Moving into action: We know what practices we want to change, now what? An implementation guide for health care practitioners - Appendices

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Table of Contents

• Appendix A: Reference List
• Appendix B: Glossary
• Appendix C: EIDM Process Algorithm (adapted from a draft algorithm developed in the Transition Office at McGill University Health Centre)
• Appendix D: Factors influencing health care behaviours and intentions: A theoretical Model
• Appendix E: Barriers, facilitators and implementation strategies spreadsheet tool
• Appendix F: Examples of barriers and facilitators
• Appendix G: Questions to assess barriers and facilitators
• Appendix H: Implementation checklist tool

Appendix A: Reference List

The ADAPTE Collaboration. (2009). The ADAPTE process: Resource toolkit for guideline adaptation, Version 2.0. Retrieved online

Ajzen, I. (1991). The theory of planned behaviour. Organizational Behavior and Human Decision Processes, 50, 170-211.

Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, N.J.: Pretence-Hall.

Bero, L.A., Grilli, R., Grimshaw, J.M., Harvey, E., Oxman, A.D. & Thomson, M. (1998). Closing the gap between research and practice: An overview of systematic reviews of interventions to promote the implementation of research findings. British Medical Journal, 315, 465-468.

Brett, J.L. (1989). Use of nursing practice research findings. Nursing Research, 36, 344-349.

Brouwers, M., Kho, M.E., Browman, G.P., Burgers, J.S., Cluzeau, F., Feder, G., … Zitzelsberger, L. for the AGREE Next Steps Consortium. (2010). AGREE II: Advancing guideline development, reporting and evaluation in healthcare. Canadian Medical Association Journal. Available online July 5, 2010. doi:10.1503/cmaj.090449

Ciliska, D. (2009). Introduction to evidence-informed decision making. Canadian Institutes of Health Research. Retrieved online

Coulter, A. & Ellins, J. (2007). Effectiveness of strategies for informing, educating, and involving patients. British Medical Journal, 335, 24-27.

Coyle, L.A. & Sokop, A.G. (1990). Innovation adoption behavior among nurses. Nursing Research, 39, 176-180.

Cummings, GG, Hutchison, AM, Scott, SD, Norton, PG, Estabrooks, CA (2010). The relationship between characteristics of context and research utilization in a pediatric setting. BMC Health Services Research, 10: 168.

Davies, B., Edwards, N., Ploeg, J., Virani, T., Skell, J. & Dobbins, M. (2006). Determinants of the sustained use of research in nursing: Final report. Canadian Health Services Research Foundation & Canadian Institutes for Health Research: Ottawa, ON.

Denis, J-L., Hebert, Y., Langley, A., Lozeau, D. & Trottier, L-H. (2002). Explaining diffusion patterns for complex health care innovations. Health Care Management Review, 27, 60-73.

Dogherty, E.J., Harrison, M.B., & Graham, I.D. (2010). Facilitation as a role and process in achieving evidence-based practice in nursing: A focused review of concept and meaning. Worldviews on Evidence-Based Nursing, 7 (2), 76-89.

Dogherty, E.J., Harrison, M.B., Baker, C., & Graham, I.D. (2012). Following a natural experiment of guideline adaptation and early implementation: a mixed-methods study of facilitation. Implementation Science, 7,9.

Drenkard, K. (2010). The business case for Magnet ®. JONA: The Journal for Nursing Administration, 40, 263-271. doi: 10.1097/NNA.0b013e3181df0fd6

Dulko, D. (2007). Audit and feedback as a clinical practice guideline implementation strategy: A model for acute care nurse practitioners. Worldviews on Evidence-Based Nursing, 4, 200-209.

Fishbein, M. & Ajzen, I. (1975). Belief, attitude, intention and behaviour: An introduction to theory of research. Reading, MA: Addison-Wesley.

