Table 1 Five stages of achieved implementation (adapted from Grol et al) [21, 22]
Stage | Description | Criteria for assessment |
|---|---|---|
1. Orientation | Awareness and interest in innovation. | Distribution of messages, key figures, and networks approached and informed. |
2. Insight | Understanding and insight into implications for routines. | Provision of instruction materials using audit methods and performance feedback. |
3. Acceptance | Positive attitude to change, positive intentions/decision to change. | Adaptation of innovation by target group, identification of resistance to change, involvement of key individuals, pilots and demonstration of feasibility, detection of barriers, and search for solutions. |
4. Change | Actual adoption, try out change in practice, exploratory use, confirmation of value of change. | Provision of resources, support for skills training, redevelopment of processes, temporary resource support, inventory of barriers, and solution attempts. |
5. Maintenance | New practice integrated into routines/routine use, new practice embedded in organization, sustainability over time. | Long-term monitoring, feedback and reminder systems, integration into routine pathways, provision of researches, and support from management. |