Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Laura J Damschroder, David C Aron, Rosalind E Keith, Susan R Kirsh, Jeffery A Alexander, Julie C Lowery, Laura J Damschroder, David C Aron, Rosalind E Keith, Susan R Kirsh, Jeffery A Alexander, Julie C Lowery

Abstract

Background: Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts.

Methods: We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts.

Results: The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct.

Conclusion: The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.

References

    1. Burnes B. Emergent change and planned change – competitors or allies? The case of XYZ construction. International Journal of Operations & Production Management. 2004;24:886–902. doi: 10.1108/01443570410552108.
    1. Ferlie EB, Shortell SM. Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q. 2001;79:281–315. doi: 10.1111/1468-0009.00206.
    1. Stetler CB, Legro MW, Wallace CM, Bowman C, Guihan M, Hagedorn H, Kimmel B, Sharp ND, Smith JL. The role of formative evaluation in implementation research and the QUERI experience. J Gen Intern Med. 2006;21:S1–8. doi: 10.1007/s11606-006-0267-9.
    1. Bammer G. Integration and Implementation Sciences: building a new specialization. Ecology and Society. 2005;10:6.
    1. VA Quality Enhancement Research Initiative (QUERI)
    1. Stetler C, Mittman B, Francis J. Overview of the VA Quality Enhancement Research Initiative (QUERI) and QUERI theme articles: QUERI Series. Book Overview of the VA Quality Enhancement Research Initiative (QUERI) and QUERI theme articles: QUERI Series (Editor ed^eds) p. 8.
    1. Institute of Medicine (IOM) The state of quality improvement and implementation research: Expert views Workshop summary. Washington, DC: The National Academies Press; 2007.
    1. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82:581–629. doi: 10.1111/j.0887-378X.2004.00325.x.
    1. Rycroft-Malone J, Harvey G, Kitson A, McCormack B, Seers K, Titchen A. Getting evidence into practice: ingredients for change. Nurs Stand. 2002;16:38–43.
    1. Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F. Book Implementation Research: A Synthesis of the Literature (Editor ed^eds) City: University of South Florida, Louis de la Parte Florida Mental Health Institute; 2005. Implementation Research: A Synthesis of the Literature.
    1. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood) 2001;20:64–78. doi: 10.1377/hlthaff.20.6.64.
    1. Kitson AL, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A. Evaluating the successful implementation of evidence into practice using the PARIHS framework: theoretical and practical challenges. Implement Sci. 2008;3:1. doi: 10.1186/1748-5908-3-1.
    1. Rabin BA, Brownson RC, Haire-Joshu D, Kreuter MW, Weaver NL. A glossary for dissemination and implementation research in health. J Public Health Manag Pract. 2008;14:117–123.
    1. Klein KJ, Sorra JS. The Challenge of Innovation Implementation. The Academy of Management Review. 1996;21:1055–1080. doi: 10.2307/259164.
    1. Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney S. Publication Guidelines for Quality Improvement Studies in Health Care: Evolution of the SQUIRE Project. J Gen Intern Med. 2008;149:670–676.
    1. Dopson S, Fitzgerald L. The active role of context. In: Dopson S, Fitzgerald L, editor. Knowledge to action? Evidence-based health care in context. Oxford, UK: Oxford University Press; 2006. p. 223.
    1. Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review: A new method of systematic review designed for complex policy interventions. J Health Serv Res Policy. 2005;1:21–34. doi: 10.1258/1355819054308530.
    1. Pettigrew A, Whipp R. Managing change and corporate performance. In: Cool K, Neven DJ, Walter I, editor. European Industrial Restructuring in the 1990s. Washington Square, NY: New York University Press; 1992. pp. 227–265.
    1. Plsek PE, Greenhalgh T. Complexity science: The challenge of complexity in health care. BMJ. 2001;323:625–628. doi: 10.1136/bmj.323.7313.625.
