Characteristics and behaviours of formal versus informal nurse champions and their relationship to innovation success

Luz, Shirly; Shadmi, Efrat; Admi, Hanna; Peterfreund, Ilana; Drach‐Zahavy, Anat

doi:10.1111/jan.13838

Cited by 22 publications

(33 citation statements)

References 56 publications

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“…In our study, front-line informal leaders were active participants in the initiative and were encouraging and motivating for others. This aligns with existing evidence that informal leaders are effective because they socially in uence other professionals, and that this in uence is a function of the respect of their peers (47,49). Furthermore, it was recognized that senior leaders (i.e.…”

Section: The In Uence Of Informal Leadership For Sustainabilitysupporting

confidence: 78%

“…Previous studies have established the in uence of formal (e.g., administrators) and informal leaders (e.g., champions) and their activities (e.g., facilitation, support) on sustainability (1,43,44). Informal leaders, sometimes referred to as champions, opinion leaders, change agents, or knowledge brokers, are considered front-line practitioners, driving the implementation of a wide range of change initiatives in healthcare settings (45)(46)(47).…”

Section: The In Uence Of Informal Leadership For Sustainabilitymentioning

confidence: 99%

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Contextual Factors and Mechanisms that Influence Sustainability: A Realist Evaluation of Two Provincially Scaled Evidence-Based Initiatives

Flynn

Mrklas

Campbell

et al. 2020

Preprint

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Background: In 2012, Alberta Health Services created Strategic Clinical NetworksTM (SCNs) to develop and implement evidence-informed, clinician-led and team-delivered health system improvement in Alberta, Canada. SCNs have had several provincial successes in improving health outcomes. Little research has been done on the sustainability of these efforts. Methods: We conducted a qualitative realist evaluation using a case study approach to identify and explain the contextual factors and mechanisms perceived to influence the sustainability of two provincial SCN initiatives. The context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic guided our research. Results: We conducted thirty realist interviews in two cases and found four important mechanisms facilitating sustainability: the use of a collaborative approach audit & feedback, the informal leadership role, and patient stories. Informal leaders were often hands-on and influential to front-line staff. Learning collaboratives broke down professional and organizational silos and encouraged collective sharing and learning, motivating participants to continue with the initiative. Continual audit-feedback interventions motivated participants to want to perform and improve on a long-term basis, increasing the likelihood of initiative sustainability. Patient stories demonstrated the initiatives’ impact on patient outcomes, motivating staff to want to continue doing the initiative, and increasing the likelihood of its sustainability. Conclusions: There are important contextual factors and mechanisms within sustainment processes that may apply to systems change implementers. Our research revealed the causal relationship between implementation and sustainability and how outcomes from implementation shape sustainability contexts. Future work is needed to evaluate the effectiveness of informal leadership, learning collaboratives, audit-feedback, and patient stories as sustainability interventions, to generate better guidance on planning sustainable improvements with long term impact.

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Section: The In Uence Of Informal Leadership For Sustainabilitysupporting

confidence: 78%

Section: The In Uence Of Informal Leadership For Sustainabilitymentioning

confidence: 99%

Contextual Factors and Mechanisms that Influence Sustainability: A Realist Evaluation of Two Provincially Scaled Evidence-Based Initiatives

Flynn

Mrklas

Campbell

et al. 2020

Preprint

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“…All study community health centers were required to identify a staff member to engage with the study team and lead the clinic's efforts to support the use of the CVD bundle-a study implementer. Based on known attributes of effective champions [30,31,[36][37][38], and our past experience [39], we suggested (but did not define or require) selecting implementers with involvement in and enthusiasm about quality improvement activities, credibility, and influence at the clinic, and interest in diabetes/cardiovascular care. One staff member could be the study implementer for up to three clinics in a single community health center.…”

