A Guide to Implementing an Innovation in a Clinical Setting
Start
Last updated: July 2026
About this guide
How to navigate this guide
What is the purpose of this guide?To support implementers through the structured process of implementing innovations in clinical settings. It offers guidance for adapting innovations to support successful implementation. Who is this guide for? This guide is intended for individuals, such as clinic managers, involved in implementing an innovation. All steps in this document are written to address individuals who will lead this process. What is in this guide? This guide assumes that the reader has selected a relevant innovation for implementation in a clinical setting. It includes five key steps for implementing innovations: 1. Prepare to implement the innovation 2. Assess the needs and resources of the clinical setting 3. Select strategies for adapting the innovation 4. Adapt the intervention 5. Implement and evaluate the adapted innovation settings. How did we develop the guide? We conducted a literature review to produce this step-by-step guide for implementing innovations. Given its importance, we emphasize the need to adapt innovations. We draw on our review in this guide to offer and operationalize a range of strategies for implementing an innovation in a clinical setting.To make the steps tangible and applicable, we focus on a health promotion intervention for chronic disease prevention in Québec. Although the guide uses this example, it can be applied to other innovations in clinical settings.
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Click the hand icon in the top right corner to highlight all interactive elements on the pageClick the “+” icons to access additional information. Close pop-ups using the “×” or click again to hide the content. Click to view in full screen Click the navigation arrows (› or ‹) to move forward or backward between pages. Use the ribbon to access each section of the guide
Introduction
Implementing an innovation Implementation refers to the process of introducing an innovation (a new idea, practice, or technology) to practice. It involves many aspects, including considering how the innovation fits within existing resources and practices of the clinical setting and the needs of the intended population, and adapting it to ensure the desired impact. Successful implementation requires careful planning, coordination, and engagement with those involved in delivering it,supported by a structured, step-by-step approach. What is adaptation? Adaptation is a crucial step to successfully implementing an innovation. It involves using strategies to improve its alignment with the needs of the intended population and the clinical setting, while preserving the core components that are expected to influence the target behaviour. Implementation researchers, clinic managers, and healthcare and social service providers make these adaptations to ensure innovations are relevant and acceptable in their clinical setting. Why adapt interventions? The success of an innovation in a clinical setting depends on its alignment with patient needs and preferences, clinician capacities, and the resources of the setting. Adapting an innovation improves its relevance and effectiveness, promotes its adoption and maintenance over time, and supports person-centered care in primary care settings.
Examples
Learn more: Behaviour change interventions
Guide to implementing an innovation in a clinical setting
Step 1. Prepare to implement the innovation Step 2. Assess the needs and resources of the clinical setting Step 3. Select strategies to adapt the innovation Step 4. Adapt the intervention Step 5. Implement and evaluate the adapted innovation
It is important to keep partners involved in meaningful ways throughout any project.
- Discussing the frequency and mode of communication ahead of time to ensure a shared understanding of roles and of the project progress.
- During an introductory meeting, agree on a regular meeting time.
- Develop the terms of reference for collaboration, including roles, responsibilities, expectations, such as decision-making rules, compensation (e.g., for service user partners), and other practices that will promote meaningful and sustainable collaboration, such as record-keeping.
Guide to developing Terms of Reference Key consideration: Co-production improves the implementation of an intervention. Co-production is a model of collaboration that explicitly responds to service user needs. Engaging users and interest holders in adapting an intervention can make the final product more applicable and appropriate. It can lead to identifying and integrating key decisions that advance equity-oriented priorities of local healthcare institutions and governing bodies. Key Consideration: Equity, diversity, and inclusion (EDI) must be considered atthroughout the implementation processes. • Ensure diverse representation in your committee • Establish transparent agreements or terms of reference • Use inclusive language and consider the cultural safety of all outputs • Create opportunity for team reflection and learning • Take time to build trust and relationships • Facilitate meaningful engagement • Foster a respectful environment for shared learning
Prepare to implement the innovation
Identify individuals who offer relevant expertise pertaining to the intervention and the clinical setting. Who should be part of the core committee and why?
The core committee will vary depending on the clinical setting, but they would ideally include a health service user with relevant experience, an expert in the practice and science of implementation and/or adaptation, a healthcare professional (healthcare or social service provider), and an expert in the intervention. 1. Health service user: Individuals (e.g., patients) who received the intervention in other settings could share valuable insights with the committee. Their firsthand experience of receiving the intervention can highlight what is most likely to help future patients. 2. Expert in implementation: Individuals with expertise in implementation methods and processes can guide adaptation and decision-making related to the process. 3. Healthcare or social service provider: A healthcare or social service provider can advise on adaptations that will ensure the intervention is feasible to implement. A provider from the clinical setting will help ensure that the committee has sufficient knowledge of the setting. 4. Expert in the intervention: An individual who is familiar with the intervention and how it has been implemented in other settings may have important insight into the facilitators and barriers of implementing the intervention in the intended clinical setting.
Examples of interest holders
Examples of interest holders
Ensure a shared understanding of the intervention within the core committee, through iterative meetings. For example, the committee needs to understand the ‘active ingredients’ or core components of the intervention and the processes through which these ingredients change behaviour. The adapted version of the intervention must maintain these core components to ensure its effectiveness. Create a formal document of the core components and other relevant features of the intervention as a resource before starting the adaptation process. Consider the following to include in the document: 1. What are the components and mechanisms of action of the intervention?
2. Which components are essential for the intervention to work as intended and, therefore, must be preserved when adapting the intervention?
3. How would the intervention be delivered, over what period of time, and with what follow up procedures? Who is responsible for delivering the intervention?
4. What is the expected impact of the intervention?
Theory and Techniques Tool helps explore the link between behaviour change techniques and mechanisms of action.
