Table 2

Challenges and strategies to drive implementation of evidence-informed policy within a government-supported Network model
Strategy Explanation Working example: establishment of a community-based, multidisciplinary rheumatology service
Challenge: taking ownership and responsibility to lead an initiative
Identify and support a local clinical leader to drive implementation priorities. A local clinical leader in a specific area can be identified and encouraged to lead a piece of work which is both of interest to them and aligns with a policy recommendation. Highlighting implementation opportunities to leaders may also facilitate this process. The government officer has a key role in supporting the leader with policy intelligence, linking them with Departmental processes and personnel, and providing project support and stakeholder engagement opportunities. A local rheumatologist was identified as a clinical leader in promoting the establishment of a community-based rheumatology service in an outer metropolitan area.
Challenge: knowing where and how to start with a service reform project
Map opportunities, barriers and enablers to implementation. The clinical leader, government officer and other stakeholders identify system barriers and enablers to implementing Model of Care recommendation(s). By exploring the barriers and enablers, a specific project(s) may be developed. Barriers and enablers were mapped, including:
Barriers: local workforce limitations (skills, knowledge, volume), establishing new clinical and clerical positions within an area health service, funding limitations especially for consultant salaries, lack of local community-based support services, lack of data to substantiate need, lack of programme evaluation expertise.
Enablers: opportunity to upskill local clinicians, engage the private sector in clinical service delivery, apply for grants to procure seed funding, partner with non-government providers in community-based service delivery, partner with universities for evaluation expertise.
Develop an evidence-informed and data-driven business case/project plan with longer term implementation/integration strategies identified. The project leader, working group and government officer develop a data-driven business/project plan to demonstrate need, explicitly identify how the work aligns with policy, and the predicted risk and benefits to the local health system. Partnerships with researchers and intra-departmental agencies (e.g. Epidemiology) are important for developing a robust and mutually agreeable business case/project plan. Providing a description of how the initiative links with the broader policy directions and funding models is critical to increasing the likelihood of acceptance from decision makers and opportunities to maintain sustainability. Project plan developed, supported by data concerning the number of referrals to tertiary hospital-based rheumatology departments according to geographic areas in the state. Geographic areas of need could then easily be identified. The plan included strategies to upskill local clinicians, engage the private sector to provide clinical services (allied health and rheumatologists), and partner with other community-based organisation to provide local services (e.g. self-management and exercise programs) in the area identified as the site for implementation.
Challenge: attracting buy-in from other stakeholders for gaining assistance and influencing decision makers
Establish a local working group of interested people from the Network. Individuals who express an interest in the project(s) are invited to join a working group, share ideas and lead sub-components of the project in a distributed leadership model. The government officer and an emerging group of stakeholders identify others to contribute to the project. Invite individuals with interest and skill sets applicable to establishing a service (clinicians, consumers, policy makers, business managers, researchers). The importance of the end goal and how the proposed iterative processes aligned with individuals’ interests were emphasised.
Maintain government officer support. The government officer provides project management support and executive support to ensure that project activities align with policy, provide in kind resources and identify opportunities for integrating with other projects and relevant stakeholders. Utilise knowledge of government officer to link project objectives with other opportunities within government (e.g. funding programs for community-based care) and attract buy-in from other stakeholders.
Seek executive support. Executive support to progress the plan is sought. This may involve approval to seek funding, identify partnership opportunities and promote the project concept to other executives. Executive support also facilitates engagement with, and support from, middle management. Project plans presented to executives for support. Regular briefings were provided on progress of implementation.
Engage support from broader stakeholder group (the Community of Practice). Maximising buy-in from other stakeholders (e.g. the clinical community, area health services, policy-makers) on a particular project can be facilitated by promoting a project objective and working group to these individuals. This may achieved through Network forums or e-newsletters. A broad support base help to forge and maintain partnerships and sustain the political will to support the initiative. Once executive support received, the project was promoted through the Network via meetings, e-newsletters and a major stakeholder forum [52].
Identify cross-sectoral partnerships in supporting implementation strategies. Engage with organisations, such as universities and non-government organisations, to promote the project concept and canvass interest in partnership opportunities. Non-government organisations are critical partners for community-based and consumer-centred projects due to their various community-based programs and established relationships with both professional bodies and consumers. Project team expanded to include partnerships with other organisations including universities for research and evaluation expertise, WA Community Physiotherapy Services for allied health services ( http://www.health.wa.gov.au/cps/about/ webcite), Arthritis and Osteoporosis WA for consumer services (e.g. provision of self-management programs and consumer engagement) ( http://www.arthritiswa.org.au/ webcite), and private service providers for clinical rheumatology services.
Challenge: gaining preliminary financial support
Procure funding or in-kind support for initial establishment. Submit funding applications for competitive grants, government grants and pooled funding initiatives between partner organisations (e.g. government, non-government organisations, universities). Grant applications submitted for funding specific components of the implementation project. A grant was awarded for a programme designed to upskill clinicians while government funding was awarded to establish a service and appoint a project manager.
Ensure service agreements with non-government organisations reflect contemporary policy. Support for implementation activities may also be provided by non-government organisations (e.g. delivery of community-based self-management programmes). Aligning service agreements between government and such organisations supports the implementation of policy recommendations and projects. A service agreement between the Department of Health and a non-government provider ensures that local community-based services are available to consumers at the implementation site and other potential replication sites.
Challenge: securing sustainability
Pilot and evaluate a model. Undertake the proposed project (e.g. a service model) and ensure evaluation is underpinned by sound research principles. Partnerships with research organisations are important to for achieving robust evaluation methods. An evaluation framework has been established to monitor consumer-centred and system-centred outcomes.
Disseminate results, e.g. through publications, reports, presentations. Communicate the outcomes of the evaluation and opportunities and barriers for achieving programme sustainability.
Integrate parallel projects to build cumulative change momentum in an area and avoid duplication of efforts. Where possible, link specific policy implementation projects through communication and project promotion. This may be achieved through forums, e-bulletins and government officers having knowledge of discrete pieces of work being developed and undertaken. Linked projects with evaluations include the establishment of a rheumatology service at a specific site, clinical workforce upskilling in rheumatoid arthritis (state and national projects) and development of self-management programs for consumers and health professionals in disease-specific musculoskeletal health conditions.

Briggs et al.

Briggs et al. BMC Health Services Research 2012 12:394   doi:10.1186/1472-6963-12-394

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