Section: Study Setting and Designmentioning

confidence: 99%

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

et al. 2020

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Background Though the knowledge base on implementation strategies is growing, much remains unknown about how to most effectively operationalize these strategies in diverse contexts. For example, while evidence shows that champions can effectively support implementation efforts in some circumstances, little has been reported on how to operationalize this role optimally in different settings, or on the specific pathways through which champions enact change. Methods This is a secondary analysis of data from a pragmatic trial comparing implementation strategies supporting the adoption of guideline-concordant cardioprotective prescribing in community health centers in the USA. Quantitative data came from the community health centers’ shared electronic health record; qualitative data sources included community health center staff interviews over 3 years. Using a convergent mixed-methods design, data were collected concurrently and merged for interpretation to identify factors associated with improved outcomes. Qualitative analysis was guided by the constant comparative method. As results from the quantitative and initial qualitative analyses indicated the essential role that champions played in promoting guideline-concordant prescribing, we conducted multiple immersion-crystallization cycles to better understand this finding. Results Five community health centers demonstrated statistically significant increases in guideline-concordant cardioprotective prescribing. A combination of factors appeared key to their successful practice change: (1) A clinician champion who demonstrated a sustained commitment to implementation activities and exhibited engagement, influence, credibility, and capacity; and (2) organizational support for the intervention. In contrast, the seven community health centers that did not show improved outcomes lacked a champion with the necessary characteristics, and/or organizational support. Case studies illustrate the diverse, context-specific pathways that enabled or prevented study implementers from advancing practice change. Conclusion This analysis confirms the important role of champions in implementation efforts and offers insight into the context-specific mechanisms through which champions enact practice change. The results also highlight the potential impact of misaligned implementation support and key modifiable barriers and facilitators on implementation outcomes. Here, unexamined assumptions and a lack of evidence-based guidance on how best to identify and prepare effective champions led to implementation support that failed to address important barriers to intervention success. Trial registration ClinicalTrials.gov, NCT02325531. Registered 15 December 2014.

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“…It is also important that there is an influential and respected person to champion the implementation process. Champions are important for success of EHR implementation because, as early adopters with positive attitude and enthusiasm towards the impending change, they help in communicating the expected benefits to their peers and encourage them to adopt the change [44][45][46][47]. Organizational flexibility, which is also significant, might not be very actionable since it is historical, but measures can be put in place to improve it, for example, having smaller units within the organization which might accelerate change processes compared to rolling out an EHR in the entire organization.…”

Section: Plos Onementioning

confidence: 99%

Assessment of organizational readiness to implement an electronic health record system in a low-resource settings cancer hospital: A cross-sectional survey

2020

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Background Organizational readiness for change is a key factor in success or failure of electronic health record (EHR) system implementations. Readiness is a multifaceted and multilevel abstract construct encompassing individual and organizational aspects, which makes it difficult to assess. Available tools for assessing readiness need to be tested in different contexts. Objective To identify and assess relevant variables that determine readiness to implement an EHR in oncology in a low-and-middle income setting. Methods At the Uganda Cancer Institute (UCI), a 100-bed tertiary oncology center in Uganda,we conducted a cross-sectional survey using the Paré model. This model has 39 indicator variables (Likert-scale items) for measuring 9 latent variables that contribute to readiness. We analyzed data using partial least squares structural equation modeling (PLS-SEM). In addition, we collected comments that we analyzed by qualitative content analysis and sentiment analysis as a way of triangulating the Likert-scale survey responses. Results One hundred and forty-six clinical and non-clinical staff completed the survey, and 116 responses were included in the model. The measurement model showed good indicator reliability, discriminant validity, and internal consistency. Path coefficients for 6 of the 9 latent variables (i.e. vision clarity, change appropriateness, change efficacy, presence of an effective champion, organizational flexibility, and collective self-efficacy) were statistically significant at p < 0.05. The R 2 for the outcome variable (organizational readiness) was 0.67. The sentiments were generally positive and correlated well with the survey scores (Pearson's r = 0.73). Perceived benefits of an EHR included improved quality, security and accessibility of

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Characteristics and behaviours of formal versus informal nurse champions and their relationship to innovation success

Cited by 22 publications

References 56 publications

Contextual Factors and Mechanisms that Influence Sustainability: A Realist Evaluation of Two Provincially Scaled Evidence-Based Initiatives

Contextual Factors and Mechanisms that Influence Sustainability: A Realist Evaluation of Two Provincially Scaled Evidence-Based Initiatives

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

Assessment of organizational readiness to implement an electronic health record system in a low-resource settings cancer hospital: A cross-sectional survey

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