Implementation guide: CIHR module

Description

Developed for the Canadian Institutes of Health Research, the online module, Moving into action: We know what practices we want to change, now what? An implementation guide for health care practitioners, addresses three phases of implementation of best practice guidelines for changing practice. Checklists, worksheets, reflective questions and resources for each implementation phase are provided.

This module aims to support practice change to reflect the best available evidence. The module addresses three implementation phases that reflect the Knowledge to Action Framework (Straus, Tetroe & Graham, 2009):

1. Adapt the evidence to the local context.
2. Assess barriers to knowledge use.
3. Tailor, select and implement interventions.

For each implementation phase, the following information is provided:

• Objective of implementation phase
• Rationale
• Background knowledge
• Actionable steps to complete the step
• Examples and scenarios
• Resources

Specific tools and checklists in the Appendix include:

• Evidence-informed decision making process algorithm
• Factors influencing health care behaviours and intentions
• Barriers, facilitators and implementation strategies tool
• Examples of barriers and facilitators
• Assessing barriers and facilitators tool
• Implementation checklist tool

Steps for Using Method/Tool

The three steps for implementing evidence to bring about a practice change are:

1. Adapt the knowledge to your local setting:

• Identify evidence you are planning on implementing (best practice guidelines, systematic reviews, etc.)
• Evaluate evidence for quality with tools (Refer to AGREEII for best practice guidelines, CASP and AMSTAR for systematic reviews)
• Involve stakeholders in the process
• Adapt recommendations from evidence using a standardized process (Refer to the ADAPTE process by the ADAPTE Collaboration Guidelines International Network (G-I-N) or CAN-IMPLEMENT resource developed by the Canadian Guideline Adapation Study Group for cancer guidelines)
• Document the adapted guideline
• Revisit adaptation of evidence during implementation

2. Identify barriers and facilitators of implementation in your local setting:

• Consider characteristics of the following when identifying barriers and facilitators: practice change; the practitioners who will be affected by the practice change; the local practice setting; and the organization
• Involve pertinent individuals and teams in identifying barriers and facilitators
• Use strategies to identify barriers and facilitators
• Assess barriers and facilitators using selected strategies.
• Prioritize barriers and facilitators for your implementation plan

3. Select and tailor implementation strategies for practice change:

• Review the most relevant barriers and facilitators
• Consider which implementation strategies best address the barriers and build on facilitators for the practice change
• Choose multiple strategies from a list of implementation strategies
• Organize selected implementation strategies according to the targeted characteristics, barriers and facilitators, and provide rationale for decisions made
• Involve stakeholders in the process
• Develop an implementation plan
• Build on successes by expanding implementation efforts