Table 4 ERIC strategies with BCTs coded (where appropriate) and type of overlap indicated
ERIC group & strategy | Strategy definition | No. of BCTs | BCT identified [grouping] | Overlap between ERIC strategy & BCT |
|---|---|---|---|---|
Group 1: Use evaluative and iterative strategies | 1.Goals and planning 2. Feedback and monitoring 4.Shaping knowledge 6.Comparison of behaviour 8.Repetition and substitution 9.Comparison of outcomes 12.Antecedents | |||
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 | 0 | - | No BCTs indicated in ERIC strategy description |
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 behaviour | 2 | 2.2. Feedback on behaviour | Clear BCT indicated in ERIC strategy |
2.7. Feedback on outcome(s) of behaviour | Clear BCT indicated in ERIC strategy | |||
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. | 3 | 1.4. Action planning | Clear BCT indicated in ERIC strategy |
1.1. Goal setting (behaviour) | Clear BCT indicated in ERIC strategy | |||
1.3. Goal setting (outcomes) | Clear BCT indicated in ERIC strategy | |||
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 | 7 | 2.2. Feedback on behaviour | Probable BCT indicated in ERIC strategy |
2.7 Feedback on outcomes of behaviour | Probable BCT indicated in ERIC strategy | |||
1.5. Review behaviour goal(s) | Probable BCT indicated in ERIC strategy | |||
1.7. Review outcome goal(s) | Probable BCT indicated in ERIC strategy | |||
1.1. Goal setting (behaviour) | Probable BCT indicated in ERIC strategy | |||
1.3. Goal setting (outcome) | Probable BCT indicated in ERIC strategy | |||
4.3. Behavioural experience | Clear BCT indicated in ERIC strategy | |||
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 | 2 | 12.1. Restructuring the physical environment | Probable BCT indicated in ERIC strategy |
12.5. Adding objects to the environment | Probable BCT indicated in ERIC strategy | |||
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 | 5 | 12.1. Restructuring the physical environment | Probable BCT subsumed under ERIC strategy |
2.1. Monitoring of behaviour by others without feedback | Clear BCT subsumed under ERIC strategy | |||
2.5. Monitoring of outcome(s) of behaviour without feedback | Clear BCT subsumed under ERIC strategy | |||
2.2. Feedback on behaviour | Probable BCT subsumed under ERIC strategy | |||
2.7. Feedback on outcome(s) of behaviour | Probable BCT subsumed under ERIC strategy | |||
Obtain and use patients/consumers and family feedback | Develop strategies to increase patient/consumer and family feedback on the implementation effort | 3 | 2.2. Feedback on behaviour | Probable BCT indicated in ERIC strategy |
9.1. Credible source | Probable BCT indicated in ERIC strategy | |||
6.3. Information about others approval | Probable BCT indicated in ERIC strategy | |||
Purposefully re-examine the implementation | Monitor progress and adjust clinical practices and implementation strategies to continuously improve the quality of care | 5 | 2.1. Monitoring of behaviour by others without feedback | Probable BCT indicated in ERIC strategy |
2.5. Monitoring of outcome(s) of behaviour without feedback | Probable BCT indicated in ERIC strategy | |||
1.5. Review behaviour goal(s) | Probable BCT indicated in ERIC strategy | |||
1.7. Review outcome goal(s) | Probable BCT indicated in ERIC strategy | |||
1.6. Discrepancy between current behaviour and goal | Probable BCT indicated in ERIC strategy | |||
Stage implementation scale up | Phase implementation efforts by starting with small pilots or demonstration projects and gradually move to a system wide rollout | 1 | 8.7. Graded tasks | Probable BCT indicated in ERIC strategy |
Conduct local need assessment | Collect and analyze data related to the need for the innovation | 0 | - | ERIC strategy not targeting behaviour change |
Group 2: Provide interactive assistance | 1.Goals and planning 3. Social support 4.Shaping knowledge 9.Comparison of outcomes 12.Antecedents | |||
Centralize technical assistance | Develop and use a centralized system to deliver technical assistance focused on implementation issues | 2 | 12.1. Restructuring the physical environment | Probable BCT indicated in ERIC strategy |
3.2. Social support (practical) | Probable BCT indicated in ERIC strategy | |||
