Mobilize Site Staff for Implementation

These strategies are used to organize, prepare and mobilize staff at implementation sites for a successful implementation of evidence-based practice (EBP). These range from establishing internal implementation leaders to setting up structures so that staff are engaged and on board with the changes to be implemented. We include evidence related to five strategies under this category. Select any of the strategies in the box below to learn more.

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Organize Implementation Teams and Team Meetings

This can include providing protected time for teams to reflect on the implementation progress, share lessons learned, make refinements to plans, and support one another’s learning.

Strength of Evidence Supporting Its Effectiveness: Inconclusive

Based on direct and indirect evidence from included studies and contextual systematic review evidence identified outside of this review, we judged evidence to be either supportive, moderate supportive, limited supportive, indirect supportive only, or inconclusive. We determined the strength of evidence supporting the contribution of this strategy to successful implementations was inconclusive.

Health Care Areas Where the Organize Implementation Teams and Team Meetings Strategy Was Used

Strategies were used in a variety of settings and areas of health care. The “Other” category includes non-traditional settings in which health care might be provided, like schools.

Results From Studies That Included Organize Implementation Teams and Team Meetings

We recorded results from four different types of outcomes across research studies that included this strategy. The table below shows the proportion of these studies that showed improvement compared to a control.

How Often Were Studies That Included the "Organize Implementation Teams and Team Meetings" Strategy Effective?

The tables below show the recorded outcomes of each study that used this strategy by setting.

Studies That Used Organize Implementation Teams and Team Meetings and Their Outcomes, By Setting

Primary care

Specialty care

Mental health

Public Health

Multiple

Other

References

Dickinson WP, Dickinson LM, Jortberg BT, et al. A Cluster Randomized Trial Comparing Strategies for Translating Self-Management Support into Primary Care Practices. J Am Board Fam Med JABFM. 2019;32(3):341-352. doi:10.3122/jabfm.2019.03.180254

Bravata D. Assessment of the Protocol-Guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) Program for Improving Quality of Care for Transient Ischemic Attack: A Nonrandomized Cluster Trial. Published online 2020.

Lowery J, Fagerlin A, Larkin AR, Wiener RS, Skurla SE, Caverly TJ. Implementation of a Web-Based Tool for Shared Decision-making in Lung Cancer Screening: Mixed Methods Quality Improvement Evaluation. JMIR Hum Factors. 2022;9(2):e32399. doi:10.2196/32399

Chinman M, Goldberg R, Daniels K, et al. Implementation of peer specialist services in VA primary care: a cluster randomized trial on the impact of external facilitation. Implement Sci. 2021;16(1):60. doi:10.1186/s13012-021-01130-2

Carter BL, Levy B, Gryzlak B, et al. Cluster-Randomized Trial to Evaluate a Centralized Clinical Pharmacy Service in Private Family Medicine Offices. Circ-Cardiovasc Qual Outcomes. 2018;11(6). doi:10.1161/CIRCOUTCOMES.117.004188

Quanbeck A, Brown RT, Zgierska AE, et al. A randomized matched-pairs study of feasibility, acceptability, and effectiveness of systems consultation: a novel implementation strategy for adopting clinical guidelines for Opioid prescribing in primary care. Implement Sci. 2018;13(1):21. doi:10.1186/s13012-018-0713-1

Parchman ML, Noel PH, Culler SD, et al. A randomized trial of practice facilitation to improve the delivery of chronic illness care in primary care: initial and sustained effects. Implement Sci IS. 2013;8:93. doi:10.1186/1748-5908-8-93

Hagedorn HJ, Gustavson AM, Ackland PE, et al. Advancing Pharmacological Treatments for Opioid Use Disorder (ADaPT-OUD): an Implementation Trial in Eight Veterans Health Administration Facilities. J Gen Intern Med. Published online January 3, 2022:1-9. doi:10.1007/s11606-021-07274-7

