incongruencies in stakeholders’ economic priorities will enhance the likelihood of implementation success and EBP sustainment

Solution testing (implementation)

Assess if the solutions worked to reduce incongruencies in cost priorities, resource allocation

Collect (or estimate) costs regularly: early on; mid-implementation; and 6-8 weeks before the program end; include mixed method evaluation to assess effects on costs/priorities of stakeholders.

Collecting costs and other information at multiple points will be worthwhile to make mid-program adjustments in resource allocation if needed and prepare for sustainment and replication

Sustainment

Identifying ongoing costs/benefits, mechanisms for sustainment

Using a multi-level approach, identify resources needed to support implementation efforts, plan for resource allocation, and ongoing cost assessment.

Planning for sustainment from a multi-level cost perspective will enhance the likelihood of institutionalization and efficient use of resources.