Commentary on “Implementing immediate postpartum contraception: a comparative case study at 11 hospitals”

Understanding the conditions and strategies for successfully implementing immediate postpartum long-acting reversible contraception (LARC) is critical for improving access to the service.  Moniz and colleagues’ concomitant use of the Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change (ERIC) guides their comparative case study, ultimately revealing how organizational context and implementation strategies influenced the implementation of immediate LARC in 11 maternity hospitals. The authors conducted semi-structured interviews with 78 individuals representing the 11 hospitals.  For their analysis, they defined three components of implementation success—stakeholder satisfaction, routinization, and sustainability—and assigned qualitative ratings of each component for each site. Their analytic approach also involved assigning quantitative ratings of influence for each CFIR condition on implementation success, summing these ratings to facilitate a comparison of positive and negative influences at each site. In addition, they identified implementation strategies used by each site, guided by the ERIC strategies.  By merging the data on CFIR conditions and strategies, the authors were able to synthesize conditions strongly associated with implementation success and strategies for promoting implementation success.  Ultimately, their analysis revealed three essential conditions for successful implementation: 1) effective implementation champions, 2) an enabling financial environment, and 3) hospital administrator engagement. Six highly influential conditions for success also were identified: 1) trust and effective communication, 2) alignment with stakeholders’ professional values, 3) perceptions of meeting patients’ needs, 4) compatibility with workflow, 5) robust learning climate, and 6) positive attitude and adequate knowledge about the clinical practice. In addition, the analysis revealed strategies widely utilized or underutilized during the implementation process, explaining why the intervention was successfully implemented at some sites while failed at others.

Overall, the authors conclude that universal reimbursement or innovative strategies to mitigate potential financial implications are needed for the successful adoption of immediate LARC by hospital administrators. Also, the authors identify a need for champions to be supported by multidisciplinary implementation teams who are essential for addressing barriers outside of champions’ influence. I would argue that the sustainability of champions and implementation teams within the organization also may be critical for successful implementation. It would have been interesting to see whether/how established multidisciplinary implementation teams enabled communication between the practice level and the administrative level for rapid improvements in policies and processes. Finally, I believe this study has important implications for assessing readiness. The essential and influential factors identified could be used when assessing and building readiness of individuals (champions, providers, administrators, patients) and organizations (resource availability, policy, and processes) implementing a new practice.

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