Identify and invite interest holders (partners) who can offer valuable guidance throughout the adaptation process. These are individuals who: 1. Have relevant scientific or clinical knowledge or lived experience related to the intervention or implementation scienceand/or2. Have the power to introduce and help promote the adoption of the intervention into the clinical setting. Consider who can facilitate collaborations with these individuals, and who can help promote the project and generate buy-in.
1. Form a core implementation committee
2. Become familiar with the intervention
3. Identify and form relationships with partners
4. Set up regular meetings with partners and develop Terms of Reference
Partners’ involvement is essential to inform adaptation decisions. Invite all partners to a consultation meeting (follow-up meetings may be needed). Before the meeting Prepare and share:1. Summary of the committee’s needs assessment and initial discussions around which parts and characteristics of the intervention to adapt 2. Agenda for the meeting to help partners come prepared 3. List of guiding questions to ask meeting participants Ask for consent to record the meeting, or assign a note-taker.During the meeting
- Present an overview of the assessment summary and answer any questions partners have.
- Go through each part of the intervention (based on needs assessment and proposed adaptations)
- Explain objectives: discuss parts of the intervention, explore feasibility, and gather input on adaptations
- Facilitate discussion to identify elements requiring adaptation and reach consensus or majority agreement
- Note uncertainties and follow-up actions
- Inform partners they will receive a summary of discussion points
- Process may be iterative, with follow-up meetings
After the meeting
- Send a written summary to all partners
- Debrief absent partners and gather feedback
- Circulate their feedback to the rest of the group.
Guiding prompts for discussion
Assess the needs and resources of the clinical setting
Assess the current practices and needs of the setting to determine how best to align the intervention.Considering EDI to ensure that the identified needs reflect experiences, barriers, and priorities of a given clinical setting, including its health service users.Consider the following tool for assessing the human, material, and financial resources needed to introduce the intervention to the clinical setting. To complete this, consult with partners and other colleagues in the clinical setting who may have knowledge about the following domains. These domains may also be relevant for other innovations. Keep a detailed record of key characteristics of the clinical setting. This record will help facilitate discussions between committee members on the most appropriate adaptations to consider. Based on this assessment, determine how the intervention needs to be adapted, including length, delivery mode, and activities/modules, to align with resources and service user needs and ensure that target populations are reached.
Assessment Tool
Schedule a meeting with the core committee to discuss adaptation priorities based on the results of this assessment. Guide the discussion as follows: 1. Discuss the characteristics of the original intervention that are not appropriate or feasible in the clinical context and need to be adapted.2. Prioritize what might facilitate and hinder the adoption of the intervention.3. Select the characteristics of the intervention that can be adapted based on these facilitators and barriers.
Tool: The Eisenhower matrix may help with this selection.
1. Assess features of the clinical setting and of the intervention
2. Define adaptation priorities
3. Consult partners to present the assessment of the clinical setting and adaptation priorities
Select strategies to adapt the innovation
- The Expert Recommendations for Implementing Change (ERIC) is a project in which experts in implementation and clinical practice refined terms and definitions to improve clarity, transparency, and comprehensiveness of implementation strategies.
ERIC strategies related to adaptation
- To illustrate the relevance of these strategies in a clinical setting, we conducted a literature review on how behaviour change interventions are adapted in primary care.These strategies may also be applied to adapt other innovations in different clinical settings.
• Apply electronic health (eHealth) tools • Implement clinical decision support systems/reminders o Electronic health record (EHR) embedded checklists
• Implement tools to screen for symptoms of health conditions • Implement automated referral pathways • Set up structured follow up consultations with service users
o Use platforms that are commonly used within the community • Training approaches o Use train-the-trainer approach
o Hire support staff such as clinical coordinators
o Plan scalable workforce training
o Create online training modules for providers
• Carry out Plan-Do-Study-Act cycles with multidisciplinary team review to refine adaptation plan • Actively involve interest holders o Involve community leaders as educators o Conduct learning meetings to gather feedback o Conduct meetings with interest holders to make necessary adjustments
• Tailor materials to strengthen health literacy and engagemento Create plain language and translated materials for health service users • Create and apply an automated, rule-based care pathway
1. Iterative and interest holder-driven feedback and refinement: Ongoing, structured adaptation cycles using data from the clinical setting
2. Intervention content and materials: Techniques for adapting the intervention content to the population context
3. Delivery: Techniques for introducing and delivering the intervention
Strategies for adapting behaviour change interventions according to ERIC concepts
Adapt the intervention
Once adaptation strategies are selected, determine how they will be applied in the intervention. This involves operationalizing the intervention, including how it will be adapted. Applying strategies may require modifying materials (e.g., documents or equipment), changing how activities/modules are structured or delivered, and adapting training or supervision of implementers. Work through each strategy and map out the adapted intervention, ensuring that decisions are documented and linked to needs and gaps identified in Step 2. Consider creating a visual representation of all phases of the intervention, including where adaptations will occur.
Visual example
Before the meeting: Provide partners with a document detailing the planned adaptations, so they can prepare feedback.During the meeting:Present the adapted intervention Facilitate a structured discussion to solicit feedback Ensure the adaptation plan is aligned with identified needs, feasible, and likely to achieve intended outcomes After the meeting: Solicit feedback from partners unable to attend (offer separate meetings if needed) Provide all partners with a written summary of discussion and decisions, including feedback from those not present
Questions for the discussion
1. Develop an adaptation plan
Convene with the core committee to integrate the partners’ feedback into the adaption plan.
- Categorize the feedback in terms of intervention components or other relevant groupings.
- Assess each recommendation/suggestion and determine what will be adopted or modified.
- Revise the adaptation plan and share it with partners for additional feedback.
- Schedule another meeting if needed.
