Implement in small steps, tests, or cycles of change to trial and cumulatively optimize delivery of the innovation.

Doing includes using iterative approaches such as Plan-Do-Study-Act change cycles or incremental steps instead of implementing all components in all planned areas within a specified period (Ashok et al., 2018; Dy et al., 2015). The original CFIR elaborated further, stating that taking an incremental approach leads to breaking the innovation down into manageable parts that can be implemented incrementally (Damanpour, 1991). The ability to implement an innovation incrementally (sometimes referred to as divisibility (R. P. Grol et al., 2007)) can help decrease perceptions of innovation complexity and thus implementation difficulty. Thus, more complex innovations especially benefit from incremental implementation (Damanpour, 1991; Grossman, 1970; Normann, 1971). In addition, incremental approaches allow deliverers to have enough time to do their work and to learn new skills associated with the new innovation (Helfrich, Weiner, et al., 2007). Successes in early increments of the implementation help increase confidence, give an opportunity to adjust the innovation or implementation (see Adapting), and gain new β€œbelievers.” Usability testing (with deliverers and recipients) promotes successful adaptation of the innovation (Feldstein & Glasgow, 2008). Dry runs (simulations or practice sessions) to allow team members to learn how to use the innovation before going live (Edmondson et al., 2001) is also beneficial.

Doing also includes trialing, which allows for time to build experience and expertise, reflect upon and test the innovation (Rycroft-Malone, Kitson, et al., 2002), gain confidence, and build an environment of psychological safety (Edmondson et al., 2001). The ability to trial is a key feature of the PDSA approach, allowing users increase coordination to manage interdependence (see also Trialability) (Leeman et al., 2007; Rabin et al., 2008). Implementers or deliverers need to be able to stop the innovation and reverse its effects if it causes problems or is ineffective (Feldstein & Glasgow, 2008). Results from trials will provide needed information about how best to implement to other units to minimize workflow disruption.

Qualitative coding guidelines that are aligned with the Updated CFIR will be added in the future.

As we become aware of measures, we will post them here. Please contact us with updates.

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