Champions in context: which attributes matter for change efforts in healthcare?

Bonawitz, Kirsten; Wetmore, Marisa; Heisler, Michele; Dalton, Vanessa K.; Damschroder, Laura J.; Forman, Jane; Allan, Katie; Moniz, Michelle H.

doi:10.1186/s13012-020-01024-9

Cited by 111 publications

(154 citation statements)

References 21 publications

(29 reference statements)

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“…Our results indicate that certain factors related to the implementation process and intervention characteristics appear to be specific to transitional care innovations. While the roles of middle managers [ 52 , 53 ] and champions [ 54 , 55 ] were indicated as facilitators to implementing general healthcare or long-term care (LTC) innovations, transition roles of frontline staff in LTC were key in facilitating the adoption and execution of TC innovations. Moreover, awareness of existing barriers in designing and tailoring TC innovations to the target population was seen as lacking across many of the studies we reviewed.…”

Section: Discussionmentioning

confidence: 99%

A myriad of factors influencing the implementation of transitional care innovations: a scoping review

et al. 2021

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Background Care transitions of older persons between multiple care settings are frequently hampered by various issues such as discontinuous care delivery or poor information transfer among healthcare providers. Therefore, several innovations have been developed to optimize transitional care (TC). This review aims to identify which factors influence the implementation of TC innovations. Methods As part of TRANS-SENIOR, an international innovative training and research network focusing on enhancing or avoiding care transitions, a scoping review was conducted. The five stages of the Arksey and O’Malley framework were followed. PubMed/MEDLINE, EMBASE, and CINAHL were searched, and eligible studies published between years 2000 and 2020 were retrieved. Data were extracted from the included studies and mapped to the domains and constructs of the Consolidated Framework for Implementation Research (CFIR) and Care Transitions Framework (CTF). Results Of 1537 studies identified, 21 were included. Twenty different TC innovations were covered and aimed at improving or preventing transitions between multiple care settings, the majority focused on transitions from hospital to home. Key components of the innovations encompassed transition nurses, teach-back methods, follow-up home visits, partnerships with community services, and transfer units. Twenty-five prominent implementation factors (seven barriers, seven facilitators, and eleven factors with equivalent hindering/facilitating influence) were shown to affect the implementation of TC innovations. Low organizational readiness for implementation and the overall implementation climate were topmost hindering factors. Similarly, failing to target the right population group was commonly reported as a major barrier. Moreover, the presence of skilled users but with restricted knowledge and mixed attitudes about the innovation impeded its implementation. Among the eminent enabling factors, a high-perceived advantage of the innovation by staff, along with encouraging transition roles, and a continuous monitoring process facilitated the implementation of several innovations. Other important factors were a high degree of organizational networks, engaging activities, and culture; these factors had an almost equivalent hindering/facilitating influence. Conclusions Addressing the right target population and instituting transition roles in care settings appear to be specific factors to consider during the implementation of TC innovations. Long-term care settings should simultaneously emphasize their organizational readiness for implementation and change, in order to improve transitional care through innovations.

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Section: Discussionmentioning

confidence: 99%

A myriad of factors influencing the implementation of transitional care innovations: a scoping review

et al. 2021

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“…Data were analyzed using framework analysis (34), an appropriate analytic approach for qualitative studies with speci c questions, a predesigned sample, and issues identi ed a priori (34). In framework analysis, data are sifted, charted and sorted in accordance with key issues and themes using seven stages (25).…”

Section: Resultsmentioning

confidence: 99%

“…'Blind invitations' to market CTM, without delivery partner organizations connecting with a champion, were thought by the CSU to undermine organizations' 'buy-in' and ultimate adoption of CTM. One positive characteristic of a champion is a 'participative leadership style' (34). Effective champions facilitated collective action in decision-making, and provided the tools needed to embed CTM into existing delivery systems; EDs and COs welcomed ongoing feedback.…”

Section: Discussionmentioning

confidence: 99%

“…Ongoing training and technical assistance/monitoring (e.g., phone or email check-ins) by the CSU, before and during CTM implementation, were also key to implementation success. These two capacity building strategies are central components of many implementation and scale-up frameworks (3,4,9,34). Importantly, the CSU built capacity across the entire CTM program life-cycle (29) training, recruitment and implementation.…”

Section: Discussionmentioning

confidence: 99%

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How Central Support Built Capacity to Deliver a Health Promoting Intervention for Older Adults

