Implementation strategies are methods used to help clinics adopt new practices. The knowledge base on these strategies is growing, but much still remains unknown about how best to select and enact strategies designed to promote practice change in different contexts. For example, evidence clearly shows that having a ‘champion’ of a given practice change can substantially impact the implementation of that practice in some circumstances. However, little has been reported on how best to operationalize the champion role in different settings, or on the specific pathways through which champions enact change. To understand this better, we conducted this mixed-methods analysis using data collected as part of a trial that compared implementation strategies targeting the adoption of guideline-concordant cardioprotective prescribing in community health centers in the USA.
Among community health centers that demonstrated statistically significant increases in the targeted outcome, a combination of factors appeared key to successful practice change: (1) a clinician champion who demonstrated sustained commitment to implementation activities and exhibited engagement, influence, credibility, and capacity; and (2) organizational support for the intervention. Conversely, community health centers that did not show improved outcomes lacked a champion with the necessary characteristics, and/or organizational support.
This study published in Implementation Science confirms the important role of champions in implementation efforts and offers insight into the context-specific mechanisms through which champions enact practice change. The results also highlight the potential impact of misaligned implementation support and key modifiable barriers and facilitators on implementation outcomes.