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Practitioners of patient safety practice change agree that champions are central to the success of implementation. The clinical champion role is a concept that has been widely promoted yet empirically underdeveloped in health services literature. Questions remain as to who these champions are, what roles they play in patient safety practice change...
Citations
... For these initiatives to gain greater traction, it might be beneficial to have designated institutional champions of practitioner mental health, whose roles in education, advocacy, relationship building and navigating institutional boundaries would not be dissimilar to champions of other clinical causes such as patient safety. 23 Strategy 2: Create a supportive, 'psychologically friendly' work environment First, the accessibility of workplace mental health support services can be optimised, either through equipping on-site occupational health physicians with adequate psychiatric training, 24 or creating free, confidential, easily accessible mental health services for physicians at/near their workplace on a self-referral basis, such as the NHS Practitioner Health service available in the UK. 25 Second, less medicalised interventions such as peer support services, which offer advice, mentorship and a listening ear, serve as an added layer of 'psychological safety net'. 26 However, providers of such services must be able to recognise and refer clients who need formal psychiatric assessment and treatment (eg those with severe symptoms, or at risk of self-harm or causing harm to others) in a timely fashion. ...
... Including key opinion leaders across multiple levels as part of the team, and strategically identifying them through a diffusion of innovation lens (i.e., early adopters) and matching their characteristics to contextual factors of the organization as recommended by (Bunce et al., 2020), could improve leadership support. Furthermore, studies have shown that multiple champions are often needed for successful implementation (Damschroder et al., 2009;Shaw et al., 2012;Soo et al., 2009), especially in a hierarchical organization like DoD with multiple levels of command. This approach could help ameliorate the fact that the senior leaders who volunteered the participation of their sites were not involved in GTO or the implementation of the chosen intervention at the site in their command-a circumstance that is common especially in large organizations. ...
While the Department of Defense (DoD) has given increased attention and priority to preventing sexual assault and sexual harassment (SA/SH), it remains a problem. To build its prevention capacity, DoD piloted Getting To Outcomes ® (GTO ®) from 2019 to 2022 at 10 military installations. GTO is an evidence-based planning and implementation support that has been used in many civilian contexts but has only recently been adapted for military SA/SH. The purpose of this study was to describe GTO use, identify its benefits and challenges, and discuss lessons the GTO effort yielded for prevention more broadly using a framework of organizational and program-level capacities needed for successful prevention in the military context, called the Prevention Evaluation Framework (PEF). GTO was piloted with 10 military installations ("sites") representing all Military Services, plus the Coast Guard and National Guard. GTO is comprised of a written guide, training, and ongoing coaching. The pilot's goal was for each site to use GTO to implement a SA/SH prevention program twice. Participants from each site were interviewed and data was collected on GTO steps completed, whether GTO spurred new evaluation activities and collaborations, and the degree of leadership support for GTO. Most sites completed all GTO steps at least once. Interviews showed that DoD participants believe GTO improved prevention understanding, planning, and evaluation capacity; strengthened confidence in chosen programs; and helped sites tailor programs to the military context. Barriers were the complexity of GTO, DoD personnel turnover, and the disruption that the COVID pandemic caused in sexual assault prevention program delivery. Many respondents were unsure if they would continue all of GTO after the coaching ended, but many believed they would continue at least some parts. According to the PEF, the GTO pilot revealed several additional prevention system gaps (e.g., need for leadership support) and changes needed to GTO (e.g., stronger leader and champion engagement), to support quality prevention. The military and other large organizations will need to focus on these issues to ensure prevention implementation and evaluation are conducted with quality.
... The importance of local champions when implementing changes in healthcare is well documented. 31,32 The dedicated and trained simulation facilitators/local champions were most likely a crucial factor for the present success in timely BMV. Importantly, the QI/simulation intervention in the present study was multifaceted including systematic clinical debriefing, own data feedback loops, and regular scenario simulation training targeting identified gaps in clinical care. ...
Introduction:
Birth asphyxia-related deaths is a major global concern. Rapid initiation of ventilation within the "Golden Minute" is important for intact survival but reported to be challenging, especially in low-/middle-income countries. Helping Babies Breathe (HBB) is a simulation-based training program for newborn resuscitation. The aim of this HBB quality improvement (QI) intervention was to decrease time from birth to ventilation and document potential changes in perinatal outcomes.
Method:
Prospective observational QI study in a rural Tanzanian hospital, October 1, 2017, to August 31, 2021, first-year baseline, second-year QI/simulation intervention, and 2-year postintervention. Trained research assistants observed wide-ranging information from all births (N = 12,938). The intervention included monthly targeted HBB simulation training addressing documented gaps in clinical care, clinical debriefings, and feedback meetings.
