Table 2 Full list of CFIR constructs, general definitions and adapted definitions
CFIR construct | General definition | Adapted definitions |
|---|---|---|
Domain: intervention characteristics | ||
 Intervention source | Perception of key stakeholders about whether the intervention is externally or internally developed | History of PCC-related program(s) or practice(s) and perceived source of the initiative |
 Evidence strength and quality | Stakeholders’ perceptions of the quality and validity of evidence supporting the belief that the intervention will have desired outcomes | Perception of intervention patient-centeredness |
 Relative advantage | Stakeholders’ perception of the advantage of implementing the intervention versus an alternative solution | Perception of the advantage of intervention relative to current practices |
 Adaptability | The degree to which an intervention can be adapted, tailored, refined, or reinvented to meet local needs | How intervention was adapted to current setting |
 Trialability | The ability to test the intervention on a small scale in the organization, and to be able to reverse course (undo implementation) if warranted | The ability to test the intervention (pilot) and to de-implement if necessary |
 Complexity | Perceived difficulty of implementation, reflected by duration, scope, radicalness, disruptiveness, centrality, and intricacy and number of steps required to implement | How hard has this been to do (scope, radicalness, disruptiveness) |
 Design quality and packaging | Perceived excellence in how the intervention is bundled, presented, and assembled | How the intervention/initiative is presented to staff |
 Cost | Costs of the intervention and costs associated with implementing the intervention including investment, supply, and opportunity costs | Funds received, facility funds used, training and staff time |
Domain: outer setting | ||
 Patient needs and resources | The extent to which patient needs, as well as barriers and facilitators to meet those needs, are accurately known and prioritized by the organization | Identified patient needs, processes used to identify them, barriers and facilitators associated with meeting needs and strategies for engaging patients to identify ways to address them |
 Cosmopolitanism | The degree to which an organization is networked with other external organizations | Connections with non-VA organizations, &/or current ideas in the literature |
 Peer pressure | Mimetic or competitive pressure to implement an intervention; typically because most or other key peer or competing organizations have already implemented or are in a bid for a competitive edge | Relationship with other VAs/OPCC/other COIs |
 External policies and incentives | A broad construct that includes external strategies to spread interventions, including policy and regulations (governmental or other central entity), external mandates, recommendations and guidelines, pay-for-performance, collaboratives, and public or benchmark reporting | Details about policy, recommendations, guidelines, could be VA/OPCC |
Domain: inner setting | ||
 Structural characteristics | The social architecture, age, maturity, and size of an organization | Size and age of facility, maturity, existing environmental/structural characteristics |
 Networks and communications | The nature and quality of webs of social networks and the nature and quality of formal and informal communications within an organization | Informal and formal communication structures (i.e. SharePoint, newsletters, etc.) |
 Culture | Norms, values, and basic assumptions of a given organization | Norms and values of organization |
 Implementation climate | The absorptive capacity for change, shared receptivity of involved individuals to an intervention, and the extent to which use of that intervention will be rewarded, supported, and expected within their organization | Capacity of change, receptivity to PCC or intervention/innovation |
 Tension for change | The degree to which stakeholders perceive the current situation as intolerable or needing change | Perceived need for change |
 Compatibility | The degree of tangible fit between meaning and values attached to the intervention by involved individuals, how those align with individuals’ own norms, values, and perceived risks and needs, and how the intervention fits with existing workflows and systems | Perception of compatibility with existing norms, values, and practices |
 Relative priority | Individuals’ shared perception of the importance of the implementation within the organization | Perception of the importance of the change relative to existing priorities |
 Organizational incentives and rewards | Extrinsic incentives such as goal-sharing awards, performance reviews, promotions, and raises in salary, and less tangible incentives such as increased stature or respect | Goal sharing awards, performance measure, and other motivators |
 Goals and feedback | The degree to which goals are clearly communicated, acted upon, and fed back to staff, and alignment of that feedback with goals | Goals are communicated, enacted, evaluated, and fed back to staff |
 Learning climate | A climate in which: (a) leaders express their own fallibility and need for team members’ assistance and input; (b) team members feel that they are essential, valued, and knowledgeable partners in the change process; (c) individuals feel psychologically safe to try new methods; and (d) there is sufficient time and space for reflective thinking and evaluation | Leaders addressing the need for feedback of team members, staff involvement in defining and refining intervention/innovation, its goals, and evaluation of progress |
 Readiness for implementation | Tangible and immediate indicators of organizational commitment to its decision to implement an intervention | Degree to which the organization is ready to implement intervention/innovation |
 Leadership engagement | Commitment, involvement, and accountability of leaders and managers with the implementation | Commitment, involvement, and accountability of leaders and managers |
 Available resources | The level of resources dedicated for implementation and on-going operations, including money, training, education, physical space, and time | Money, training, education, physical space, and time |
 Access to knowledge and information | Ease of access to digestible information and knowledge about the intervention and how to incorporate it into work tasks | Availability and usefulness of intervention information |
Domain: characteristics of the individual | ||
 Knowledge and beliefs about the intervention | Individuals’ attitudes toward and value placed on the intervention as well as familiarity with facts, truths, and principles related to the intervention | Individuals’ attitudes toward and value placed on the intervention as well as familiarity with facts, truths, and principles related to the intervention |
 Self-efficacy | Individual belief in their own capabilities to execute courses of action to achieve implementation goals | Individual belief in capabilities to achieve implementation goals |
 Individual stage of change | Characterization of the phase an individual is in, as he or she progresses toward skilled, enthusiastic, and sustained use of the intervention | Changes in the individual’s disposition toward the change |
 Identification with organization | A broad construct related to how individuals perceive the organization, and their relationship and degree of commitment with that organization | Perception of the organization, and relationship and commitment to it |
 Other personal attributes | A broad construct to include other personal traits such as tolerance of ambiguity, intellectual ability, motivation, values, competence, capacity, and learning style | Perception of personal traits (i.e. motivation, values, capacity, and learning style) |
Domain: process | ||
 Planning | The degree to which a scheme or method of behavior and tasks for implementing an intervention are developed in advance, and the quality of those schemes or methods | Methods and tasks and for implementing an intervention identified |
 Engaging | Attracting and involving appropriate individuals in the implementation and use of the intervention through a combined strategy of social marketing, education, role modeling, training, and other similar activities | Presence and description of people (opinion leaders, implementation leaders, champions) who educated/trained, role modeled, etc) |
 Opinion leaders | Individuals in an organization who have formal or informal influence on the attitudes and beliefs of their colleagues with respect to implementing the intervention | Individual with informal or formal influence on the attitudes\beliefs of colleagues |
 Formally-appointed implementation leaders | Individuals from within the organization who have been formally appointed with responsibility for implementing an intervention as coordinator, project manager, team leader, or other similar role | Formally appointed leaders with clearly defined responsibilities related to implementation |
 Champions | Overcoming indifference or resistance that the intervention may provoke in an organization | Individuals who are formally appointed or informally volunteer to support change |
 External change agents | Individuals who are affiliated with an outside entity who formally influence or facilitate intervention decisions in a desirable direction | Outside groups who assist in intervention |
 Executing | Carrying out or accomplishing the implementation according to plan | Carrying out or accomplishing the implementation according to planned |
 Reflecting and evaluating | Quantitative and qualitative feedback about the progress and quality of implementation accompanied with regular personal and team debriefing about progress and experience | Steps to evaluate implementation and patient outcomes |