Table 6.
Context–mechanism–outcome configurations for implementation strategies aligning with Organisational Readiness Theory. The broad context is for individual and collective implementers of large-scale hospital interventions
| Implementation strategy (ERIC wording) | Context | Mechanism | Outcome | Component of Organisational Readiness Theory | Evidence from the literature on large-scale hospital projects |
| Baseline audit results shared with implementers (Audit and provide feedback) |
When implementers see their baseline audit results and perceive that current practice is not optimal | …a tension for change is developed leading to | … members being more likely to engage in the project | Appropriateness Personal valence |
Support10 47 |
| Clear evidence provided on effectiveness of intervention (Audit and provide feedback) |
When implementers see clear evidence that the intervention is effective and will improve patient care | … implementers value the change | … members are more likely to engage in the project | Appropriateness Personal valence |
Support48 |
| When implementers do not see clear evidence of the effectiveness of the intervention / do not see the link with improved outcomes for patients | … implementers do not value the change | … members are less likely to engage in the project | Appropriateness Personal valence |
Limited support39 40 | |
| Sharing the positive experience of early adopters of the intervention (Create a learning collaborative) |
When implementers are told of the success of early adopters at other sites | …a tension for change is developed and perceptions of feasibility at their own site will improve leading to | … members being more likely to engage in the project | Appropriateness Personal valence |
Support49 |
| A lead-in period is provided when local needs are assessed (Conduct local needs assessment) |
When local needs of implementers are assessed before any proposed change | … confidence in capability rises, resulting in greater levels of commitment and collaboration | … resulting in more effective implementation | Appropriateness Change-specific efficacy |
Support 10 31 38 50–52 |
| When local needs are not accurately assessed (eg, time needed for new practice underestimated) | … confidence in capability falls, resulting in poorer levels of commitment and collaboration | … resulting in poor adoption and outcomes | Not supported37
Support38 |
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| Executive and management are engaged and support the intervention (Involve executive boards; obtain formal commitments) |
Executive /management support that is visible to the implementers | … increases perceptions of feasibility and organisational capacity | … resulting in increased engagement | Management support | Support10 52–55 |
| Commitment to support the change from executive level is communicated to implementers | … increases perceptions of feasibility and organisational capacity | … resulting in increased engagement | Support28 48 50–52 | ||
| Executive /management support is inadequate or not visible to the implementers | … decreases perceptions of feasibility and value of the change | … resulting in lack of engagement | Support32 38 | ||
| Executive /management support is inadequate or distant, but local or within team leadership is seen as strong and autonomous | … does not decrease perceptions of feasibility and value of the change | … and does not impact intention to commit | Supported56 | ||
| Executive /management support is inadequate, but local or within team leadership is seen as strong | … increases perceptions of siloed change, decreasing perceptions of feasibility | … resulting in lower staff buy-in and commitment | Supported55 | ||
| Executive /management support is inadequate, and local or within team leadership is also inadequate/ non participatory | … decreases perceptions of feasibility and value of the change | … resulting in lack of engagement | Supported55 | ||
| Support from external agencies/peak bodies for the intervention (Develop academic partnerships; use an implementation advisor; use advisory boards and workgroups) |
When external support and/or endorsement of the proposed change is present | implementers may value the change more favourably or feel a greater tension for change | …resulting in increased engagement and commitment | Appropriateness | Support10 27 48 50 53 57 |
| Clear and consistent communication with identified/designated leaders of the intervention (Identify and prepare champions; Recruit, designate, and train for leadership) |
Consistent messages and actions from leaders, opinion leaders and champions | … increase perceptions of organisational capacity | … resulting in more effective engagement | Management support Appropriateness |
Support50 57 |
| Mixed or missed information from leaders, opinion leaders and champions | … decrease perceptions of organisational capacity and disempowerment | … resulting in poorer engagement | Support38 58 | ||
| Align intervention with other organisational priorities | When the proposed change aligns with other organisational or national priorities | … implementers may value the change more favourably and see their efforts as contributing to a larger, more significant programme | … resulting in more effective engagement | Personal valence Appropriateness | Support48 57 |
| When the proposed change is part of a collaborative effort across multiple sites | … stakeholders’ perceptions of the value of the change may increase | … resulting in greater commitment | Support27 28 48 59 | ||
| Align with known concerns/priorities of implementers | When the proposed change aligns with the personal priorities of implementers | …the change is valued more highly by implementers | … resulting in more effective engagement | Personal valence | Support32 51 |
| When the proposed change does not align with personal or group priorities/ do not make sense | … the value of the change is discounted | …resulting in poor engagement | Individual and group valence | Support58 | |
| Provide opportunities for formal and informal planning and knowledge exchange around the intervention (Create a learning collaborative; Capture and share local knowledge) |
When there is appropriate and timely information sharing through social interaction, and shared experience | … may increase collective vision and purpose | … resulting in greater engagement and persistence | Support10 38 47 51 52 57 | |
| Providing appropriate education (Develop educational materials) |
Development of educational packages appropriately pitched at key implementers | …… increase perceptions of feasibility and organisational capacity | … members are more likely to engage in the project | Change-specific efficacy | Support31 47 51 57 59 |
| Development of educational packages not tailored to specific group’s knowledge base perceived as inappropriate | … decreases perceptions of capability | …members are less likely to engage or commit to the project | Support38 | ||
| Providing appropriate implementation support (Facilitation: Develop a formal implementation blueprint) |
Provision or preparation of implementation blueprints or plans | …… increase perceptions of feasibility and organisational capacity | … members are more likely to engage in the project | Change-specific efficacy | Support31 |
| Appealing to past successes | In spite of previous successes and capabilities, if local needs and capabilities are not considered adequate by those enacting this specific change proposed …. | … collective capability will be seen as deficient | … levels of commitment will be poor | Change-specific efficacy | No evidence found |
ERIC, Expert Recommendations for Implementing Change.