Continue refining the adaptation plan in this manner until all committee members and partners (or the majority, depending on your decision-making rule) agree that the adapted intervention is acceptable.
2. Present the adaptation plan to partners
3. Refine the adaptation plan
Implement and evaluate the adapted innovation
List the tasks involved with respect to implementing the intervention.Assign each of these tasks to individuals in the clinical setting. Plan training sessions for individuals to learn how to deliver the intervention according to their responsibilities. Define training objectives (e.g., using Bloom’s taxonomy, which includes levels such as knowledge, comprehension, application, analysis, synthesis, and evaluation). By the end of the training, participants will be able to:
- Explain the purpose and goals of the intervention
- Describe their specific role in implementing the intervention
- Apply the steps of the intervention correctly in the clinical setting
- Identify when and how to refer patients to other services
- Use tools, forms, or resources associated with the intervention
- Record information related to the intervention accurately
- Identify when the intervention is not going as planned and know who to notify
Once these objectives are agreed on, they can then guide decisions about:
• Content: What needs to be taught to meet each objective?
• Format: Should training be in-person, online, or hybrid?
• Training lead: Who will lead the training session?
• Audience: Which objectives apply to which individuals?
• Duration: How much time is needed to cover the content?
• Assessment: How will participants know they have met the training objectives?
Templates and Tools
Contact the individuals listed in 6.1.1 and invite them to training sessions based on their responsibilities. Offer additional sessions for those who are not available.Create a post-training feedback form to circulate after training sessions to assess participants’ attitudes, knowledge, and behaviours with respect to the tasks they will have to carry out when implementing the intervention. Consider using questions from the Modified Knowledge/Attitudes/Behaviours Questionnaire.Modify and conduct additional training sessions, as needed, based on feedback. Once everyone has reached a level of confidence and competence in carrying out their responsibilities, based on the prespecified training objectives, the clinical setting can begin to implement the intervention.
To learn how well the intervention was implemented, consider gathering the following information from healthcare providers who have delivered the intervention. This can be modified for other individuals in the clinical setting who were involved in implementing the intervention, such as clinic managers and administrative or other support staff. Information to gather from healthcare providers: 1. What challenges have you felt or encountered when delivering this intervention? 2. What suggestions do you have to improve the process of introducing this intervention to the clinical setting? 3. What might facilitate continuing to deliver this intervention? a. Individual-level: e.g., attitudes, beliefs, skills, knowledge, practices b. Interpersonal-level: e.g., team structure and functionality, roles, workflows c. Institutional-level: e.g., leadership, resources d. Other: e.g., training, engagement of healthcare providers 4. Is there anything else you would like to share about your experience with delivering the intervention that you have not already shared? For specific questions and examples of how to gather information pertaining to each dimension of the RE-AIM framework, consider the following table (adapted from Holtrop et al., 2018).
Guiding prompts for discussion
To evaluate how well the intervention was implemented, consider conducting brief check-in meetings or interviews with healthcare providers, managers, and/or other individuals involved in the implementation.Use the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to assess the following aspects of the implementation:• Reach: Reflects how well the intervention reaches its target audience• Effectiveness: Assesses the overall success of the implementation• Adoption: Assesses the involvement of staff in implementing the intervention• Implementation: Reflects how well the core components are delivered as intended• Maintenance: Assesses the long-term sustainability of the intervention
1. Implement the innovation
1.1 Plan training sessions on delivering the intervention
Keep a record of all check-in meetings, observations, and interviews.
As a core committee, set up a meeting to reflect on the feedback received from these and discuss potential next steps for improving the intervention and its implementation. Summarize the feedback and provide these summaries to the partners.
Set up a meeting with the partners to present the evaluation and recommendations for improving the intervention and to solicit their feedback. Consider further adaptations based on their feedback.
Continue to monitor, evaluate, and refine the intervention and its implementation.
1.2 Train individuals to deliver the intervention
2. Evaluate the implementation process
2.1 Decide how to evaluate the implementation process and outcomes
2.2 Meet with additional interest holders to evaluate the implementation
2.3 Document and learn from the evaluation
A guide to implementing an innovation in a clinical setting © 2026 by Karen Wassef, Dorsa Salimi, Tibor Schuster, Paula L. Bush, Tracie A. Barnett is licensed under CC BY-NC-ND 4.0. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/ How to cite this guide Wassef, K., Salimi, D., Schuster, T., Bush, P.L., Barnett, T.A. (2026). A guide to implementing an innovation in a clinical setting. [Interactive presentation]. Genially. https://view.genially.com/6970d3d670c106e0056fc192 About the authors:
Karen Wassef, MSc, PhD Student, Family Medicine, McGill University. Dorsa Salimi, MD, MSc, Research Assistant, Family Medicine, McGill University. Paula L. Bush, PhD, Academic Associate, Family Medicine, McGill University. Tibor Schuster, PhD, Associate Professor, Family Medicine, McGill University.
Tracie A. Barnett, PhD, Associate Professor, Family Medicine, McGill University and Co-Director, Data Valorization Axis of the Unité de Soutien SSA Québec.
For more details, explore the full report PDF.
Full report PDF
Glossary
Last updated: July 2026
- Feasibility: The extent to which an innovation can be implemented based on specific factors, such as the available human, financial, and material resources in a clinical setting.
- Healthcare or social service provider: A professional who delivers medical or allied healthcare to patients, such as physicians, nurses and nurse practitioners, social workers, nutritionists, kinesiologists, physiotherapists, and pharmacists.
- Health promotion: The process of empowering people to participate in healthy behaviours. Health promotion usually addresses behavioural risk factors such as tobacco use, obesity, diet and physical inactivity, as well as areas of mental health, injury prevention, drug abuse control, alcohol control, and sexual health.
- Health service user: A person who receives professional healthcare services.
