Table 1 Key facilitators to SBIR implementation

Process–

Planning

IST:

Planning process in AHS (systems level)

Planning at pilot site

Planning for patients’ information needs

Operational plans needed to support SBIR implementation

• Collaboration with AHS teams to align risk factor screening with Canadian guidelines; align AHS health practices, standards, evidence, and ethics for risk factors; develop process to acquire data from Cancer Epidemiology and Prevention Research dept

• Promotional material facilitate understanding - professional looking and branding facilitate buy-in

• Printed health information easy to use

• Evaluation of SBIR was supported by evaluation expertise; easy to understand scripts for clinical workers; training materials for users; funding a dedicated program facilitator

“There are departments within Alberta Health Services that own a risk factor, so Nutrition Services owns healthy eating, that’s the way they would see it. So, [we worked] with leadership in departments… to tailor the questions in a way that did not compete or contradict any of the in-depth screening that they do… [it is] very important for that alignment.” (Interview 1)

Engaging

IST:

Engaging with hospital teams

Facilitator engaging with CTI

Engagement with hospital management

• Engaging with facilitator using regular touch base conversations facilitate adaptations of the SBIR; on the ground facility understanding; time to train users; facilitate user comfort and comprehension of the SBIR tool - knowledge and awareness risk factors; willingness of CTI to participate and be involved

• CTI champion facilitates usage of the SBIR tool - connected other clinical staff

• Feedback reports used to understand patient referral- Decision making around how to structure report to meet needs of hospital unit; communication and coordination for sustainability of the project; seeing the big picture or goal of the project; supportive team provided on site help

“Hearing the response from the facilities,… when they receive those reports.… they were well received.… They were very respectfully put [together]. There was a back-and-forth process, so the facility co-designed that feedback loop.…. And because of that we felt confident that it would… keep the wind in the sail for the clinicians.” (Interview 1)

Inner Setting–Readiness for

IST:

AHS health system readiness for change– leadership engagement to develop coordination between depts

Pilot site readiness:

1. Available resources needed to implement SBIR and foster buy-in

2. Access to knowledge and information to create confidence

3. IST assessed leadership readiness as being prepared for SBIR implementation

• Collaboration with AHS teams to align components / departments in system: align SBIR with Canadian guidelines; align with AHS departments on risk factor question: align with internal AHS screening guidelines; aligning health practices, standards, evidence, and ethics.

• Funds for human resources; existing relationships with staff and community; meeting end-users needs (1-page SBIR screening tool to fit clinician time); develop SBIR workflow with clinic

• Developed scripts for CTI to reduce fear of using the tool; SBIR training for CTI

• Existing knowledge, skills, and leadership buy-in, co-designed feedback reports

“We put those scripts together that would give a guideline… because that was something that we did run into, ‘I don’t know how to talk about this’. ‘I don’t know how to discuss tobacco’ or ‘I don’t know how to discuss alcohol’. [It] really made a difference… because it took away that fear.” (Interview 3)

“I think that the written materials were very comprehensive. The training always helps. The one pager and other promotional materials [were]…very important for the clinicians, and for the patients as well…” (Interview 1)

implementation

Availableresources

Access to knowledge and

information

Leadership readiness

*Diverging Perspectives of Facilitator and Barrier (opposing views between support and clinical team on implementation climate)

Implementation climate

IST (Facilitator):

• Implementation driven by managerial decision.

“I do think that having more leadership involvement would be useful for swaying people’s perspectives on getting a little bit more buy-in… [SBIR implementation facilitator] was very invested.… It was good because she had a great relationship with a lot of the other nurses, so she was able to get them on board.” (Interview 5)

CTI (Barrier):

• Implementation climate was driven by managers: This was seen as a top-down process coming from managers regardless of clinical staff’s own views.

“I would need buy-in from… all managers, at the table, not on a Zoom conference.

I had one manager… who is [the] worst… I’ve sent you 8 million emails about this. So of course, she’s not promoting [SBIR] and checking with her staff to see if they’re doing [SBIR].” (Interview 4)