{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T06:26:40Z","timestamp":1780640800109,"version":"3.54.1"},"reference-count":17,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T00:00:00Z","timestamp":1670544000000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/N015924\/1"],"award-info":[{"award-number":["MR\/N015924\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2022,11,7]]},"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Champions are recognised as important to driving organisational change in healthcare quality improvement initiatives in high-income settings. In low-income and middle-income countries with a high disease burden and constrained human resources, their role is highly relevant yet understudied. Within a broader study on policy implementation for decentralised drug-resistant tuberculosis care in South Africa, we characterised the role, strategies and organisational context of emergent policy champions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Interviews with 34 healthcare workers in three South African provinces identified the presence of individuals who had a strong influence on driving policy implementation forward. Additional interviews were conducted with 13 participants who were either identified as champions in phase II or were healthcare workers in facilities in which the champions operated. Thematic analyses using a socio-ecological framework further explored their strategies and the factors enabling or obstructing their agency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All champions occupied senior managerial posts and were accorded legitimacy and authority by their communities. \u2018Disease-centred\u2019 champions had a high level of clinical expertise and placed emphasis on clinical governance and clinical outcomes, while \u2018patient-centred\u2019 champions promoted pathways of care that would optimise patients\u2019 recovery while minimising disruption in other spheres of their lives. Both types of champions displayed high levels of resourcefulness and flexibility to adapt strategies to the resource-constrained organisational context.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Policymakers can learn from champions\u2019 experiences regarding barriers and enablers to implementation to adapt policy. Research is needed to understand what factors can promote the sustainability of champion-led policy implementation, and to explore best management practices to support their initiatives.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjgh-2022-008907","type":"journal-article","created":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T14:15:14Z","timestamp":1670595314000},"page":"e008907","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["The role of emergent champions in policy implementation for decentralised drug-resistant tuberculosis care in South Africa"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0020-1414","authenticated-orcid":false,"given":"Sacha Roxanne","family":"Le Roux","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waasila","family":"Jassat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindy","family":"Dickson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5295-0591","authenticated-orcid":false,"given":"Leila","family":"Mitrani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Cox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koleka","family":"Mlisana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Black","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"Loveday","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison D","family":"Grant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9438-7095","authenticated-orcid":false,"given":"Mosa","family":"Moshabela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5519-1658","authenticated-orcid":false,"given":"Karina","family":"Kielmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark P","family":"Nicol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,12,9]]},"reference":[{"key":"2024051501235596000_7.12.e008907.1","unstructured":"World Health Organisation . Global TB Report [Internet], 2018. Who p. 277. Available from:. Available: https:\/\/www.who.int\/tb\/publications\/global_report\/en\/"},{"key":"2024051501235596000_7.12.e008907.2","doi-asserted-by":"publisher","DOI":"10.7196\/samj.7689"},{"key":"2024051501235596000_7.12.e008907.3","unstructured":"National department of health South Africa. multi-drug resistant tuberculosis: a policy framework on decentralised and deinstitutionalised management for South Africa. Pretoria 2011."},{"key":"2024051501235596000_7.12.e008907.4","unstructured":"Cox HS , Dickson-Hall L , Jassat W . Drug-Resistant tuberculosis in South Africa: history, progress and opportunities for achieving universal access to diagnosis and effective treatment. South African Health Review 2017 2017:157\u201367."},{"key":"2024051501235596000_7.12.e008907.5","doi-asserted-by":"crossref","unstructured":"Soo SD . The role of champions in the implementation of patient safety practice change by the role of champions in the implementation of patient safety practice change. University of Toronto, 2010.","DOI":"10.12927\/hcq.2009.20979"},{"key":"2024051501235596000_7.12.e008907.6","unstructured":"Agendas KJ . Alternatives, and public policies. 2nd. Longman Publishing Group, 2003."},{"key":"2024051501235596000_7.12.e008907.7","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-015-0209-1"},{"key":"2024051501235596000_7.12.e008907.8","unstructured":"Cassim A . What happens to policy when policy champions move on\u202f? The case of welfare in South Africa [Internet], 2016 p. 16. Available from:. Available: https:\/\/opendocs.ids.ac.uk\/opendocs\/handle\/20.500.12413\/11672 [Accessed cited 2020 May 1]."},{"key":"2024051501235596000_7.12.e008907.9","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.mnl.2015.06.001","article-title":"Building nursing unit staff champion programs to improve clinical outcomes","volume":"13","author":"Creehan","year":"2015","journal-title":"Nurse Lead"},{"key":"2024051501235596000_7.12.e008907.10","doi-asserted-by":"crossref","first-page":"335","DOI":"10.7196\/SAMJ.2016.v106i4.10671","article-title":"A multifaceted hospital-wide intervention increases hand hygiene compliance","volume":"106","author":"Patel","year":"2016","journal-title":"S Afr Med J"},{"key":"2024051501235596000_7.12.e008907.11","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2012.05.110281"},{"key":"2024051501235596000_7.12.e008907.12","doi-asserted-by":"crossref","unstructured":"Flanagan ME , Plue L , Miller KK . A qualitative study of clinical champions in context\u202f: Clinical champions across three levels of acute care. SAGE Open Med [Internet] 2018;6.","DOI":"10.1177\/2050312118792426"},{"key":"2024051501235596000_7.12.e008907.13","doi-asserted-by":"publisher","DOI":"10.1258\/jtt.2012.GTH115"},{"key":"2024051501235596000_7.12.e008907.14","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2009.034199"},{"key":"2024051501235596000_7.12.e008907.15","unstructured":"Porter RL . How to Foster Champions. 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