Successfully Implement Care Projects: The Monika Concept

A shirt can make a care project visible—when someone lives the idea in daily work.

Successfully implement care projects means planning more than the intervention itself. A good care project can still remain invisible in daily work. In an anonymized care facility, a shirt became a conversation starter: an engaged cleaning team lead wore it visibly, spoke with colleagues, and turned the idea of an upright posture into a shared team topic. According to the internal case observation, voluntary challenges followed.

The related figure also comes exclusively from internal project material: during working hours, upright posture was reported at 10 percent initially and 15 percent after five weeks. This is a project figure that still needs careful interpretation—not a research finding and not evidence that the project caused the difference. The measurement definition, sample, collection method, comparison standard, and possible alternative explanations remain open.

That leads to the practical question: How does a measure become a topic that people voluntarily take up and carry forward within the team?

Care project implementation: A project needs a face—but not one permanent owner

In brief

• A credible person can support attention and participation in a care project.
• The working term used here for this role is not an established professional model.
• For engagement to last, the role needs time, support, and shared responsibility.

A new shirt, training session, or digital tool does not change a shift routine by itself. People make an idea socially workable. They show what a measure looks like in practice, answer early questions, and give it a place in conversations among colleagues.

The face of a project does not have to be a manager. Other qualities may matter more: Does this person know the local routines? Do colleagues find them credible? Can they speak to coworkers as an equal? Can they take feedback from the team back to the project leads?

Miech et al. evaluated 199 healthcare articles on champions and related roles. Visible support, personal conversations, training, problem-solving, data use, and recruiting further participants were recurring activities. At the same time, only four of the 199 studies randomized the presence of a champion. The review therefore describes the role as part of a system, not as the sole cause of implementation success. [1]

What the Monika concept means as an internal metaphor

In this article, the Monika concept means a visible, credible, and voluntarily engaged team driver. It is a memorable translation for practice—not a ready-made method from a textbook and not an established scientific model.

Research uses terms such as champion, change agent, and opinion leader for related roles. The terms overlap, but they are not used consistently. Santos et al. examined 35 quantitative studies. In seven studies focused on use at the organizational or facility level, five reported a positive association between champion involvement and use of an innovation. Evidence for use by individual providers or patients and for health outcomes was mixed, limited, or not examined. [2]

For your care project, translate the role into four tasks:

1. Make the idea visible in daily work.
2. Translate it into the team’s language and routines.
3. Support colleagues who want to join voluntarily.
4. Bring obstacles and improvement ideas back to the organization.

Pettersen, Eide, and Berg found similar tasks for technology champions in a review of 23 studies in healthcare. These included training, technical help, social support, planning, coordination, and mediation between management and practice. Most studies came from hospitals, however. In long-term residential care, you therefore need to adapt the principle to your own shifts, tasks, and resources. [3]

The review also names conditions that support the role: organizational integration, knowledge of local routines, professional or technical competence, accessibility, recognition, and leadership support. Scheduled time and additional compensation were rarely described. The practical boundary is clear: the team driver should not be expected to close the gap between the project plan and shift work through unpaid labor. [3]

Health project in a care facility: The internal case observation

Case material and research are separate here: In the anonymized case observation, an engaged cleaning team lead made a shirt and the idea of an upright posture visible within the team. The cleaning team lead spoke with colleagues. According to the observation, colleagues then began trying voluntary challenges together.

This scene does not show that everyone took part. It also does not show whether a measurement changed because of the project. The story describes a possible implementation chain: visibility can start conversations; conversations can make voluntary participation easier. Both steps need to be checked separately in your own project.

The internal project figure is this: during working hours, upright posture was reported at 15 percent after five weeks rather than 10 percent previously. Treat that figure as a prompt for verification, not as an efficacy finding. Without a measurement definition, sample, method, comparison standard, and follow-up, it is unclear how robust the difference is. Changed tasks, shifts, training, or a different composition of the measured group are also possible alternative explanations.

Before publication or a far-reaching internal decision, clarify consent, data protection, and voluntary participation for observation- or sensor-based data. Choose the location, role, and other details so the person cannot be recognized unintentionally.

Change management in nursing: Turning a team driver into a sustainable project

Normalization Process Theory offers a practical framework for checking the work. May et al. analyzed 130 articles from 108 studies and organized the work involved in new health interventions around four questions:

1. Understand: Does the team know what the project is about and why it matters?
2. Participate: Who takes a role and invites others in?
3. Act together: Which time, skills, routines, and resources make use possible during a shift?
4. Reflect: How will the team check what works and what needs adjustment?

The review shows that this framework is used for intervention development, implementation planning, and process evaluation. It does not show that a project using the framework will automatically succeed. [5]

Translate the questions into a five-week plan:

1. Week 1—Clarify the goal and role: Define the observed behavior, target group, and measurement. Agree on time within working hours, data-protection rules, and a substitute. Also clarify who makes decisions and who is available for questions.
2. Week 2—Model and listen: The team driver tries the measure visibly, speaks with colleagues in a low-threshold way, and collects concerns from different shifts and tasks. No one needs to disclose personal or health information.
3. Week 3—Make participation possible: Start a short, optional challenge with several ways to take part. Individual contribution and team progress can be shown separately. A public ranking with personal data and group pressure do not belong in the format.
4. Week 4—Check the process: Record separately who knows the goal, participates voluntarily, and uses the measure in daily work. Gather brief feedback. Also check whether time, technology, and cover are actually available.
5. Week 5—Review and distribute: Check the figure together with missing values and the comparison standard. Share the findings transparently with the team and leadership. Set a follow-up measurement and distribute tasks across several people.

This keeps the team driver as a starting point for participation rather than making them the permanent sole owner.

