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Table 2 Barriers to the use of the NIRN Model

From: Facilitating implementation of the Decision-Making Capacity Assessment (DMCA) Model: senior leadership perspectives on the use of the National Implementation Research Network (NIRN) Model and frameworks

Category/theme Supporting quotes
Gaining buy-in from various levels and disciplines can be challenging “Trying to get other people to buy in would be hard.” (2016-08-15); [Adopting it] would need a lot of buy in and a lot of work (2016-10-24); “There was not a lot of physician buy in. Having the medical director involved too was essential.” (2016-11-25); “Some projects in the past have failed because there was no buy in from the leadership… You do need a driversomeone that will be in charge.” (2016-08-02); “If the leadership is not behind you, a lot of time things fall down. So you need them on board for things to move. No matter what the level of motivation is at the grass roots, without that higher level supportthings tend to die because there are competing demands and people don’t have time to do everything. To have the time to do it and focusmake priority, then leadership has to be on board.” (2016-08-02)
There is a tendency to not clearly articulate outcome measures when introducing best-practices “From the point of view of education or practice change, we often think about what we want the outcome to be, but we don’t often articulate it in a very clear way and then are incredibly surprised when we don’t get what we expected.” (2016-06-20)
NIRN lacks outcome measures and does not capture change at the person level “It does not address the individual change process. There are certainly some principles in the NIRN material on how to involves people, and that you should involve them in order for them to be invested in the change, but it pretty well ignores the whole psychological part of change as an individual” (2016-10-24); [It doesn’t, however,] “offer ways to capture outcome data” (2016-10-24);The process of implementation takes time. “We know implementation takes 3-5 years.” (2016-11-25)
Using the NIRN Model and AIFs is resource-intensive “For me, it was a little sobering to hear timelines being quoted of 24 years when using this process from beginning to implementation that sometimes can be overwhelming to present to a team or organization when they think about resources allocation and so forth… and again, the barriers are always the buy in making sure that the right people are knowledgeable and educated about the process and that they are willing and interested to be involved in the amount of time and effort that this is going to take up front.” (2016-10-24)
It is highly detailed and time-intensive to learn “It was a significant learning curve to adjust to the language and the different practice i.e. the different worksheets and things like that. [The tools] was useful as we went through it but it was time intensive and I think it was hard to get my head around some of the pieces that it was looking for.” (2016-10-24)
The language of the NIRN frameworks is not specific to healthcare “Languageneed it to be specified from education to healthcare and DMCA.” (2016-08-15)
Usability is a potential concern “I couldn’t use these tools and figure it out by myself.” (2016-08-15) “You have to be pretty disciplined to use [the NIRN tools]. I wonder about the usefulness in a very concrete way in the real worldworry that there’s just too much going on there. I like the content, but I find it seems a bit overwhelming.” (2016-08-15)
Organizational drivers regarding documentation can be difficult to implement on a system-wide basis “Part of what we continued to lack is the consistent documentation and consistent expectations of documentation… If we are all using the same documents and the judge could expect to see the same documents, as a system we would expect those same documents and we would expect everyone works with the same tools. I still think that is going to be an identified issue despite how hard people have worked to create the worksheet and the rest of the array of tools. [I’m] not sure that everyone has bought-into is using the ones we had.” (2016-08-02)