Results:
During the QI/simulation intervention, 68.5% nonbreathing newborns were ventilated within 60 seconds after birth compared with 15.8% during baseline and 42.2% and 28.9% during the 2 postintervention years (P < 0.001). Time to first ventilation decreased from median 101 (quartiles 72-150) to 55 (45-67) seconds (P < 0.001), before increasing to 67 (49-97) and 85 (57-133) seconds after intervention. More nonbreathing newborns were ventilated in the intervention period (12.9%) compared with baseline (8.5%) and the postintervention years (10.6% and 9.4%) (P < 0.001). Assumed fresh stillborns decreased significantly from baseline to intervention (3.2%-0.7%) (P = 0.013).
Conclusions:
This QI study demonstrates an increase in nonbreathing newborns being ventilated within the Golden Minute and a significant reduction in fresh stillborns after introduction of an HBB QI/simulation intervention. Improvements are partially reversed after intervention, highlighting the need for continuous simulation-based training and research into QI efforts essential for sustainable changes.
... Facility-based champions have emerged to be central in facilitating movements for change within the organization or in the process of adopting new interventions [27][28][29][30]. The introduction of facility-based champions during SBBC implementation has been well received and perceived to facilitate the acceptability of the bundle in health facilities. ...
Background: SaferBirths Bundle of Care (SBBC) is a package of innovative clinical and training tools coupled with low-dose high-frequency simulation-based on-job training guided by local data. This bundle of care is a new initiative being implemented in 30 health facilities from five regions of Tanzania aiming at improving birth outcomes. Objective: To assess the perception of healthcare workers and facility leaders on the “SaferBirths Bundle of Care” towards saving women’s and newborns’ lives at birth. Method: We used a qualitative approach using focused group discussion (FGD) and individual interviews. A total of 21 FGD and 43 individual interviews were conducted between August and November 2022. In total, 94 midwives and 12 doctors were involved, some of whom were in leadership roles. The framework method for the analysis of qualitative data was used for analysis. Results: Healthcare workers and facility leaders received the bundle well and regarded it as effective in saving lives and improving healthcare provision. Five themes emerged as facilitators to the acceptance of the bundle: (1) the bundle is appropriate to our needs, (2) the training modality and data use fit our context, (3) use of champions and periodic mentorship, (4) learning from our mistakes, and (5) clinical and training tools are of high quality but can be further improved. Conclusion: The relevance of SaferBirths Bundle of Care in addressing maternal and perinatal deaths, the quality and modality of training, and the culture that enhances learning from mistakes were among the facilitators of the acceptability of the SBBC. A well-accepted intervention has huge potential for bringing the intended impact in health provision.
... At each site, a clinic champion is identified who will guide the local implementation effort. Champions typically arise through self or peer-nomination [65]. This person typically plays a central role in implementing new systems and has a demonstrated ability to communicate effectively, navigate the organizational environment, promote a project, and work well with others [65,66]. ...
... Champions typically arise through self or peer-nomination [65]. This person typically plays a central role in implementing new systems and has a demonstrated ability to communicate effectively, navigate the organizational environment, promote a project, and work well with others [65,66]. The champion is identified by asking clinic administrators, lead nurses, and lead physicians who meet these qualities and would be willing to serve in this role. ...
Background
Screening for colorectal cancer (CRC) is widely recommended but underused, even though CRC is the third most diagnosed cancer and the second leading cause of cancer death in the USA. The mPATH™ program is an iPad-based application designed to identify patients due for CRC screening, educate them on the commonly used screening tests, and help them select their best option, with the goal of increasing CRC screening rates.
Methods
The mPATH™ program consists of questions asked of all adult patients at check-in (mPATH™-CheckIn), as well as a module specific for patients due for CRC screening (mPATH™-CRC). In this study, the mPATH™ program is evaluated through a Type III hybrid implementation-effectiveness design. Specifically, the study consists of three parts: (1) a cluster-randomized controlled trial of primary care clinics comparing a “high touch” evidence-based implementation strategy with a “low touch” implementation strategy; (2) a nested pragmatic study evaluating the effectiveness of mPATH-CRC™ on completion of CRC screening; and (3) a mixed-methods study evaluating factors that facilitate or impede the maintenance of interventions like mPATH-CRC™. The primary objective is to compare the proportion of patients aged 50–74 who are eligible for CRC screening who complete mPATH™-CRC in the 6th month following implementation between the “high touch” and “low touch” implementation strategies. Effectiveness of mPATH™-CRC is evaluated by comparing the proportion who complete CRC screening within 16 weeks of their visit to the clinic between a pre-implementation cohort (8 months before implementation) and a post-implementation cohort (8 months after implementation).
