Barriers and supports to implementation of MDI/spacer use in nine Canadian pediatric emergency departments: a qualitative study

Scott, Shannon D; Osmond, Martin H; O'Leary, Kathy A; Graham, Ian D; Grimshaw, Jeremy; Klassen, Terry

Furthermore, our findings suggest that the adoption of MDI/spacers is not easily reduced to the decision by an individual ED physician. Rather, the decision to adopt MDI spacers requires support and decisions at levels ranging from the individual practitioner, parents, department, institution, and regional levels. Our findings illustrate that individual clinicians cannot simply decide to change their clinical practice decision making and prescribe the use of MDI/spacers. Our findings offer that this is an ED decision and the 'adopter' per se is the ED, not the individual clinician. The decision is not straightforward and does not involve exclusively practitioners becoming convinced only of the strength and rigour of the scientific evidence promoting the efficacy of this innovation, but rather, the organizational decision to adopt MDI/spacers is a complex decision that requires savvy and persuasion at multiple levels (clinician, department decision-makers) and the allocation of significant resources (human, equipment, and financial) in order to facilitate success. The complexity of this organizational decision, by default, suggests that planned change strategies are required to facilitate the adoption of MDI/spacers. Our findings suggest that passive techniques where there are no champions in place and the strength of the research evidence is the sole motivator for adoption are not effective. In essence, knowledge is not enough to facilitate adoption. In particular, clarity over who is going to bear the cost of the MDI/spacer and harnessing the support of leadership and a champion were critical forces in garnering adoption in our study.