Provide local technical assistance | Develop and use a system to deliver technical assistance focused on implementation issues using local personnel | 2 | 12.2. Restructuring the social environment | Clear BCT indicated in ERIC strategy |
3.2. Social support (practical) | Probable BCT indicated in ERIC strategy | |||
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 | 3 | 3.1. Social support (unspecified) | Clear BCT indicated in ERIC strategy |
1.2. Problem solving | Clear BCT indicated in ERIC strategy | |||
3.2. Social support (practical) | Probable BCT indicated in ERIC strategy | |||
Provide clinical supervision | Provide clinicians with ongoing supervision focusing on the innovation. | 3 | 12.2. Restructuring the social environment | Clear BCT indicated in ERIC strategy |
9.1. Credible source | Probable BCT indicated in ERIC strategy | |||
4.1 Instruction on how to perform behaviour | Probable BCT indicated in ERIC strategy | |||
Group 3: Adapt and tailor to context | 1.Goals and planning 3.Social Support 9.Comparison of outcomes 12.Antecedents | |||
Use data experts | Involve, hire, and/or consult experts to inform management on the use of data generated by implementation efforts | 2 | 9.1. Credible source | Probable BCT indicated in ERIC strategy |
3.2. Social support (practical) | Probable BCT indicated in ERIC strategy | |||
Use data warehousing techniques | Integrate clinical records across facilities and organizations to facilitate implementation across systems | 1 | 12.1. Restructuring the physical environment | Probable BCT indicated in ERIC strategy |
Tailor strategies | Tailor the implementation strategies to address barriers and leverage facilitators that were identified through earlier data collection | 1 | 1.2. Problem solving | Probable BCT indicated in ERIC strategy |
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 | 0 | - | No BCTs indicated in ERIC strategy description |
Group 4: Develop stakeholder interrelationships | 1.Goals and planning 2. Feedback and monitoring 3.Social Support 6.Comparison of behaviour 8.Repetition and substitution 9.Comparison of outcomes 12.Antecedents 13. Identity | |||
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 | 1 | 9.2. Pros and cons | Probable BCT indicated in ERIC strategy |
Develop academic partnerships | Partner with a university or academic unit for the purposes of shared training and bringing research skills to an implementation project | 1 | 12.2. Restructuring the social environment | Probable BCT indicated in ERIC strategy |
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 | 4 | 12.2. Restructuring the social environment | Clear BCT indicated in ERIC strategy |
9.1. Credible source | Clear BCT indicated in ERIC strategy | |||
3.1. Social support (unspecified) | Probable BCT indicated in ERIC strategy | |||
13.1. Identification of self as role model | Probable BCT indicated in ERIC strategy | |||
Identify early adopters | Identify early adopters at the local site to learn from their experiences with the practice innovation | 1 | 6.2. Social comparison | Probable BCT indicated in ERIC strategy |
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 | 2 | 9.1. Credible source | Probable BCT indicated in ERIC strategy |
13.1 Identification of self as role model | Clear BCT indicated in ERIC strategy | |||
Recruit, designate, and train for leadership | Recruit, designate, and train leaders for the change effort | 1 | 12.2. Restructuring the social environment | Probable BCT indicated in ERIC strategy |
Use an implementation advisor | Seek guidance from experts in implementation | 2 | 9.1. Credible source | Probable BCT indicated in ERIC strategy |
3.1. Social support (unspecified) | Probable BCT indicated in ERIC strategy | |||
Visit other sites | Visit sites where a similar implementation effort has been considered successful | 4 | 6.2. Social comparison | Clear BCT indicated in ERIC strategy |
6.1. Demonstration of behaviour | Clear BCT indicated in ERIC strategy | |||
9.1. Credible source | Probable BCT indicated in ERIC strategy | |||
3.2. Social support (practical) | Clear BCT indicated in ERIC strategy | |||
Model and simulate change | Model or simulate the change that will be implemented prior to implementation | 2 | 8.1. Behavioural rehearsal | Probable BCT indicated in ERIC strategy |