    1. Kirsh SR, Lawrence RH, Aron DC. Tailoring an intervention to the context and system redesign related to the intervention: A case study of implementing shared medical appointments for diabetes. Implement Sci. 2008;3:34. doi: 10.1186/1748-5908-3-34.
    1. Institute of Medicine . Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
    1. Pettigrew AM, Woodman RW, Cameron KS. Studying organizational change and development: Challenges for future research. Acad Manage J. 2001;44:697–713. doi: 10.2307/3069411.
    1. Grol RP, Bosch MC, Hulscher ME, Eccles MP, Wensing M. Planning and studying improvement in patient care: The use of theoretical perspectives. Milbank Q. 2007;85:93–138. doi: 10.1111/j.1468-0009.2007.00478.x.
    1. Godin G, Belanger-Gravel A, Eccles M, Grimshaw J. Healthcare professionals' intentions and behaviours: A systematic review of studies based on social cognitive theories. Implement Sci. 2008;3:36. doi: 10.1186/1748-5908-3-36.
    1. Frambach RT, Schillewaert N. Organizational innovation adoption: a multi-level framework of determinants and opportunities for future research. Journal of Business Research. 2001;55:163–176. doi: 10.1016/S0148-2963(00)00152-1.
    1. Mendel P, Meredith LS, Schoenbaum M, Sherbourne CD, Wells KB. Interventions in organizational and community context: a framework for building evidence on dissemination and implementation in health services research. Adm Policy Ment Health. 2008;35:21–37. doi: 10.1007/s10488-007-0144-9.
    1. Stetler CB. Updating the Stetler Model of research utilization to facilitate evidence-based practice. Nurs Outlook. 2001;49:272–279. doi: 10.1067/mno.2001.120517.
    1. Gustafson DH, Sainfort F, Eichler M, Adams L, Bisognano M, Steudel H. Developing and testing a model to predict outcomes of organizational change. Health Serv Res. 2003;38:751–776. doi: 10.1111/1475-6773.00143.
    1. Carroll C, Patterson M, Wood S, Booth A, Rick J, Balain S. A conceptual framework for implementation fidelity. Implement Sci. 2007;2:40. doi: 10.1186/1748-5908-2-40.
    1. Perrin KM, Burke SG, O'Connor D, Walby G, Shippey C, Pitt S, McDermott RJ, Forthofer MS. Factors contributing to intervention fidelity in a multi-site chronic disease self-management program. Implement Sci. 2006;1:26. doi: 10.1186/1748-5908-1-26.
    1. Feldstein AC, Glasgow RE. A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. Joint Commission journal on quality and patient safety/Joint Commission Resources. 2008;34:228–243.
    1. Leeman J, Baernholdt M, Sandelowski M. Developing a theory-based taxonomy of Methods for implementing change in practice. J Adv Nurs. 2007;58:191–200. doi: 10.1111/j.1365-2648.2006.04207.x.
    1. Rycroft-Malone JA, Kitson G, Harvey B, McCormack K, Seers AT, Estabrooks C. Ingredients for change: revisiting a conceptual framework. (Viewpoint) Quality and Safety in Health Care. 2002;11:174–180. doi: 10.1136/qhc.11.2.174.
    1. Kochevar LK, Yano EM. Understanding health care organization needs and context. Beyond performance gaps. J Gen Intern Med. 2006;21:S25–29.
    1. Klein KJ, Conn AB, Sorra JS. Implementing computerized technology: An organizational analysis. J Appl Psychol. 2001;86:811–824. doi: 10.1037/0021-9010.86.5.811.
    1. Shortell SM, Marsteller JA, Lin M, Pearson ML, Wu SY, Mendel P, Cretin S, Rosen M. The role of perceived team effectiveness in improving chronic illness care. Med Care. 2004;42:1040–1048. doi: 10.1097/00005650-200411000-00002.
    1. Graham ID, Logan J. Innovations in knowledge transfer and continuity of care. Can J Nurs Res. 2004;36:89–103.
    1. Brehem J, Rahn W. Individual Level Evidence for the Causes and Consequences of Social Capital. American Journal of Political Science. 1997;41:999–1023. doi: 10.2307/2111684.
    1. Walston SL, Kimberly JR, Burns LR. Institutional and economic influences on the adoption and extensiveness of managerial innovation in hospitals: The case of reengineering. Med Care Res Rev. 2001;58:194–228. doi: 10.1177/107755870105800203. discussion 229-133.
    1. Thompson J, Scott W, Zald M. Organizations in Action: Social Science Bases of Administrative Theory. Edison, NJ: Transaction Publishers; 2003.
