Table 3 Illustrative quotes

1. Taking a process approach to implementation

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“A lot of people don’t recognize how long this [implementation] process can take…I think helping people understand that this is a dynamic process and that it is fluid and things will change. Flexibility is important and sometimes there will be other competing priorities that this [implementation project] might have to go on hold for, and that’s okay.” (Team I)

2. Identifying and applying implementation TMFAs

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“They [learners] struggle with many of the frameworks including applying the frameworks and being able to see how this works in their context. How would they apply it? Do they need to adapt it? What does that literally look like?” (Team N)

3. Learning implementation steps and skills

3.1 Defining the problem and understanding context

“Often a course jumps straight into cycles and context and the intervention and the stakeholders and the context. But what we often were finding with a lot of different clinician groups was that the conceptualization of the problem was pretty shaky and the healthcare providers really jumped to solutions. So we have spent quite a lot of time pondering how we get to the bottom of a problem.” (Team D)

3.2 Finding, appraising, and adapting the evidence to be implemented

“The challenge is that groups think they want to implement something, but they haven’t actually figured out what is the thing that needs to be implemented? And is there good evidence for it? And are we doing the right thing by wanting to implement it? Or is this just ‘we heard about it and we think it’s a good idea,’ but maybe there isn’t really good evidence for it?” (Team H)

3.3 Assessing barriers and facilitators

“The barriers and facilitators piece is absolutely fundamental because our process historically has just been ‘I want you to adopt this new thing.’ Then I tell you in a meeting and then I hope you just do it. I don’t think about like have I convinced you it’s important? Do you know where to find the form? Is there an algorithm that tells you when and how to do this? Why should you do it? How’s it going to impact patient care? Whatever practice you’re trying to change, what keeps them from changing?” (Team A)

3.4 Selecting and tailoring implementation strategies

“What are their barriers or facilitators and what strategies will they use to support people to change their behavior? In my mind, if people don’t have that then nothing else matters; there’s no reason to proceed because chances are you arbitrarily picked implementation strategies not knowing they were implementation strategies, and you will move forward with them even though they don’t address underlying barriers to change.” (Team N)

3.5 Monitoring and evaluating

“Clinicians may or may not appreciate the value of measuring the evidence practice gap at the beginning and then again later on […] It wasn’t just for research purposes, but being able to communicate to the team that what you’ve been doing has made this amount of change.” (Team L)

“They [learners] are often people who haven’t had much experience with measurement and evaluation and often feel a bit threatened by measurement and evaluation. So it’s really trying to think about what might be simple things that you could measure? What are the meaningful things? How does it relate to your problem?” (Team D)

3.6 Sustaining and scaling

“When we were getting close to wrapping up, we look at the [Knowledge-to-Action] cycle again and outcomes of interest—what metrics they wanted to measure and issues around sustainability, explaining how difficult it is to sustain these efforts in many settings.” (Team K)

3.7 Disseminating

“It’s important to provide a fulsome understanding of what knowledge translation encompasses. So looking at some of the jargon or buzz words that people hear and where they sit within the knowledge translation umbrella of dissemination and implementation and really helping people to understand the difference between the two.” (Team J)

4. Developing relational skills

4.1 Forming and maintaining an implementation team

“We cover how to assemble the right team to develop and progress a project to support implementation of a specific innovation.” (Team G)

4.2 Identifying and engaging interested and affected parties

“Part of the training was learning to engage them [clinical team members and administrators] early in the process and knowing that they had to do that rather than just going in and doing what they wanted to implement and then saying ‘oh we’re doing this by the way.’” (Team L)

4.3 Building implementation leadership and facilitation

“A decent amount of time in our program is devoted to leadership development—thinking about yourself as a leader and thinking about facilitation and relationships…those are skills not everybody has, so people need ongoing development in those areas.” (Team O)

6. Offering applied and pragmatic content

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“It [capacity-building initiative] was an opportunity to bring people together to expose them to an array of tools. The feedback that we got from people was that they were so grateful that somebody had done this compilation for them and that they now had a package that they could walk away with and use in the way that they felt most appropriate.” (Team B)

7. Tailoring and evolving capacity-building initiative content

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“We’re constantly tweaking and adjusting the content to tailor it to the personalities and the projects. It is a very comprehensive full on three-days, but that’s just our personalities to want to make it really tailored…we don’t just rinse and repeat the same course because it’s easy.” (Team F)

“One of the biggest things that we’ve done in the last couple of years is really making sure that we take an intersectionality lens right from the very beginning and get people to reflect on our positions within the project, the biases that we bring, and thinking about who is on the team? Who is not on the team?” (Team P)