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Table 1 Five stages of achieved implementation (adapted from Grol et al) [21, 22]

From: “Many miles to go …”: a systematic review of the implementation of patient decision support interventions into routine clinical practice

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.