    1. Damanpour F. Organizational Innovation: A Meta-Analysis of Effects of Determinants and Moderators. The Academy of Management Journal. 1991;34:555–590. doi: 10.2307/256406.
    1. Edmondson AC, Bohmer RM, Pisana GP. Disrupted routines: Team learning and new technology implementation in hospitals. Adm Sci Q. 2001;46:685–716. doi: 10.2307/3094828.
    1. Dewar RD, Dutton JE. The Adoption of Radical and Incremental Innovations: An Empirical Analysis. Management Science. 1986;32:1422–1433. doi: 10.1287/mnsc.32.11.1422.
    1. Fitzgerald LA, van Eijnatten FM. Reflections: Chaos in organizational change. Journal of Organizational Change Management. 2002;15:402–411. doi: 10.1108/09534810210433700.
    1. Plsek PE, Wilson T. Complexity, leadership, and management in healthcare organisations. BMJ. 2001;323:746–749. doi: 10.1136/bmj.323.7313.625.
    1. Safran DG, Miller W, Beckman H. Organizational dimensions of relationship-centered care. Theory, evidence, and practice. J Gen Intern Med. 2006;21:S9–15. doi: 10.1111/j.1525-1497.2006.00303.x.
    1. Pronovost PJ, Berenholtz SM, Goeschel CA, Needham DM, Sexton JB, Thompson DA, Lubomski LH, Marsteller JA, Makary MA, Hunt E. Creating high reliability in health care organizations. Health Serv Res. 2006;41:1599–1617. doi: 10.1111/j.1475-6773.2006.00567.x.
    1. Simpson DD, Dansereau DF. Assessing Organizational Functioning as a Step Toward Innovation. NIDA Science & Practice Perspectives. 2007;3:20–28.
    1. Gershon R, Stone PW, Bakken S, Larson E. Measurement of Organizational Culture and Climate in Healthcare. J Nurs Adm. 2004;34:33–40. doi: 10.1097/00005110-200401000-00008.
    1. van Eijnatten FM, Galen M. Chaos, dialogue and the dolphin's strategy. Journal of Organizational Change Management. 2002;15:391–401. doi: 10.1108/09534810210433692.
    1. Martin J. Organizational culture: Mapping the terrain. Thousand Oaks, CA: Sage Publications; 2002.
    1. Helfrich CD, Weiner BJ, McKinney MM, Minasian L. Determinants of implementation effectiveness: adapting a framework for complex innovations. Med Care Res Rev. 2007;64:279–303. doi: 10.1177/1077558707299887.
    1. VanDeusen Lukas CV, Holmes SK, Cohen AB, Restuccia J, Cramer IE, Shwartz M, Charns MP. Transformational change in health care systems: An organizational model. Health Care Manage Rev. 2007;32:309–320.
    1. Nembhard I, Edmonson A. Making it safe: the effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. Journal of Organizational Behavior. 2006;27:941–966. doi: 10.1002/job.413.
    1. Templeton GF, Lewis BR, Snyder CA. Development of a measure for the organizational learning construct. Journal of Management Information Systems. 2002;19:175–218.
    1. Fitzgerald LE, Wood FM, Hawkins C. Interlocking Interactions: the Diffusion of Innovations in Health Care. Human Relations. 2002;55:1429–1449. doi: 10.1177/001872602128782213.
    1. Weiner BJ, Savitz LA, Bernard S, Pucci LG. How do integrated delivery systems adopt and implement clinical information systems? Health Care Manage Rev. 2004;29:51
    1. VanDeusen Lukas CV, Meterko MM, Mohr D, Seibert MN, Parlier R, Levesque O, Petzel RA. Implementation of a clinical innovation: the case of advanced clinic access in the Department of Veterans Affairs. J Ambul Care Manage. 2008;31:94–108.
    1. Rogers E. Diffusion of Innovations. 5. New York, NY: Free Press; 2003.
    1. Saint S, Kowalski CP, Banaszak-Holl J, Forman J, Damschroder L, Krein SL. How Active Resisters and Organizational Constipators Affect Health Care-Acquired Infection Prevention Efforts. The Joint Commission Journal on Quality and Patient Safety. 2009;35:239–246.
    1. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179–211. doi: 10.1016/0749-5978(91)90020-T.
    1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191–215. doi: 10.1037/0033-295X.84.2.191.
    1. Theory at a Glance: A guide for health promotion practice
    1. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12:38–48.
    1. Greenberg J. Organizational justice: Yesterday, today, and tomorrow. Journal of Management. 1990;16:399–432. doi: 10.1177/014920639001600208.
