Relative Advantage

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Relative Advantage
Intervention Characteristics
Design Quality & Packaging
Evidence Strength & Quality
Intervention Source
Relative Advantage
Measurement maturity
Quantitative tools


Version 1.0

Stakeholders’ perception of the advantage of implementing the intervention versus an alternative solution.


Stakeholders' perception of the advantage of implementing the intervention versus an alternative solution[1].

Rationale for inclusion

Stakeholders’ perception of the advantage of implementing the intervention versus an alternative solution[1].

Relative advantage must be recognized and acknowledged by all key stakeholders for effective implementation[2]. If users perceive a clear, unambiguous advantage in effectiveness or efficiency of the intervention, it is more likely the implementation will be successful. In fact, this perceived relative advantage is sine qua non for adoption/implementation[2]. Greenhalgh et al, the PRISM model, and Grol et al’s implementation model all list observability as a separate construct[2][3][4]. Benefits of the intervention must be clearly visible (observable) to stakeholders to assess relative advantage and thus, efforts to demonstrate benefits of the intervention clearly will help implementation[2][3][5][6][7]. Observability was incorporated into the relative advantage construct. Observability (or visibility) of benefits is tightly coupled with stakeholders’ perception of relative advantage and it would be challenging to tease out separable measures for both in the real world. Thus, we consolidated the two factors, while acknowledging the role of both. The extent to which the intervention is codifiable may also influence perception of relative advantage. Many interventions contain significant tacit components and may have significant benefits that are more difficult to understand or discern[8][9] and thus evaluate for relative advantage.


Qualitative codebook guidelines

Inclusion criteria

Include statements that demonstrate the innovation is better (or worse) than existing programs.

  • “We evaluated a lot of systems and this one is clearly better for our clinic.”

Exclusion criteria

Exclude statements that do or do not demonstrate a strong need for the innovation and/or that the current situation is untenable, e.g., statements that the innovation is absolutely necessary or that the innovation is redundant with other programs, and code to Tension for Change.

Exclude statements regarding specific needs of individuals that demonstrate a need for the innovation and code to Patient Needs & Resources.

Note: CFIR V2 will rename Patient Needs and Resources to Needs and Resources of Those Served by the Organization.

Quantitative measures



  1. 1.0 1.1 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.
  2. 2.0 2.1 2.2 2.3 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.
  3. 3.0 3.1 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.
  4. Feldstein AC, Glasgow RE: A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. Jt Comm J Qual Patient Saf 2008, 34:228-243.
  5. Dopson S, FitzGerald L, Ferlie E, Gabbay J, Locock L: No magic target! Changing clinical practice to become more evidence based. Health Care Manage Rev 2002, 27:35-47.
  6. Denis JL, Hebert Y, Langley A, Lozeau D, Trottier LH: Explaining diffusion patterns for complex health care innovations. Health Care Manage Rev 2002, 27:60-73.
  7. Meyer AD, Goes JB: Organisational Assimilation of Innovations: A Multi-Level Contextual Analysis. Acad Manage J 1988, 31:897-923.
  8. Tucker AL, Nembhard I, Edmondson. AC: Implementing New Practices: An Empirical Study of Organizational Learning in Hospital Intensive Care Units. Management Science 2007, 53:894-907.
  9. Berta WB, Baker GR: Factors that Impact the Transfer and Retention of Best Practices for Reducing Error in Hospitals. Health Care Manage Rev 2004, 29:90-97.
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