226 Chapter 8 as identifying and preparing champions, reexamining the implementation, educational meetings, and providing local technical assistance. These strategies aimed to build trust and credibility by explaining the purpose and development of DRAAI in educational sessions and encouraging champions to reassure their colleagues. During the pilot study, we learned that additionally to the identification of determinants prior to implementation, continuously identifying determinants during the implementation phase is crucial. Chan, Lee [10] conducted a systematic review on the implementation of prediction models in emergency departments. They found that close stakeholder engagement helped address important needs, ensuring a strong alignment between the intervention, determinants, and implementation strategies. Selecting, specifying and reporting implementation strategies The systematic reviews in chapters 2 and 3 resulted in a limited number of studies utilizing an implementation theory, model or framework. Even fewer studies reported using their determinants analysis to select implementation strategies. These findings align with the results of a systematic review by Davies, Walker and Grimshaw [11], which analyzed 235 studies and found that only 23% used determinants or theory to inform the selection and design of implementation strategies. When the link between determinants and implementation strategies is disregarded, a “black box” is created – obscuring the reasoning behind chosen strategies for overcoming barriers or enhancing facilitators. This obscurity limits our ability to learn from past studies and improve future implementations [12]. Without a clear understanding of the mechanisms at play, it is hard to replicate successful strategies or avoid repeating of ineffective ones. Therefore, aligning determinants with implementation strategies is crucial to enhance transparency, facilitate an evidence base for effective and ineffective strategies, and ultimately improve patient outcomes. The Implementation Research Logic Model (IRLM), developed by Smith, Li and Rafferty [13], can help clarify the connections between determinants, implementation strategies, mechanisms of action, and implementation outcomes. It serves as a useful tool for planning, executing, reporting, and synthesizing processes and findings throughout implementation projects. A possible starting-point to select possible implementation strategies is to use the CFIR-ERIC matching tool [12]. In this tool barriers identified with CFIR [14] are matched to implementation strategies from the Expert Recommendations for Implementing Change (ERIC) [15, 16]. This tool was developed with expert input, ranking the top seven ERIC strategies to each identified barrier from CFIR. However, it is important to note that the tool is not grounded on empirical evidence proving the effectiveness of specific strategies in addressing these particular barriers.
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