Developing a theory-based taxonomy of methods for implementing change in practice.
OBJECTIVE
In this paper we present a theory-based taxonomy of the methods used to implement change in practice.


BACKGROUND
Implementation research is characterized by inconsistent terminology for the methods employed and inattention to differences in the relevance of methods across different disciplines. Studies of the effectiveness of implementation have yielded mixed results. Positive effects shown have been small. The limited success of many efforts to implement change in practice may be due, in part, to the absence of a framework to guide the use of implementation methods.


METHODS
A provisional taxonomy of implementation methods, derived from theory and existing taxonomies, was used to content analyse a convenience sample of 43 reports of empirical studies of the implementation of one or more research-based practice changes involving nurses that had been published between 1995 and 2005. This taxonomy was revised throughout the course of analysis to capture more completely the information in each report.


RESULTS
Following the analysis, nine of the 11 methods in the provisional taxonomy were retained, two were removed and five new methods were identified. The final taxonomy includes 14 implementation methods organized into five categories: (a) increasing coordination; (b) raising awareness; (c) persuasion via interpersonal channels; (d) persuasion via reinforcing belief that behaviour will lead to desirable results and (e) increasing behavioural control.


CONCLUSIONS
The taxonomy presented here differs from prior taxonomies by focusing on nursing and by providing a clear and mutually exclusive guide to implementation methods. By deriving the initial coding strategy from theory, the taxonomy links the methods to theoretical constructs that may inform the selection of methods across different practice changes and settings.
Leeman
Jennifer
J
School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. jleeman@email.unc.edu
Baernholdt
Marianne
M
Sandelowski
Margarete
M
D036262:Empirical Research; D006284:Health Plan Implementation / Q000145:classification*; D006801:Humans; D008962:Models, Theoretical; D009729:Nursing / Q000145:classification*; D009936:Organizational Innovation; D011216:Practice Management, Medical / Q000145:classification; D009626:Terminology as Topic