Discussion
This study will provide data on both the implementation of the mPATH™ program and its effectiveness in improving screening rates for CRC. In addition, this work has the potential to have an even broader impact by identifying strategies to support the sustained use of other similar technology-based primary care interventions.
Trial registration
ClinicalTrials.gov NCT03843957. Registered on 18 February 2019.
... Further, this sheds light on another way to ensure hospital staff feel informed in the lead up to organizational change: by leveraging change agents. Change agents, otherwise termed "champions" or "brokers" in the healthcare literature, can be used to transfer information across boundaries (professions, wards, day/night shifts) (39) and are integral in the adoption and diffusion of new phenomena (40)(41)(42). Change agents are essential for the success of organizational change because of their collaborative power (i.e., ability to bridge boundaries and pass on information) and advocacy (i.e., spreading a positive message about the change). We also found that most staff (n = 101/153) reported multiple channels of change communication as useful (as opposed to only reporting one useful channel), supporting past healthcare literature emphasizing the importance of using multiple channels of change communication for successful organizational change (22). ...
Background
Hospital organizational change can be a challenging time, especially when staff do not feel informed and ready for the change to come. A supportive workplace culture can mitigate the negative effects allowing for a smooth transition during hospital organizational change. In this paper, we test an exploratory path model by which teamwork culture influences staff attitudes in feeling informed and ready for change, and which are ultimately related to reduced staff burnout. We also examined different types of change communication, identifying the channels that were perceived as most useful for communicating organizational change.
Methods
In 2019, a cross-sectional online and paper-based survey of all staff (clinical and non-clinical) was conducted at a hospital undergoing major organizational change in Sydney, Australia. The survey included items regarding teamwork culture, communication (feeling informed, communication channels), change readiness (appropriateness, change efficacy), and burnout. With a sample size of 153 (62% clinical staff), regression and path analyses were used to examine relationships between variables.
Results
The total effects between teamwork culture and burnout was significant [β (Total) = −0.37, p < 0.001) and explained through a serial mediation. This relationship was found to be mediated by three factors (feeling informed, appropriateness of change and change efficacy) in a full mediation. Further, change readiness (appropriateness of change and change efficacy) mediated the relationship between feeling informed and burnout. The most useful channels of change communication included face-to-face informal communication, emails, and a newsletter specifically about the change.
Conclusion
Overall, the results supported the predicted hypotheses and were consistent with past research. In the context of large hospital change, staff with a positive teamwork culture who feel informed are more likely to feel change-ready, heightening the chances of successful organizational change and potentially reducing staff burnout. Understanding the pathways on how culture and communication related to burnout during organizational change provides an explanatory pathway that can be used to heighten the chances of a smooth change transition with minimal disruption to staff and patient care.
... However, despite this initiative, patients diagnosed with DR-TB continue to experience delays in treatment initiation and difficulties linking from testing to care. 4 There are differences in outcomes across health districts in South Africa and there is significant variability in the extent of decentralisation. 5 Insufficient funding for DR-TB policy directives, inadequate infrastructure and lack of provincial support have hindered the shift of responsibility, 4 however, it is notable that some South African districts were early adopters of decentralised care as a result of advocacy by specific actors within their respective facilities. These individuals may be considered emergent policy champions or policy entrepreneurs. ...
... 9 However, there is a paucity of literature on the role and influence of the clinical champion role on health policy implementation in LMIC. 5 Studies note the role of champions in promoting the implementation of specific interventions, for example, hand hygiene in Cape Town, South Africa. 10 A benefit of fully understanding the champion role is that it encourages critical examination of variables that may be important for organisational change. ...
Objective
Champions are recognised as important to driving organisational change in healthcare quality improvement initiatives in high-income settings. In low-income and middle-income countries with a high disease burden and constrained human resources, their role is highly relevant yet understudied. Within a broader study on policy implementation for decentralised drug-resistant tuberculosis care in South Africa, we characterised the role, strategies and organisational context of emergent policy champions.
Design
Interviews with 34 healthcare workers in three South African provinces identified the presence of individuals who had a strong influence on driving policy implementation forward. Additional interviews were conducted with 13 participants who were either identified as champions in phase II or were healthcare workers in facilities in which the champions operated. Thematic analyses using a socio-ecological framework further explored their strategies and the factors enabling or obstructing their agency.
