Journal Article

Champions as catalysts for change: a realist evaluation of their impact in primary care

Martin, Elisabeth, Bergeron, Dave, Gaboury, Isabelle

2025

Overview

Background The healthcare system, particularly primary care, is constantly evolving to adapt to technological innovations and demographic changes. Quality improvement (QI) initiatives are a key strategy for optimizing care processes and better meeting patient needs. However, their success depends on several contextual factors, including alignment with organizational priorities, resource availability, and stakeholder engagement. While champions are widely recognized as important for change within organizations, the specific causal relationship of their impact remain unclear. This study aims to deepen understanding of champions’ behaviours in the QI process within interdisciplinary primary care settings. Method A multiple case study was conducted using a realist evaluation approach to refine and validate the program theory. Data collection involved document analysis and individual semi-structured interviews. Context-Mechanism-Outcome (CMO) configurations were constructed to explore relationships between context (pre-existing elements shaping interventions), mechanisms (processes activated in a given context), and outcomes to iteratively refine the program theory. The study was conducted in primary healthcare clinics, the predominant model of primary care clinics in Quebec, Canada. Data were collected between 2022 and 2023 from four cases of champions in Quebec and Ontario who had implemented a change using a QI approach. Results Seven CMO configurations were observed empirically. Findings highlight that a strong coalition of champions, facilitated by cohesion, collaboration, and a shared vision, enhances mobilization. Champions influence QI by prioritizing objectives, reducing perceived effort, and leveraging data to justify change. Their leadership and credibility increase motivation, while their on-site presence helps them anticipate barriers and adapt strategies. Champions initiate small-scale testing to refine interventions and engage peers. Effective communication of results sustains momentum. Ultimately, a champion’s ability to engage the right individuals at the right time, build trust, and provide mentorship determines the success and sustainability of QI initiatives. Conclusion This study underscores the complexity of implementing change in primary care organizations. The refined program theory enhances understanding of how champions contribute to successful change implementation and how their behaviours can be adapted to local contexts to optimize outcomes. These findings support a context-sensitive approach to leveraging champions as facilitators of change.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Champion / Health Administration / Health facilities / Health Informatics / Humans / Interviews as Topic / Leadership / Medicine / Medicine & Public Health / Methods / Nursing Research / Ontario / Organizational Case Studies / Organizational Innovation / Primary health care / Primary Health Care - organization & administration / Primary Health Care - standards / Primary Healthcare clinic / Program Evaluation / Public Health / Quality control / Quality improvement / Quality Improvement - organization & administration / Quality management / Quebec / Realist Evaluation