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More complex study interventions required more recruiting efforts with more stakeholders at more levels, at the clinic, in the system, and across roles. Building on past relationships helped with initial and on-going recruitment conversations, yet those alone were insufficient. There were often multiple contacts and visits to practices that included a wide range of stakeholders: lead clinicians (on the system and individual practice levels), office managers, system “c-suite” leaders, health information technology leads, care management or health coaching leads, and others. This also meant identifying how the project aligns with multiple roles and interests in a practice. We were not surprised to find reluctance among busy practice staff and clinicians; however, there were clear signs in some practices that the staff members who were likely to implement much of the study had not been included in discussions or they were overtly opposed to doing anything related to the study. We realized we would have to re-sell the project to them. In large and small practices, team communication was ineffective at either letting staff and clinicians know the details of the project or how it might work. Our practice facilitators often fulfilled that role. |
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Recruitment was a process that took longer than expected with unplanned turnover of key contacts. Recruitment does not end when a leader says, “Yes, we'll do it.” You still need to win over individual administrators, staff, and clinicians. After system-level buy-in, there may be a need to continue to work on practice-level staff and clinician buy-in. The lag times from initial agreement, to randomization, and then to study launch can mean turnover and changing of priorities. In several instances, a key person who was identified as a champion or key contact left the practice. We had to actively seek out a new champion or contact to carry the project forward. |
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