Results
All champions occupied senior managerial posts and were accorded legitimacy and authority by their communities. ‘Disease-centred’ champions had a high level of clinical expertise and placed emphasis on clinical governance and clinical outcomes, while ‘patient-centred’ champions promoted pathways of care that would optimise patients’ recovery while minimising disruption in other spheres of their lives. Both types of champions displayed high levels of resourcefulness and flexibility to adapt strategies to the resource-constrained organisational context.
Conclusion
Policymakers can learn from champions’ experiences regarding barriers and enablers to implementation to adapt policy. Research is needed to understand what factors can promote the sustainability of champion-led policy implementation, and to explore best management practices to support their initiatives.
... The term champion was coined by Schon in 1953 [14] applied to product champions for weaponry in the military. The concept of clinical champion was introduced in 2001 [15], subsequently reviewed [16,17]. At COH, roles of tobacco cessation champions are knowledge brokers for oncology specialists and change agents influencing clinical decision-making, incorporating cessation as part of the clinical plan and improving incorporating cessation attitudes of clinical staff. ...
Background
We designed a process to increase tobacco cessation in an academic center and its widely distributed network community sites using clinical champions to overcome referral barriers.
Methods
In 2020 a needs assessment was performed across the City of Hope Medical Center and its 32 community treatment sites. We reviewed information science strategies to choose elements for our expanded tobacco control plan, focusing on distributed leadership with tobacco cessation champions. We analyzed smoking patterns in patients with cancer before and following program implementation. We evaluated the champion experience and measured tobacco abstinence after 6 months of follow-up.
Results
Cancer center leadership committed to expanding tobacco control. Funding was obtained through a Cancer Center Cessation Initiative (C3I) grant. Multi-disciplinary leaders developed a comprehensive plan. Disease-focused clinics and community sites named cessation champions (a clinician and nurse) supported by certified tobacco treatment specialists. Patient, staff, clinician, and champion training/education were developed. Roles and responsibilities of the champions were defined. Implementation in pilot sites showed increased tobacco assessment from 80.8 to 96.6%, increased tobacco cessation referral by 367%, and moderate smoking abstinence in both academic (27.2%) and community sites (22.5%). 73% of champions had positive attitudes toward the program.
Conclusion
An efficient process to expand smoking cessation in the City of Hope network was developed using implementation science strategies and cessation champions. This well-detailed implementation process may be helpful to other cancer centers, particularly those with a tertiary care cancer center and community network.
... • Executive sponsorship and commitment from site leadership team is needed for the project to be seen as a priority • Roles and responsibilities of participants and individual accountabilities need to be clarified prior to commencement • Guidance from a steering committee is required to ensure any challenges to the project implementation or adoption are addressed in a timely manner • Codesigning how the intervention will be implemented will ensure a whole of site buy-in, top-down staff engagement and better preparation/readiness of sites for practice change • RN or careworkers should be part of the needs round discussions as only management staff from the site are currently involved • Ongoing support through adequate staffing/supporting resources is key to achieving progress with all aspects of the intervention • Support in the form of back up staff (to cover for staff attending training) is important to increase uptake of the tools and assessments among aged care staff • Ensuring presence of dedicated staff in the organisation who can act as a point of contact for follow up discussion regarding the project • To alleviate staff workload pressures and achieve progress with implementation, a stepped approach to intervention (start small, pilot, learn and adapt) was recommended ahead of a full-scale intervention • Assist sites achieve slow integration of tools/ assessments into routine practice, good understanding of how to implement and more importantly realise real benefits of the intervention to residents • A holistic medical team approach should be used to ensure timely attention is paid to resident needs (including easy access to a PC doctor who can liaise with GPs to discuss residents' PC needs) There is abundant evidence in the implementation science literature to show that the role played by champion staff is an important facilitator of successful implementation irrespective of the care settings (Hall et al., 2021;Soo et al., 2009). Champions can assist with education, influencing peers to make changes to routine practice approaches and navigate challenges through use of their communication and networking skills (Soo et al., 2009) In our study, participants highlighted lack of GP knowledge, preparation and support for providing timely PC to the residents. ...
