Wilmer John Santos
Wilmer John Santos, Ian D Graham, Michelle Lalonde, Melissa Demery Varin, Janet E Squires
Institution of primary author:
Clinical Epidemiology Program, Ottawa Hospital Research Institute
The deployment of champions by clinicians, leaders, or organizations in facilitating implementation has been theorized, promoted, or/and demonstrated to improve use of innovations. Despite this, the effectiveness of champions in increasing use of innovations or improving outcomes across different health care settings is not well synthesized in the health care literature. The aim of this systematic review is to summarize champions’ effectiveness at increasing the use of innovations or improving outcomes in health care settings.
We followed the JBI approach for systematic review of effectiveness to conduct this review. We formulated and applied a PRESSed search strategy in eight electronic databases. Quantitative primary studies (peer reviewed articles or unpublished theses and dissertations) that operationalized champions and statistically evaluated relationships between champions and innovation use or outcomes within a health care setting were included. Title and abstract screening, full text screening, data extraction, and quality appraisal was completed independently and in duplicate by two researchers. We conducted a narrative synthesis; data synthesis comprised of content analysis and vote counting.
A total of 35 studies were included in our review. Many of the included studies were conducted using an observational study design (n = 28 studies, 80%). Champions were operationalized as a dichotomous variable (presence or absence of a champion) in 26 out of 35 (74.3%) studies. We found that the use of champions was associated with increased organizational uptake of best practices, programs, and/or technological innovations in 5 out of 7 studies (71.4%). Many of the included studies evaluated the relationship between deployment of champions and innovation use by providers (conceptual innovation use: n = 4 of 35 (11.4%) studies; instrumental innovation use: n = 17 of 35 (48.6%) studies) and patient outcomes (n = 6 of 35 (17.1%) studies). However, we found that the evidence in these subsets of studies regarding champions’ effectiveness was overall mixed.
Our review identified literature that collectively reported that the deployment of champions is associated with instrumental use of innovations by facilities and systems. However, the existing evidence found in this review cannot ascertain causation between deployment of champions and innovation use and/or outcomes. This is because of the minimal of use of experimental study design, the lack of detailed description of the champion strategy, and the dearth of reliable and valid measures used in many of the included studies. Hence more rigorous research is required to ascertain champions’ effectiveness in health care implementation. Further, although there is no substantiate evidence found in our review to suggest that champions are harmful to implementation, their use could be associated with opportunity cost. Therefore, the decision to deploy champion should consider the goal of implementation, the needs, and resources of the organization, and include an evaluation plan.Wilmer John Santos_poster