Table 3

Implementation guidance and fidelity in case study hospitals

Guidance from programme developers*		Levels of fidelity by hospital						Examples of medium/low fidelity
Guidance from programme developers*		A	B	C	D	E	F	Examples of medium/low fidelity
Strategic alignment	Define clear goals that align with Trust strategy; secure executive support	Insufficient data
Implementation and governance structures	Set-up: steering group (including chief executive officer, executive leader, medical director, finance director, general managers, nursing managers); implementation team; ward teams (including matron and representatives from all staff groups)	Medium	Medium	Medium	Low	Medium	Medium	No steering group (D) Steering group did not include medical/ finance directors (A, B, C, F) Matrons omitted from ward team implementation (A) Doctors not engaged at ward level (B, C, D, E) Limited reach/scope of ward staff involvement (D)
Project planning	Create project plan including: roll-out sequence; timetable; resources required; activities; outcomes checklist; progress reviews	High	High	High	High	High	High
Selecting showcase wards	Invite applications and select showcase wards using the NHSI selection template and sustainability model and guide	High	Medium	Low	Medium	Medium	Low	No application process (B, C, D, E, F) Wards chosen based on patient demographics and incidents (high risk) (C) Readiness to start not measured (F)
Implementation scope	Wards to evaluate current practice with respect to all modules	High	Medium	Low	Medium	High	Medium	Only limited number modules implemented on all implementing wards (typically three foundation modules plus one to three more) (B, C, D, F) Roll-out restricted to half the wards for first 2 years (C)
Productive Ward Leader role	Leading Productive Ward Facilitators; tracking progress and quality; strategic learning; stakeholder management; updating executive leader	High	High	High	High	High	High
Productive Ward Facilitator role, ward support and training	Support and guide wards and ward managers (not to do the tasks, or act without ward managers’ agreement); provide training	High	High	High	High	Medium	Medium	Productive Ward Facilitators did much of the implementation work (E, F)
Productive Ward Facilitator role (other)	Monitor implementation and measurement; work with central services	High	High	n/a	High	High	High
Communication	Create and use a communication plan—‘who, what, when, how, why’	Insufficient data

*These columns derive from the NHS Institute for Innovation and Improvement Executive Leader’s Guide and Project Leader’s Guide.
NHSI, NHS Institute for Innovation and Improvement.