Table 1 Strategies to address challenges... | Emerald Publishing

Table 1

Strategies to address challenges in engaging healthcare organisations (the RELATE model)

Challenges	Strategies to address challenges	Practical examples
1. Recognising and navigating an organisation's complexity and hierarchy to identify influencers	Ensuring familiarity with formal organisational chart Leveraging working relationships to create opportunities for informal conversations with staff to understand key people in the network and understand norms	Requesting time to briefly introduce intervention at existing decision-making fora, e.g. management team, clinical leaders, nursing management, health and social care professionals meetings Holding open lunchtime sessions to introduce the intervention to staff Meeting with existing contacts in the organisation to identify key influencers/opinion leaders and spending time explaining the rationale and evidence for the intervention (recognising that they will influence others to participate)
2. Enhancing understanding of the priorities of different stakeholder groups and demonstrating how the intervention helps address those priorities	Understanding and documenting diverse priorities Seeking alignment to organisation's vision and strategy Engaging stakeholders in co-design to ensure intervention and approach to implementation is fit-for-purpose Bestowing ownership through involvement	Rather than presenting a finished product, bringing evidence and ideas to a forum that engages the intended targets of the intervention to co-design or adapt both the content and the approach to delivery. This co-design process surfaces the diverse priorities in the organisation, provides the research team with an enhanced understanding of the organisational dynamics and the potential barriers or sticking points and how to overcome these Leveraging institutional agreements/memoranda of understanding to demonstrate contribution to a larger vision
3. Leveraging common values and communicating to key individuals the value of implementation research	Mapping key stakeholders to promote/authorise planning collaboration and engagement Recognising and addressing conflicting values (real and perceived) in the organisation Tailoring messages to each group based on diverse interests: identifying unique value to individuals/teams and shared value to wider teams/organisation Ensuring continued relevance through regular updates to the management team	Nuancing presentations on the intervention to demonstrate the research team's understanding of value system and challenges of the particular group/audience, e.g. a management team may be more focused on the end result of improved patient safety whereas a clinical team, whilst striving to achieve patient safety may be more concerned with the processes, roles and responsibilities in the team
4. Aligning and positioning intervention to illustrate synergies with other initiatives	Understanding and mapping other improvement initiatives in the system. Identifying and emphasising complementarities, synergies and alignment between efforts rather than competition Ensuring explicit alignment to the organisation's objectives/strategic plan	Engaging in sense-making. Resisting the temptation to compete with other interventions, instead identifying synergies and complementarities and demonstrating how the intervention can add value to on-going work/other initiatives in the organisation
5. Building and maintaining credibility and trust in the research team	Demonstrating an understanding of the value system through work in the preceding phases Acknowledging the challenges and constraints that exist within the organisation Adding value to the organisation through feeding back evidence, findings and results (or other agreement mechanisms of communication) Ensuring a certain level of authority/credibility required among team members meeting with hospital management Considering resource commitments Ensuring behavioural integrity	Investing the time and resources to build a relationship for the longer term, not just for the project Increasing understanding of research and the potential of the research team to help the organisation attain its objectives Helping with other organisational initiatives, e.g. help staff to publish previous work, develop a research framework for a project, write a proposal for funding, etc. Providing timely and practical feedback as the research progresses – demonstrate value early to help bring more people on board (Powell et al., 2015) Recognising that seniority confers credibility, ensuring that senior researchers in the team are visible and engaged in supporting more junior researchers Behaving with integrity, maintaining a neutral stance, refraining from engaging in organisational politics, etc.
6. Evolving the intervention through listening and learning	Recognising that some staff will feel threatened by change in the status quo. (listening to and learning from resistance) Listening to concerns, demonstrating how intervention addresses these and being willing to adapt intervention to better address needs	Utilising resistance as a positive force to adapt an intervention and increase its fit-for-purpose Harnessing evidence-based implementation strategies to support adaptation (e.g. Powell et al., 2015) Demonstrating that the team understands and takes seriously the concerns of individuals and groups also helps build the credibility of the research team

