How the champion can make the change implementation a success - a realist evaluation approach

Context: The champion, as a member of an organization that facilitates the implementation of change, appears to be a critical factor in the success of such initiative. The causal relationship between the presence of the champion and successful implementation of change, however, is complex and underresearched, especially in primary care organizations.

Objective: To explain how, why, and under which circumstances the champion facilitates organizational change in Family Medicine Groups (FMG).

Study Design and Analysis: A multiple case study design using a realist evaluation approach has been used to refine and validate the program theory. Data has been collected through documentary analysis and individual semi-structured interviews. The relationships between the context (pre-existing elements to an intervention/program), the mechanisms (underlying processes triggered in a particular context) and the outcomes have been represented in Context-Mechanism-Outcome configurations, to refine the program theory.

Setting: FMGs in the province of Québec, Canada. FMG is the main model of primary care clinics in the province of Québec.

Population Studied: Four cases of champions in FMG who implemented an organizational change were identified. To inform each case, the champion and other individuals targeted by the change were then recruited.

Findings: 24 individuals were interviewed. The findings suggest that the champion enhances trust around the project; he/she builds, tests and contextualizes the change and demonstrates the feasibility and the benefice of the change proposal. This trust increases peers’ confidence in the change and reduces reluctance. The champion who takes responsibility for the change: to resolve barriers as they arise, promote progress in patient outcomes and ensure the prioritization of this change, will support motivation and momentum of the change implementation. The presence of a champion favours fluid communication between the field and decision-makers. Fluid communication will help to deliver the resources needed to implement change promptly, which will also support the momentum of change.

Conclusion: This study highlights the complexity associated with implementing change in healthcare organizations. This program theory developed further enhances our understanding of how and why champions contribute to the implementation of changes in healthcare organizations and how to adapt their actions to the local context to optimized their outcomes.