- Implementation: The introduction and bringing of an innovation into practice through planned, intentional activities.
- Implementation science: The scientific study of methods to promote the uptake of an innovation into routine practice and to improve the quality and effectiveness of healthcare.
- Implementer: An individual who supports, plans, and takes part in the implementation of an innovation.
- Innovation: A new idea, practice, or technology.
- Mechanism of action: The process by which a behaviour change technique enacts behaviour change.
- Primary care: The element within primary health care that focuses on healthcare services, including health promotion, illness and injury prevention, and the diagnosis and treatment of illness and injury. Primary care is delivered by clinicians, including family physicians, nurse practitioners, pharmacists.
- Train the trainer: A capacity-building strategy in which people are trained to transfer skills to others.
Glossary
- Acceptability: The perception that an intervention is acceptable or satisfactory based on specific factors.
- Adaptation: The intentional modification of an intervention to achieve a better fit between an intervention and a new setting.
- Adoption: The intention, initial decision, or action to implement an intervention.
- Applicability: The extent to which an intervention can be applied to a specific setting.
- Behaviour change intervention: A coordinated set of activities designed to change specified behaviours.
- Behaviour change technique: A process that represents the smallest part of the behaviour change intervention content and that is designed to change behaviour.
- Chronic disease: Also known as non-communicable disease (NCD), a chronic disease is characterized by its long duration and is the result of genetic, physiological, environmental and behavioural factors. For example: cancer, cardiovascular disease, diabetes, and chronic lung or respiratory disease.
- Core components: Elements that are essential for an intervention to function as intended.
- Disease burden: The impact on and distribution of disease in a population based on indicators such as mortality rates and financial costs for individuals, healthcare systems, and societies.
- Disease prevention: The minimization of the burden of diseases and risk factors through targeted interventions.
- Evaluation: The systematic assessment of outcomes related to the implementation, including adaptation, of an intervention.
Guidance for evaluating implementation outcomes with respect to the RE-AIM framework
Guidance for using the CFIR framework for evaluating implementation outcomes using an intersectional lens
Click on the table to view in full screen
Strategies for adapting behaviour change interventions according to ERIC concepts
Complex innovations in clinical settings: behaviour change interventions
What are behaviour change interventions?
Behaviour change interventions are “coordinated sets of activities designed to change specified behaviour patterns”.They are used in various healthcare and social service settings, including mental health and primary care, and can drive improvements in patient and healthcare provider experience, population health outcomes, healthcare expenditure, and health equity.They target behaviours such as smoking, physical activity, diet, and vaccination uptake. Behavioural interventions are typically complex and include multiple components, such as education and skill development. They are evidence-based and integrate techniques or strategies demonstrated to increase successful behaviour change. Why are behaviour change interventions important for chronic disease prevention? Chronic diseases, such as diabetes, obesity, cardiovascular disease, and cancer, account for 86% of deaths in Canada and 75% of deaths globally. This burden is largely attributable to smoking, excessive alcohol consumption, physical inactivity, and unhealthy diet. Behaviour change interventions for preventing chronic diseases offer evidence-based solutions by promoting healthy behaviours. In Québec, these interventions are usually delivered in settings of primary care by family doctors, nurses, nutritionists, and/or kinesiologists. Behaviour change interventions can reduce cardiometabolic risk factors, such as high cholesterol, blood pressure, body mass index, and body weight. For example, in people with overweight, obesity, and prediabetes, physical activity interventions can help reduce the risk of developing type 2 diabetes. Physical activity interventions promote participation in physical activity and improve symptoms of depression, anxiety, and distress in the adult populations. They can also help reduce the risk of developing certain cancers. Dietary interventions, such as nutritional counseling, have also been shown to improve cardiovascular and metabolic risk factors. Although the evidence demonstrates benefits of behaviour change interventions for chronic disease prevention, they must be adapted to the settings where they are introduced and the individuals to whom they are delivered. This guide therefore presents a step-by-step approach to implementing innovations using chronic disease prevention as the primary context, while offering a framework that can be applied to other innovations intended to be implemented in clinical settings.
1. To what extent do the selected adaptations address the needs identified in this setting? Are there any identified needs or gaps that you feel have not been sufficiently addressed by the planned adaptations?
2. What modifications would you recommend, if any, to strengthen the alignment between the adaptation plan and the identified needs?
3. Are there any proposed adaptations that have been made that are unnecessary, or that may compromise the core components of the original intervention?
4. What are the greatest risks to implementing the adapted intervention as planned, and how might these be mitigated?
5. Overall, how confident are you that the adapted intervention, as currently planned, will be successful with respect to the goals of the clinical setting?
Examples of adaptations
• Switching from in-person visits to virtual or hybrid care
• Delivering an intervention in shorter, more frequent sessions instead of longer appointments
• Changing when the intervention occurs (e.g., during triage instead of during the physician visit)
• Using text message reminders instead of phone calls or emails to follow up with service users
Delivery adaptations(how the innovation reaches users)
• Simplifying tools into shorter, decision-focused summaries for busy staff
• Modifying non-essential components of an intervention with respect to the local context
Content adaptations (what is delivered)
• Modifying training approaches (e.g., shorter sessions, on-demand modules, or peer-led training) • Adjusting staff roles (e.g., shifting patient education tasks from physicians to nurses)
Adaptations to the introduction process
Changes to the planning and preparation for the innovation.
Adaptations to the introduction process
Hospital Change Readiness Questionnaire: Pomare C, Ellis LA, Long JC, et al. “Are you ready?” Validation of the Hospital Change Readiness (HCR) Questionnaire. BMJ Open 2020; 10: e037611. Learning Health System readiness questionnaire: Giroux CM, Bush PL, Alkhaldi M, et al. Assessing healthcare organizations’ readiness to implement a learning health system: questionnaire validation using a Delphi method. BMC Health Serv Res 2025; 25: 1626.