Flodgren, G., Parmelli, E., Doumit, G., Gattellari, M., O'Brien, M.A., Grimshaw, J. & Eccles, M.P. (2007). Local opinion leaders: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews, 1. CD000125. doi: 10.1002/14651858.CD000125.pub3

Forsetlund, L., Bjørndal, A., Rashidian, A., Jamtvedt, G., O'Brien, M.A., Wolf, F.,… Oxman, A.D. (2009). Continuing education meetings and workshops: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews, 2, CD003030. doi: 10.1002/14651858.CD003030.pub2

Foy, R., Eccles, M.P., Jamtvedt, G., Young, J., Grimshaw, J.M. & Baker, R. (2005). What do we know about how to do audit and feedback? Pitfalls in applying evidence from a systematic review. BMC Health Services Research, 5, 50. doi: 10.1186/1472-6963-5-50.

Gifford, W., Davies, B., Edwards, N., Griffin, P. & Lybannon, V. (2007). Managerial leadership for nurses' use of research evidence: An integrative review of the literature. Worldviews on Evidence-Based Nursing, 4, 126-145.

Gifford, W., Davies, B., Tourangeau, A. & Lefebre, N. (2011). Developing team leadership to facilitate guideline utilization: Planning and evaluating a 3-month intervention strategy. Journal of Nursing Management, 19, 121-132.

goal. (n.d.). Collins English Dictionary - Complete & Unabridged 10th Edition. Retrieved online

Godin, G., Bélanger-Gravel, A., Eccles, M. & Grimshaw, J. (2008). Healthcare professionals' intention and behaviours: A systematic review of studies based on social cognitive theories. Implementation Science, 3, 36-48.

Goossens, A., Bossuyt, P.M.M. & de Haan, R.J. (2008). Physicians and nurses focus on different aspects of guidelines when deciding whether to adopt them: Application of conjoint analysis. Medical Decision Making, 28, 138-145. doi: 10.1177/0272989X07308749

Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W. & Robinson, N. (2006), Lost in knowledge translation: Time for a map? Journal of Continuing Education in the Health Professions, 26, 13–24. doi: 10.1002/chp.47

Graham, I.D. & Tetroe, J.M. (2010). The knowledge to action framework. In J. Rycroft-Malone & T. Bucknall (Eds.), Models and Frameworks for Implementing Evidence-Based Practice: Linking Evidence to Action (pp. 207-221). West Sussex, UK: Wiley-Blackwell.

Grant, M.J. & Booth, A. (2009). A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information and Libraries Journal, 26, 91-108.

Gravel, K., Legare, F. & Graham, I.D. (2006). Barriers and facilitators to implementing shared decision-making in clinical practice: A systematic review of health professionals' perceptions. Implementation Science, 1, 16-28. doi: 10.1186/1748-5908-1-16
Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P. & Kyriakidou, O. (2004). Diffusion of innovations in service organizations. The Milbank Quarterly, 82, 581-629.

Grimshaw, J.M., Thomas, R.E., MacLennan, G., Fraser, C., Ramsay, C.R. & Vale, L., Donaldson, C. (2004). Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment, 8, 1-84.

Grol, R., Dalhuijsen, J., Thomas, S., in 't Veld., C., Rutten., G. & Mokkink, H. (1998). Attributes of clinical guidelines that influence use of guidelines in general practice: observational study. BMJ, 317, 858-861.

Grol, R., Wensing, M., & Eccles, M. (2005). Improving patient care: The implementation of change in clinical practice. Philadelphia, PA: Elsevier Limited.

Harrison, M.B. & van den Hoek, J. for the Canadian Guideline Adaptation Study Group. (2011). CAN-IMPLEMENT©: A Guideline Adaptation and Implementation Planning Resource. Queen's University School of Nursing and Canadian Partnership Against Cancer, Kingston, Ontario. Retrieved online

Harrison, M.B., Legare, F., Graham, I.D. & Fervers, B. (2010). Adapting clinical practice guidelines to local context and assessing barriers to their use. Canadian Medical Association Journal, 182, E78-84.

Harvey, G., Loftus-Hills, A., Rycroft-Malone, J., Titchen, A., Kitson, A., McCormack, B., Seers, K. (2002). Getting evidence into practice: The role and function of facilitation. Journal of Advanced Nursing, 37 (6, 577-588.

Harvey, G. & Wensing, M. (2003). Methods for evaluation of small scale quality improvement projects. Quality and Safety in Health Care, 12, 210-214.

Health Quality Council. (Accessed March 20, 2011). The model for improvement. Retrieved online

Hinoul, P., Goosens, A. & Roovers, J.P. (2010). Factors determining the adoption of innovative needle suspension techniques with mesh to treat urogenital prolapse: A conjoint analysis study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 151, 212-216.