Grigoryan L, Naik AD, Lichtenberger P, et al. Analysis of an Antibiotic Stewardship Program for Asymptomatic Bacteriuria in the Veterans Affairs Health Care System. JAMA Netw Open. 2022;5(7):e2222530-e2222530. doi:10.1001/jamanetworkopen.2022.22530

Schneider EC, Sorbero ME, Haas A, et al. Does a quality improvement campaign accelerate take-up of new evidence? A ten-state cluster-randomized controlled trial of the Institute for Health Improvement’s Project JOINTS. Implement Sci. 2017;12. doi:10.1186/s13012-017-0579-7

Naar S, MacDonell K, Chapman J, et al. Tailored Motivational Interviewing in Adolescent HIV Clinics: Primary Outcome Analysis of a Stepped Wedge Implementation Trial. J Acquir Immune Defic Syndr. 2022;90(S1):S74-s83. doi:10.1097/qai.0000000000002967

Bauer MS, Miller CJ, Kim B, et al. Effectiveness of Implementing a Collaborative Chronic Care Model for Clinician Teams on Patient Outcomes and Health Status in Mental Health: A Randomized Clinical Trial. JAMA Netw Open. 2019;2(3):e190230. doi:10.1001/jamanetworkopen.2019.0230

Chinman M, McCarthy S, Hannah G, Byrne TH, Smelson DA. Using Getting To Outcomes to facilitate the use of an evidence-based practice in VA homeless programs: a cluster-randomized trial of an implementation support strategy. Implement Sci. 2017;12(1):34. doi:10.1186/s13012-017-0565-0

Chokron Garneau H, Assefa MT, Jo B, Ford JH, Saldana L, McGovern MP. Sustainment of Integrated Care in Addiction Treatment Settings: Primary Outcomes From a Cluster-Randomized Controlled Trial. Psychiatr Serv. 2022;73(3):280-286. doi:10.1176/appi.ps.202000293

Williams, N.J., et al., Mechanisms of Change in the ARC Organizational Strategy: Increasing Mental Health Clinicians' EBP Adoption Through Improved Organizational Culture and Capacity. Adm Policy Ment Health, 2017. 44(2): p. 269-283.

Knott CL, Chen C, Bowie JV, et al. Cluster-randomized trial comparing organizationally tailored versus standard approach for integrating an evidence-based cancer control intervention into African American churches. Transl Behav Med. 2022;12(5):673-682. doi:10.1093/tbm/ibab088

Maxwell AE, Danao LL, Cayetano RT, Crespi CM, Bastani R. Implementation of an evidence-based intervention to promote colorectal cancer screening in community organizations: a cluster randomized trial. Transl Behav Med. 2016;6(2):295-305. doi:10.1007/s13142-015-0349-5

Jacob RR, Parks RG, Allen P, et al. How to “Start Small and Just Keep Moving Forward”: Mixed Methods Results From a Stepped-Wedge Trial to Support Evidence-Based Processes in Local Health Departments. Front Public Health. 2022;10. doi:10.3389/fpubh.2022.853791

Smelson DA, Chinman M, Hannah G, Byrne T, McCarthy S. An evidence-based co-occurring disorder intervention in VA homeless programs: outcomes from a hybrid III trial. BMC Health Serv Res. 2018;18(1):332. doi:10.1186/s12913-018-3123-9

Chinman M, Ebener P, Burkhart Q, et al. Evaluating the impact of getting to outcomes-underage drinking on prevention capacity and alcohol merchant attitudes and selling behaviors. Prev Sci. 2014;15(4):485-496. doi:10.1007/s11121-013-0389-3

Morton I, Hurley B, Castillo EG, et al. Outcomes of two quality improvement implementation interventions for depression services in adults with substance use problems. Am J Drug Alcohol Abuse. 2020;46(2):251-261. doi:10.1080/00952990.2019.1708085

Resnick B, Van Haitsma K, Kolanowski A, et al. Implementation of the Evidence Integration Triangle for behavioral and psychological symptoms of dementia (EIT-4-BPSD) in care communities. Nurs Outlook. 2021;69(6):1058-1071. doi:10.1016/j.outlook.2021.06.004

Conduct Internal Consensus Discussions to Develop Buy-In

This strategy involves identifying relevant stakeholders (eg, providers, support staff, community workers, patients) for each project and establishing whether the goal of the consensus discussion is to characterize consensus or build consensus for the need of implementing an EBP. In this project, these strategies were limited to efforts involving internal staff.