Examples of interest holders:
- Researchers
- Healthcare and social service providers
- Health service users (patients and caregivers)
- Patient advocacy group members
- Healthcare/clinic managers and other decision-makers
- Policymakers
- Administrative and support staff
Guiding prompts for the committee to facilitate the group discussion
- Discuss the alignment of the intervention with all the domains that were previously assessed (i.e., staffing, resources, training, technology, time, and workflow impact, organizational policies, leadership priorities, patient population needs, etc.).
- Discuss the domains that might facilitate and hinder the introduction of the intervention.
- Discuss what should be adapted and what may or may not be possible to adapt based on these facilitators and barriers.
- Discuss who will need to support or drive the proposed changes (e.g., department heads, clinicians, administrators, key champions).
ERIC strategies related to adaptation
Our team selected ERIC strategies related to adapting interventions. Below, we present these strategies and their definitions. Some have been introduced in earlier sections of this guide. We modified these definitions/explanations to ensure they are relevant with respect to the applications described in this guide.
Click on the table to view in full screen
Template to document the roles and responsibilities
Other suggested project management tools:
RACI (Responsible, Accountable, Consulted, and Informed)
WBS (Work Breakdown Structure).
Template to document the purpose, content, target audience, and the lead trainers of training sessions
In addition to formal training, consider mentorship opportunities in the clinical setting, such as reflexive practice workshops. Participants can: • Reflect on their own practice and identify areas for growth
• Use feedback from training sessions to improve
• Share challenges and solutions with peers and mentors
Examples of reflective practice questions:
1. Think about the situation: What happened exactly and in what order, where were you at the time and who else was involved? What part did you have to play? What was the final outcome?
2. How did the situation, yourself, and others interact? Did the situation go well or was there room for improvement?
3. Could you have done anything differently? Think about what factors you could have influenced.
4. When similar situations happen again, will things change as you would expect them to?
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Transcript
A Guide to Implementing an Innovation in a Clinical Setting
Start
Last updated: July 2026
About this guide
How to navigate this guide
What is the purpose of this guide?To support implementers through the structured process of implementing innovations in clinical settings. It offers guidance for adapting innovations to support successful implementation. Who is this guide for? This guide is intended for individuals, such as clinic managers, involved in implementing an innovation. All steps in this document are written to address individuals who will lead this process. What is in this guide? This guide assumes that the reader has selected a relevant innovation for implementation in a clinical setting. It includes five key steps for implementing innovations: 1. Prepare to implement the innovation 2. Assess the needs and resources of the clinical setting 3. Select strategies for adapting the innovation 4. Adapt the intervention 5. Implement and evaluate the adapted innovation settings. How did we develop the guide? We conducted a literature review to produce this step-by-step guide for implementing innovations. Given its importance, we emphasize the need to adapt innovations. We draw on our review in this guide to offer and operationalize a range of strategies for implementing an innovation in a clinical setting.To make the steps tangible and applicable, we focus on a health promotion intervention for chronic disease prevention in Québec. Although the guide uses this example, it can be applied to other innovations in clinical settings.
Interactive buttons allow you to personalize your path according to your needs:
Click the hand icon in the top right corner to highlight all interactive elements on the pageClick the “+” icons to access additional information. Close pop-ups using the “×” or click again to hide the content. Click to view in full screen Click the navigation arrows (› or ‹) to move forward or backward between pages. Use the ribbon to access each section of the guide
Introduction
Implementing an innovation Implementation refers to the process of introducing an innovation (a new idea, practice, or technology) to practice. It involves many aspects, including considering how the innovation fits within existing resources and practices of the clinical setting and the needs of the intended population, and adapting it to ensure the desired impact. Successful implementation requires careful planning, coordination, and engagement with those involved in delivering it,supported by a structured, step-by-step approach. What is adaptation? Adaptation is a crucial step to successfully implementing an innovation. It involves using strategies to improve its alignment with the needs of the intended population and the clinical setting, while preserving the core components that are expected to influence the target behaviour. Implementation researchers, clinic managers, and healthcare and social service providers make these adaptations to ensure innovations are relevant and acceptable in their clinical setting. Why adapt interventions? The success of an innovation in a clinical setting depends on its alignment with patient needs and preferences, clinician capacities, and the resources of the setting. Adapting an innovation improves its relevance and effectiveness, promotes its adoption and maintenance over time, and supports person-centered care in primary care settings.
Examples
Learn more: Behaviour change interventions
Guide to implementing an innovation in a clinical setting
Step 1. Prepare to implement the innovation Step 2. Assess the needs and resources of the clinical setting Step 3. Select strategies to adapt the innovation Step 4. Adapt the intervention Step 5. Implement and evaluate the adapted innovation
It is important to keep partners involved in meaningful ways throughout any project.
- Develop the terms of reference for collaboration, including roles, responsibilities, expectations, such as decision-making rules, compensation (e.g., for service user partners), and other practices that will promote meaningful and sustainable collaboration, such as record-keeping.