9.3. Comparative imaginings | Clear BCT indicated in ERIC strategy | |||
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 | 3 | 12.2. Restructuring the social environment | Clear BCT indicated in ERIC strategy |
1.2. Problem solving | Probable BCT indicated in ERIC strategy | |||
1.3. Goal setting (outcome) | Probable BCT indicated in ERIC strategy | |||
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 | 2 | 12.2. Restructuring the social environment | Clear BCT indicated in ERIC strategy |
3.1. Social support (unspecified) | Clear BCT indicated in ERIC strategy | |||
Build a coalition | Recruit and cultivate relationships with partners in the implementation effort | 1 | 12.2. Restructuring the social environment | Clear BCT indicated in ERIC strategy |
Obtain formal commitments | Obtain written commitments from key partners that state what they will do to implement the innovation | 3 | 1.9. Commitment | Clear BCT indicated in ERIC strategy |
1.1. Goal setting (behaviour) | Clear BCT indicated in ERIC strategy | |||
1.8. Behavioural contract | Clear BCT indicated in ERIC strategy | |||
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 | 2 | 3.2. Social support (practical) | Clear BCT indicated in ERIC strategy |
6.2. Social comparison | Clear BCT indicated in ERIC strategy | |||
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 | 3 | 12.2. Restructuring the social environment | Clear BCT indicated in ERIC strategy |
2.1. Monitoring of behaviour by others without feedback | Clear BCT indicated in ERIC strategy | |||
2.5. Monitoring outcome(s) of behaviour by others without feedback | Clear BCT indicated in ERIC strategy | |||
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 | 2 | 12.2. Restructuring the social environment | Clear BCT indicated in ERIC strategy |
3.2. Social support (practical) | Clear BCT indicated in ERIC strategy | |||
Develop an implementation glossary | Develop and distribute a list of terms describing the innovation, implementation, and stakeholders in the organizational change | 0 | ERIC strategy not targeting behaviour change | |
Group 5: Train and educate stakeholders | 1.Goals and planning 2. Feedback and monitoring 3.Social support 4.Shaping knowledge 5.Natural consequences 6.Comparison of behaviour 8.Repetition and substitution 9.Comparison of outcomes 12.Antecedents 13.Identity | |||
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 | 3 | 4.1. Instruction on how to perform behaviour | Probable BCT indicated in ERIC strategy |
5.1. Information about health consequences | Probable BCT indicated in ERIC strategy | |||
6.1. Demonstration of the behaviour | Probable BCT indicated in ERIC strategy | |||
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 | 7 | 9.1. Credible source | Clear BCT indicated in ERIC strategy |
4.1. Instruction on how to perform behaviour | Probable BCT indicated in ERIC strategy | |||
5.1. Info about health consequences | Probable BCT indicated in ERIC strategy | |||
6.1. Demonstration of the behaviour | Probable BCT indicated in ERIC strategy | |||
2.2. Feedback on behaviour | Probable BCT indicated in ERIC strategy | |||
1.2. Problem solving | Probable BCT indicated in ERIC strategy | |||
8.2. Behavioural substitution | Probable BCT indicated in ERIC strategy | |||
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 | 2 | 12.2. Restructuring the social environment | Clear BCT indicated in ERIC strategy |
3.1. Social support (unspecified) | Probable BCT indicated in ERIC strategy | |||
Conduct ongoing training | Plan for and conduct training in the clinical innovation in an ongoing way | 3 | 4.1. Instruction on how to perform behaviour | Probable BCT indicated in ERIC strategy |
6.1. Demonstration of behaviour | Probable BCT indicated in ERIC strategy | |||
8.1. Behavioural practice/rehearsal | Probable BCT indicated in ERIC strategy | |||
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 | 0 | No BCTs indicated in ERIC strategy description | |
Distribute educational materials | Distribute educational materials (including guidelines, manuals, and toolkits) in person, by mail, and/or electronically | 2 | 4.1. Instruction on how to perform behaviour | Probable BCT indicated in ERIC strategy |
