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Key implementation and evolution factors using Grol and Wensing's Characteristics of Innovations Framework [32]. |
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| Characteristic of Innovation ~Degree to which innovation provides or is: |
Promoting Factor for SMA Implementation |
Hindering Factor for SMA Implementation |
Addressing the Issues to Facilitate Implementation and Sustainability |
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| Relative advantage or utility over existing or other methods |
Advantage of seeing several experts at same time, especially for behavioral barriers |
No clear evidence; questioned value and whether patients would accept group format |
Proved not to be a major issue |
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| Compatibility with existing norms and values |
Consistent with norm and values of achieving process measures |
Inconsistent with norm and value of sacred primary care provider-patient relationship; Different roles of healthcare professionals filling in-difficult switching from traditional to multidisciplinary team approach |
Had a few team building and motivational interviewing learning sessions-lecture versus facilitation of patient info |
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| Complexity of explaining, understanding and using |
Too vague and many unknowns; not easy to explain |
Explain and sell it and take advantage of a trial period with small numbers of patients to highlight success and have observers (it was easier for providers to see it first hand) |
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| Costs relative to benefits and level of investment |
Efficacy questioned regarding clinical physiological outcomes and uncertain level of investment for various stakeholders |
1. Reorganizing flow allowed up to 18 patients to be seen in one SMA |
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| 2. Change in way patient data distributed in order to reduce prep time of Clinical Pharmacist and overall cost |
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| 3. Introduced use of templated notes that included documentation of SMA activities at a general group level and also permitted individualized patient level documentation |
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| Risks related to uncertainty regarding results and consequences |
High-risk – no conceptual model for designing or plan for diffusion |
The organizational culture supported risk taking |
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| Flexibility, adaptability to situation/needs of local context/target group |
Vagueness provided options for adapting to local context and needs |
Key non-flexible components not consistent with micro-system and mesosystem silo design |
Recognition of additional patient needs prompted addition of a nutritionist to the team |
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| Involvement of target group in development |
High involvement of the core team only |
Existing structure impeding additional staff involvement |
Unanticipated impact on staff not involved feeling left out addressed by creating opportunities for these staff to observe and get feedback/up dates |
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| Divisibility so able to try out parts separately |
Low divisibility of shared appointments (i.e., can't try out various parts) |
Unable to address; we have kept the basic model of SMAs |
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| Trialability, reversibility without risk if doesn't work |
High and approached as a trial period |
Because of early successes, this proved not to be a major issue |
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| Visibility, observability of results by other people |
High – part of local culture is feedback |
High – part of local culture is feedback |
Patient successes led to increased referral of patients close to performance measure goals overloading the clinic and prompting the redirection of resources |
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| Centrality of impact on daily working routine |
High |
Impact of patients' stories has contributed to team finding meaning in their work, negating the effects of the changes in work routine |
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| Pervasiveness, scope, impact on total work, people involved, time it takes and relationships |
High: fear more work and would jeopardize primary care provider-patient relationships |
Proved not to be a major issue |
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| Magnitude, disruptiveness, radicalness |
High |
The core team was made up of individuals willing to take risk and were unafraid of the potential disruption |
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| Duration for when innovation/change must take place |
Not a pressing factor |
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| Form, physical properties of innovation: material or social; technical or administrative, etc.) |
High: material change, space requirements, schedule changes, administrative and technical adjustments |
Continues to provide challenges |
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| Collective action related to decisions |
Low collective action |
Strong core team (3–5 members) |
Unanticipated impact on staff not involved feeling left out. Some of these staff were recruited to participate in other types of SMAs where they were involved in the decision-making. |
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| Nature of Presentation: length, clarity, attractiveness |
High attractiveness |
Low clarity |
Began projects to share knowledge and experience with others |
Kirsh et al. Implementation Science 2008 3:34 doi:10.1186/1748-5908-3-34 |
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