The importance of studying real world implementation of efficacious interventions and the roles of key players for implementation success, such as leadership, is highly recognized. This study explored clinical managers’ experiences and perceptions about the implementation of an informatics intervention called Choice into regular clinical practice. Choice is designed to support patient-provider communication and had shown to be efficacious in a previous RCT.
6 nurses and 3 physicians in leadership positions at the 5 units in which Choice was implemented were interviewed post-implementation according to a structured interview guide. The following barriers emerged from the transcribed interviews: In spite of extensive preparation and training prior to implementation, more was needed; there was still resistance to change practice and a lack of motivation among some care providers. Also, time pressure and high turn-over rates required continuous re-training that hampered intervention use. Managers perceived sustained support from and collaboration with the interventionists as vital for the integration of Choice into routine practice.
This study confirms that attitudes, established practices and clinical cultures are deeply rooted and hard to change. More research is needed to identify strategies for overcoming these barriers, and how leadership may be better supported to utilize the key role they play for implementation success.