Guide to developing Terms of Reference Key consideration: Co-production improves the implementation of an intervention. Co-production is a model of collaboration that explicitly responds to service user needs. Engaging users and interest holders in adapting an intervention can make the final product more applicable and appropriate. It can lead to identifying and integrating key decisions that advance equity-oriented priorities of local healthcare institutions and governing bodies. Key Consideration: Equity, diversity, and inclusion (EDI) must be considered atthroughout the implementation processes. • Ensure diverse representation in your committee • Establish transparent agreements or terms of reference • Use inclusive language and consider the cultural safety of all outputs • Create opportunity for team reflection and learning • Take time to build trust and relationships • Facilitate meaningful engagement • Foster a respectful environment for shared learningPrepare to implement the innovation
Identify individuals who offer relevant expertise pertaining to the intervention and the clinical setting. Who should be part of the core committee and why? The core committee will vary depending on the clinical setting, but they would ideally include a health service user with relevant experience, an expert in the practice and science of implementation and/or adaptation, a healthcare professional (healthcare or social service provider), and an expert in the intervention. 1. Health service user: Individuals (e.g., patients) who received the intervention in other settings could share valuable insights with the committee. Their firsthand experience of receiving the intervention can highlight what is most likely to help future patients. 2. Expert in implementation: Individuals with expertise in implementation methods and processes can guide adaptation and decision-making related to the process. 3. Healthcare or social service provider: A healthcare or social service provider can advise on adaptations that will ensure the intervention is feasible to implement. A provider from the clinical setting will help ensure that the committee has sufficient knowledge of the setting. 4. Expert in the intervention: An individual who is familiar with the intervention and how it has been implemented in other settings may have important insight into the facilitators and barriers of implementing the intervention in the intended clinical setting.
Examples of interest holders
Examples of interest holders
Ensure a shared understanding of the intervention within the core committee, through iterative meetings. For example, the committee needs to understand the ‘active ingredients’ or core components of the intervention and the processes through which these ingredients change behaviour. The adapted version of the intervention must maintain these core components to ensure its effectiveness. Create a formal document of the core components and other relevant features of the intervention as a resource before starting the adaptation process. Consider the following to include in the document: 1. What are the components and mechanisms of action of the intervention? 2. Which components are essential for the intervention to work as intended and, therefore, must be preserved when adapting the intervention? 3. How would the intervention be delivered, over what period of time, and with what follow up procedures? Who is responsible for delivering the intervention? 4. What is the expected impact of the intervention?
Theory and Techniques Tool helps explore the link between behaviour change techniques and mechanisms of action.
Identify and invite interest holders (partners) who can offer valuable guidance throughout the adaptation process. These are individuals who: 1. Have relevant scientific or clinical knowledge or lived experience related to the intervention or implementation scienceand/or2. Have the power to introduce and help promote the adoption of the intervention into the clinical setting. Consider who can facilitate collaborations with these individuals, and who can help promote the project and generate buy-in.
1. Form a core implementation committee
2. Become familiar with the intervention
3. Identify and form relationships with partners
4. Set up regular meetings with partners and develop Terms of Reference
Partners’ involvement is essential to inform adaptation decisions. Invite all partners to a consultation meeting (follow-up meetings may be needed). Before the meeting Prepare and share:1. Summary of the committee’s needs assessment and initial discussions around which parts and characteristics of the intervention to adapt 2. Agenda for the meeting to help partners come prepared 3. List of guiding questions to ask meeting participants Ask for consent to record the meeting, or assign a note-taker.During the meeting
- Present an overview of the assessment summary and answer any questions partners have.
- Go through each part of the intervention (based on needs assessment and proposed adaptations)
- Explain objectives: discuss parts of the intervention, explore feasibility, and gather input on adaptations
- Facilitate discussion to identify elements requiring adaptation and reach consensus or majority agreement
- Note uncertainties and follow-up actions
- Inform partners they will receive a summary of discussion points
- Process may be iterative, with follow-up meetings
After the meetingGuiding prompts for discussion
Assess the needs and resources of the clinical setting
Assess the current practices and needs of the setting to determine how best to align the intervention.Considering EDI to ensure that the identified needs reflect experiences, barriers, and priorities of a given clinical setting, including its health service users.Consider the following tool for assessing the human, material, and financial resources needed to introduce the intervention to the clinical setting. To complete this, consult with partners and other colleagues in the clinical setting who may have knowledge about the following domains. These domains may also be relevant for other innovations. Keep a detailed record of key characteristics of the clinical setting. This record will help facilitate discussions between committee members on the most appropriate adaptations to consider. Based on this assessment, determine how the intervention needs to be adapted, including length, delivery mode, and activities/modules, to align with resources and service user needs and ensure that target populations are reached.
Assessment Tool
Schedule a meeting with the core committee to discuss adaptation priorities based on the results of this assessment. Guide the discussion as follows: 1. Discuss the characteristics of the original intervention that are not appropriate or feasible in the clinical context and need to be adapted.2. Prioritize what might facilitate and hinder the adoption of the intervention.3. Select the characteristics of the intervention that can be adapted based on these facilitators and barriers.
Tool: The Eisenhower matrix may help with this selection.
1. Assess features of the clinical setting and of the intervention
2. Define adaptation priorities
3. Consult partners to present the assessment of the clinical setting and adaptation priorities
Select strategies to adapt the innovation
ERIC strategies related to adaptation
• Apply electronic health (eHealth) tools • Implement clinical decision support systems/reminders o Electronic health record (EHR) embedded checklists • Implement tools to screen for symptoms of health conditions • Implement automated referral pathways • Set up structured follow up consultations with service users o Use platforms that are commonly used within the community • Training approaches o Use train-the-trainer approach o Hire support staff such as clinical coordinators o Plan scalable workforce training o Create online training modules for providers
• Carry out Plan-Do-Study-Act cycles with multidisciplinary team review to refine adaptation plan • Actively involve interest holders o Involve community leaders as educators o Conduct learning meetings to gather feedback o Conduct meetings with interest holders to make necessary adjustments
• Tailor materials to strengthen health literacy and engagemento Create plain language and translated materials for health service users • Create and apply an automated, rule-based care pathway
1. Iterative and interest holder-driven feedback and refinement: Ongoing, structured adaptation cycles using data from the clinical setting
2. Intervention content and materials: Techniques for adapting the intervention content to the population context
3. Delivery: Techniques for introducing and delivering the intervention
Strategies for adapting behaviour change interventions according to ERIC concepts
Adapt the intervention
Once adaptation strategies are selected, determine how they will be applied in the intervention. This involves operationalizing the intervention, including how it will be adapted. Applying strategies may require modifying materials (e.g., documents or equipment), changing how activities/modules are structured or delivered, and adapting training or supervision of implementers. Work through each strategy and map out the adapted intervention, ensuring that decisions are documented and linked to needs and gaps identified in Step 2. Consider creating a visual representation of all phases of the intervention, including where adaptations will occur.
