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A repeat audit after changes have occurred is the core activity of this step, including careful examination of the results and discussion among the implementation team about next steps, with the goal of 100% compliance with all proposed evidence-based criteria associated with the project (Pearson, Field & Jordan 2009).

Determining the ideal timing of this repeat audit requires careful consideration of the following:

• Type of strategies implemented (simple versus complex). For example, if one of the strategies required the introduction of a new form of documentation, this will often need to go through committee reviews and several levels of approval, each of which take time to plan. Once approved, each of the different members of the clinical team would need to be oriented to the new documentation. This is only one of possibly three to four strategies the team may need to introduce into the organisation to achieve effective implementation of the evidence
• Volume of staff involved in the process
• Experience level of staff involved
• Hostile versus accommodating culture

Once results have been collected, a careful review of the differences between the baseline and follow-up results needs to be undertaken by the project team. All data and ideas used during the review of baseline audit results must be transparent during this and subsequent repeat audits. The project team needs to feel supported in sharing their ideas about the strengths and weaknesses of current strategies and the determination of alternative solutions/strategies.

A common experience following the repeat/follow-up audit is to lose hope, particularly if the audit results show poor compliance. The project team have now entered the stage of their implementation project that has been coined the “awkward stage”. To be successful, the team need to be willing to:

• Learn from mistakes
• Provide new and effective strategies
• Continue buy-in efforts with the organisation as a whole
• Manage expectations
• Overcome fear and inertia

The executive leadership buy-in will only be upheld if the team demonstrates they are effectively managing the initial phases of the implementation by asking the question: “How are we supporting and problem solving the anticipated fallout of the change process?” The project team needs to appreciate that practice change is an ongoing process that requires constant attention.

Successful implementation on a useful scale requires organised, expert assistance:

• An individual or group of individuals with programmatic content expertise who actively work to implement the proposed strategies as intended
• These experts accumulate data and experiential knowledge and become more effective and efficient overtime
• They work simultaneously at multiple levels of the organisation/system

This expert assistance is essentially the project team. However, depending on the nature of the project, additional local implementation teams may need to be formulated. These additional teams will involve people who have the knowledge, skill, freedom and authority to act (e.g. within a larger organisation or consortium).

The data collection process for the follow-up audit should mimic that of the first audit to ensure that results and data are comparable.

Go to Step 7: Consider sustainability of the project