What is the phase ‘Select, Tailor, and Implement Interventions’?
Once barriers and facilitators to knowledge use are identified, you are ready to select, tailor and implement the practice change in your setting. To effectively implement the practice change in your setting, you need to use implementation strategies. This phase requires careful planning as you select and tailor these strategies to your setting. Strategies can be used to address the barriers you identified in the previous action cycle phase. This phase helps you select the right strategies, and tailor them to your local context.
Why is the phase ‘Select, Tailor, and Implement Interventions’ important?
Change is more likely to occur if you take the time to plan your implementation strategies. Unfortunately, many strategies are implemented without a planned process; strategies are often chosen based on common sense or what has worked in another organization (Michie, 2011). To identify the types of strategies likely to be effective, you and your team can review a range of strategies and have a planned process to select them (Michie 2011). You can use a planned approach to select strategies that address barriers and leverage facilitators in your local setting.
Avoid the “ISLAGIATT” principle* (It-Seemed-Like-A-Good-Idea-at-the Time)
*Coined by Marin Eccles, implementation researcher, for implementing change.
Implementation strategies are methods or techniques used to enhance the uptake, implementation, and sustainability of an intervention, program, or practice (Proctor et al., 2013). Strategies vary in their scale, their intended outcomes, the settings into which they are applied, and the nature of the practice change or interventions they intend to promote and support. The literature offers numerous implementation strategies for practices and interventions. For instance, the Expert Recommendations for Implementing Change taxonomy (ERIC; Powell et al., 2015) has 73 implementation strategies and the Behaviour Change taxonomy has 93 strategies (Michie et al., 2013) in healthcare settings that vary in their impact and feasibility (Powell et al., 2015; Waltz et al., 2015).
Here are some examples of implementation strategies from the ERIC taxonomy (Powell et al., 2015 - see the link to the paper in 'Additional resources' with the full list of strategies and their definitions):
- Capture and share local knowledge
- Conduct educational outreach visits to inform others about the innovation
- Identify and prepare champions
- Inform local opinion leaders about the innovation
- Develop a formal implementation plan
- Distribute educational materials
- Provide clinical supervision
- Remind clinicians
How to select and tailor implementation strategies
To effectively implement the change, you must select and tailor implementation strategies based on practice barriers you want to address in your context. Implementation strategies can be used in combination or independently, depending on your objectives and your context. It is important to tailor them to your objectives and to your context. No single strategy is effective in all contexts/settings; there is no “one size fits all” (LaRocca et al., 2015)
Why tailoring strategies is important
Tailored implementation strategies are more likely to support implementation efforts. Contextual factors can influence implementation outcomes through their effects on the ways that support systems or delivery systems enact strategies or how strategies function (Leeman & Nilsen, 2020). For example, staffing shortages on a busy intensive care unit may affect staff's ability to fully engage in implementation processes, resulting in low use of the new intervention. Staffing shortages may also limit the number of staff that the unit sends to a learning collaborative. In the former case, implementation processes may need to be refined to involve less frequent and/or shorter meetings. In the latter case, the learning collaborative may need to be converted to a blended format that combines one brief in-person meeting with a series of conference calls.
More is not always better!
- Using more strategies at the same time does not always lead to higher chances of implementation success (Wuchner et al., 2014).
- In some cases, it may be more effective to use a single strategy and focus on one key problem of implementation instead of trying to tackle numerous problems using complex, multifaceted strategies. (Lau et al., 2015; Squires et al., 2014)
- The complexity of strategies may dilute the key benefits of the practice change and reduce the ability of clinicians to understand or to acquire the information they need to change practice (LaRocca et al., 2015).