Table 2-.
Strategies considered for applicability with corresponding original and collaboratively adapted strategy definitions for CBO-based BI screening and referral.
| Strategy | ERIC Definitions | BI project definitions |
|---|---|---|
| 1. Access new funding | Access new or existing money to facilitate the implementation | Co-designed by community-academic partnership per protocol |
| 2. Alter incentive/allowance structures | Work to incentivize the adoption and implementation of the clinical innovation | Explore the possibility of offering incentives to clients who actively participate in brain injury screening. |
| 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 | Not relevant to the project |
| 4. Assess for readiness and identify barriers and facilitators | 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 | Assess the readiness of community-based organizations (CBOs) to implement brain injury screening. This includes considering factors like staff expertise, resources, and infrastructure and identifying barriers, such as staff resistance or resource constraints, that may impede the successful rollout |
| 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 | Conduct regular audits of brain injury screening practices and provide feedback to community-based organizations (CBOs) to support quality improvement |
| 6. Build a coalition | Recruit and cultivate relationships with partners in the implementation effort | Co-designed by community-academic partnership per protocol |
| 7. 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 | Co-designed by community-academic partnership per protocol |
| 8. Centralize technical assistance | Develop and use a centralized system to deliver technical assistance focused on implementation issues | Establish a centralized system to deliver technical assistance for brain injury screening implementation |
| 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 | Not relevant to the project |
| 10. Change liability laws | Participate in liability reform efforts that make clinicians more willing to deliver the clinical innovation | Not relevant to the project |
| 11. Change physical structure and equipment | Evaluate 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 | Ensure that facilities are physically accessible and welcoming to clients and their families |
| 12. Change record systems | Change records systems to allow better assessment of implementation or clinical outcomes | Not relevant to the project |
| 13. Change service sites | Change the location of clinical service sites to increase access | Co-designed by community-academic partnership per protocol |
| 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 | Implement periodic changes using small tests of brain injury screening before taking changes system-wide |
| 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 | Host educational meetings or seminars within the organization to inform staff about the importance of brain injury screening and the associated benefits. |
| 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 | Conduct outreach visits to other community-based organizations to share knowledge and best practices related to brain injury screening. |
| 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 | Co-designed by community-academic partnership per protocol |
| 18. Conduct local needs assessment | Collect and analyze data related to the need for the innovation | Not relevant to the project |
| 19. Conduct ongoing training | Plan for and conduct training in the clinical innovation in an ongoing way | Offer continuous training opportunities to staff members to ensure they remain competent in conducting brain injury screenings. |
| 20. 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 | Co-designed by community-academic partnership per protocol |
| 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) | Establish dedicated teams or units specifically focused on brain injury screening and management |
| 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 | Not relevant to the project |
| 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. Use and update this plan to guide the implementation effort over time | Develop a detailed implementation plan that outlines the steps, responsibilities, and timelines for implementing brain injury screening throughout the community-based organizations (CBOs) |
| 24. Develop academic partnerships | Partner with a university or academic unit for the purposes of shared training and bringing research skills to an implementation project | Co-designed by community-academic partnership per protocol |
| 25. Develop an implementation glossary | Develop and distribute a list of terms describing the innovation, implementation, and stakeholders in the organizational change | Create a local implementation glossary that defines key terms and concepts specific to brain injury screening and referral |
| 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 | Create standardized protocols and tools for quality monitoring of brain injury screening that align with best practices |
| 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 | Set up an efficient system for tracking the progress of brain injury screening, including data collection, reporting, and analysis |
| 28. Develop disincentives | Provide financial disincentives for failure to implement or use the clinical innovations | Not relevant to the project |
| 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 | Create locally tailored educational materials that explain the purpose and process of brain injury screening. |
| 30. Develop resource sharing agreements | Develop partnerships with organizations that have resources needed to implement the innovation | Collaborate with neighboring facilities to establish resource-sharing agreements that facilitate the exchange of expertise, equipment, or personnel |
| 31. Distribute educational materials | Distribute educational materials (including guidelines, manuals, and toolkits) in person, by mail, and/or electronically | Disseminate educational materials to staff at community-based organizations, clients and their families through various channels, including reception area, websites, and community events. |
| 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 | Develop clear communication strategies to convey the potential risks and consequences of not participating in brain injury screening |
| 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 | Employ facilitators who can help organizational teams navigate the complexities of brain injury screening implementation. |
| 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 the innovation | Not relevant to the project |
| 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 | Identify individuals who are passionate about the importance of brain injury screening and willing to champion the cause. |
| 36. Identify early adopters | Identify early adopters at the local site to learn from their experiences with the practice innovation | Identify and engage staff within the community-based organizations (CBOs) who are enthusiastic about implementing brain injury screening. |
| 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 | Not relevant to the project |
| 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 | Identify and engage local opinion leaders and influential figures within the community who can help promote the benefits of brain injury screening |
| 39. Intervene with patients/consumers to enhance uptake and adherence | Develop strategies with patients to encourage and problem solve around adherence | Develop client support programs to address barriers to uptake and adherence, such as transportation issues or language barriers |
