Local adaption on the intervention—to encourage local ownership.

Robust evidence for intervention—multiple publications showing PROMPT effect on clinical outcomes.

Peer endorsement—anecdotal stories from PROMPT Wales implementation team who had prior experience with PROMPT, benefit of engaging ‘peer educators’.

Professional branding of tools and resources.

Standardised implementation tools and guidance.

Funding—‘Starter pack’ training and resources funded by the Welsh Risk Pool.

Choosing intervention of national interest—improving safety in maternity is a nationally important issue for families and staff (Each Baby Counts, MBBRACE, Kirkup report).

Utilising pre-existing leadership meetings to gain support for programme (HoMAG and NSAG).

Benchmarking of implementation progress by sharing information between units (networking facilitated by NI team; newsletters, social media, events).

Obtaining visual government support and clearly defining targets—PROMPT Wales standards from Welsh government to implement PROMPT.

Supporting local team working and communication—the implementation team organised and chaired local team meetings and phone calls, supporting the team to bond and work together more effectively. Communication channels between local teams were encouraged (PROMPT Wales team text and email groups).

Implementation support tailored to unit needs—culture assessed by SAQs and planning discussions with local teams to identify local issues, tailoring of support to address these.

Course observations and structure feedback—to provide praise as well as clear and measurable improvement goals during implementation process.

Careful selection of local champions—local faculty were nominated by management, those who showed enthusiasm and had prior experience of training were put forward.

Building a partnership between implementation team and maternity unit—via face-to-face support and regular check-ins.

Assessing readiness for change—this was assessed by implementation planning session on T3 and at initial unit visits.

Troubleshooting—implementation team listened and acknowledged concerns about achieving implementation goals and tailored support to local teams. They shared learning and acted as the ‘go between’ for local teams, their managers and the executive committee.

Positive reinforcement—use of ‘PROMPT Stars’ to recognise individual contributions and excellence.

An incremental approach to implementation—ongoing support and reinforcement was crucial due to the complexity of the intervention.

Site visits—for planning and support, face-to-face was valued by local teams.

Engaging local leaders for example, heads of midwifery—invited to observe T3 course to understand intervention and resources required.

Engaging and motivating the local implementation delivery team—close relationships formed between the implementation team and practice development midwives who were instrumental in leading the organisation of training and coordinating the team.

Pacing—providing implementation timeline and regular check-ins.

Organic modification of the implementation plan based on trialling and local feedback.

Clear governance structure of Implementation team with MDT input—regular debriefing of the implementation team with the executive committee.

Evaluation plan—process and outcome measures decided in planning phase of project. Information gathered from multiple sources (course evaluation forms, structured observations, programme evaluations, informal and formal feedback).