Table 3 Specification overview of the multifaceted implementation and sustainment facilitation (ISF) Strategy
Discrete implementation strategies: Defining characteristic according to Proctor et al. [41] | Operational definition of key dimensions for each discrete implementation strategy | ||||||
|---|---|---|---|---|---|---|---|
Actor(s) | Actions(s) | Target(s) of the action | Temporality | Dose | Targeted implementation outcome(s) | Justification | |
K. Use an improvement and implementation advisor: Seek guidance from experts in implementation, including consultation with outside experts (e.g., university-affiliated faculty members, quality improvement experts, implementation professionals) | An individual with training and experience in assisting organizations with practice improvement and implementation efforts | The overarching implementation strategy that encompasses the other discrete implementation strategies listed below | An ASO’s designated staff working on the project (SWOP) team (2 BI staff and 2–4 leadership staff) Implementation readiness, implementation climate, leadership engagement | The initial kickoff meeting should be held within 1 month of completing the exploration phase | Fidelity (i.e., proficiency and implementation effectiveness) and sustainment | ||
L. Develop tools for quality improvement: Develop, test, and introduce quality-improvement tools with inputs (e.g., measures) specific to the innovation being implemented | An individual with training and experience in assisting organizations with practice improvement and implementation efforts | Decisional Balance Exercise; Performance Review, Evaluation, and Planning Exercise; Climate Evaluation and Optimization Exercise | SWOP team. Implementation readiness, implementation climate, leadership engagement | Finalization of tools for quality improvement (e.g., decisional balance worksheet) should be prior to the initial kickoff meeting | Fidelity (i.e., proficiency and implementation effectiveness) and sustainment | ||
M. Organize implementation team meetings: Develop and support teams of clinicians who are implementing the innovation and give them protected time to reflect on the implementation effort, share lessons learned, and support one another’s learning | An individual with training and experience in assisting organizations with practice improvement and implementation efforts | Meetings that enable direct interaction between the actors—implementation and sustainment facilitation (ISF) staff— and SWOP team | SWOP team. Implementation readiness, implementation climate, leadership engagement | First implementation team meeting should be held within 1 month of completing the exploration phase | Fidelity (i.e., proficiency and implementation effectiveness) and sustainment | ||
N. Identify and prepare champions: Cultivate relationships with people who will champion the clinical innovation and spread the word of the need for it | An individual with training and experience in assisting organizations with practice improvement and implementation efforts | Learning about and engaging with the SWOP team | SWOP team. Implementation readiness, implementation climate, leadership engagement | Identification and preparation of champions should begin during the process of organizing the initial implementation team meeting | fidelity (i.e., proficiency and implementation effectiveness) and sustainment | ||
O. Assess for readiness and identify barriers: Assess various aspects of an organization to determine its degree of readiness to implement, barriers that may impede implementation, and strengths that can be used in the implementation effort | An individual with training and experience in assisting organizations with practice improvement and implementation efforts | Utilization of the ISF exercises described above (L. Develop tools for quality improvement) | SWOP team. Implementation readiness, implementation climate, leadership engagement | Assessments of readiness and identification of barriers should begin during the process of organizing the initial implementation team meeting | Fidelity (i.e., proficiency and implementation effectiveness) and sustainment | ||
P. Conduct local consensus discussions: Include providers and other stakeholders in discussions that address whether the chosen problem is important and whether the clinical innovation to address it is appropriate | An individual with training and experience in assisting organizations with practice improvement and implementation efforts | Completion of an in-person, stakeholder-engagement and sustainment-planning meeting | SWOP team. Implementation readiness, implementation climate, leadership engagement | Should be held as soon as possible after the first implementation month has been completed | Fidelity (i.e., proficiency and implementation effectiveness) and Sustainment | ||
Q. Conduct cyclical small tests of change: Implement changes in a cyclical fashion using small tests of change | An individual with training and experience in assisting organizations with practice improvement and implementation efforts | Completion of study-act-plan-do cycles | SWOP team. Implementation readiness, implementation climate, leadership engagement | Should begin as soon as necessary | Fidelity (i.e., proficiency and implementation effectiveness) and sustainment | ||