Table 3

Implementation guidance and fidelity in case study hospitals

Guidance from programme developers*Levels of fidelity by hospitalExamples of medium/low fidelity
Strategic alignmentDefine clear goals that align with Trust strategy; secure executive supportInsufficient data
Implementation and governance structuresSet-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)MediumMediumMediumLowMediumMedium
  • 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 planningCreate project plan including: roll-out sequence; timetable; resources required; activities; outcomes checklist; progress reviewsHighHighHighHighHighHigh
Selecting showcase wardsInvite applications and select showcase wards using the NHSI selection template and sustainability model and guideHighMediumLowMediumMediumLow
  • 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 scopeWards to evaluate current practice with respect to all modulesHighMediumLowMediumHighMedium
  • 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 roleLeading Productive Ward Facilitators; tracking progress and quality; strategic learning; stakeholder management; updating executive leaderHighHighHighHighHighHigh
Productive Ward Facilitator role, ward support and trainingSupport and guide wards and ward managers (not to do the tasks, or act without ward managers’ agreement); provide trainingHighHighHighHighMediumMedium
  • Productive Ward Facilitators did much of the implementation work (E, F)

Productive Ward Facilitator role (other)Monitor implementation and measurement; work with central servicesHighHighn/aHighHighHigh
CommunicationCreate 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.