Specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory

Abstract

BackgroundThe use of implementation strategies is an active and purposive approach to translate research findings into routine clinical care. The Expert Recommendations for Implementing Change (ERIC) identified and defined discrete implementation strategies, and Proctor and colleagues have made recommendations for specifying operationalization of each strategy. We use empirical data to test how the ERIC taxonomy applies to a large dissemination and implementation initiative aimed at taking cardiac prevention to scale in primary care practice.MethodsEvidenceNOW is an Agency for Healthcare Research and Quality initiative that funded seven cooperatives across seven regions in the USA. Cooperatives implemented multi-component interventions to improve heart health and build quality improvement capacity, and used a range of implementation strategies to foster practice change. We used ERIC to identify cooperatives’ implementation strategies and specified the actor, action, target, dose, temporality, justification, and expected outcome for each. We mapped and compiled a matrix of the specified ERIC strategies across the cooperatives, and used consensus to resolve mapping differences. We then grouped implementation strategies by outcomes and justifications, which led to insights regarding the use of and linkages between ERIC strategies in real-world scale-up efforts.ResultsThirty-three ERIC strategies were used by cooperatives. We identified a range of revisions to the ERIC taxonomy to improve the practical application of these strategies. These proposed changes include revisions to four strategy names and 12 definitions. We suggest adding three new strategies because they encapsulate distinct actions that were not described in the existing ERIC taxonomy. In addition, we organized ERIC implementation strategies into four functional groupings based on the way we observed them being applied in practice. These groupings show how ERIC strategies are, out of necessity, interconnected, to achieve the work involved in rapidly taking evidence to scale.ConclusionsFindings of our work suggest revisions to the ERIC implementation strategies to reflect their utilization in real-work dissemination and implementation efforts. The functional groupings of the ERIC implementation strategies that emerged from on-the-ground implementers will help guide others in choosing among and linking multiple implementation strategies when planning small- and large-scale implementation efforts.Trial registrationRegistered as Observational Study at www.clinicaltrials.gov (NCT02560428).Electronic supplementary materialThe online version of this article (10.1186/s13012-019-0876-4) contains supplementary material, which is available to authorized users.

From novice to expert: a qualitative study of implementation facilitation skills

“…The Expert Recommendations for Implementing Change (ERIC) project created a taxonomy of discrete implementation strategies, one of which is facilitation [51]. Perry et al [54] tested the ERIC taxonomy in multiple large studies that applied practice facilitation, "a more specific type of implementation facilitation," to support implementation of evidence-based cardiovascular preventive care, and they further refined the ERIC taxonomy. The study found that facilitators did incorporate many other strategies into their efforts.…”

Implementing a social network intervention: can the context for its workability be created? A quasi-ethnographic study

“…This is also the case in relation to the strategy of building community connections and promoting patient involvement as part of implementation for SMS interventions. In terms of the intervention discussed here, the expected implementation outcomes for strategies included, establishing improved community connections and improved referrals to accessible patient resources [ 31 ]. What the study here shows is that in the instance of the original implementation strategy having to be abandoned, or the strategy not materialising as originally envisaged, making an intervention implementable emerges from network resilience and contingencies which arise as a result of attempts to make the intervention workable on the ground.…”

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

“…While the evidence on effective implementation strategies is growing, much remains unknown about how best to select and enact these strategies for a given context. Currently, such planning usually focuses on which implementation strategies to use, typically informed by knowledge of/hypotheses about likely implementation barriers [1,3,[9][10][11][12][13][14][15], existing evidence about the effectiveness of the strategies [1,3,9,[13][14][15][16], the experience of the implementation team [17], guidance from conceptual models [6,[18][19][20][21][22][23][24][25], and pragmatic concerns [1,3,9,15] including available resources [4,5,13,26]. However, these sources generally do not provide detailed guidance on how these strategies should be operationalized to maximize their impact.…”