Lessons learned about the effective operationalization of champions as an implementation strategy: Results from a qualitative process evaluation of a pragmatic trial.

Bunce, A. E., Gruß, I., Davis, J. V., Cowburn, S., Cohen, D., Oakley, J., & Gold, R. (2020). Lessons learned about the effective operationalization of champions as an implementation strategy: Results from a qualitative process evaluation of a pragmatic trial. Implementation Science, 15(1), 1-12.

 

The field of implementation science focuses on identifying barriers to practice change and introducing implementation strategies to address such barriers. The current authors previously completed a project where they utilized 5 implementation strategies to integrate a new guideline into clinical practice. Clinics involved received varying level of implementation intensity, and they hypothesized that the greater number of intensive implementation supports received the greater the improvement in guideline integration. Results from this study revealed that greater supports did not lead to greater integration. This result led the authors to look further at specific implementation strategies and the success of specific strategies in individual community clinics. This also demonstrated the importance of operationalizing implementation strategies to better aid in the selection of strategies. 

 

In this study, the authors re-analyzed quantitative and qualitative data from the previous project. Results revealed that for the clinic sites demonstrating a significant pre-post difference in guideline integration, the two factors associated with this change were the influence of the “implementers” or “champions” and their impact on the organizational context. Implementers were defined as a champion for promoting guideline related activity and acting as a liaison between the health centre and the researchers.  In an analysis of the factors associated with change, the 4 key implementer characteristics were engagement in promoting intervention, influence to foster trust, credibility, and capacity. 

 

These results add to the literature supporting the use of implementers/champions and organizational support in efforts to change practice. Further these results open the discussion surrounding how to support these individuals and better operationalize what factors are associated with a successful implementer. Broadly, this research highlights the complexity of identifying what implementation strategies will support change in a clinical context.

                                            

Blogger: Meghan Vollebregt is a student in the combined SLP                                                                                                       MClSc/PhD program working under the supervision of Dr. Lisa Archibald.