Strength of Evidence Supporting Its Effectiveness: Inconclusive

Based on direct and indirect evidence from included studies and contextual systematic review evidence identified outside of this review, we judged evidence to be either supportive, moderate supportive, limited supportive, indirect supportive only, or inconclusive. We determined the strength of evidence supporting the contribution of this strategy to successful implementations was inconclusive.

Health Care Areas Where Conduct Internal Consensus Discussions to Develop Buy-in Was Used

Strategies were used in a variety of settings and areas of health care. The “Other” category includes non-traditional settings in which health care might be provided, like schools.

Results From Studies That Included Conduct Internal Consensus Discussions to Develop Buy-in Strategy

We recorded results from four different types of outcomes across research studies that included this strategy. The table below shows the proportion of these studies that showed improvement compared to a control.

How Often Were Studies That Included the "Conduct Internal Consensus Discussions to Develop Buy-In" Strategy Effective?

The tables below show the recorded outcomes of each study that used this strategy by setting.

Studies That Used Conduct Internal Consensus Discussions to Develop Buy-in and Their Outcomes, by Setting

Primary Care

Specialty Care

Mental Health

Public Health

References

Quanbeck A, Brown RT, Zgierska AE, et al. A randomized matched-pairs study of feasibility, acceptability, and effectiveness of systems consultation: a novel implementation strategy for adopting clinical guidelines for Opioid prescribing in primary care. Implement Sci. 2018;13(1):21. doi:10.1186/s13012-018-0713-1

Parchman ML, Noel PH, Culler SD, et al. A randomized trial of practice facilitation to improve the delivery of chronic illness care in primary care: initial and sustained effects. Implement Sci IS. 2013;8:93. doi:10.1186/1748-5908-8-93

Gilkey MB GB. Coaching and Communication Training for HPV Vaccination: A Cluster Randomized Trial. Pediatrics. 2022;150(2).

Kauth MR, Sullivan G, Blevins D, et al. Employing external facilitation to implement cognitive behavioral therapy in VA clinics: a pilot study. Implement Sci. 2010;5:75. doi:10.1186/1748-5908-5-75

Bauer MS, Miller CJ, Kim B, et al. Effectiveness of Implementing a Collaborative Chronic Care Model for Clinician Teams on Patient Outcomes and Health Status in Mental Health: A Randomized Clinical Trial. JAMA Netw Open. 2019;2(3):e190230. doi:10.1001/jamanetworkopen.2019.0230

Chokron Garneau H, Assefa MT, Jo B, Ford JH, Saldana L, McGovern MP. Sustainment of Integrated Care in Addiction Treatment Settings: Primary Outcomes From a Cluster-Randomized Controlled Trial. Psychiatr Serv. 2022;73(3):280-286. doi:10.1176/appi.ps.202000293

Chinman M, Acosta J, Ebener P, Malone PS, Slaughter ME. Can implementation support help community-based settings better deliver evidence-based sexual health promotion programs? A randomized trial of Getting To Outcomes®. Implement Sci IS. 2016;11(1):78. doi:10.1186/s13012-016-0446-y

Brown CH, Chamberlain P, Saldana L, Padgett C, Wang W, Cruden G. Evaluation of two implementation strategies in 51 child county public service systems in two states: results of a cluster randomized head-to-head implementation trial. Implement Sci. 2014;9:134. doi:10.1186/s13012-014-0134-8

Jacob RR, Parks RG, Allen P, et al. How to “Start Small and Just Keep Moving Forward”: Mixed Methods Results From a Stepped-Wedge Trial to Support Evidence-Based Processes in Local Health Departments. Front Public Health. 2022;10. doi:10.3389/fpubh.2022.853791

Recruit, Designate, and Train Site Staff for Leadership

This may include recruiting from outside the institution rather than using current personnel to implement the change. Designated change leaders can include an executive sponsor and a day-to-day manager of the effort.