Information Services-University of Kent. (Accessed April 26, 2011). Critical appraisal of the journal literature. Retrieved online

Institute for Healthcare Improvement. (Accessed March 15, 2011). Testing changes. Retrieved online

Jamtvedt, G., Young, J.M., Kristoffersen, D.T., O'Brien, M.A. & Oxman, A.D. (2006). Audit and feedback: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews, 2, CD000259. doi: 10.1002/14651858.CD000259.pub2

Kauth, M.R., Sullivan, G., Blevins, D., Cully, J.A., Landes, R.D., Said, Q., & Teasdale, T.A. (2010). Employing external facilitation to implement cognitive behavioral therapy in VA clinics: a pilot study. Implementation Science, 5: 75.

Kitson, A., Rycroft-Malone, J., Harvey, G., McCormack, B. Seers, K. & Titchen, A. (2008). Evaluating the successful implementation of evidence into practice using the PARIHS framework: Theoretical and practical challenges. Implementation Science, 3, 1-13. doi: 10.1186/1748-5908-3-1

Kitson, A. & Straus, S.E. (2010). The knowledge-to-action cycle: Identifying the gaps. Canadian Medical Association Journal, 182, E73-E77.

KT Clearinghouse. (Accessed March 17, 2011). The knowledge-to-action cycle. Canadian Institutes of Health Research. Retrieved online

Knowledge Utilisation Colloquium. (2011). Retrieved online

Langley, A. & Denis, J.L. (2011). Beyond evidence: The micropolitics of improvement. British Medical Journal Quality & Safety, 20(Suppl 1), i43-i46. doi: 10.1136/bmjqs.2010.046482

Latimer, M.A., Johnston, C.C., Ritchie, J.A., Clarke, S.P. & Gillin, D. (2009). Factors affecting delivery of evidence-based procedural pain care in hospitalized neonates. Journal of Obstetric, Gynecologic and Neonatal Nursing, 38, 182-194. doi: 10.1111/j.1552-6909.2009.01007.x

McKleroy, V.S., Galbraith, J.S., Cummings, B., Jones, P., Harshbarger, C., Collins, C., … ADAPT team. (2006). Adapting evidence-based behavioural interventions for new settings and target populations. AIDS Education and Prevention, 18(Suppl A), 59-73.

Nasser, M., Oxman, A.D., Paulsen, E., & Fedorowicz, Z. (2007). Local consensus processes: effects on professional practice and health care outcomes (Protocol). Cochrane Database of Systematic Reviews, 1, CD003165. doi: 10.1002/14651858.CD003165.pub3.

National Collaborating Centre for Methods and Tools (Accessed March 17, 2011). Introduction to evidence informed decision making. Retrieved online

Newhouse, R.P. (2007). Creating infrastructure supportive of evidence-based nursing practice: Leadership strategies. Worldviews on Evidence Based Nursing 4, 21-29.

NHS institute for innovation and improvement (accessed July 11, 2011). Sustainability. Ensuring continuity in improvement. Retrieved online

O'Brien M.A., Rogers, S., Jamtvedt, G., Oxman, A.D., Odgaard-Jensen, J., Kristoffersen, D.T., … Harvey, E. (2007). Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews, 4, CD000409. doi: 10.1002/14651858.CD000409.pub2

O'Connor, A. (2009). Patient-mediated interventions. In SE Straus, J Tetroe & ID Graham (Eds), Knowledge translation in health care: Moving from evidence into practice. West Sussex, England: Blackwell Publishing Ltd.

Pan, I. & Dendukuri, N. (2010, April 28). Efficacy and cost-effectiveness of a gentamicin-loaded collagen sponge as an adjuvant antibiotic prophylaxis for colorectal surgery. Retrieved online

Ploeg, J., Skelly, J., Rowan, M., Edwards, N., Davies, B., Grinspun, D. …Downey, A. (2010). The role of nursing best practice champions in diffusing practice guidelines: A mixed methods study. Worldviews on Evidence-Based Nursing, 7, 238-251. doi: 10.1111/j.1741-6787.2010.00202.