Motivating care staff: Challenges need room, not pressure

A challenge can make conversations easier and encourage joint action. It should not turn colleagues into an audience or an engaged team driver into a monitor. Offer small tasks with choices: try something alone, start in pairs, reflect as a team, or simply provide feedback.

Johnson and May analyzed 67 reviews using Normalization Process Theory. Formats involving action and feedback—such as reminders, audit and feedback, or short learning prompts—tended to be associated with more positive results than a single information-only message. The authors do not say that every combination works. For practice, the finding supports connecting experimentation with reflection. [6]

A randomized workplace trial by Patel et al. with 304 adults in 76 four-person teams compared individual, team-only, and combined financial incentives. All participants received daily feedback on a goal of 7,000 steps. During the 13-week incentive phase, the combined group reached the goal on 35 percent of participant-days, compared with 18 percent in the control group. After the incentive phase, the differences for the primary goal were no longer clear. [7]

The study examined one organization, required a smartphone, and used financial incentives. It therefore does not directly demonstrate that voluntary challenges in care or upright posture work. It offers only a cautious design cue: show shared progress, but do not make one person personally liable for other people’s behavior.

How to read the 10-to-15 percent figure

Before assessing a posture figure, you need to know what one percent means. Is it the share of people, specific measurement intervals, or working time? Without that definition, the difference is difficult to interpret.

Before publication or an internal decision, check:

• How was “upright posture” operationally defined?
• Was the same method used at every time point?
• How large were the sample and the measurement volume?
• How were missing values handled?
• Were there multiple baseline measurements or only before-and-after values?
• Were shifts, tasks, and working conditions comparable?
• Was the change checked again after five weeks?

Simpson, Maharaj, and Mobbs analyzed 37 publications on wearable systems for spinal posture. Inertial Measurement Units were the most common technology. The review describes good accuracy for available systems in clinical applications, but calls for further validation for long-term use and practical integration. This does not show that an internal method is unreliable. It shows that the method, validity, and feasibility in daily work need to be documented. [8]

For interpreting posture figures, it also helps to distinguish correlation and causality in posture and back pain. For the workplace, typing without looking at the keyboard and posture offers another example of embedding a small, voluntarily learned habit into routines—without treating it as a guarantee.

What the concept can—and cannot—do

Separate five levels when assessing progress in your care project:

1. Attention: Does the team know the idea and its goal?
2. Participation: Who joins a challenge or conversation voluntarily?
3. Use: Is the measure actually used in the workflow?
4. Behavior: Does the predefined behavior change under comparable conditions?
5. Outcome: Is there robust evidence of health-related or organizational consequences?

These levels are connected, but they are not one success score. A Cochrane review by Flodgren et al. summarized 24 randomized studies. Local opinion-leader interventions improved agreement with evidence-based practice by a median of 10.8 percentage points. Median follow-up was twelve months. Evidence for patient outcomes was very uncertain; only three studies with five dichotomous outcomes contributed to it. [4]

For your care project, this means you can use a team driver deliberately for visibility, participation, and local implementation. Any change in posture, discomfort, or other health outcomes needs a separate, appropriate measurement. Working conditions, shift patterns, leadership, available time, and data protection remain important implementation conditions.

The next step for your care project

With your team, identify who would credibly model a new measure. Agree on the goal, time budget, voluntary entry point, data protection, and measurement definition. Decide which tasks belong to leadership, the project group, and several team members.

Then schedule a short first challenge and a shared review point after five weeks. The Monika concept can serve as a useful memory aid for implementation: start visibly, involve people fairly, check carefully, and share responsibility.

Sources

1. Miech EJ, Rattray NA, Flanagan ME, Damschroder L, Schmid AA, Damush TM. Inside help: An integrative review of champions in healthcare-related implementation. 2018. SAGE Open Medicine, 6. https://doi.org/10.1177/2050312118773261
2. Santos WJ, Graham ID, Lalonde M, Demery Varin M, Squires JE. The effectiveness of champions in implementing innovations in health care: a systematic review. 2022. Implementation Science Communications, 3, 80. https://doi.org/10.1186/s43058-022-00315-0
3. Pettersen S, Eide H, Berg A. The role of champions in the implementation of technology in healthcare services: a systematic mixed studies review. 2024. BMC Health Services Research, 24, 456. https://doi.org/10.1186/s12913-024-10867-7
4. Flodgren G, O’Brien MA, Parmelli E, Grimshaw JM. Local opinion leaders: effects on professional practice and healthcare outcomes. 2019. Cochrane Database of Systematic Reviews, 2019(6), CD000125. https://doi.org/10.1002/14651858.CD000125.pub5
5. May CR, Cummings A, Girling M, Bracher M, Mair FS, May CM, Murray E, Myall M, Rapley T, Finch T. Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review. 2018. Implementation Science, 13, 80. https://doi.org/10.1186/s13012-018-0758-1
6. Johnson MJ, May CR. Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews. 2015. BMJ Open, 5(9), e008592. https://doi.org/10.1136/bmjopen-2015-008592
7. Patel MS, Asch DA, Rosin R, Small DS, Bellamy SL, Eberbach K, Walters KJ, Haff N, Lee SM, Lisa Wesby, Hoffer K, Shuttleworth D, Taylor DH, Hilbert V, Zhu J, Yang L, Wang X, Volpp KG. Individual Versus Team-Based Financial Incentives to Increase Physical Activity: A Randomized, Controlled Trial. 2016. Journal of General Internal Medicine, 31(7), 746–754. https://doi.org/10.1007/s11606-016-3627-0
8. Simpson L, Maharaj MM, Mobbs RJ. The role of wearables in spinal posture analysis: a systematic review. 2019. BMC Musculoskeletal Disorders, 20, 55. https://doi.org/10.1186/s12891-019-2430-6