As any healthcare provider or leader can attest, implementing new practices and programs is difficult and complex. Our previous research at BORN showed that while BORN data and information products can help alert teams to potential problems, this alone is not always enough to generate successful and sustainable improvements in clinical practices.¹

“Implementation science” is a growing field that can inform what approaches and methods teams use to implement and sustain new evidence-informed practices and programs. However, the implementation science literature is large and can be difficult to navigate and apply in practice. Our team therefore aimed to create a user-friendly and practical resource, which we call an “implementation toolkit,” to present an implementation science informed approach to making practice changes in birthing and newborn care settings.

 

Partnership Approach

In this research we are using an Integrated Knowledge Translation (IKT) approach, which means that the researchers are partnering with representatives of the target end-user groups throughout the research process, from designing the study through to sharing and implementing the results.

Our research team includes a parent, a regional director, a nurse educator, a BORN manager and regional coordinators, and researchers who specialize in implementation science and practice. By working directly with healthcare providers and leaders to conduct the study, we hope to make the implementation toolkit more relevant and usable for teams.

 

What Informed the Toolkit Content?

So far, our team has conducted a series of studies to determine what information is most important to include in the implementation toolkit. First, we talked with implementation science experts to learn about what they think leaders and healthcare providers need to know to successfully implement practice changes.² Then we analyzed interviews with nursing leaders working in Ontario birthing and newborn care hospitals to learn about what steps they usually take to implement practice changes.³ Finally, we surveyed Ontario birthing and newborn care hospitals to explore which implementation steps they currently conduct and how confident they are completing them.⁴

 

The New Toolkit

Using this information from the three studies, we have now drafted the first version of the implementation toolkit. The implementation toolkit is based on an implementation science framework called the “Implementation Roadmap”⁵ and outlines 13 core steps to consider when implementing a practice change:

1. Form a working group and engage partners
2. Understand your problem
3. Select an evidence-informed solution
4. Understand current practice and define your evidence-practice gap
5. Customize the evidence-informed solution to your local context
6. Make the decision to proceed or not
7. Identify barriers and drivers to the practice
8. Select your implementation strategies
9. Plan for monitoring
10. Plan for evaluation
11. Plan for sustainability
12. Implement the change
13. Monitor, evaluate, and sustain the change

The toolkit provides information on what each step involves, why it is important for implementation success, considerations for equity, diversity, and inclusion, and tools and templates that can support completion of the step.

² Essential content for teaching implementation practice in healthcare: a mixed-methods study of teams offering capacity-building initiatives

³ Planning and implementing practice changes in Ontario maternal-newborn hospital units: a secondary qualitative analysis.

⁴ Implementation processes and capacity-building needs in Ontario maternal-newborn care hospital settings: A cross-sectional survey. 

⁵ Knowledge translation in nursing and healthcare: a roadmap to evidence-informed practice.