Prochaska, J.O. & Velicer, W.F. (1997). The transtheoretical model of health behaviour change. American Journal of Health Promotion, 12, 38-48.

Registered Nurses Association of Ontario (2002). Crisis Intervention. Toronto, Canada: Registered Nurses Association of Ontario.

Registered Nurses Association of Ontario (2002). Toolkit: Implementation of clinical practice guidelines. Toronto, Canada: Registered Nurses' Association of Ontario.

Registered Nurses Association of Ontario (n.d.) Champions. Retrieved online.

Rogers, Everett M. (2003). Diffusion of innovations. (5th ed.). New York, NY: Free Press.

Rycroft-Malone, J. (2004). The PARIHS framework-A framework for guiding the implementation of evidence-based practice. Journal of Nursing Care Quality, 19, 297-304.

Rycroft-Malone, J., Harvey, G., Seers, K., Kitson, A., McCormack, B. & Titchen, A. (2004). An exploration of the factors that influence the implementation of evidence into practice. Journal of Clinical Nursing, 13, 913–924.

Shojania, K.G., Jennings, A., Mayhew, A., Ramsay, C., Eccles, M. & Grimshaw, J. (2010). Effect of point-of-care computer reminders on physician behaviour: A systematic review. Canadian Medical Association Journal, 182, E216-E225.

Squires, J.E., Estabrooks, C.A., Gustavsson, P. & Wallin, L. (2011). Individual determinants of research utilization by nurses: A systematic review update. Implementation Science, 6, 1-21.

Squires, J.E., Hutchinson, A.M., Bostrom, A., O'Rourke, H.M., Cobban, S.J. & Estabrooks, C.A. (2011). To what extent do nurses use research in clinical practice? A systematic review. Implementation Science, 6, 21-37. doi:10.1186/1748-5908-6-21

Stetler, C.B. (2002). Evidence-based practice and the use of research: A synopsis of basic concepts & strategies to improve care. Amherst, MA: Nova Foundation.

Stetler, C.B., Legro, M.W., Rycroft-Malone, J., Bowman, C., Curran, G., Guihan, M., Hagedorn, H., Pineros, S., Wallace, C.M. (2006). Role of "external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration. Implementation Science, 1:23 doi: 10.1186/1748-5908-1-23

Stetler, C.B., Ritchie, J.A., Rycroft-Malone, J., Schultz, A.A. & Charns, M.P. (2009). Institutionalizing evidence-based practice: An organizational case study using a model of strategic change. Implementation Science, 4, 78-97. doi: 10.1186/1748-5908-4-78

Straus, S., Tetroe, J., & Graham, I.D. (Eds.). (2009). Knowledge translation in health care: Moving from evidence to practice. West Sussex, England: Blackwell Publishing Ltd.

Straus, S. E., Tetroe, J., Graham, I.D., Zwarenstein, M., Bhattacharyya, O. & Shepperd, S. (2010). Monitoring use of knowledge and evaluating outcomes. Canadian Medical Association Journal, 182, E94-98.

Thedacare Centre for Healthcare Values. (2011). Mission, vision and values. Retrieved online

Titler, M.G. (2002). Toolkit for promoting evidence-based practice. Iowa City, IA: Research, Quality and Outcomes Management. Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics.

Triandis, H.C. (1980). Values, attitudes and interpersonal behaviour. In M.M. Page (ed.), Nebraska symposium on motivational beliefs, attitudes and values volume 1 (195-259). Lincoln, NE: University of Nebraska Press.

Turoff, M. & Linstone, H.A. (2002). The Delphi method: Techniques and applications. Retrieved online

Woo, S., Berta, W. & Baker, G.R. (2009). Role of champions in the implementation of patient safety practice change. Healthcare Quarterly, 12, 123-128.

Zayim, N., Yildirim, S., & Saka, O. (2006). Technology adoption of medical faculty in teaching: Differentiating factors in adopter categories. Educational Technology & Society, 9 (2), 213-222.

Appendix B: Glossary

Adapting the evidence: Existing evidence is evaluated and customized to fit the local context through a systematic process.

ADAPTE process: "…a systematic approach to adapting guidelines produced in one setting for use in a different cultural and organization context. The process has been designed to ensure that the adapted guideline not only addresses specific health questions relevant to the context of use but also is suited to the needs, priorities, legislation and resources in the target setting."

