Tension for Change

The degree to which stakeholders perceive the current situation as intolerable or needing change. 

Domain: INNER SETTING

Construct: Implementation Climate

Children

The degree to which stakeholders perceive the current situation as intolerable or needing change [1][2][3][4]. An acute sense of the need for change can be the trigger for designing an intervention internally. Externally developed interventions are often in response to a need for change (or gap in performance) at a macro level, rather than locally. Whether or not local stakeholders who are involved in local implementation actually feel a Tension for Change is an important antecedent for successful implementation [5][6]. Effective communication (see Networks and Communications) can foster tension for change by building dissatisfaction with status quo as well as announcing a change, cultivating commitment, and reducing resistance [1]. When stakeholders have first-hand experience with the problem, implementation is especially more likely to be successful [7]. It is difficult to create a tension for change when none actually exists.

Inclusion Criteria

Include statements that (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. Note: If a participant states that the innovation is redundant with a preferred existing program, (double) code lack of Relative Advantage.

  • “We had a weight management clinic before but we were not able to follow up with any patients because we didn’t have the staff… and we didn’t have a multi-disciplinary team.”
  • “We really need to do something to get patients to take their meds.”
  • “The current system is down all the time and I can’t get what I need in time to do any good.”

Exclusion Criteria

Exclude statements regarding specific needs of individuals that demonstrate a need for the innovation, but do not necessarily represent a strong need or an untenable status quo, 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.

Exclude statements that demonstrate the innovation is better (or worse) than existing programs and code to Relative Advantage.

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. 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.
  2. Simpson DD, Dansereau DF: Assessing Organizational Functioning as a Step Toward Innovation. NIDA Science & Practice Perspectives 2007, 3:20-28.
  3. Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA 2002, 288:1909-1914.
  4. Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness. JAMA 2002, 288:1775-1779.
  5. Meyer AD, Goes JB: Organisational Assimilation of Innovations: A Multi-Level Contextual Analysis. Acad Manage J 1988, 31:897-923.
  6. 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.
  7. 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.