Table 1.

Sustainment-explicit expert recommendations for implementing change (ERIC) (8–13) glossary.

Conceptual strategy category from original ERIC compilation (20)	Strategy number from original ERIC compilation (20)	Strategy name	Strategy definition (8, 13)	Specific phase(s) when the strategies could be considered and applied
Use evaluative and iterative strategies	4	Assess for readiness and identify barriers and facilitators	Assess various aspects of an organization $\text{and the broader context}$ to determine its degree of readiness to implement $\text{and sustain}$, barriers that may impede implementation $\text{and sustainment}$, and strengths that can be used in the implementation and $\text{sustainment}$ effort	Preparation, implementation and Sustainment
	5	Audit and provide 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	Preparation, Implementation and Sustainment
	New sustainment strategy	Communicate with stakeholders the continued impact of the EBP	Communicate data to external stakeholders, end-users and consumers to demonstrate the ongoing benefit, cost effectiveness or return on investment of the innovation with continued implementation.	Implementation, Sustainment
	14	Conduct 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	Implementation and Sustainment
	18	Conduct local needs assessment	Collect and analyze data related $\text{to the initial and ongoing need for and fit of}$ the innovation	All phases
	23	Develop a formal implementation blueprint	Develop a formal implementation blueprint that includes all goals and strategies. The blueprint should include the following: (1) aim/purpose of the implementation; (2) scope of the change (e.g., what organizational units are affected); (3) timeframe and milestones; and (4) appropriate performance/progress measures; $\left(5\right)\text{plan for maintenance and sustainment of the EBI once it has been implemented}.$ Use and update this plan to guide the implementation effort over time	Preparation, Implementation and Sustainment
	61	Stage implementation scale up	Phase implementation efforts by starting with small pilots or demonstration projects and gradually move to a system wide rollout $\text{while sustaining delivery of the EBP in the original sites}$	Implementation, Sustainment
	26	Develop and implement 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 $\text{and sustained}$	Preparation, Implementation and Sustainment
	27	Develop and organize quality monitoring systems	Develop and organize systems and procedures that monitor clinical processes and/or outcomes for the purpose of quality assurance and improvement	Preparation, implementation and sustainment
	46	Obtain and use patients/consumers and family feedback	Develop strategies to increase patient/consumer and family feedback on the implementation and $\text{sustainment}$ effort	Preparation, implementation and Sustainment
	56	Purposely reexamine the implementation	Monitor progress and adjust clinical practices and implementation strategies to continuously improve the quality of care	Implementation and Sustainment
	8	Centralize technical assistance	Develop and use a centralized system to deliver technical assistance focused on implementation $\text{and sustainment}$ issues	Preparation and Implementation and Sustainment
Provide interactive assistance	33	Facilitation	A process of interactive problem solving and support that occurs in a context of a recognized need for improvement and a supportive interpersonal relationship	All phases
	53	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	Implementation and Sustainment
	54	Provide local technical assistance	Develop and use a system to deliver technical assistance focused on implementation $\text{and sustainment}$ issues using local personnel	Preparation and Implementation and Sustainment
	51	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. $\text{Continue to assess and adapt the fit of the innovation to ensure that is appropriate and sustained if still relevant}.$	All phases
	63	Tailor strategies	Tailor the implementation $\text{or sustainment}$ strategies to address barriers and leverage facilitators that were identified through $\text{ongoing}$ data collection	Preparation, Implementation and Sustainment
	67	Use data experts	Involve, hire, and/or consult experts to inform management on the use of data generated by implementation $\text{and sustainment efforts}$	Preparation and Implementation and Sustainment
	68	Use data warehousing techniques	Integrate clinical records across facilities and organizations to facilitate implementation across systems, $\text{continually assess that they are still appropriate}$	Preparation, Implementation and Sustainment
	6	Build a coalition	Recruit, cultivate and $\text{maintain}$ relationships with partners in the implementation and $\text{sustainment}$ effort	All phases
Develop staekholder interrelationships	7	Capture and share local knowledge	Capture local knowledge from implementation sites on how implementers and clinicians made something work $\text{and continue to work}$ in their setting and then share it with other sites	Implementation and Sustainment
	17	Conduct local consensus discussions	Include local providers and other stakeholders in discussions that address whether the chosen problem is important and whether the clinical innovation to address it is appropriate $\text{and continues to be appropriate}$	Exploration and Sustainment
	40	Involve executive boards	Involve existing governing structures (e.g., boards of directors, medical staff boards of governance) in the implementation $\text{and sustainment}$ effort, including the review of data on implementation $\text{and sustainment}$ processes	All phases
