Table 3 Recommendations regarding use of NIRN Model with the DMCA Model

Using the whole NIRN implementation process is advisable

“Need to follow the NIRN framework and stay true to it… While the tools can be used individually, it really is a whole process.” (2016-10-24)

Buy-in at and participation from various levels of leadership and disciplines is needed

“Buy in from managers and administrators.” (2016-11-25)

“Having the freedom and flexibility to plan get together.” (2016-11-25)

“Getting buy in from staff is something we need to focus on.” (2016-11-25)

“Time is needed to sit down with people who are clinicians and those who have the senior leader’s eye to facilitate practice change.” (2016-09-12)

“You need leadership at all levels, but also in parallel lines.” (2016-08-02)

Mentorship and consultants are essential resources during implementation

“Someone to go to or a resource when they were stumped.” (2016-11-25)

Implementation: access to champions/teams are critical to ensuring all aspects of implementation

“Is it necessary to have a champion?—unequivocally yes—someone who understands it really well so that can build on it right away.” (2016-10-24)

“Having an implementation team or individual to guide the process is ideal” (2016-10-24)

“…The implementation team… that… guides the process had worked very well… That would be the ideal scenario, but at least one person to shoulder it and be the standard bearer as the process is being utilized.” (2016-10-24)

“If there were an in situ implementation team that would [simplify the tools] and take that forward to the group that is in the process and make the tools like the plan, to be usable for them, to be practical. I don’t think they need to have the full 12 course meal of the NIRN, but they could have a reasonable takeout version of it so that it is practical, useable, and it’s supporting them and they can sustain it but still holds to the fidelity of the model.” (2016-10-24)

Training in use of the NIRN Model is needed

“I would be more optimistic if I had good partners to work with who have a good understanding of [NIRN tools]. If I’m just on my own, it’s overwhelming.” (2016-08-15)

“Use of learning strategies to support learning of the DMCA Model (e.g., huddles and worksheets) and NIRN Model (working groups) is advisable.”

“IIf you didn’t have the huddles… it would’ve been effective. It helped with educating.” (2016-11-25)

“The huddles really help work through problems. Worksheets are a nice guide for huddles, really helps drive our huddles.” (2016-11-25)

“I really liked the worksheet. It really helped guide and outline the process and as far as education goes, I think it is one of those things that you do enough of it then you learn how to do it.” (2016-11-25)

DMCA-specific NIRN tools would facilitate use

“[The NIRN] tools would be usable if we prepare them and sell them in the right way—may need to sit down and decide what part can be done in a bigger group and what part needs to be done in the smaller group.” (2016-08-15)

“Simplify the tools… make things a little less jargony for certain organizations depending on who is becoming involved in the process. I think all of that would be helpful.” (2016-10-24)

Sustainability efforts are needed throughout implementation and spread efforts

“It’s important not to underestimate the need to think ahead to consider sustainability planning while in initial implementation, although you don’t get to that until the full implementation stage.” (2016-08-15)

“We need site leaders that are actually engaged and attached to the mentoring team otherwise it will not sustain or implement.” (2016-11-25)