The selection of implementation strategies should be informed by the goals that the Implementation Team has identified around the clinic’s work with SGM patients and the approaches it prioritizes, given its organizational mission, vision, values, and operating principles. As the old saying goes, “context matters.” By context, we refer to the professional, educational, and organizational factors that are likely to affect the introduction of new policies and practices in your clinic. Therefore, the organizational assessment should provide insight into contextual factors specific to the clinic so that the team can address them proactively through action planning.
The team should consider strategies to capitalize on facilitators and overcome barriers to implementation. Facilitators and barriers may exist at multiple levels of a clinic, such as the patient-, provider-, team-, organizational-, and system-levels, or in the community. The team should think about strategies with the greatest potential to address facilitators and barriers. The team should also document why it is selecting particular strategies. To aid this process, the team can ask questions such as:
· What strategies can be employed to increase the chance of implementation success;
· How will these strategies contribute to implementation success;
· Why are these strategies likely to increase implementation success;
· How would our patients and the community define successful implementation?5
As the drivers of organizational change, the Implementation Team will play the lead role in selecting strategies. The team should consult with others in the clinic about the strategies and the likelihood that they can be feasibly applied to increase the use of the innovations. High-level administrators, for example, may need to be consulted to ensure the team adheres to clinic-specific procedures to modify a policy or put a new one in place, change registration and intake forms, or carve out time in busy work schedules for training. Table 7.2 has examples of the barriers that teams may face in putting some implementation strategies into action, along with examples of facilitating factors they can leverage.
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| Implementation Strategies to Overcome Barriers and Leverage Facilitators | |||
| Implementation Strategy | Barrier | Facilitator | |
| Meetings and Training | Lack of provider and staff education and training | Availability of space and continuing education credits | |
| Multilevel Engagement, Leadership, and Policy | Employee resistance to change | Presence of change champions interested in SGM health care | |
| Partnerships | Insufficient SGM patient engagement | Presence of SGM advocacy organizations in the community | |
| Quality Assurance and Data Systems | No formal collection of SO/GI information in health records | Health Resources and Services Administration mandate to collect gender identity information | |
| Role-Modeling | Discomfort in asking about names and pronouns | Best practice scripts for asking about names and pronouns | |
When selecting an implementation strategy, it is important to account for existing barriers and resources (e.g., people, money, materials) relevant to each innovation being introduced. Expect to use multiple strategies to get things done, like providing information to coworkers and patients, reducing resistance by enhancing their support for the organizational change at hand, removing other barriers, and leveraging available resources (e.g., SGM competency training from community partners).6