Strength of Evidence Supporting Its Effectiveness: Inconclusive

Based on direct and indirect evidence from included studies and contextual systematic review evidence identified outside of this review, we judged evidence to be either supportive, moderate supportive, limited supportive, indirect supportive only, or inconclusive. We determined the strength of evidence supporting the contribution of this strategy to successful implementations was inconclusive.

Health Care Areas Where Recruit, Designate, and Train Site Staff for Leadership Was Used

Strategies were used in a variety of settings and areas of health care. The “Other” category includes non-traditional settings in which health care might be provided, like schools.

Results From Studies That Included Recruit, Designate, and Train Site Staff for Leadership Strategy

We recorded results from four different types of outcomes across research studies that included this strategy. The table below shows the proportion of these studies that showed improvement compared to a control.

How Often Were Implementation Efforts That Included the "Recruit, Designate, and Train Site Staff for Leadership" Strategy Effective?

The tables below show the recorded outcomes of each study that used this strategy by setting.

Studies That Used Recruit, Designate, and Train Site Staff for Leadership and Their Outcomes, by Setting

Primary Care

Mental Health

Public Health

Multiple

References

Gold R, Bunce A, Cowburn S, et al. Does increased implementation support improve community clinics’ guideline-concordant care? Results of a mixed methods, pragmatic comparative effectiveness trial. Implement Sci. 2019;14(1):100. doi:10.1186/s13012-019-0948-5

Chokron Garneau H, Assefa MT, Jo B, Ford JH, Saldana L, McGovern MP. Sustainment of Integrated Care in Addiction Treatment Settings: Primary Outcomes From a Cluster-Randomized Controlled Trial. Psychiatr Serv. 2022;73(3):280-286. doi:10.1176/appi.ps.202000293

Williams, N.J., et al., Mechanisms of Change in the ARC Organizational Strategy: Increasing Mental Health Clinicians' EBP Adoption Through Improved Organizational Culture and Capacity. Adm Policy Ment Health, 2017. 44(2): p. 269-283.

Maxwell AE, Danao LL, Cayetano RT, Crespi CM, Bastani R. Implementation of an evidence-based intervention to promote colorectal cancer screening in community organizations: a cluster randomized trial. Transl Behav Med. 2016;6(2):295-305. doi:10.1007/s13142-015-0349-5

Smith SN, Liebrecht CM, Bauer MS, Kilbourne AM. Comparative effectiveness of external vs blended facilitation on collaborative care model implementation in slow-implementer community practices. Health Serv Res. 2020;55(6):954-965. doi:10.1111/1475-6773.13583

Identify and Prepare Clinical Champions

Champion descriptions often vary based on the topic of an implementation project (eg, guideline or hand-washing champion), job position (eg, nurse or physician champion) or a broader organizational role (eg, executive or clinical champion), and the setting.

Strength of Evidence Supporting Its Effectiveness: Inconclusive

Based on direct and indirect evidence from included studies and contextual systematic review evidence identified outside of this review, we judged evidence to be either supportive, moderate supportive, limited supportive, indirect supportive only, or inconclusive. We determined the strength of evidence supporting the contribution of this strategy to successful implementations was inconclusive.

Health Care Areas Where the Identify and Prepare Clinical Champions Strategy Was Used

Strategies were used in a variety of settings and areas of health care. The “Other” category includes non-traditional settings in which health care might be provided, like schools.