Visual example
Before the meeting: Provide partners with a document detailing the planned adaptations, so they can prepare feedback.During the meeting:Present the adapted intervention Facilitate a structured discussion to solicit feedback Ensure the adaptation plan is aligned with identified needs, feasible, and likely to achieve intended outcomes After the meeting: Solicit feedback from partners unable to attend (offer separate meetings if needed) Provide all partners with a written summary of discussion and decisions, including feedback from those not present
Questions for the discussion
1. Develop an adaptation plan
Convene with the core committee to integrate the partners’ feedback into the adaption plan.
- Categorize the feedback in terms of intervention components or other relevant groupings.
- Assess each recommendation/suggestion and determine what will be adopted or modified.
- Revise the adaptation plan and share it with partners for additional feedback.
- Schedule another meeting if needed.
Continue refining the adaptation plan in this manner until all committee members and partners (or the majority, depending on your decision-making rule) agree that the adapted intervention is acceptable.2. Present the adaptation plan to partners
3. Refine the adaptation plan
Implement and evaluate the adapted innovation
List the tasks involved with respect to implementing the intervention.Assign each of these tasks to individuals in the clinical setting. Plan training sessions for individuals to learn how to deliver the intervention according to their responsibilities. Define training objectives (e.g., using Bloom’s taxonomy, which includes levels such as knowledge, comprehension, application, analysis, synthesis, and evaluation). By the end of the training, participants will be able to:
- Explain the purpose and goals of the intervention
- Describe their specific role in implementing the intervention
- Apply the steps of the intervention correctly in the clinical setting
- Identify when and how to refer patients to other services
- Use tools, forms, or resources associated with the intervention
- Record information related to the intervention accurately
- Identify when the intervention is not going as planned and know who to notify
Once these objectives are agreed on, they can then guide decisions about: • Content: What needs to be taught to meet each objective? • Format: Should training be in-person, online, or hybrid? • Training lead: Who will lead the training session? • Audience: Which objectives apply to which individuals? • Duration: How much time is needed to cover the content? • Assessment: How will participants know they have met the training objectives?Templates and Tools
Contact the individuals listed in 6.1.1 and invite them to training sessions based on their responsibilities. Offer additional sessions for those who are not available.Create a post-training feedback form to circulate after training sessions to assess participants’ attitudes, knowledge, and behaviours with respect to the tasks they will have to carry out when implementing the intervention. Consider using questions from the Modified Knowledge/Attitudes/Behaviours Questionnaire.Modify and conduct additional training sessions, as needed, based on feedback. Once everyone has reached a level of confidence and competence in carrying out their responsibilities, based on the prespecified training objectives, the clinical setting can begin to implement the intervention.
To learn how well the intervention was implemented, consider gathering the following information from healthcare providers who have delivered the intervention. This can be modified for other individuals in the clinical setting who were involved in implementing the intervention, such as clinic managers and administrative or other support staff. Information to gather from healthcare providers: 1. What challenges have you felt or encountered when delivering this intervention? 2. What suggestions do you have to improve the process of introducing this intervention to the clinical setting? 3. What might facilitate continuing to deliver this intervention? a. Individual-level: e.g., attitudes, beliefs, skills, knowledge, practices b. Interpersonal-level: e.g., team structure and functionality, roles, workflows c. Institutional-level: e.g., leadership, resources d. Other: e.g., training, engagement of healthcare providers 4. Is there anything else you would like to share about your experience with delivering the intervention that you have not already shared? For specific questions and examples of how to gather information pertaining to each dimension of the RE-AIM framework, consider the following table (adapted from Holtrop et al., 2018).
Guiding prompts for discussion
To evaluate how well the intervention was implemented, consider conducting brief check-in meetings or interviews with healthcare providers, managers, and/or other individuals involved in the implementation.Use the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to assess the following aspects of the implementation:• Reach: Reflects how well the intervention reaches its target audience• Effectiveness: Assesses the overall success of the implementation• Adoption: Assesses the involvement of staff in implementing the intervention• Implementation: Reflects how well the core components are delivered as intended• Maintenance: Assesses the long-term sustainability of the intervention
1. Implement the innovation
1.1 Plan training sessions on delivering the intervention
Keep a record of all check-in meetings, observations, and interviews. As a core committee, set up a meeting to reflect on the feedback received from these and discuss potential next steps for improving the intervention and its implementation. Summarize the feedback and provide these summaries to the partners. Set up a meeting with the partners to present the evaluation and recommendations for improving the intervention and to solicit their feedback. Consider further adaptations based on their feedback. Continue to monitor, evaluate, and refine the intervention and its implementation.
1.2 Train individuals to deliver the intervention
2. Evaluate the implementation process
2.1 Decide how to evaluate the implementation process and outcomes
2.2 Meet with additional interest holders to evaluate the implementation
2.3 Document and learn from the evaluation
A guide to implementing an innovation in a clinical setting © 2026 by Karen Wassef, Dorsa Salimi, Tibor Schuster, Paula L. Bush, Tracie A. Barnett is licensed under CC BY-NC-ND 4.0. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/ How to cite this guide Wassef, K., Salimi, D., Schuster, T., Bush, P.L., Barnett, T.A. (2026). A guide to implementing an innovation in a clinical setting. [Interactive presentation]. Genially. https://view.genially.com/6970d3d670c106e0056fc192 About the authors: Karen Wassef, MSc, PhD Student, Family Medicine, McGill University. Dorsa Salimi, MD, MSc, Research Assistant, Family Medicine, McGill University. Paula L. Bush, PhD, Academic Associate, Family Medicine, McGill University. Tibor Schuster, PhD, Associate Professor, Family Medicine, McGill University. Tracie A. Barnett, PhD, Associate Professor, Family Medicine, McGill University and Co-Director, Data Valorization Axis of the Unité de Soutien SSA Québec.
