External Change Agents

Individuals who are affiliated with an outside entity who formally influence or facilitate intervention decisions in a desirable direction.   


Domain: Process

Construct: Engaging

External Change Agents usually have professional training in a technical field related to organizational change science or in the technology being introduced into the organization. This role includes outside researchers who may be implementing a multi-site intervention study and other formally appointed individuals from an external entity (related or unrelated to the organization), e.g., a facilitator from a corporate or regional office or a hired consultant.

The more external change agents actually do on behalf of the receiving organization, the more likely implementation will be successful in the near-term but the less likely the intervention can be sustained; the less they do, the less effective implementation is likely to be in the near-term but more effective over the longer term because local individuals may take more ownership. The PARiHS framework describes facilitators who are task-oriented versus holistic, the latter approach being valued more highly than the former [1].

Inclusion Criteria

Include statements related to engagement strategies and outcomes, e.g., how the external change agent (entities outside the organization that facilitate change) became engaged with the innovation and what their role is in implementation, e.g., how they supported implementation efforts. 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 an external change agent that are not successful, or if the external change agent leaves their organization and this role is vacant, the construct receives a negative rating. In addition, you may also want to code the “quality” of the external change agent here – their capabilities, motivation, and skills, i.e. how good they are at their job, and this affects the rating as well.

  • “The project manager for the research study was always available and helpful to us.”
  • “Someone from the collaborative that we participated in checked in with us regularly.”

Exclusion Criteria

Note: It is important to clearly define what roles are external and internal to the organization. Exclude statements regarding facilitating activities, such as training in the mechanics of the program, and code to Access to Knowledge & Information if the change agent is considered internal to the study, e.g., a staff member at the national office. If the study considers this staff member internal to the organization, it should not be coded to Access to Knowledge & Information, even though their support may overlap with what would be expected from an External Change Agent.

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.

  1. Rycroft-Malone J, A., 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.