That local actions to address identified issues were suggested fits with the general finding that differences in implementation resulted from decision-making and tailoring at a local level, and that solutions needed to consider local systems.
We consider that implementation results from the climate in which the program is implemented (itself influenced by management strategies and incentives used), the level of trust and involvement of stakeholders, the organizational structure that is likely to help or hinder implementation, and collective leadership and training.
For comprehension of the above algorithm, we present the implementation results from the treatment of patients with diabetic foot syndrome in a middle-sized public hospital in Greece, during the year 2008.
It illustrates some of the implementation difficulties resulting from conflicting interests of the various user groups.
There were implementation weaknesses resulting from the limited number of staff in the UNICEF EAPRO HIV team, including occasional lack of timely follow-up after initial inputs had been given and delays in initiating work in some areas.
Although there was a significant direct effect between IPP and implementation effectiveness, over a third of the total effect of IPP on implementation effectiveness resulted from the indirect effect of IPP on implementation effectiveness operating through perceptions of implementation climate.
These implementation tensions result from political choices during policy design and present underappreciated challenges to transforming the electricity system.
Many of the initial challenges that have been encountered broadly in clinical implementation have resulted from real-world limitations in standardizing genotyping platforms for clinical practice, storing genetic data in computable formats, developing CDS capabilities, adapting clinical strategies as evidence and technology rapidly develop, and accessing outcomes data.