For more details, explore the full report PDF.
Full report PDF
Glossary
Last updated: July 2026
Glossary
Guidance for evaluating implementation outcomes with respect to the RE-AIM framework
Guidance for using the CFIR framework for evaluating implementation outcomes using an intersectional lens
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Strategies for adapting behaviour change interventions according to ERIC concepts
Complex innovations in clinical settings: behaviour change interventions
What are behaviour change interventions? Behaviour change interventions are “coordinated sets of activities designed to change specified behaviour patterns”.They are used in various healthcare and social service settings, including mental health and primary care, and can drive improvements in patient and healthcare provider experience, population health outcomes, healthcare expenditure, and health equity.They target behaviours such as smoking, physical activity, diet, and vaccination uptake. Behavioural interventions are typically complex and include multiple components, such as education and skill development. They are evidence-based and integrate techniques or strategies demonstrated to increase successful behaviour change. Why are behaviour change interventions important for chronic disease prevention? Chronic diseases, such as diabetes, obesity, cardiovascular disease, and cancer, account for 86% of deaths in Canada and 75% of deaths globally. This burden is largely attributable to smoking, excessive alcohol consumption, physical inactivity, and unhealthy diet. Behaviour change interventions for preventing chronic diseases offer evidence-based solutions by promoting healthy behaviours. In Québec, these interventions are usually delivered in settings of primary care by family doctors, nurses, nutritionists, and/or kinesiologists. Behaviour change interventions can reduce cardiometabolic risk factors, such as high cholesterol, blood pressure, body mass index, and body weight. For example, in people with overweight, obesity, and prediabetes, physical activity interventions can help reduce the risk of developing type 2 diabetes. Physical activity interventions promote participation in physical activity and improve symptoms of depression, anxiety, and distress in the adult populations. They can also help reduce the risk of developing certain cancers. Dietary interventions, such as nutritional counseling, have also been shown to improve cardiovascular and metabolic risk factors. Although the evidence demonstrates benefits of behaviour change interventions for chronic disease prevention, they must be adapted to the settings where they are introduced and the individuals to whom they are delivered. This guide therefore presents a step-by-step approach to implementing innovations using chronic disease prevention as the primary context, while offering a framework that can be applied to other innovations intended to be implemented in clinical settings.
1. To what extent do the selected adaptations address the needs identified in this setting? Are there any identified needs or gaps that you feel have not been sufficiently addressed by the planned adaptations? 2. What modifications would you recommend, if any, to strengthen the alignment between the adaptation plan and the identified needs? 3. Are there any proposed adaptations that have been made that are unnecessary, or that may compromise the core components of the original intervention? 4. What are the greatest risks to implementing the adapted intervention as planned, and how might these be mitigated? 5. Overall, how confident are you that the adapted intervention, as currently planned, will be successful with respect to the goals of the clinical setting?
Examples of adaptations
• Switching from in-person visits to virtual or hybrid care • Delivering an intervention in shorter, more frequent sessions instead of longer appointments • Changing when the intervention occurs (e.g., during triage instead of during the physician visit) • Using text message reminders instead of phone calls or emails to follow up with service users
Delivery adaptations(how the innovation reaches users)
• Simplifying tools into shorter, decision-focused summaries for busy staff • Modifying non-essential components of an intervention with respect to the local context
Content adaptations (what is delivered)
• Modifying training approaches (e.g., shorter sessions, on-demand modules, or peer-led training) • Adjusting staff roles (e.g., shifting patient education tasks from physicians to nurses)
Adaptations to the introduction process
Changes to the planning and preparation for the innovation.
Adaptations to the introduction process
Hospital Change Readiness Questionnaire: Pomare C, Ellis LA, Long JC, et al. “Are you ready?” Validation of the Hospital Change Readiness (HCR) Questionnaire. BMJ Open 2020; 10: e037611. Learning Health System readiness questionnaire: Giroux CM, Bush PL, Alkhaldi M, et al. Assessing healthcare organizations’ readiness to implement a learning health system: questionnaire validation using a Delphi method. BMC Health Serv Res 2025; 25: 1626.
Examples of interest holders:
Guiding prompts for the committee to facilitate the group discussion
ERIC strategies related to adaptation
Our team selected ERIC strategies related to adapting interventions. Below, we present these strategies and their definitions. Some have been introduced in earlier sections of this guide. We modified these definitions/explanations to ensure they are relevant with respect to the applications described in this guide.
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Template to document the roles and responsibilities
Other suggested project management tools:
RACI (Responsible, Accountable, Consulted, and Informed)
WBS (Work Breakdown Structure).
Template to document the purpose, content, target audience, and the lead trainers of training sessions
In addition to formal training, consider mentorship opportunities in the clinical setting, such as reflexive practice workshops. Participants can: • Reflect on their own practice and identify areas for growth • Use feedback from training sessions to improve • Share challenges and solutions with peers and mentors Examples of reflective practice questions: 1. Think about the situation: What happened exactly and in what order, where were you at the time and who else was involved? What part did you have to play? What was the final outcome? 2. How did the situation, yourself, and others interact? Did the situation go well or was there room for improvement? 3. Could you have done anything differently? Think about what factors you could have influenced. 4. When similar situations happen again, will things change as you would expect them to?