... • Executive sponsorship and commitment from site leadership team is needed for the project to be seen as a priority • Roles and responsibilities of participants and individual accountabilities need to be clarified prior to commencement • Guidance from a steering committee is required to ensure any challenges to the project implementation or adoption are addressed in a timely manner • Codesigning how the intervention will be implemented will ensure a whole of site buy-in, top-down staff engagement and better preparation/readiness of sites for practice change • RN or careworkers should be part of the needs round discussions as only management staff from the site are currently involved • Ongoing support through adequate staffing/supporting resources is key to achieving progress with all aspects of the intervention • Support in the form of back up staff (to cover for staff attending training) is important to increase uptake of the tools and assessments among aged care staff • Ensuring presence of dedicated staff in the organisation who can act as a point of contact for follow up discussion regarding the project • To alleviate staff workload pressures and achieve progress with implementation, a stepped approach to intervention (start small, pilot, learn and adapt) was recommended ahead of a full-scale intervention • Assist sites achieve slow integration of tools/ assessments into routine practice, good understanding of how to implement and more importantly realise real benefits of the intervention to residents • A holistic medical team approach should be used to ensure timely attention is paid to resident needs (including easy access to a PC doctor who can liaise with GPs to discuss residents' PC needs) There is abundant evidence in the implementation science literature to show that the role played by champion staff is an important facilitator of successful implementation irrespective of the care settings (Hall et al., 2021;Soo et al., 2009). Champions can assist with education, influencing peers to make changes to routine practice approaches and navigate challenges through use of their communication and networking skills (Soo et al., 2009) In our study, participants highlighted lack of GP knowledge, preparation and support for providing timely PC to the residents. ...
Access to high‐quality and safe evidence‐based palliative care (PC) is important to ensure good end‐of‐life care for older people in residential aged care homes (RACHs). However, many barriers to providing PC in RACHs are frequently cited. The Quality End‐of‐Life Care (QEoLC) Project was a multicomponent intervention that included training, evidence‐based tools and tele‐mentoring, aiming to equip healthcare professionals and careworkers in RACHs with knowledge, skills and confidence in providing PC to residents. This study aims to understand: (1) the experiences of healthcare professionals, careworkers, care managers, planners/implementers who participated in the implementation of the QEoLC Project; and (2) the barriers and facilitators to the implementation. Staff from two RACHs in New South Wales, Australia were recruited between September to November 2021. Semi‐structured interviews and thematic data analysis were used. Fifteen participants (seven health professionals [includes one nurse, two clinical educators, three workplace trainers, one clinical manager/nurse], three careworkers and five managers) were interviewed. Most RACH participants agreed that the QEoLC Project increased their awareness of PC and provided them with the skills/confidence to openly discuss death and dying. Participants perceived that the components of the QEoLC Project had the following benefits for residents: more appropriate use of medications, initiation of timely pain management and discussions with families regarding end‐of‐life care preferences. Key facilitators for implementation were the role of champions, the role of the steering committee, regular clinical meetings to discuss at‐risk residents and mentoring. Implementation barriers included: high staff turnover, COVID‐19 pandemic, time constraints, perceived absence of executive sponsorship, lack of practical support and systems‐related barriers. The findings underline the need for strong leadership, supportive organisational culture and commitment to the implementation of processes for improving the quality of end‐of‐life care. Furthermore, the results highlight the need for codesigning the intervention with RACHs, provision of dedicated staff/resources to support implementation, and integration of project tools with existing systems for achieving effective implementation outcomes.
... EBP implementation in nursing provides the opportunity to integrate more research into clinical care and enables healthcare professionals to play a leading role in delivering high-quality healthcare. EBP has proven to be a problem-solving strategy that raises nurses' productivity and effectiveness 11,12,16,23,24,30 . The purpose of this research was to convert the EBPQ created by Upton and Upton into Hindi and to test how reliable it was. ...
Introduction
Many research training programmes evaluate that evidence-based practice (EBP) improves the
overall quality of point-of-care delivered by nurses by measuring nurses' knowledge, attitude, and practice. EBP implementation in nursing provides the opportunity to integrate more research into clinical care and enables healthcare professionals to play a leading role in delivering high-quality healthcare. EBP has proven to be a problem-solving strategy that raises nurses' productivity and effectiveness 11, 12, 16, 23, 24, 30. The purpose of this research was to convert the EBPQ created by Upton and Upton into Hindi and to test how reliable it was.
Method
The process of translating the tool from English to Hindi complied with World Health Organization
principles for instrument adaptation and translation (World Health Organization, 2017). The EBPQ was
backward translated when the forward translation and debate phase were over, and then it was pretested
and finalized. To test how reliable the questionnaire was, it was given to 40 registered nurses from different hospitals in Lucknow.
Result
All items are valid. The levels for practice, attitudes, and knowledge averaged 0.91, 0.830, and 0.84,
respectively, with an average inter-correlation of the items of 0.916. So, the final version of EBPQ had 24
translated statements that were found to be true and reliable.
Conclusion
The validity and reliability of the Hindi-Indian version of the EBPQ, which was originally created by Upton and Upton (2006), were then evaluated. The outcomes suggest that the Indian EBPQ version is very reliable. It is planned to use it to see how well registered nurses in India understand, interpret, and use EBPQ.