| 40. Involve executive boards | Involve existing governing structures (e.g., boards of directors, medical staff boards of governance) in the implementation effort, including the review of data on implementation processes | Not relevant to the project |
| 41. Involve patients/consumers and family members | Engage or include patients/consumers and families in the implementation effort | Engage clients and their family members as partners in the brain injury screening process from the outset |
| 42. Make billing easier | Make it easier to bill for the clinical innovation | Not relevant to the project |
| 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 | Use engaging and interactive training methods that encourage active participation and knowledge retention. |
| 44. Mandate change | Have leadership declare the priority of the innovation and their determination to have it implemented | Collaborate with regulators or policymakers to establish mandates or guidelines that require the integration of brain injury screening into standard practice for DVSA organizations. |
| 45. Model and simulate change | Model or simulate the change that will be implemented prior to implementation | Use simulation tools to illustrate the potential impact of brain injury screening on patient outcomes. |
| 46. Obtain and use patients/consumers and family feedback | Develop strategies to increase patient/consumer and family feedback on the implementation effort | Actively seek feedback from survivors of intimate partner violence regarding their experiences with brain injury screening |
| 47. Obtain formal commitments | Obtain written commitments from key partners that state what they will do to implement the innovation | Co-designed by community-academic partnership per protocol |
| 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 | Schedule regular meetings of implementation teams to share progress, exchange ideas, and address challenges. |
| 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) | Not relevant to the project |
| 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 | Educate clients about the importance of their active involvement in the screening process. |
| 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 | Encourage adaptability within the implementation process, allowing community-based organizations (CBOs) teams to tailor the screening approach to individual clients needs and settings |
| 52. Promote network weaving | Identify and build on 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 the innovation | Facilitate networking and collaboration among different community-based organizations (CBOs), departments, and organizations involved in brain injury screening |
| 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 | Implement a system of supervision to oversee the quality and consistency of brain injury screening |
| 54. Provide local technical assistance | Develop and use a system to deliver technical assistance focused on implementation issues using local personnel | Establish local technical assistance teams within community-based organizations (CBOs) to provide on-site support and guidance during the implementation of brain injury screening |
| 55. Provide ongoing consultation | Provide ongoing consultation with one or more experts in the strategies used to support implementing the innovation | Offer ongoing consultation and support to organization teams as they encounter challenges during the implementation of brain injury screening. |
| 56. Purposely reexamine the implementation | Monitor progress and adjust clinical practices and implementation strategies to continuously improve the quality of care | Monitor progress and adjust community-based organizations (CBOs) practices and implementation strategies to continuously improve the quality of brain injury screening implementation |
| 57. Recruit, designate, and train for leadership | Recruit, designate, and train leaders for the change effort | Identify and train local leaders who can assume leadership roles within the implementation teams |
| 58. Remind clinicians | Develop reminder systems designed to help clinicians to recall information and/or prompt them to use the clinical innovation | Implement regular reminders and notifications within the organization to conduct brain injury screenings when appropriate. |
| 59. Revise professional roles | Shift and revise roles among professionals who provide care, and redesign job characteristics | Redefine the roles and responsibilities of community-based organizations (CBOs) staff to incorporate brain injury screening as a standard practice |
| 60. Shadow other experts | Provide ways for key individuals to directly observe experienced people engage with or use the targeted practice change/innovation | Arrange for staff to shadow experienced experts in brain injury screening to gain hands-on experience and learn best practices. |
| 61. Stage implementation scale up | Phase implementation efforts by starting with small pilots or demonstration projects and gradually move to a system wide rollout | Phase implementation efforts by starting with small pilots or demonstration projects and gradually move to a system wide rollout |
| 62. 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 | Not relevant to the project |
| 63. Tailor strategies | Tailor the implementation strategies to address barriers and leverage facilitators that were identified through earlier data collection | Customize implementation strategies to align with the unique characteristics of the community-based organizations (CBOs), client population, and local culture |
| 64. 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 | Establish local advisory boards or workgroups composed of diverse stakeholders to provide input and guidance on the implementation process |
| 65. Use an implementation advisor | Seek guidance from experts in implementation | Seek guidance from an implementation advisor with expertise in brain injury screening. |
| 66. Use capitated payments | Pay providers or care systems a set amount per patient/consumer for delivering clinical care | Not relevant to the project |
| 67. Use data experts | Involve, hire, and/or consult experts to inform management on the use of data generated by implementation efforts | Co-designed by community-academic partnership per protocol |
| 68. Use data warehousing techniques | Integrate clinical records across facilities and organizations to facilitate implementation across systems | Implement data warehousing techniques to efficiently store, manage, and analyze large volumes of screening data |
| 69. Use mass media | Use media to reach large numbers of people to spread the word about the clinical innovation | Not relevant to the project |
| 70. Use other payment schemes | Introduce payment approaches (in a catch-all category) | Not relevant to the project |
| 71. Use train-the-trainer strategies | Train designated clinicians or organizations to train others in the clinical innovation | Train a select group within community-based organizations as trainers who can then educate their peers on the principles and practices of brain injury screening. |
| 72. Visit other sites | Visit sites where a similar implementation effort has been considered successful | Visit other organizations that have successfully implemented brain injury screening. |
| 73. Work with educational institutions | Encourage educational institutions to train clinicians in the innovation | Not relevant to the project |