Results from Studies that Included Identify and Prepare Clinical Champions Strategy

We recorded results from four different types of outcomes across research studies that included Identify and Prepare Clinical Champions. The table below shows the proportion of these studies that showed improvement compared to a control.

How Often Were Studies That Included the "Identify and Prepare Clinical Champions" Strategy Effective?

The tables below show the recorded outcomes of each study that used this strategy by setting.

Studies That Used Identify and Prepare Clinical Champions and Their Outcomes, by Setting

Primary Care

Specialty Care

Mental Health

Multiple

Other

References

Bravata D. Assessment of the Protocol-Guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) Program for Improving Quality of Care for Transient Ischemic Attack: A Nonrandomized Cluster Trial. Published online 2020.

Grigoryan L, Naik AD, Lichtenberger P, et al. Analysis of an Antibiotic Stewardship Program for Asymptomatic Bacteriuria in the Veterans Affairs Health Care System. JAMA Netw Open. 2022;5(7):e2222530-e2222530. doi:10.1001/jamanetworkopen.2022.22530

Chokron Garneau H, Assefa MT, Jo B, Ford JH, Saldana L, McGovern MP. Sustainment of Integrated Care in Addiction Treatment Settings: Primary Outcomes From a Cluster-Randomized Controlled Trial. Psychiatr Serv. 2022;73(3):280-286. doi:10.1176/appi.ps.202000293

Smith SN, Liebrecht CM, Bauer MS, Kilbourne AM. Comparative effectiveness of external vs blended facilitation on collaborative care model implementation in slow-implementer community practices. Health Serv Res. 2020;55(6):954-965. doi:10.1111/1475-6773.13583

Resnick B, Van Haitsma K, Kolanowski A, et al. Implementation of the Evidence Integration Triangle for behavioral and psychological symptoms of dementia (EIT-4-BPSD) in care communities. Nurs Outlook. 2021;69(6):1058-1071. doi:10.1016/j.outlook.2021.06.004

Inform Internal Opinion Leaders About Implementation

Individuals who refer people to services, or who initiate the connection to services function in a key opinion role. Additionally, keeping opinion leaders informed from pre-implementation through maintenance of the effective practice is important.

Strength of Evidence Supporting Its Effectiveness: Not Evaluated

For some of the most common strategies we judged the strength of research support based on included studies and contextual systematic review evidence identified outside of this review. We did not evaluate the strength of evidence for this strategy. The information below represents the data we collected from studies including this strategy.

Health Care Areas Where the External Implementation Facilitation Strategy Was Used

Strategies were used in a variety of settings and areas of health care. The “Other” category includes non-traditional settings in which health care might be provided, like schools.

Results from Studies that Included "Inform Internal Opinion Leaders About Implementation"

We recorded results from four different types of outcomes across research studies that included this strategy. The table below shows the proportion of these studies that showed improvement compared to a control.

How Often Were Studies That Included the "Inform Internal Opinion Leaders About Implementation" Strategy Effective?

The tables below show the recorded outcomes of each study that used this strategy by setting.

Studies That Used Inform Internal Opinion Leaders About Implementation and Their Outcomes, by Setting

Multiple

References

Smith SN, Liebrecht CM, Bauer MS, Kilbourne AM. Comparative effectiveness of external vs blended facilitation on collaborative care model implementation in slow-implementer community practices. Health Serv Res. 2020;55(6):954-965. doi:10.1111/1475-6773.13583

Kilbourne AM, Goodrich DE, Nord KM, et al. Long-Term Clinical Outcomes from a Randomized Controlled Trial of Two Implementation Strategies to Promote Collaborative Care Attendance in Community Practices. Adm Policy Ment Health. 2015;42(5):642-653. doi:10.1007/s10488-014-0598-5

Morton I, Hurley B, Castillo EG, et al. Outcomes of two quality improvement implementation interventions for depression services in adults with substance use problems. Am J Drug Alcohol Abuse. 2020;46(2):251-261. doi:10.1080/00952990.2019.1708085