[[050 - Implementation Science Index]] | [[Change Management]] | Related to Source : https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-4-50 1. The introduction of the “Consolidated Framework for Implementation Research (CFIR)” 2. Five Domains in CFIR 1. Intervention Characteristics 1. Eight Constructs 2. Outer Setting 1. Four constructs 3. Inner Setting [[Stakeholder Theory]] 1. 12 Constructs 4. Characteristics of the individuals [[Theory of Reasoned Action and Planned Behavior]] | [[Social Cognitive Theory]] | 1. Five Constructs 5. Process of Implementation. 1. Eight Constructs I like this quote “To see far is one thing, going there is another' Constantin Brancusi, 1876–1957. - There is a current gaps in implementation theories because each theory will have one or two constructs missing, so they created a consolidated framework First, the definition of “Implementation” - “Implementation is the constellation of processes intended to get an intervention into use within an organization [13]; it is the means by which an intervention is assimilated into an organization. Implementation is the critical gateway between an organizational decision to adopt an intervention and the routine use of that intervention; the transition period during which targeted stakeholders become increasingly skillful, consistent, and committed in their use of an intervention [14].” Implementation is a social process and depends on the specifc context in that place. Therefore different context will have a different process. “Implementation, by its very nature, is a social process that is intertwined with the context in which it takes place [15]. Context consists of a constellation of active interacting variables and is not just a backdrop for implementation [16]. For implementation research, 'context' is the set of circumstances or unique factors that surround a particular implementation effort” Let’s dive into the Five Domains 1. Characteristics of the intervention being implemented 1. There must be a right fit between the solution and the organisation - if not people will resist, require lots of work to engage them to use it. 2. What is the “core components” of the interventions - Core features, must have. 3. What are the “adaptable periphery” - Secondary features. Good to haves, and can be adjusted. 2. Inner Setting 3. outer setting 1. This is the systemic perspective: Outer setting (economic, political, social context) which influence organisation. Inner setting (organisational culture, structure, politics). 4. Individuals involved with the intervention and/or implementaton process 1. About the stakeholders involved in the process. 2. Theory of Planned Behavior (TPB) model most used model. 3. What is the psychology of the people. 5. Implementation Process 1. Individuals from inner/outer may actively promote. 2. There will be series of sub-processes that happens either planned or spontaenous, linear or nonlinear (I think the implementation process, can apply these strategies [[050 - Implementation Science Index]] - ERIC) ## Detailed Description of CFIR Constructs ### Intervention Characteristics 1. Intervention Source - Legitimacy of the source is important, who initiated the idea? 2. Evidence Strength and Quality - What's the evidence, quality, validity? 3. Relative advantage - What's the benefit or advantage compare to alternative? 4. Adaptability - What's the "Core feature" and "periphery features"? How much can it be modified to meet local needs? to find the right fit 5. Trial-ability - Can try it out before buying? Pilot? Can reserve course? 6. Complexity - If perceived to be too difficult to implement, people will not use. Determine the length (number of process/steps) to implement, 1. *One way to determine complexity is by assessing 'length' (the number of sequential sub-processes or steps for using or implementing an intervention) and 'breadth' (number of choices presented at decision points) [34]. Complexity is also increased with higher numbers of potential target organizational units (teams, clinics, departments) or types of people (providers, patients, managers) targeted by the intervention [34], and the degree to which the intervention will alter central work processes* 7. Design quality and packaging - Perceived excellence (packaging, marketing) 8. Cost - $ cost in investment, maintain, train.. ### Outer Setting 1. Patient needs and resources - make sure that patient needs are considered using this frame work 1. "The Practical, Robust Implementation and Sustainability Model PRISM delineates six elements that can help guide evaluation of the extent to which patients are at the center of organizational processes and decisions: patient choices are provided, patient barriers are addressed, transition between program elements is seamless, complexity and costs are minimized, and patients have high satisfaction with service and degree of access and receive feedback [31]" 2. Cosmopolitanism - how networked, open the organisation is to other organisation. The more open, the faster the adoption. (-reminded me of Family System whether it's closed or open). 3. Peer Pressure - Are there competitors in the market? 4. Eternal policies and incentives - policy, regulation, mandates, etc. ### Inner Setting 1. Structural Characteristics - 1. Social architecture - age, maturity and size of organisation 2. functional differentiation (division of labor) 3. administrative intensity (manager-to-employee ratio) 4. team stability 5. Centralization (decision-making autonomy) can either positively or negatively influence innovation, depending on the stage of an initiative 2. Networks and Communication - social connection, networks, team morale, community. 3. culture - norms, values, assumptions. "Climate is a phenomenon that can vary across teams or units, and is typically less stable over time compared to culture." 4. Implementation Climate - 1. Tension for change - is there a need for change, to use this new tool? 2. compatibility - is new tool align with user value/meaning? Do they fear it? 3. Relative priority - Maybe they dont think it's important 4. Organisational incentives and rewards - any rewards? 5. Goals and Feedback - Whats the goals, has it been communicated clearly? any feedback? 1. Chronic Care Model emphasise the importance of multiple methods of evaluation and feedback. 6. Learning climate - "A climate in which: leaders express their own fallibility and need for team members' assistance and input; team members feel that they are essential, valued, and knowledgeable partners in the change process; individuals feel psychologically safe to try new methods; and there is sufficient time and space for reflective thinking and evaluation (in general, not just in a single implementation) [14,35,54]" 7. Readiness for implementation 1. Leadership engagement - Commitment, involvement, and accountability of leaders and managers [35,53] with the implementation. 2. Available Resources - money, training, education, physical space and time 3. Access to information and knowledge ### Characteristics of Individuals 1. Knowledge and Beliefs about the intervention - 2. Self-efficacy - Do staff believe they can use it? its not complicated. 3. Individual stage of change - motivation to use? (Prochaska's trans-theoretical model characterizes these stages as pre-contemplation, contemplation, preparation, and action and maintenance) 4. Individual Identification with organisation - Do they feel committed to the organisation? This can be influenced by how staff feel about the job, or to the organisation.. burn out etc. 5. Other personal attributes - intellectual, motivation, competence, ..etc .. ### Process 1. planning - ok.. must have plans. 2. Engage key individuals - opinion leaders, formally appointed change implementation leaders, champions, external change agents 3. Executing - Once you have a plan, then execute the plan. Need to follow through 4. Reflecting and evaluating -- feedback loop, reflection Nothing new for me here.