ArticleBMC health services research2025
Champions as catalysts for change: a realist evaluation of their impact in primary care.
Article in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed.
- Implementing multidomain non-pharmaceutical interventions for preventing cognitive decline in community-dwelling older adults in China: An embedded mixed-methods implementation study of determinants and strategies.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2026Article
- Development of an Ethico-Legal Framework for Quality Improvement and Performance Management in Health Care: Protocol for a Qualitative Study.JMIR research protocols · 2026Article
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe healthcare system, particularly primary care, is constantly evolving to adapt to technological innovations and demographic changes. Quality improvement (QI) initiatives are a key strategy for optimizing care processes and better meeting patient needs. However, their success depends on several contextual factors, including alignment with organizational priorities, resource availability, and stakeholder engagement. While champions are widely recognized as important for change within organizations, the specific causal relationship of their impact remain unclear. This study aims to deepen understanding of champions’ behaviours in the QI process within interdisciplinary primary care settings.
methodA multiple case study was conducted using a realist evaluation approach to refine and validate the program theory. Data collection involved document analysis and individual semi-structured interviews. Context-Mechanism-Outcome (CMO) configurations were constructed to explore relationships between context (pre-existing elements shaping interventions), mechanisms (processes activated in a given context), and outcomes to iteratively refine the program theory. The study was conducted in primary healthcare clinics, the predominant model of primary care clinics in Quebec, Canada. Data were collected between 2022 and 2023 from four cases of champions in Quebec and Ontario who had implemented a change using a QI approach.
resultsSeven CMO configurations were observed empirically. Findings highlight that a strong coalition of champions, facilitated by cohesion, collaboration, and a shared vision, enhances mobilization. Champions influence QI by prioritizing objectives, reducing perceived effort, and leveraging data to justify change. Their leadership and credibility increase motivation, while their on-site presence helps them anticipate barriers and adapt strategies. Champions initiate small-scale testing to refine interventions and engage peers. Effective communication of results sustains momentum. Ultimately, a champion’s ability to engage the right individuals at the right time, build trust, and provide mentorship determines the success and sustainability of QI initiatives.
conclusionThis study underscores the complexity of implementing change in primary care organizations. The refined program theory enhances understanding of how champions contribute to successful change implementation and how their behaviours can be adapted to local contexts to optimize outcomes. These findings support a context-sensitive approach to leveraging champions as facilitators of change.
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