Introduction
Clinical practice guidelines (CPG) derived from scientific knowledge are more likely to be implemented if they fill practice gaps deemed important by clinical teams. In order to promote implementation, knowledge-to-practice gaps were identified and prioritized by acute and rehabilitation TBI healthcare provider organizations via an online survey. Obstacles to filling these evidence-to-practice gaps were identified; lack of access to targeted funds and staff time were frequent barriers.

Methodology
The organizations who completed the online survey were invited to apply for catalyst grants to implement one or more recommendations from the CPG. The details of the implementation projects were determined by each site based on local relevance, prioritization and feasibility. The amount of the catalyst grant was purposely set to provide one-time funding support without creating dependence. Projects were required to follow an implementation framework with attention to planning, data collection and sustainability. All successful projects were required to have their clinical and implementation tools freely available through the CPG website and write-up their project as a casebook, so others could replicate their methods. All projects had access to an implementation specialist as part of the catalyst grant to advise and support the implementation planning and activities. 

Results
Ninety-two percent of the online survey respondents submitted a catalyst grant application and 82% of proposed projects were funded. These projects ranged from implementation of clinical practice recommendations to system-level cross-sector recommendations, and from urban to small-urban settings across the province. Stakeholder identification and engagement were key activities and all projects involved persons with lived experience in the project development process. The degree of senior leadership and direct manager involvement had a direct influence on the success of the project. All projects collected baseline data (i.e., chart audit, staff and patient surveys) as well as process and outcome clinical and implementation data, including on feasibility and sustainability. The data indicate over 80% of site respondents reported the implemented change as a feasible and sustainable improvement. At every site the new practice was embedded as common practice. For those projects addressing system-level change, new cross-sector networks and practices were developed to allow for more efficient care for complex patients with TBI and mental health and/or addiction problems. Care was taken to address issues of privacy and confidentiality and obtain institutional agreements to participate in the new networks.

Discussion
This work has confirmed that targeted effort involving careful planning, broad stakeholder engagement, additional resources and funding, process and outcome data collection, and sustainability planning were necessary to implement practice changes. By having grant recipients have their methods and tools available online, spread and scaling of the implementation efforts is more likely. There has already been interest from new sites to work on implementation projects.

Wide-scale provincial implementation of a clinical practice guideline for adults with moderate-to-severe traumatic brain injury.