TEC programme data review and evaluation: options study

Incentives

Incentive structure

Work to incentivize the adoption and implementation of the clinical innovation

Mandate change

Have leadership declare the priority of the innovation and their determination to have it implemented

Disincentive structure

Provide financial disincentives for failure to implement or use the clinical innovations

Local context

Assess readiness

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

Tailor strategies

Tailor the implementation strategies to address barriers and leverage facilitators that were identified through earlier data collection

Local needs assessment

Collect and analyse data related to the need for the innovation

Measurement

Audit and feedback

Collect and summarize clinical performance data over a specified time period and give it to clinicians and administrators to monitor, evaluate, and modify provider behavior

Change records system

Change records systems to allow better assessment of implementation or clinical outcomes

Facilitate relay of clinical data to providers

Provide as close to real-time data as possible about key measures of process/outcomes using integrated modes/channels of communication in a way that promotes use of the targeted innovation

Academic partnerships

Partner with a university or academic unit for the purposes of shared training and bringing research skills to an implementation project

Purposely reexamine the implementation

Monitor progress and adjust clinical practices and implementation strategies to continuously improve the quality of care

Tools for quality monitoring

Develop, test, and introduce into quality-monitoring systems the right input—the appropriate language, protocols, algorithms, standards, and measures (of processes, patient/consumer outcomes, and implementation outcomes) that are often specific to the innovation being implemented

Information/sharing/best practice

Educational meetings

Hold meetings targeted toward different stakeholder groups ( e.g., providers, administrators, other organizational stakeholders, and community, patient/consumer, and family stakeholders) to teach them about the clinical innovation

Educational materials

Develop and distribute educational materials

Capture and share local knowledge

Capture local knowledge from implementation sites on how implementers and clinicians made something work in their setting and then share it with other sites

Educational outreach

Have a trained person meet with providers in their practice settings to educate providers about the clinical innovation with the intent of changing the provider's practice

Create a learning collaborative

Facilitate the formation of groups of providers or provider organizations and foster a collaborative learning environment to improve implementation of the clinical innovation

Partnership/coalition building

Build a coalition

Recruit and cultivate relationships with partners in the implementation effort

Obtain formal commitments

Obtain written commitments from key partners that state what they will do to implement the innovation

Develop resource sharing agreements

Develop partnerships with organizations that have resources needed to implement the innovation

Technology

Have technical assistance

Develop and use a system - local, centralised or both - to deliver technical assistance focused on implementation issues

Change technology infrastructure and equipment

Evaluate current configurations and adapt, as needed, the infrastructure and/or equipment to best deliver the targeted innovation

Piloting

Cyclical small tests of change

Implement changes in a cyclical fashion using small tests of change before taking changes system-wide. Tests of change benefit from systematic measurement, and results of the tests of change are studied for insights on how to do better. This process continues serially over time, and refinement is added with each cycle

Stage implementation scale up

Phase implementation efforts by starting with small pilots or demonstration projects and gradually move to a system wide rollout

Training

Ongoing training

Plan for and conduct training in the clinical innovation in an ongoing way

Use train-the-trainer strategies

Train designated clinicians or organizations to train others in the clinical innovation

Provide clinical supervision

Provide clinicians with ongoing supervision focusing on the innovation. Provide training for clinical supervisors who will supervise clinicians who provide the innovation

Shadow other experts and visit sites

Provide ways for key individuals to directly observe experienced people engage with or use the targeted practice change/innovation

Work with training colleges

Encourage educational institutions to train clinicians in the innovation

Make training dynamic

Vary the information delivery methods to cater to different learning styles and work contexts, and shape the training in the innovation to be interactive

Templates/manuals

Implementation glossary

Develop and distribute a list of terms describing the innovation, implementation, and stakeholders in the organizational change

Blueprint

Develop a formal implementation blueprint that includes all goals and strategies.

Funding

Fund and contract for the clinical innovation

Governments and other payers of services issue requests for proposals to deliver the innovation, use contracting processes to motivate providers to deliver the clinical innovation, and develop new funding formulas that make it more likely that providers will deliver the innovation

Champions

Identify and prepare champions

Identify and prepare individuals who dedicate themselves to supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization

Stakeholder engagement

Involve patients/consumers and family members

Engage or include patients/consumers and families in the implementation effort. Develop strategies with patients to encourage and problem solve around adherence

Obtain and use patients/consumers and family feedback

Develop strategies to increase patient/consumer and family feedback on the implementation effort

Prepare patients/consumers to be active participants

Prepare patients/consumers to be active in their care, to ask questions, and specifically to inquire about care guidelines, the evidence behind clinical decisions, or about available evidence-supported treatments

Leadership

Organize clinician 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

Promote adaptability

Identify the ways a clinical innovation can be tailored to meet local needs and clarify which elements of the innovation must be maintained to preserve fidelity

Provide clinical supervision

Provide clinicians with ongoing supervision focusing on the innovation. Provide training for clinical supervisors who will supervise clinicians who provide the innovation

Provide ongoing consultation

Provide ongoing consultation with one or more experts in the strategies used to support implementing the innovation

Recruit, designate, and train for leadership

Recruit, designate, and train leaders for the change effort

Promotion

Use mass media

Use media to reach large numbers of people to spread the word about the clinical innovation

Inform local opinion leaders

Inform providers identified by colleagues as opinion leaders or "educationally influential" about the clinical innovation in the hopes that they will influence colleagues to adopt it

Start a dissemination organization

Identify or start a separate organization that is responsible for disseminating the clinical innovation. It could be a for-profit or non-profit organization

Remind clinicians

Develop reminder systems designed to help clinicians to recall information and/or prompt them to use the clinical innovation

Specialist skills

Use an implementation advisor

Seek guidance from experts in implementation

Use a data expert

Involve, hire, and/or consult experts to inform management on the use of data generated by implementation efforts

Use advisory boards and workgroups

Create and engage a formal group of multiple kinds of stakeholders to provide input and advice on implementation efforts and to elicit recommendations for improvements