The effectiveness of champions in implementing innovations in health care: a systematic review

Abstract

Background Champions have been documented in the literature as an important strategy for implementation, yet their effectiveness has not been well synthesized in the health care literature. The aim of this systematic review was to determine whether champions, tested in isolation from other implementation strategies, are effective at improving innovation use or outcomes in health care. Methods The JBI systematic review method guided this study. A peer-reviewed search strategy was applied to eight electronic databases to identify relevant articles. We included all published articles and unpublished theses and dissertations that used a quantitative study design to evaluate the effectiveness of champions in implementing innovations within health care settings. Two researchers independently completed study selection, data extraction, and quality appraisal. We used content analysis and vote counting to synthesize our data. Results After screening 7566 records titles and abstracts and 2090 full text articles, we included 35 studies in our review. Most of the studies (71.4%) operationalized the champion strategy by the presence or absence of a champion. In a subset of seven studies, five studies found associations between exposure to champions and increased use of best practices, programs, or technological innovations at an organizational level. In other subsets, the evidence pertaining to use of champions and innovation use by patients or providers, or at improving outcomes was either mixed or scarce. Conclusions We identified a small body of literature reporting an association between use of champions and increased instrumental use of innovations by organizations. However, more research is needed to determine causal relationship between champions and innovation use and outcomes. Even though there are no reported adverse effects in using champions, opportunity costs may be associated with their use. Until more evidence becomes available about the effectiveness of champions at increasing innovation use and outcomes, the decision to deploy champions should consider the needs and resources of the organization and include an evaluation plan. To further our understanding of champions’ effectiveness, future studies should (1) use experimental study designs in conjunction with process evaluations, (2) describe champions and their activities and (3) rigorously evaluate the effectiveness of champions’ activities. Registration Open Science Framework (https://osf.io/ba3d2). Registered on November 15, 2020.

Development and Validation of a Meta-Instrument for the Assessment of Functional Capacity, the Risk of Falls and Pressure Injuries in Adult Hospitalization Units (VALENF Instrument) (Part II)

“…In fact, the VALENF Instrument is currently being implemented in the electronic clinical records of the hospital where it was developed. Due to the reliability results, interventions based on previous studies are being carried out, such as including help text on how to assess and interpret the items in the programming [ 38 ], setting up a team of assistants that will help in the implementation of the VALENF Instrument [ 39 ], carry out specific training [ 40 ] or schedule reassessment alerts [ 41 ]. Future studies should explore the opinion of nurses on the usefulness and applicability of the VALENF Instrument and other similar tools that may begin to be developed.…”

Can clinician champions reduce potentially inappropriate medications in people living with dementia? Study protocol for a cluster randomized trial

“…Although there is a strong rationale for the use of a clinician champion as a de-implementation strategy [ 24 ], few studies have employed them to address low-value care, although Colla and colleagues identified strategies that champions might employ such as clinician education and provider feedback as effective [ 34 ]. Santos and colleagues recently completed a systematic review of the effectiveness of a clinician champion when implementing an innovation into health care settings [ 35 ]. Only one of the 35 studies included in the review was focused on de-implementing a low-value care service, that of urinary catheters in pediatric patients.…”

Systematic review of health literacy champions: Who, what and how?

“…However, there is surprisingly little research defining the concept of 'change champion,' and evaluating the impact of change champions on healthcare implementation efforts. Often research on champions is only descriptive in nature, lacking in detail, or the findings are embedded within broader, complex implementation efforts that cannot isolate the individual effect of the champions (Miech et al, 2018;Santos et al, 2022;Shea, 2021). To illustrate, two reviews on champions in healthcare implementation reported that the vast majority of articles only considered champions in terms of presence or absence (more than 90% of 199 articles (integrative review) (Miech et al, 2018), 71% of 35 articles (systematic review of quantitative research only) (Santos et al, 2022).…”

“…Often research on champions is only descriptive in nature, lacking in detail, or the findings are embedded within broader, complex implementation efforts that cannot isolate the individual effect of the champions (Miech et al, 2018;Santos et al, 2022;Shea, 2021). To illustrate, two reviews on champions in healthcare implementation reported that the vast majority of articles only considered champions in terms of presence or absence (more than 90% of 199 articles (integrative review) (Miech et al, 2018), 71% of 35 articles (systematic review of quantitative research only) (Santos et al, 2022). Santos and colleagues' (2022) systematic review of quantitative research related to healthcare champions reported that though champions were related to increased use of healthcare innovations at an organisational level (i.e.…”