Table 1 Implementation strategy based on the Quality Implementation Framework (Meyers et al. 2012)
Quality Implementation Framework (QIF) | Application in project | |||
|---|---|---|---|---|
Phase | Step category | QIF step according to phase | Definition | Operationalization |
Phase One: Initial considerations regarding the host setting | Assessment strategies | 1–3. Conducting a needs and resources assessment, a fit assessment, and a capacity/readiness assessment | Initial assessment | Initial assessments were not considered applicable, as the initiative for implementing Medication Review and Medication Report was a governmental decision based on scientific findings. |
Decisions about adaptation | 4. Possibility for adaptation | Adaptation | All units were allowed to decide on local routines in addition to the general routine that was implemented. | |
Capacity-building strategies | 5. Obtaining explicit buy-in from critical stakeholders | Decision | A decision of systematic implementation of Medication Review and Medication Report in Health Care in the county council of Östergötland, was made at the county council management level. | |
6. Building general/organizational capacity | Steering group | A steering group including the head health care manager, medical directors and health care managers from different sectors was recruited to supervise the implementation. | ||
7. Staff recruitment/maintenance | Staff | Recruitment of a project manager, and delegates representing the three parts of the county, the department of clinical pharmacy, and medical doctors from primary care and hospital care. An implementation researcher was also invited to the group. | ||
8. Effective pre-innovation staff training | Guideline available | Guidelines for Medication Review and Medication Report were developed and made available for staff at the internal website. | ||
Phase Two: Creating a structure for implementation | Structural features for implementation | 9. Creating implementation teams | Teams | One implementation agent (IA) in each part of the county was assigned to lead the activities. |
10. Developing an implementation plan | Implementation plan / Communication plan | A local implementation plan was developed, including the following steps:IA contacts the manager, local timetable is set IA meets all physicians at the unit, a “physician in charge” is assignedSecond physician meeting, including information about documentation The manager is in charge of informing the nurse group. | ||
Phase Three: Ongoing structure once implementation begins | Ongoing implementation support strategies | 11. Technical assistance/coaching/supervision | Electronic medical record system | The medical record system was developed in order to facilitate performance and reporting of Medication Reviews and Medication Reports. |
12. Process evaluation | Post-implementation interview | Structured interviews with managers when all the facilitating activities had been completed | ||
13. Supportive feedback mechanism | Feed-back | Follow-up data on unit level was made available to all managers, intended to increase adoption and sustainability | ||
Phase Four: Improving future applications | 14. Learning from experience | Follow-up survey | At follow-up after five years, facilitating and impeding factors were identified, based on open-ended questions | |