The results of the literature review matched those found in the Delphi study, and 50 potentially relevant determinants of innovation processes were identified. Many of the innovation studies had several methodological flaws, such as not adjusting innovation strategies to relevant determinants of the innovation process, or that data on determinants were gathered only from non-users. Furthermore, the degree of implementation was evaluated in several ways, which made comparison difficult.

ObjectiveTo develop a short instrument to measure determinants of innovations that may affect its implementation.DesignWe pooled the original data from eight empirical studies of the implementation of evidence-based innovations. The studies used a list of 60 potentially relevant determinants based on a systematic review of empirical studies and a Delphi study among implementation experts. Each study used similar methods to measure both the implementation of the innovation and determinants. Missing values in the final data set were replaced by plausible values using multiple imputation. We assessed which determinants predicted completeness of use of the innovation (% of recommendations applied). In addition, 22 implementation experts were consulted about the results and about implications for designing a short instrument.SettingEight innovations introduced in Preventive Child Health Care or schools in the Netherlands.ParticipantsDoctors, nurses, doctor's assistants and teachers; 1977 respondents in total.ResultsThe initial list of 60 determinants could be reduced to 29. Twenty-one determinants were based on the pooled analysis of the eight studies, seven on the theoretical expectations of the experts consulted and one new determinant was added on the basis of the experts' practical experience.ConclusionsThe instrument is promising and should be further validated. We invite researchers to use and explore the instrument in multiple settings. The instrument describes how each determinant should preferably be measured (questions and response scales). It can be used both before and after the introduction of an innovation to gain an understanding of the critical change objectives.

BackgroundA growing number of new technologies are becoming available within nursing care that can improve the quality of care, reduce costs, or enhance working conditions. However, such effects can only be achieved if technologies are used as intended. The aim of this study is to gain a better understanding of determinants influencing the success of the introduction of new technologies as perceived by nursing staff.MethodsThe study population is a nationally representative research sample of nursing staff (further referred to as the Nursing Staff Panel), of whom 685 (67%) completed a survey questionnaire about their experiences with recently introduced technologies. Participants were working in Dutch hospitals, psychiatric organizations, care organizations for mentally disabled people, home care organizations, nursing homes or homes for the elderly.ResultsHalf of the respondents were confronted with the introduction of a new technology in the last three years. Only half of these rated the introduction of the technology as positive.The factors most frequently mentioned as impeding actual use were related to the (kind of) technology itself, such as malfunctioning, ease of use, relevance for patients, and risks to patients. Furthermore nursing staff stress the importance of an adequate innovation strategy.ConclusionsA prerequisite for the successful introduction of new technologies is to analyse determinants that may impede or enhance the introduction among potential users. For technological innovations special attention has to be paid to the (perceived) characteristics of the technology itself.

Background The rapid uptake of electronic devices and information sources has enormous implications for guideline developers and implementers. In 2000, our organisation anticipated this trend and developed an electronic production system. Objectives To develop the capacity to publish and update electronic versions of a comprehensive set of clinical guidelines. Methods An audit of technology and resourcing requirements was undertaken, new software was commissioned, and staff with IT and electronic publishing skills were recruited. Stringent quality control and editorial processes were developed to ensure the fidelity of electronic versions. A comprehensive communications and marketing plan was implemented. Results All guidelines, covering 14 books titles and around 3000 topics, were integrated into an electronic, searchable website with links to other quality electronic resources, tools and reference materials.-Electronic subscriptions and site licenses have grown by 200% between 2004 and2012, and currently make up 75% of users; 25% continue to use books. Discussion The switch from paper to computer and mobile devices presents both financial and logistical challenges and requires long-term commitment. Furthermore, as the diversity of electronic integration systems multiplies, there are challenges in keeping up with technological advances. It is clear from the uptake of our electronic guidelines that health professionals and other users want access to comprehensive, up-to-date and easyto-use electronic guidelines. Implications for Guideline Developers/Users For guidelines to be useful in practice in 2013 and beyond, they must be available electronically and be able to interact with other electronic resources used in health settings. Background In 2002, we developed a list of 60 potential relevant determinants that are critical for a successful implementation of innovations in health care, such as guidelines. This list was a result of a review of empirical studies and a Delphi study among implementation experts. Since 2002, we used the list in eight empirical studies concerning the implementation of guidelines/programs. Objectives The development of a generic measurement instrument for the assessment of determinants of implementation of innovations. Methods In each study, a similar method was used to measure implementation of the guideline/program as well as the determinants. The information of the eight empirical studies were combined into one data set. Missing values in the final data set were replaced by plausible values using multiple imputation. We assessed which determinants 'predict' the implementation: separately and in combination with each other. In addition, 22 implementation experts commented on the results of the metaanalyses. Results An instrument with 29 determinants was established; 7 are related to the guideline/programme itself; 11 to the user; 11 to the organisation and socio-political context. Discussion This instrument is to be used before or after a guideline is introduced in order to gain ins...

Background Internet-based Cognitive Behavioural Therapy (iCBT) is found effective in treating common mental disorders. However, the use of these interventions in routine care is limited. The international ImpleMentAll study is funded by the European Union’s Horizon 2020 programme. It is concerned with studying and improving methods for implementing evidence-based iCBT services for common mental disorders in routine mental health care. A digitally accessible implementation toolkit (ItFits-toolkit) will be introduced to mental health care organizations with the aim to facilitate the ongoing implementation of iCBT services within local contexts. This study investigates the effectiveness of the ItFits-toolkit by comparing it to implementation-as-usual activities. Methods A stepped wedge cluster randomized controlled trial (SWT) design will be applied. Over a trial period of 30 months, the ItFits-toolkit will be introduced sequentially in twelve routine mental health care organizations in primary and specialist care across nine countries in Europe and Australia. Repeated measures are applied to assess change over time in the outcome variables. The effectiveness of the ItFits-toolkit will be assessed in terms of the degree of normalization of the use of the iCBT services. Several exploratory outcomes including uptake of the iCBT services will be measured to feed the interpretation of the primary outcome. Data will be collected via a centralized data collection system and analysed using generalized linear mixed modelling. A qualitative process evaluation of routine implementation activities and the use of the ItFits-toolkit will be conducted within this study. Discussion The ImpleMentAll study is a large-scale international research project designed to study the effectiveness of tailored implementation. Using a SWT design that allows to examine change over time, this study will investigate the effect of tailored implementation on the normalization of the use of iCBT services and their uptake. It will provide a better understanding of the process and methods of tailoring implementation strategies. If found effective, the ItFits-toolkit will be made accessible for mental health care service providers, to help them overcome their context-specific implementation challenges. Trial registration ClinicalTrials.gov NCT03652883. Retrospectively registered on 29 August 2018