	47	Obtain formal commitments	Obtain written commitments from key partners that state what they will do to implement the innovation $\text{and how they will support sustainment if it has the intended beneficial effects}$	Preparation
	Extension of strategy #47 explicit to sustainment	Re-affirm formal commitments	Revisit the written commitments obtained from key partners that state what they will do to implement and sustain the innovation. Assess whether these commitments are being upheld and whether new commitments are required to help sustain the innovation	Sustainment
	52	Promote network weaving	Identify, $\text{build and maintain}$ existing high-quality working relationships and networks within and outside the organization, organizational units, teams, etc. to promote information sharing, collaborative problem-solving, and a shared vision/goal related to implementing $\text{and sustaining}$ the innovation	All phases
	64	Use advisory boards and workgroups	Create and engage a formal group of multiple kinds of stakeholders to provide input and advice on implementation $\text{and sustainment}$ efforts and to elicit recommendations for improvements	All phases
	24	Develop academic partnerships	Partner with a university or academic unit for the purposes of shared $\text{and ongoing}$ training and bringing $\text{relevant}$ research skills to an implementation $\text{or sustainment}$ project	All phases
	25	Develop an implementation glossary	Develop and distribute a list of terms describing the innovation, implementation, and stakeholders in the organizational change	Preparation and Implementation
	36	Identify early adopters	Identify early adopters at the local site to learn from their experiences with the practice innovation	Exploration, Preparation and Implementation
	Extension of strategy #36 explicit to sustainment	Identify successful sustainers	Identify successful sustainer at the local site to learn from their experiences with the practice innovation	Sustainment
	38	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	Preparation and Implementation
	Extension of strategy #38 explicit to sustainment	Re-engage with local opinion leaders	Periodically re-engage with providers identified by colleagues as opinion leaders or “educationally influential” about the importance of continuing to deliver the practice innovation in the hopes that they will influence colleagues to sustain its use	Sustainment
	35	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 $\text{and continue to support sustainment}$	Preparation and Implementation and Sustainment
	45	Model and simulate change	Model or simulate the change that will be implemented prior to implementation	Exploration and Preparation
	48	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	Preparation and Implementation and Sustainment
	57	Recruit, designate, and train for leadership	Recruit, designate, train $\text{and retrain as necessary}$, leaders for the change effort	Preparation and Implementation and Sustainment
	65	Use an implementation advisor	Seek guidance from experts in implementation $\text{and sustainability}$	All phases
	72	Visit other sites	Visit sites where a similar implementation $\text{or sustainment}$ effort has been considered successful	Preparation, implementation and Sustainment
	15	Conduct 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	Preparation and Implementation and Sustainment
Train and educate stakeholders	16	Conduct educational outreach visits	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	Implementation and Sustainment
	29	Develop educational materials	Develop and format manuals, toolkits, and other supporting materials in ways that make it easier for stakeholders to learn about the innovation and for clinicians to learn how to deliver the clinical innovation	Preparation
	Extension of strategy #29 explicit to sustainment	Review and update educational materials	Review manuals, toolkits, and other supporting materials on how to deliver the clinical innovation $\text{and ensure they continue to be appropriate}$. Update the $\text{resources based on changing scientific evidence}$ as needed	Sustainment
	60	Shadow other experts	Provide ways for key individuals to directly observe experienced people engage with or use the targeted practice change/innovation	Implementation and Sustainment
	19	Conduct ongoing training	Plan for and conduct training in the clinical innovation in an ongoing way, $\text{including training of new staff and booster training for existing staff}$	Preparation and Implementation and Sustainment
	20	Create a learning collaborative	Facilitate the formation of groups of $\text{relevant stakeholders}$ or organizations and foster a collaborative learning environment to improve implementation $\text{and sustainment}$ of the clinical innovation	Preparation and Implementation and Sustainment
	31	Distribute educational materials	Distribute educational materials (including guidelines, manuals, and toolkits) in person, by mail, and/or electronically	Implementation and Sustainment
	43	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	Preparation and Implementation and Sustainment
	55	Provide ongoing consultation	Provide ongoing consultation with one or more experts in the strategies used to support implementing $\text{and sustaining}$ the innovation	Preparation and Implementation and Sustainment
	71	Use train-the-trainer strategies	Train designated $\text{personnel}$ or organizations to train others in the clinical innovation	Implementation and Sustainment
	73	Work with educational institutions	Encourage educational institutions to train clinicians in the innovation	Preparation and Implementation and Sustainment
