Teams for sustainability of evidence implementation.

Abstract

Research on implementation effectiveness and sustainability is growing expontentially, enhancing the limited evidence for evidence implementation, despite the significant investment of staff time and other resources.1–4 Failure to maintain change might reflect lack of focus on cohesive team development in evidence implementation leading to individualistic rather than team-based clinical leadership.5 Teams are key mechanisms for organizationally sustainable practice change; however, successful implementation involves an organization's institutional norms changing to enable frequent, long-lasting interaction among team members, a focus on each other, and centered on joint tasks.6 On the basis of the experience of JBI, achieving sustainable change requires the following critical characteristics: effective leadership and facilitation skills, team members with the ability to articulate a plan and a purpose; to inform, motivate and persuade others; to solicit support; and foster team development.7 Furthermore leadership itself can be understood and practiced as distributed teamwork; a group endeavor within which communication using naturalistic relationships and the interactions of multiple actors (staff and other key stakeholders) rather than a reliance on individuals are the priority.5This raises the question, to what extent do the Implementation Case Study reports published in JBI Evidence Implementation reflect the role of teams in implementation? An analysis of articles since Issue 3, Volume 18 showed of 17 published reports, 6 did not mention the number of implementation team members, 9 did not include clear information referring to team engagement, whereas 5 did not describe the specific roles team members undertook in the evidence implementation project. No articles described a multidisciplinary team based process for the GRiP component or discussion on sustainability of change.We clearly need to do much better in implementation projects, methodological work and reporting on teams in the global literature that is implementation science. In this issue, we find examples of teams, team functions and distributed clinical leadership for implementation are also increasing. An implementation study by Neo et al. in 2021 on fundamental care in subcutaneous anticoagulant injections demonstrated sustainability of outcomes was associated with effective team engagement. In particular, the study authors established a team highly relevant to the practice issue, specifically developed roles for change champions as data collectors, and ensured open, frequent discussion with all clinical staff across three involved units, with an emphasis on discussing organizational sustainability while addressing individual barriers through constructive conversations. The primary implementation strategy in this study was communication, with results at end of project, and at 8 months follow-up using JBI GRiP contributed to effective uptake of subcutaneous injection techniques that reduced patient bruising and pain. Two studies in this issue demonstrate further the role and value of teams in implementation sustainability. An article on training women's pelvic floor muscles during pregnancy and postpartum shows project set up is primarily about roles and clarity on how a group will work together on a strategic organisational priority. The mechanism of action for this was to define team member functions in relation to organisational sustainability rather than individual, discrete project activity. Similarly, the article by Dr Ferreira, Dr Kelli Borges dos Santos and colleagues in Brazil serves as a case study for organisational sustainability through multidisciplinary teaming, workflow integration, with an emphasis on establishing pathways for feedback from clinical staff to project staff, and initiating stakeholder discussions. From this evidence, we encourage future authors to write up in detail the relational aspects of implementation efforts and systematically develop and embed team level elements in implementation. In this context, more will be learned about building teams and sustainability for EBHC. This, we suggest, is a challenge the readers of JBI Evidence Implementation are well suited to address. Acknowledgements Conflicts of interest The authors report no conflicts of interest.