Systematic Decision-Making for Using Technological Strategies to Implement Evidence-Based Interventions: An Illustrated Case Study

Abstract

Technology can improve implementation strategies' efficiency, simplifying progress tracking and removing distance-related barriers. However, incorporating technology is meaningful only if the resulting strategy is usable and useful. Hence, we must systematically assess technological strategies' usability and usefulness before employing them. Our objective was therefore to adapt the effort-vs-impact assessment (commonly used in systems science and operations planning) to decision-making for technological implementation strategies. The approach includes three components – assessing the effort needed to make a technological implementation strategy usable, assessing its impact (i.e., usefulness regarding performance/efficiency/quality), and deciding whether/how to use it. The approach generates a two-by-two effort-vs-impact chart that categorizes the strategy by effort (little/much) and impact (small/large), which serves as a guide for deciding whether/how to use the strategy. We provide a case study of applying this approach to design a package of technological strategies for implementing a 5 A's tobacco cessation intervention at a Federally Qualified Health Center. The effort-vs-impact chart guides stakeholder-involved decision-making around considered technologies. Specification of less technological alternatives helps tailor each technological strategy within the package (minimizing the effort needed to make the strategy usable while maximizing its usefulness), aligning to organizational priorities and clinical tasks. Our three-component approach enables methodical and documentable assessments of whether/how to use a technological implementation strategy, building on stakeholder-involved perceptions of its usability and usefulness. As technology advances, results of effort-vs-impact assessments will likely also change. Thus, even for a single technological implementation strategy, the three-component approach can be repeatedly applied to guide implementation in dynamic contexts.

Sustaining the collaborative chronic care model in outpatient mental health: a matrixed multiple case study

“…For instance, of the three factors found to most notably trend with CCM sustainability, Collaborativeness and teamwork may be strengthened through shorter-term team-building interventions at the organizational and/or clinic levels [ 38 ], Turnover of clinic staff and leadership may be mitigated by aiming for longer-term culture/climate change at the system and/or organizational levels [ 44 – 46 ], and Having a consistent and strong internal facilitator may be ensured more immediately by selecting an individual with fitting expertise/characteristics to serve in the role [ 15 ] and imparting innovation/facilitation knowledge to them [ 47 ]. Which of these factors to focus on, and through what specific strategies, can be decided in partnership with an implementation site—for instance, candidate strategies can be identified based on ones that literature points to for addressing these factors [ 48 ], systematic selection of the strategies to move forward can happen with close input from site personnel [ 49 ], and explicit further specification of those strategies [ 50 ] can also happen in collaboration with site personnel to amply account for site-specific contexts [ 51 ].…”

Implementation mapping for tobacco cessation in a federally qualified health center

“…For designing implementation strategies (methods or techniques used to enhance the adoption, implementation, and sustainability of a clinical program or practice) (25,26), a systems science method (27) was used to assess the variable impact and effort of each potential strategy and adapted for developing implementation strategies within this FQHC (28). Consistent with community-engaged practices (2), this process enabled power-sharing by identifying staff-driven strategies, later mapped onto a taxonomy of expert-identified strategies (26) for consistency in reporting.…”

“…There is much debate in the literature about best methods for selecting strategies, with general consensus that a systematic and constituent-influenced approach is optimal, with the entire IM process often cited as an option (35, 36). Here, a three-component approach was adapted from the effort-vs-impact assessment method of operations planning, fully described elsewhere (28). In brief, this approach charted strategies according to effort (low/high) and impact (low/high).…”

“…The third component assessed whether to use or abandon the strategy by cross-referencing results from the previous two components. Rapid analysis of staff interviews and leader surveys were coded according to a spectrum of perceived effort and impact (28). Results identified seven priority strategies, primarily enacted by the CEDI support system (37) (SW, CC) to target behavioral change in the delivery system (medical assistants and clinicians).…”