Strategies Used by Clinical Champions to De-Implement a Low-Value Care Service

Abstract Background: Clinical champions are front-line clinicians who advocate for and influence practice change in their local context. The strategies they use when leading efforts to de-implement the use of a low-value service have not been well described. The purpose of this study is to identify and describe important strategies used by six clinical champions who launched a de-implementation project as part of a fellowship training experience.Methods: Fellows participated in a two-round modified Delphi survey to identify the key strategies they used during their de-implementation project. In the second round the fellows were asked to identify one important strategy they would be willing to discuss in an interview. A 30-minute semi-structured interview was conducted with each fellow, transcribed and thematically analyzed.Results: The six strategies were: build a coalition, conduct a local needs assessment, develop a formal implementation blueprint, conduct educational meetings, use facilitation, and develop clinical reminders. Additional common strategies that emerged across the interviews were the use of data to engage clinicians in conversations, including the patient’s perspective in designing the interventions, and investing the time upfront to plan and launch the initiative because of the inherent challenges of relinquishing a service. Conclusions: Clinical champions identified multiple strategies as important when de-implementing a low-value service. Many were used to engage in conversations with stakeholders, including leadership, providers, and patients, to increase buy-in and support, challenge beliefs, promote behavior change, and gather insights about next steps in their effort to support de-implementing their chosen low-value service. Future work is needed to better understand how prepare clinicians for this role and to understand the mechanisms through which these strategies might be effective.