    1. Abraham R. Organizational cynicism: bases and consequences. Genet Soc Gen Psychol Monogr. 2000;126:269–292.
    1. Pearce CL, Ensley MD. A reciprocal and longitudinal investigation of the innovation process: the central role of shared vision in product and process innovation teams (PPITs) Journal of Organizational Behavior. 2004;25:259–278. doi: 10.1002/job.235.
    1. Smith AC, Organ D, Near J. Organizational Citizenship Behavior: Its Nature and Antecedents. J Appl Psychol. 1983;68:653–663. doi: 10.1037/0021-9010.68.4.653.
    1. Cropanzano R, Rupp DE, Byrne ZS. The relationship of emotional exhaustion to work attitudes, job performance, and organizational citizenship behaviors. J Appl Psychol. 2003;88:160–169. doi: 10.1037/0021-9010.88.1.160.
    1. Estabrooks CA, Midodzi WK, Cummings GG, Wallin L. Predicting research use in nursing organizations: a multilevel analysis. Nurs Res. 2007;56:S7–23. doi: 10.1097/01.NNR.0000280647.18806.98.
    1. Brach C, Lenfestey N, Roussel A, Amoozegar J, Sorensen A. Will It Work Here? A Decisionmaker's Guide to Adopting Innovations. Agency for Healthcare Research & Quality (AHRQ); 2008.
    1. Glisson C, Landsverk J, Schoenwald S, Kelleher K, Hoagwood KE, Mayberg S, Green P. Assessing the Organizational Social Context (OSC) of Mental Health Services: Implications for Research and Practice. Adm Policy Ment Health. 2008;35:98–113. doi: 10.1007/s10488-007-0148-5.
    1. Ven AH Van de, Polley DE, Garud R, Vandataraman S. The Innovation Journey. Oxford: Oxford University Press; 1999.
    1. Institute for Healthcare Improvement . Book The Breakthrough Series: IHI's Collaborative Model for Achieving Breakthrough Improvement (Editor ed^eds) City: Institutue for Healthcare Improvement; 2003. The Breakthrough Series: IHI's Collaborative Model for Achieving Breakthrough Improvement; p. 20.
    1. Institute for Healthcare Improvement Going Lean in Health Care. Book Going Lean in Health Care (Editor ed^eds) City. 2005.
    1. Grol R, Wensing M, Eccles M. Improving Patient Care: The Implementation of Change in Clinical Practice. Edinburgh, Scotland: Elsevier; 2005.
    1. Glisson C, Schoenwald SK. The ARC organizational and community intervention strategy for implementing evidence-based children's mental health treatments. Mental health services research. 2005;7:243–259. doi: 10.1007/s11020-005-7456-1.
    1. Estabrooks CA, Thompson DS, Lovely JJ, Hofmeyer A. A guide to knowledge translation theory. J Contin Educ Health Prof. 2006;26:25–36. doi: 10.1002/chp.48.
    1. Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: a model for large scale knowledge translation. BMJ. 2008;337:a1714. doi: 10.1136/bmj.a1714.
    1. Cruess SR, Cruess RL, Steinert Y. Role modelling–making the most of a powerful teaching strategy. BMJ. 2008;336:718–721. doi: 10.1136/.
    1. Greenhalgh T, Robert G, Bate P, Kyriakidou O, Macfarlane F, Peacock R. Book How to Spread Good Ideas (Editor ed^eds) City: National Co-ordinating Centre for NHS Service Delivery and Organisation R & D; 2004. How to Spread Good Ideas; p. 424.
    1. Maidique MA. Entrepeneurs, champions and technological innovation. Sloan Manage Rev. 1980;21:59–76.
    1. Schon DA. Champions for radical new inventions. Harv Bus Rev. 1963;41:77–86.
    1. Pearson ML, Wu S, Schaefer J, Bonomi AE, Shortell SM, Mendel PJ, Marsteller JA, Louis TA, Rosen M, Keeler EB. Assessing the implementation of the chronic care model in quality improvement collaboratives. Health Serv Res. 2005;40:978–996. doi: 10.1111/j.1475-6773.2005.00397.x.
    1. Glasgow RE, McKay HG, Piette JD, Reynolds KD. The RE-AIM framework for evaluating interventions: what can it tell us about approaches to chronic illness management? Patient Educ Couns. 2001;44:119–127. doi: 10.1016/S0738-3991(00)00186-5.
    1. Sim I, Owens DK, Lavori PW, Rennels GD. Electronic trial banks: a complementary method for reporting randomized trials. Med Decis Making. 2000;20:440–450. doi: 10.1177/0272989X0002000408.

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