Challenges	Strategies to address challenges	Practical examples
1. Recognising and navigating an organisation's complexity and hierarchy to identify influencers	Ensuring familiarity with formal organisational chart Leveraging working relationships to create opportunities for informal conversations with staff to understand key people in the network and understand norms	Requesting time to briefly introduce intervention at existing decision-making fora, e.g. management team, clinical leaders, nursing management, health and social care professionals meetings Holding open lunchtime sessions to introduce the intervention to staff Meeting with existing contacts in the organisation to identify key influencers/opinion leaders and spending time explaining the rationale and evidence for the intervention (recognising that they will influence others to participate)
2. Enhancing understanding of the priorities of different stakeholder groups and demonstrating how the intervention helps address those priorities	Understanding and documenting diverse priorities Seeking alignment to organisation's vision and strategy Engaging stakeholders in co-design to ensure intervention and approach to implementation is fit-for-purpose Bestowing ownership through involvement	Rather than presenting a finished product, bringing evidence and ideas to a forum that engages the intended targets of the intervention to co-design or adapt both the content and the approach to delivery. This co-design process surfaces the diverse priorities in the organisation, provides the research team with an enhanced understanding of the organisational dynamics and the potential barriers or sticking points and how to overcome these Leveraging institutional agreements/memoranda of understanding to demonstrate contribution to a larger vision
3. Leveraging common values and communicating to key individuals the value of implementation research	Mapping key stakeholders to promote/authorise planning collaboration and engagement Recognising and addressing conflicting values (real and perceived) in the organisation Tailoring messages to each group based on diverse interests: identifying unique value to individuals/teams and shared value to wider teams/organisation Ensuring continued relevance through regular updates to the management team	Nuancing presentations on the intervention to demonstrate the research team's understanding of value system and challenges of the particular group/audience, e.g. a management team may be more focused on the end result of improved patient safety whereas a clinical team, whilst striving to achieve patient safety may be more concerned with the processes, roles and responsibilities in the team
4. Aligning and positioning intervention to illustrate synergies with other initiatives	Understanding and mapping other improvement initiatives in the system. Identifying and emphasising complementarities, synergies and alignment between efforts rather than competition Ensuring explicit alignment to the organisation's objectives/strategic plan	Engaging in sense-making. Resisting the temptation to compete with other interventions, instead identifying synergies and complementarities and demonstrating how the intervention can add value to on-going work/other initiatives in the organisation
5. Building and maintaining credibility and trust in the research team	Demonstrating an understanding of the value system through work in the preceding phases Acknowledging the challenges and constraints that exist within the organisation Adding value to the organisation through feeding back evidence, findings and results (or other agreement mechanisms of communication) Ensuring a certain level of authority/credibility required among team members meeting with hospital management Considering resource commitments Ensuring behavioural integrity	Investing the time and resources to build a relationship for the longer term, not just for the project Increasing understanding of research and the potential of the research team to help the organisation attain its objectives Helping with other organisational initiatives, e.g. help staff to publish previous work, develop a research framework for a project, write a proposal for funding, etc. Providing timely and practical feedback as the research progresses – demonstrate value early to help bring more people on board (Powell et al., 2015) Recognising that seniority confers credibility, ensuring that senior researchers in the team are visible and engaged in supporting more junior researchers Behaving with integrity, maintaining a neutral stance, refraining from engaging in organisational politics, etc.
6. Evolving the intervention through listening and learning	Recognising that some staff will feel threatened by change in the status quo. (listening to and learning from resistance) Listening to concerns, demonstrating how intervention addresses these and being willing to adapt intervention to better address needs	Utilising resistance as a positive force to adapt an intervention and increase its fit-for-purpose Harnessing evidence-based implementation strategies to support adaptation (e.g. Powell et al., 2015) Demonstrating that the team understands and takes seriously the concerns of individuals and groups also helps build the credibility of the research team