Barrier: A factor that may inhibit implementation.

Business case: "A proposal that can assist […] in presenting the reasoning for beginning a change project or group of tasks. […]The business case includes the reason for the project, the expected business results and benefits, and the costs and the risks. […] The case serves as a way to capture knowledge, functions as a basis for receiving funding and approval, helps prioritize the project against other competing initiatives that might also require funding, and secures a consistent message to all key stakeholders in the process."

Champion: "…champions can take many different roles such as bringing awareness of best practices to their organization, influencing groups and committees to consider these best practices, mobilizing, coordinating, and facilitating the training and development of professional staff in best practice guideline implementation etc."

Clinical practice guideline: Systematically developed statements of the recommended best practice in a specific clinical area, designed to provide direction to the practitioners in their practice.

Delphi Method: "Method for structuring a group communication process…to deal with a complex problem." This may involve creating a questionnaire that is then sent to a larger group. The results are then summarized and a new questionnaire is formed for the respondents to evaluate the original answers. This can occur until a consensus is formed.

Evidence: "credible verifiable data, facts, or information that have been systematically obtained." Evidence can be based on research findings, local data, consensus of recognized experts/national or international standards, patient preferences, or clinical expertise. For the purposes of this document a preference is made for research based knowledge.

Facilitator: A factor that may enhance implementation.

Focus Groups: Discussion and group interviews to elicit information about a specific topic.

Goal: "The aim or object towards which an endeavour is directed. " It is a concrete, observable and measureable target that you are trying to achieve, usually within a specific time frame.

Implementation: The process by which knowledge is applied to a setting.

Innovation: An idea, practice or object that is perceived as new by an individual or other unit of adoption.

Knowledge to Action Framework: "…based on a concept analysis of 31 planned action theories, was developed to help make sense of […] 'knowledge translation' or 'implementation' by offering a holistic view of the phenomenon by integrating the concepts of knowledge creation and action."

Opinion Leaders: "…informal leaders from the local healthcare setting who are viewed as important and respected sources of influence among their peer group."

Outcomes: The effects of your intervention and practice change on specific outcomes. These should include patient outcomes (e.g.: Lower infection rates). They may also include process outcomes such as specific rates of targeted behaviours; provider outcomes such as reduced turnover, or organizational outcomes such as hospital accreditation.

PARIHS framework: The framework comprises three elements: evidence, context and facilitation where successful implementation is function of these and their interrelationships. This framework can be used as a practical tool by clinicians in the local setting or in research.

Plan, Do, Study, Act (PDSA) Cycle: "…shorthand for testing a change, by planning it, trying it, observing the results, and acting on what is learned."

Stakeholders (taskforce or other organized group): A special committee with an expressed purpose, made up of individuals or groups that have an interest in, or are directly or indirectly affected by the implementation process.

Sustainability: "the degree to which an innovation continues to be used, after initial efforts to secure adoption is completed" (Rogers 2005, pg. 429).

Systematic Review: "seeks to systematically search for, appraise and synthesise research evidence [primary studies], often adhering to the guidelines."

Appendix C: EIDM Process Algorithm (adapted from a draft algorithm developed in the Transition Office at McGill University Health Centre)

This algorithm provides an example of a graphic depiction of the Evidence Informed Decision Making Process that outlines decision points in five inter-dependent phases for implementation and gives the planner an opportunity to consider the Local Resources, including the Tools and Supports, that might be required or available to assist in implementation. The algorithm refers to five phases: Identifying the practice, searching and appraising the evidence, adapting to the local context, implementing the change, and evaluating.

Identifying the practice: first identify the clinical issue and them identify a team to review clinical practice. The team should include a project lead, team members and stakeholders

Searching and appraising the evidence: first formulate a question to guide the review of the evidence, search the literature, assemble relevant research and literature, appraise and synthesise research for use in practice. Ask if there is sufficient knowledge to guide practice.

If the answer is no, then consult other types of evidence, conduct research, or consider other methods to determine what the practice should be.

If the answer is yes, then proceed to the next phase.

Adapting to local context: Consider the acceptability and applicability of the proposed practice, write an evidence-informed practice document and recommendations (eg adapted clinical practice guidelines), assess barriers and faciltators of implementation in this setting.

