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Table 3 Key implementation and evolution factors using Grol and Wensing's Characteristics of Innovations Framework [32].

From: Tailoring an intervention to the context and system redesign related to the intervention: A case study of implementing shared medical appointments for diabetes

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

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

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

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)

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

   

2. Change in way patient data distributed in order to reduce prep time of Clinical Pharmacist and overall cost

   

3. Introduced use of templated notes that included documentation of SMA activities at a general group level and also permitted individualized patient level documentation

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

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

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

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

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

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

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

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

Magnitude, disruptiveness, radicalness

 

High

The core team was made up of individuals willing to take risk and were unafraid of the potential disruption

Duration for when innovation/change must take place

Not a pressing factor

  

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

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.

Nature of Presentation: length, clarity, attractiveness

High attractiveness

Low clarity

Began projects to share knowledge and experience with others