Sims‐Gould¹,

McKay²,

Franke³

2020

Preprint

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Background: A number of conceptual frameworks guide implementation and scale-up of evidence based (health promoting) interventions (EBIs). However, few studies delve into these frameworks to describe aspects of the delivery system--such as capacity building--that support successful scale-up. A standardized approach to capacity building is needed to develop new strategies and transfer successful strategies to new settings. Therefore, our objectives were to describe: (1) implementation strategies adopted by the central support system to build practitioners’ capacity to implement and scale-up a health promoting intervention (Choose to Move (CTM)), and (2) elements within capacity building strategies deemed essential to effectively implement CTM in diverse community contexts.Methods: CTM is a flexible, scalable, community-based health promoting physical activity (PA) and social connectedness intervention for older adults. In 2018-2020, eight health and social service societies, rural or remote municipalities, or community based organizations delivered CTM programs (n=22) that served older adults (n=322). We conducted in depth interviews with delivery partners (n=23), and a focus group with the central support system (n= 4) to assess key elements within capacity building strategies.Results: Capacity building strategies that delivery partners adopted were site selection/marketing, training, tools, technical assistance, peer networking, assessment and feedback. Essential elements that emerged within capacity building strategies were: a support system champion, activity coach skills, self efficacy and confidence; interactive assistance to answer questions and clarify materials. Key elements of central support that emerged were helping organizations-- adapt and tailor the EBI, leverage resources and strategies, maintain fidelity to the EBI, develop partnerships, train and monitor, learn from peers, increase awareness of older adult needs, increase PA programs for older adults and inform future organizational practices and processes. Central support provided a sounding board to organizations and were more successful if they were familiar with delivery partner resources and values, created buy-in and planned ahead.Conclusion: There is a key role for capacity building under the stewardship of central support units to promote implementation success. More clearly described capacity-building strategies that are designed and delivered to support implementation and scale-up would serve to advance the field, in future.

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“…23,27 Clinician champions will provide practice facilitation and feedback on performance. Clinician champions have been shown to facilitate change efforts by building organizational support; 28 and performance feedback can be effective in adopting evidence based practices. 23,29−31 To incentivize the uptake of the program, we aligned the program with each healthcare organization's internal performance metrics and when available, with quality improvement bonuses.…”

Section: Implementation Strategiesmentioning

confidence: 99%

Implementation of the Connect for Health Pediatric Weight Management Program: Study Protocol and Baseline Characteristics

Simione

Farrar-Muir

Mini

et al. 2020

Preprint

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Background: Promising approaches for reduction of childhood obesity include interventions such as Connect for Health, a scalable, primary care-based intervention to improve family-centered outcomes for children ages 2-12 years. Substantial gaps remain in the adoption of proven-effective interventions particularly in settings that care for low-income children. Methods: We used the Consolidated Framework for Implementation Research to examine contextual determinants of implementation of Connect for Health in four organizations that deliver primary care to low-income children in Boston, MA, Denver, CO, and Greenville, SC. The Connect for Health program includes (1) electronic health record (EHR)-based clinical decision support tools to guide clinicians; (2) family educational materials; and (3) text messages for parents to support behavior change. We used the RE-AIM framework to guide our mixed-methods evaluation. Using a quasi-experimental design, we will examine the effectiveness of stakeholder-informed strategies in supporting program adoption and child outcomes. At baseline, we abstracted EHR data from the organizations to describe characteristics of children ages 2-12 years with a BMI ≥ 85th percentile.Results: During the 15-month period prior to implementation, 26,161 children with a BMI ≥ 85th percentile ages 2-12 years were seen for a primary care visit. Across the organizations, 79% of children with a BMI ≥ 85th percentile had public insurance, 49% were Hispanic, and 18% were Black. Approximately 37% of children had a BMI ≥ 95th percentile and 15% had a BMI in the severe obesity category. Childhood obesity ICD-10 diagnostic codes were used more for children with obesity (44%) and severe obesity (60%) than children with overweight (17%); nutrition (7%) and physical activity (6%) counseling codes were seldom used. Referrals for weight management programs were less than 17% and less than 16% for nutrition services. Laboratory evaluations were ordered more often for children with obesity (39%) and severe obesity (64%) than children with overweight (29%)Discussion: A majority of children with overweight and obesity lacked recommended diagnosis codes, referrals, and laboratory evaluations for assessment and management of obesity and related co-morbidities. These findings suggest the need to augment current approaches to increase uptake of proven-effective weight management programs. Trial Registration: Clinicaltrials.gov, NCT04042493, Registered on August 2, 2019; https://clinicaltrials.gov/ct2/show/NCT04042493

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Champions in context: which attributes matter for change efforts in healthcare?

Cited by 111 publications

References 21 publications

A myriad of factors influencing the implementation of transitional care innovations: a scoping review

A myriad of factors influencing the implementation of transitional care innovations: a scoping review

How Central Support Built Capacity to Deliver a Health Promoting Intervention for Older Adults

Implementation of the Connect for Health Pediatric Weight Management Program: Study Protocol and Baseline Characteristics

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