Expert recommendations for implementing change (ERIC): protocol for a mixed methods study

Abstract

BackgroundIdentifying feasible and effective implementation strategies that are contextually appropriate is a challenge for researchers and implementers, exacerbated by the lack of conceptual clarity surrounding terms and definitions for implementation strategies, as well as a literature that provides imperfect guidance regarding how one might select strategies for a given healthcare quality improvement effort. In this study, we will engage an Expert Panel comprising implementation scientists and mental health clinical managers to: establish consensus on a common nomenclature for implementation strategy terms, definitions and categories; and develop recommendations to enhance the match between implementation strategies selected to facilitate the use of evidence-based programs and the context of certain service settings, in this case the U.S. Department of Veterans Affairs (VA) mental health services.Methods/DesignThis study will use purposive sampling to recruit an Expert Panel comprising implementation science experts and VA mental health clinical managers. A novel, four-stage sequential mixed methods design will be employed. During Stage 1, the Expert Panel will participate in a modified Delphi process in which a published taxonomy of implementation strategies will be used to establish consensus on terms and definitions for implementation strategies. In Stage 2, the panelists will complete a concept mapping task, which will yield conceptually distinct categories of implementation strategies as well as ratings of the feasibility and effectiveness of each strategy. Utilizing the common nomenclature developed in Stages 1 and 2, panelists will complete an innovative menu-based choice task in Stage 3 that involves matching implementation strategies to hypothetical implementation scenarios with varying contexts. This allows for quantitative characterizations of the relative necessity of each implementation strategy for a given scenario. In Stage 4, a live web-based facilitated expert recommendation process will be employed to establish expert recommendations about which implementations strategies are essential for each phase of implementation in each scenario.DiscussionUsing a novel method of selecting implementation strategies for use within specific contexts, this study contributes to our understanding of implementation science and practice by sharpening conceptual distinctions among a comprehensive collection of implementation strategies.

Methods to Improve the Selection and Tailoring of Implementation Strategies

“…Waltz et al 8 have recently used concept mapping to create conceptually distinct categories of strategies and determine their importance and feasibility according to experts in implementation science and clinical practice.…”

“…5–7 However, selecting the most appropriate implementation strategies is a complex task – one for which the literature has provided limited guidance. 8 This article outlines challenges associated with selecting implementation strategies, presents an argument for selecting and tailoring implementation strategies to address the unique needs of implementation efforts, and fills a gap in the literature by suggesting four potential methods that may be used to guide that process.…”

“…8 The evidence-base for implementation strategies has advanced considerably in recent years and numerous randomized trials have been conducted. 9 However, reviews and syntheses of that literature provide limited guidance regarding the types of strategies that may be effective in particular circumstances.…”

“…24 These intervention types may require the use of unique constellations of implementation strategies to ensure that they are integrated and sustained. 25 Contextual variation also has implications for selecting strategies, 8 as settings are likely to vary with regard to patient-level (e.g., fit between patient's cultural values and EBP, 26 patient “buy in” to EBP); 27 provider-level (e.g., attitudes toward EBPs 28 and specific behavior change mechanisms 7 ); organizational-level (e.g. culture and climate, 29 implementation climate 30 ); and system-level characteristics (e.g., policies and funding structures 31,32 ).…”

Getting the most out of knowledge and innovation transfer agents in health care: a qualitative study

“…[12][13][14] For example, practitioners are alleged to lack the time, motivation and capacity to use evidence 15,16 or are purported to be overwhelmed by the quantity of diverse evidence. [17][18][19] Research reports may lack relevance, can be opaque and verbose 20 and it can be a long time before they are released. 21 Some argue that research output is dominated by a biomedical focus on drugs, tests and devices.…”