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.
Engaging members of teams tasked with implementing an intervention (or to be ‘first users’) is an often overlooked part of implementation . It is vital that early members are carefully and thoughtfully selected or allowed to rise naturally , especially ‘implementation leaders’ and ‘champions.’ If early users and leaders are homophilous (similar socioeconomic, professional, educational, and cultural backgrounds) with intended users, individuals will be more likely to adopt the intervention . The influence of these leaders can be evaluated by assessing their presence or absence (e.g., does the implementation effort have a clear champion or not?), how they are brought on board (e.g., appointed, volunteered), their role in the organization (formal and/or informal roles), and their role in implementation. One means by which influence is transmitted is role modeling .
The positive influence of having the “right people in the right seats”  is strong. Likewise, having the wrong people or missing key opportunities to “engage” important individuals can have tremendous negative influence on implementation success. An approach used in some implementations, is simply to select people by virtue of their role in the organization or to select somewhat randomly. This approach may be effective in some situations but in others it squanders a valuable opportunity to build a cohesive team consisting of effective champions and stakeholders who are most likely to make the implementation a success. If supporters of the intervention outnumber and are better strategically positioned than opponents are, the implementation is more likely to be successful . Involving all stakeholders (e.g., leadership, agents, users) early in implementation enhances success . Engaging staff in meaningful problem-solving is one of five interactive elements critical to transform patient care . Implementation will be more effective when key individuals are dedicated (in terms of time and energy), empowered, and supported in their efforts . Key individuals are those who rise up in any capacity to help shepherd the implementation process to completion. Implementation leaders may be opinion leaders, formally appointed internal implementation leaders, champions, and/or external change agents. The quality of support provided by these implementation leaders is positively associated with implementation . Effectively identifying and engaging these key individuals early in the process is important . These leadership roles are used inconsistently and sometimes synonymously in the literature . It is important to provide clarity in defining these roles. Implementation leaders may emerge somewhat organically through the course of implementation. For example, a leader may emerge out of a grass-roots (bottom-up) initiative to improve compliance with an infection control practice. Alternatively, implementation leaders may be identified through top-down appointment for example, by appointing local champions or a project coordinator. The PARiHS model asserts that “the role of the appropriately prepared facilitator, along with the team(s) they are working with, is to construct a programme of change that meets individual and team learning needs” [11, pg. 22]. The CFIR takes a broader view, recognizing the role of many different types of leaders and influencers. Specific roles and expectations will vary depending on the study and setting and even over time within a single implementation effort. However, any one role cannot function in isolation; personal characteristics certainly matter but relationships between these individuals can be more important than individual roles or characteristics .
Include statements related to engagement strategies and outcomes, i.e., if and how staff and innovation participants became engaged with the innovation and what their role is in implementation. Note: Although both strategies and outcomes are coded here, the outcome of engagement efforts determines the rating, i.e., if there are repeated attempts to engage staff that are not successful, or if a role is vacant, the construct receives a negative rating. In addition, you may also want to code the “quality” of staff – their capabilities, motivation, and skills, i.e., how good they are at their job, and this affects the rating as well.
Note: Two new sub-constructs are proposed: Engaging: Key Stakeholders (e.g., providers and staff) and Engaging: Innovation Participants (e.g., patients). These sub-constructs will be included in CFIR V2.
Engaging: Key Stakeholders
Include statements related to engagement strategies and outcomes, e.g., how key stakeholders became engaged with the innovation and what their role is in implementation. Note: Although both strategies and outcomes are coded here, the outcome of efforts to engage staff determines the rating, i.e., if there are repeated attempts to engage key stakeholders that are not successful, the construct receives a negative rating.
Engaging: Innovation Participants
Include statements related to engagement strategies and outcomes, e.g., how innovation participants became engaged with the innovation. Note: Although both strategies and outcomes are coded here, the outcome of efforts to engage participants determines the rating, i.e., if there are repeated attempts to engage participants that are not successful, the construct receives a negative rating.
Exclude statements related to specific sub constructs, e.g., Champions or Opinion Leaders.
Exclude or double code statements related to who participated in the decision process to implement the innovation to Intervention Source, as an indicator of internal or external intervention source.
Engaging: Key Stakeholders
Exclude statements related to implementation leaders’ and users’ access to knowledge and information regarding using the program, i.e., training on the mechanics of the program, and code to Access to Knowledge & Information. Exclude statements about general networking, communication, and relationships in the organization, such as descriptions of meetings, email groups, or other methods of keeping people connected and informed, and statements related to team formation, quality, and functioning, and code to Networks & Communications.
Engaging: Innovation Participants
Exclude statements demonstrating (lack of) awareness of the needs and resources of those served by the organization and whether or not that awareness influenced the implementation or adaptation of the innovation and code to Patient Needs & Resources.
Check out SIRC’s Instrument Review project and published systematic review protocol, which has cataloged over 400 implementation-related measures.
Note: As we become aware of measures, we will post them here. Please contact us with updates.
- Pronovost PJ, Berenholtz SM, Needham DM: Translating evidence into practice: a model for large scale knowledge translation. BMJ 2008, 337:a1714.
- Edmondson AC, Bohmer RM, Pisana GP: Disrupted routines: Team learning and new technology implementation in hospitals. Adm Sci Q 2001, 46:685-716.
- 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.
- Cruess SR, Cruess RL, Steinert Y: Role modelling–making the most of a powerful teaching strategy. BMJ 2008, 336:718-721.
- Collins J: Good to Great: Why Some Companies Make the Leap… and Others Don’t New York, NY: HarperBusiness; 2001.
- 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.
- 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.
- 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.
- Fixsen DL, Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F.: Implementation Research: A Synthesis of the Literature. (The National Implementation Research Network ed.: University of South Florida, Louis de la Parte Florida Mental Health Institute; 2005.
- Ovretveit J, Bate P, Cleary P, Cretin S, Gustafson D, McInnes K, McLeod H, Molfenter T, Plsek P, Robert G, et al: Quality collaboratives: lessons from research. Qual Saf Health Care 2002, 11:345-351.
- 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.
- Plsek PE, Wilson T: Complexity, leadership, and management in healthcare organisations. BMJ 2001, 323:746-749.