ArticleImplementation science : IS2020
Champions in context: which attributes matter for change efforts in healthcare?
Article in Implementation science : IS, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 117 papers, 2 of them syntheses that pooled it.
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Who cites it
117 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Training and education provided to local change champions within implementation trials: a rapid systematic review.Implementation science : IS · 2025Pooled it
- The role of champions in the implementation of technology in healthcare services: a systematic mixed studies review.BMC health services research · 2024Pooled it
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- Barriers and facilitators to using practice facilitators to implement a remote cancer symptom management intervention: a mixed methods study.BMC health services research · 2025Trial
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- Implementation facilitators and barriers of stress first aid to protect mental health of frontline health care workers during the COVID-19 pandemic: a qualitative study.BMC health services research · 2024Trial
- Process evaluation of a tailored nudge intervention to promote appropriate care and treatment of older patients at the end-of-life.BMC geriatrics · 2024Trial
- Examining the sustainability and effectiveness of co-created physical activity interventions in vocational education and training: a multimethod evaluation.BMC public health · 2022Trial
- Process evaluation of a cluster randomised controlled trial to improve bronchiolitis management - a PREDICT mixed-methods study.BMC health services research · 2021Trial
- Process evaluation of an implementation trial to improve the triage, treatment and transfer of stroke patients in emergency departments (TImplementation science : IS · 2020Trial
- AI integration in pediatric radiology: perspectives from international academic leaders.European radiology · 2026Article
- Designing for delivery: a Delphi study of feasibility-informed implementation strategies for a fear of cancer recurrence clinical pathway.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026Article
- Article
- Getting to best practice: a practice-oriented checklist for monitoring clinic-level fidelity to hypertension interventions in a large safety-net healthcare system.BMC health services research · 2026Article
- Emergency Departments Leading the Transformation of Alzheimer's and Dementia Care: Emergency Care Redesign.Journal of the American Geriatrics Society · 2026Article
- Champions and early adopters in an implementation-effectiveness study of shared decision making: implications for interpersonal strategies.Implementation science communications · 2026Article
- Article
- Evolving determinants of implementing low-risk childbirth quality improvement in Japan: a longitudinal qualitative study.BMC health services research · 2026Article
- Perspectives on Clinical Champions Implementing Hospital-Based Opioid Treatment in US Hospitals.JAMA network open · 2026Article
- Successful adoption of an advance care planning evidence-based practice: impact of clinical champion and site factors.Implementation science : IS · 2026Article
57 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
backgroundResearch to date has focused on strategies and resources used by effective champions of healthcare change efforts, rather than personal characteristics that contribute to their success. We sought to identify and describe champion attributes influencing outcomes of healthcare change efforts. To examine attributes of champions, we used postpartum contraceptive care as a case study, because recommended services are largely unavailable, and implementation requires significant effort.
methodsWe conducted a comparative case study of the implementation of inpatient postpartum contraceptive care at 11 U.S. maternity hospitals in 2017-18. We conducted site visits that included semi-structured key informant interviews informed by the Consolidated Framework for Implementation Research (CFIR). Phase one analysis (qualitative content analysis using a priori CFIR codes and cross-case synthesis) showed that implementation leaders ("champions") strongly influenced outcomes across sites. To understand champion effects, phase two inductive analysis included (1) identifying and elaborating key attributes of champions; (2) rating the presence or absence of each attribute in champions; and 3) cross-case synthesis to identify patterns among attributes, context, and implementation outcomes.
resultsWe completed semi-structured interviews with 78 clinicians, nurses, residents, pharmacy and revenue cycle staff, and hospital administrators. All identified champions were obstetrician-gynecologists. Six key attributes of champions emerged: influence, ownership, physical presence at the point of change, persuasiveness, grit, and participative leadership style. These attributes promoted success by enabling champions to overcome institutional siloing, build and leverage professional networks, create tension for change, cultivate a positive learning climate, optimize compatibility with existing workflow, and engage key stakeholders. Not all champion attributes were required for success, and having all attributes did not guarantee success.
conclusionsEffective champions appear to leverage six key attributes to facilitate healthcare change efforts. Prospective evaluations of the interactions among champion attributes, context, and outcomes may further elucidate how champions exert their effects.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.