5.1. Information about health consequences | Probable BCT indicated in ERIC strategy | |||
Use train-the-trainer strategies | Train designated clinicians or organizations to train others in the clinical innovation | 4 | 6.1. Demonstration of the behaviour | Probable BCT indicated in ERIC strategy |
4.1. Instruction on how to perform behaviour | Probable BCT indicated in ERIC strategy | |||
9.1. Credible source | Probable BCT indicated in ERIC strategy | |||
13.1 Identification of self as role model | Probable BCT indicated in ERIC strategy | |||
Provide ongoing consultation | Provide ongoing consultation with one or more experts in the strategies used to support implementing the innovation | 4 | 3.1. Social support (unspecified) | Clear BCT indicated in ERIC strategy |
9.1. Credible source | Clear BCT indicated in ERIC strategy | |||
2.2. Feedback on behaviour | Clear BCT indicated in ERIC strategy | |||
4.1. Instruction on how to perform behaviour | Clear BCT indicated in ERIC strategy | |||
Shadow other experts | Provide ways for key individuals to directly observe experienced people engage with or use the targeted practice change/innovation | 1 | 6.1. Demonstration of behaviour | Clear BCT indicated in ERIC strategy |
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 | 0 | - | No BCTs indicated in ERIC strategy description |
Work with educational institutions | Encourage educational institutions to train clinicians in the innovation | 0 | - | Strategy does not focus on behaviour change for implementation |
Group 6: Support clinicians | 2. Feedback and monitoring 3.Social support 7.Associations 12.Antecedents | |||
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 | 4 | 2.2. Feedback on behaviour | Clear BCT indicated in ERIC strategy |
2.7. Feedback on outcome(s) of behaviour | Clear BCT indicated in ERIC strategy | |||
12.1. Restructuring the physical environment | Probable BCT indicated in ERIC strategy | |||
12.2. Restructuring the social environment | Probable BCT indicated in ERIC strategy | |||
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) | 1 | 12.2. Restructuring the social environment | Clear BCT indicated in ERIC strategy |
Develop resource sharing agreement | Develop partnerships with organizations that have resources needed to implement the innovation | 2 | 12.2. Restructuring the social environment | Clear BCT indicated in ERIC strategy |
3.2. Social support (practical) | Clear BCT indicated in ERIC strategy | |||
Remind clinicians | Develop reminder systems designed to help clinicians to recall information and/or prompt them to use the clinical innovation | 2 | 7.1. Prompts/cues | Clear BCT subsumed under ERIC strategy |
12.5. Adding objects to the environment | Clear BCT subsumed under ERIC strategy | |||
Revise professional roles | Shift and revise roles among professionals who provide care, and redesign job characteristics | 1 | 12.2. Restructuring the social environment | Clear BCT indicated in ERIC strategy |
Group 7: Engage consumers | 1.Goals and planning 5.Natural consequences 6.Comparison of behaviour 7.Associations 9.Comparison of outcomes 12.Antecedents | |||
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 | 2 | 6.2. Social comparison | Probable BCT indicated in ERIC strategy |
9.1. Credible source | Probable BCT indicated in ERIC strategy | |||
Involve patients/consumers and family members | Engage or include patients/consumers and families in the implementation effort | 1 | 12.2. Restructuring the social environment | Probable BCT indicated in ERIC strategy |
Intervene with patients/consumers to enhance uptake and adherence | Develop strategies with patients to encourage and problem solve around adherence | 1 | 1.2. Problem solving | Probable BCT indicated in ERIC strategy |
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 | 1 | 5.1. Information about health consequences | Probable BCT indicated in ERIC strategy |
Use mass media | Use media to reach large numbers of people to spread the word about the clinical innovation | 2 | 12.5. Adding objects to the environment | Probable BCT indicated in ERIC strategy |
7.1. Prompts/cues | Probable BCT indicated in ERIC strategy | |||
Group 8: Utilize financial incentives | 1.Goals and planning 10.Reward and threat 12.Antecedents 14.Scheduled consequences | |||