	21	Create new clinical teams	Change who serves on the clinical team, adding different disciplines and different skills to make it more likely that the clinical innovation is delivered (or is more successfully delivered) $\text{in an ongoing way}$	Preparation and Implementation and Sustainment
Support clinicians	30	Develop resource sharing agreements	Develop partnerships with organizations that have resources needed to implement $\text{and sustain}$ the innovation	Preparation and Implementation and Sustainment
	32	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	Implementation and Sustainment
	58	Remind clinicians	Develop, $\text{review and update}$ reminder systems designed to help clinicians to recall information and/or prompt them to use the clinical innovation	Preparation and Implementation and Sustainment
	59	Revise professional roles	Shift and revise roles among professionals who provide care, and redesign job characteristics	Preparation and Implementation and Sustainment
	37	Increase demand	Attempt to influence the market for the clinical innovation to increase competition intensity and to increase the maturity of the market for the clinical innovation	Preparation and Implementation and Sustainment
Engage consumers	39	Intervene with patients/consumers to enhance uptake and adherence	Develop strategies with patients to encourage and problem solve around adherence	Preparation, implementation and Sustainment
	41	Involve patients/consumers and family members	Engage or include patients/consumers and families in the implementation $\text{and sustainment}$ efforts	All phases
	50	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	All phases
	69	Use mass media	Use media to reach large numbers of people to spread the word about the clinical innovation	Implementation and Sustainment
	1	Access new funding	Access new or existing money to facilitate the implementation $\text{and}/\text{or sustainment}$	All phases
Utilize financial strategies	2	Alter incentive/allowance structures	Work to incentivize the adoption, implementation $\text{and sustainment}$ of the clinical innovation	Preparation and Implementation and Sustainment
	3	Alter patient/consumer fees	Create fee structures where patients/consumers pay less for preferred treatments (the clinical innovation) and more for less-preferred treatments	Preparation, implementation and sustainment
	28	Develop disincentives	Provide financial $\text{or professional}$ disincentives for failure to implement or use the clinical innovations	Preparation and Implementation and Sustainment
	34	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 $\text{and sustain}$ the innovation	Preparation and Implementation and Sustainment
	42	Make billing easier	Make it easier to bill for the clinical innovation	Preparation, implementation and sustainment
	49	Place innovation on fee for service lists/formularies	Work to place the clinical innovation on lists of actions for which providers can be reimbursed (e.g., a drug is placed on a formulary, a procedure is now reimbursable)	Preparation, implementation and sustainment
	66	Use capitated payments	Pay providers or care systems a set amount per patient/consumer for delivering clinical care	Preparation, implementation and sustainment
	70	Use other payment schemes	Introduce, $\text{review and update}$ payment approaches (in a catch-all category) $\text{to support implementation and sustainment of the innovation}$	Preparation, implementation and sustainment
	9	Change accreditation or membership requirements	Strive to alter accreditation standards so that they require or encourage use of the clinical innovation. Work to alter membership organization requirements so that those who want to affiliate with the organization are encouraged or required to use the clinical innovation	Preparation, implementation and sustainment
Change infrastructure	10	Change liability laws	Participate in liability reform efforts that make clinicians more willing to deliver the clinical innovation	Preparation, implementation and sustainment
	11	Change physical structure and equipment	Evaluate $\text{periodically}$ current configurations and adapt, as needed, the physical structure and/or equipment (e.g., changing the layout of a room, adding equipment) to best accommodate the targeted innovation	Preparation and Implementation and Sustainment
	12	Change record systems	Change records systems to allow better assessment of implementation or clinical outcomes	Preparation and Implementation and Sustainment
	13	Change service sites	Change the location of clinical service sites to increase access	Preparation and Implementation and Sustainment
	22	Create or change credentialing and/or licensure standards	Create an organization that certifies clinicians in the innovation or encourage an existing organization to do so. Change governmental professional certification or licensure requirements to include delivering the innovation. Work to alter continuing education requirements to shape professional practice toward the innovation	Preparation and Implementation and Sustainment
	44	Mandate change	Have leadership declare the priority of the innovation and their determination to have it implemented $\text{and sustained}$	Preparation and Implementation $\text{and Sustainment}$
	62	Start a dissemination organization	Identify or start a separate organization that is responsible for disseminating $\text{and supporting the ongoing delivery of the}$ clinical innovation. It could be a for-profit or non-profit organization	Preparation and Implementation and Sustainment

NB: Categories, strategies and definitions are per the existing ERIC taxonomy (8, 13) with sustainment wording changes highlighted in red.