Implementing the change: Plan implementation strategies and test on a small scale. Ask if the practice change is appropriate for full deployment.

If the answer is no, then modify the implementation plan as needed

If the answer is yes, then implement the practice change.

Evaluating: Monitor and evaluate the outcomes, disseminate the results, sustain the change.

Appendix D: Factors influencing health care behaviours and intentions: A theoretical Model

Reproduced with permission from Implementation Science 2008, 3, 36-48.

This figure, reproduced here with permission from Implementation Science, volume 3 was published in 2008 by Godin and colleagues. The diagram identifies possible factors that could influence the intention and behaviour of health professionals. These factors were identified through a systematic review of studies that used social cognitive theories to explain healthcare behaviour.

The determinants of professionals' intention to adopt a particular behaviour are their beliefs about consequences, social influences, moral norm, role and identity, and the characteristics of the health profressionals. The intention to adopt the behaviour is influenced by the professionals' beliefs about their capabilities and their habits and past behaviours. Together, these three influence the actual behaviour.

Appendix E: Barriers, facilitators and implementation strategies spreadsheet tool

Appendix F: Examples of barriers and facilitators

Adapted from KT Clearinghouse, CIHR and Implementation Science 2006, 1, 16-28.

Appendix G: Questions to assess barriers and facilitators

These can be used to assess barriers and facilitators with individual practitioners or formal leaders through:

• Informal discussions or conversations with individuals
• Semi-structured individual interviews
• Focus groups
• Following a presentation to introduce the innovation and group discussion
• A paper based survey

The answers will help you consider which implementation strategies might be most appropriate.

Adapt the questions so that they are specific to your innovation and health practitioner (adapted from Brett, 1989):

1. Have you heard or read about the innovation?
2. Have you observed this innovation in use?
3. What do you know about the innovation?
4. Do you already use this innovation?
5. Do you believe this innovation to be appropriate for this setting? Why or why not?
6. Do you think this innovation fits with your role (as a nurse, physician, physical therapist etc…)?
7. Do you think the innovation will lead to improved patient outcomes?
8. Do you feel you have the skills/training needed to carry out the innovation?
9. Do you think that there are enough resources (time, financial, space, personnel) to carry out the innovation?
10. Is this innovation important to you? To your colleagues? To the leadership group? To your organization? To the patients and families?

Appendix H: Implementation checklist tool

Checklist

• A question or concern came up in my practice or practice setting.
  • Stakeholders were assembled to address the question and to review the evidence.
• Evidence for an innovation or practice change was found or created and reviewed.
  • The strength of the evidence was appraised.
  • The best evidence (one or more sources) was found.
• The gaps between the evidence and actual practice were identified through measurement.
  • Baseline data was collected in my practice setting about the actual state of practice at present.
  • A decision was made whether this concern is relevant enough to warrant moving to implement a change, based on the findings.
  • Goals for the practice change are written and are measurable.
  • The target for the behaviour change was determined. (Who? Where? When? What? How long?)
• The evidence was adapted to my local setting.
  • The source of evidence was identified.
  • The recommendations were evaluated against evidence.
  • The stakeholders were involved.
  • The recommendations were developed into a user friendly format for my setting.
• Barriers and facilitators were identified in my setting.
  • A spreadsheet was created.
  • Preparations and considerations were made prior to an assessment of barriers and facilitators.
  • A strategy or strategies to asses barriers and facilitators were chosen.
  • Barriers and facilitators were assessed.
  • The most relevant and influential barriers and facilitators as targets for implementation were determined.
• Implementation strategies were used to target goals, barriers and to enable facilitators of change.
  • The most relevant and influential barriers and facilitators in my setting were reviewed.
  • Implementation strategies were considered for use in my setting.
  • Implementation strategies were organized in a spreadsheet.
  • The plan was discussed with the stakeholders and adjustments were made.
  • An implementation plan was made.
  • Methods of monitoring and ongoing support during the trial period were created. Adjustments were made as needed.
  • Successes were built on by expanding the implementation (to the objective initially set out.)
• Outcomes were monitored.
• The outcomes for implementation were evaluated.
• Practice change was sustained over time.

Date modified:

2012-09-04