Alter incentive/allowance structures | Work to incentivize the adoption and implementation of the clinical innovation | 2 | 10.1. Material incentive (behaviour) | Clear BCT indicated in ERIC strategy |
10.6. Non-specific incentive | Probable BCT indicated in ERIC strategy | |||
Place innovation on fee for service lists/formularies | Work to place clinical innovation on lists of actions for which providers can be reimbursed | 1 | 10.2. Material reward (behaviour) | Clear BCT indicated in ERIC strategy |
Develop disincentives | Provide financial disincentives for failure to implement or use the clinical innovations | 2 | 14.1. Behaviour cost | Clear BCT indicated in ERIC strategy |
14.3. Remove reward | Clear BCT indicated in ERIC strategy | |||
Use capitated payments | Pay providers or care systems a set amount per patient/consumer for delivering clinical care | 1 | 10.2. Material reward (behaviour) | Clear BCT indicated in ERIC strategy |
Make billing easier | Make it easier to bill for the clinical innovation | 1 | 12.1. Restructuring the physical environment | Probable BCT indicated in ERIC strategy |
Alter patient/consumer fees | Create fee structures where patients/consumers pay less for preferred treatments (the clinical innovation) and more for less-preferred treatments | 1 | 14.8. Reward alternative behaviour | Probable BCT indicated in ERIC strategy |
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 | 2 | 10.1. Material incentive (behaviour) | Probable BCT indicated in ERIC strategy |
1.8. Behavioural contract | Probable BCT indicated in ERIC strategy | |||
Use other payment schemes | Introduce payment approaches (in a catch-all category) | 2 | 12.5. Adding objects to the environment | Probable BCT indicated in ERIC strategy |
10.3. Material incentive (behaviour) | Probable BCT indicated in ERIC strategy | |||
Access new funding | Access new or existing money to facilitate the implementation | 2 | 12.5. Adding objects to the environment | Probable BCT indicated in ERIC strategy |
10.3. Material incentive (behaviour) | Probable BCT indicated in ERIC strategy | |||
Group 9: change infrastructure | 4.Shaping knowledge 6.Comparison of behaviour 7. Associations 9. Comparison of outcomes 10.Reward and threat 12.Antecedents 14.Scheduled consequences | |||
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) | 4 | 12.1. Restructuring the physical environment | Probable BCT subsumed under ERIC strategy |
12.2. Restructuring the social environment | Probable BCT subsumed under ERIC strategy | |||
10.6. Non-specific incentive | Probable BCT subsumed under ERIC strategy | |||
4.1. Instruction on how to perform behaviour | Probable BCT subsumed under ERIC strategy | |||
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 | 1 | 10.6. Non-specific incentive | Probable BCT indicated in ERIC strategy |
Change service sites | Change the location of clinical service sites to increase access | 1 | 12.1. Restructuring the physical environment | Clear BCT indicated in ERIC strategy |
Change record systems | Change records systems to allow better assessment of implementation or clinical outcomes | 1 | 12.1. Restructuring the physical environment | Probable BCT indicated in ERIC strategy |
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 | 2 | 12.1. Restructuring the physical environment | Direct 1-1 overlap |
12.5. Adding objects to the environment | Clear BCT indicated in ERIC strategy | |||
Change liability law | Participate in liability reform efforts that make clinicians more willing to deliver the clinical innovation | 4 | 7.5. Remove adverse stimulus | Probable BCT indicated in ERIC strategy |
14.1 Behavioural cost | Probable BCT indicated in ERIC strategy | |||
14.2 Punishment | Probable BCT indicated in ERIC strategy | |||
10.1. Material incentive (behaviour) | Probable BCT indicated in ERIC strategy | |||
Mandate change | Have leadership declare the priority of the innovation and their determination to have it implemented | 2 | 9.1. Credible source | Probable BCT subsumed under ERIC strategy |
6.3. Information about others approval | Clear BCT subsumed under ERIC strategy | |||
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 | 0 | - | ERIC strategy not targeting behaviour change |