Clinical champions are often engaged to implement new evidence-based practices in health care settings. Previous research suggests that the mere presence of a champion does not guarantee successful implementation; therefore, we aimed to identify specific champion attributes and site-level factors that contribute to evidence-based practice adoption. During a Department of Veterans Affairs (VA) quality improvement program, we engaged site champions to implement an advance care planning evidence-based practice with seriously ill Veterans in VA home based primary care (HBPC) and community nursing homes (CNHs). We conducted interviews ( N = 99) with champions and leadership at 11 HBPC programs and 6 VA CNH programs. Guided by the Tailored Implementation in Chronic Diseases (TICD) framework and Shea’s conceptual model of champion impact, we analyzed interview data to examine champion characteristics and site factors associated with successful adoption of the evidence-based practice. Additionally, we categorized sites as successful or not successful in terms of adopting the evidence-based practice and compared champion characteristics and site factors between these sites using a Matrixed Multiple Case Study approach. Eight HBPC programs (73%) and four CNH programs (67%) were successful. Champions at successful sites believed in the importance of eliciting and documenting Veterans goals of care, were motivated and committed to participating in the project, and were dedicated to serving as champions. Successful sites had champions who engaged in champion activities beyond attending coaching calls, including supporting and educating peers. The degree of leadership support, as well as the relative priority of the project varied; unsuccessful sites mentioned competing priorities and lower levels of leadership engagement. Results suggest that champion belief in the importance of the evidence-based practice, commitment to the program, motivation to serve as a champion, and engagement with peers are characteristics common among champions at sites that successfully adopted the evidence-based practice. At the site-level, the degree of leadership engagement and the priority of implementing the evidence-based practice emerged as factors influencing success. These findings can assist future healthcare interventions and programs in identifying clinical champions for implementing evidence-based practices.
Magid et al. (Thu,) studied this question.