Identify roles and responsibilities, outline specific steps and milestones, and define goals and measures for implementation success in advance.
The fundamental objective of planning is to design a course of action to promote effective implementation by building local capacity for using the innovation, collectively and individually (Mendel et al., 2008); this construct includes contingency planning (Dy et al., 2015), goal-setting (see also Reflecting and Evaluation for monitoring progress toward set goals), selecting strategies, and occurs within context of incremental implementation approaches or testing cycles.
The original CFIR elaborated on this construct, stating that regardless of the degree of complexity of the innovation, simple, clear, and detailed implementation plans, schedules, and task assignments contribute to successful implementation (Gustafson et al., 2003). The specific steps in plans should be based on the underlying theories or models used to promote change at organization and individual levels (R. P. Grol et al., 2007). For example, the Institute for Healthcare Improvement (Institute for Healthcare Improvement, 2003, 2005), Grol et al. (R. Grol et al., 2005), and Glisson and Schoenwald (Glisson & Schoenwald, 2005) describe comprehensive approaches to implementation on which implementation plans can be developed. However, these theories prescribe different sets of activities because they were developed in different contexts (though commonalities exist as well). Grol et al. list 14 different bodies of theories for changing behaviors in social or organizational contexts (R. P. Grol et al., 2007), and Estabrooks et al. list 18 different models of organizational innovation (Estabrooks et al., 2006). Thus, the content of plans will vary depending on the theory or model being used to guide implementation and the context within which implementation will occur.
Setting goals and identifying metrics or measures to track progress are integral aspects planning (Greenhalgh, Robert, et al., 2004; E. Rogers, 2003). Planned measures should include implementation and innovation outcomes that are important to key constituencies (von Thiele Schwarz et al., 2019), including at a minimum, leaders, deliverers, and recipients (Damschroder et al., 2022). Goals should be specific, measurable, attainable, relevant, and timely (the SMART rubric) (Brach et al., 2008); goal planning includes documenting objectives, benchmarks, and timeline with consideration of feasibility and adequacy (Dy et al., 2015). Note that the degree to which monitoring and evaluation occurs is captured in Reflecting and Evaluating.
Qualitative coding guidelines that are aligned with the Updated CFIR will be added in the future.
Include evidence of pre-implementation planning as well as refinements to the plan.
- “We held an all-day working meeting where everyone developed a process map and then we tried to figure out what the steps should be to get the new process going.”
Regarding quantitative measurement of this construct: In a systematic review of quantitative measures related to implementation, Dorsey et al. identified five measures (Dorsey et al., 2021). Using PAPERS criteria of measurement quality with an aggregate scale ranging from -9 to +36 (Lewis, Mettert, Stanick, et al., 2021), The Community Leader Survey (Planning) (Valente et al., 2007) had the highest score of seven. Results indicate the need for continued development of high-quality measures.
As we become aware of measures, we will post them here. Please contact us with updates.
Brach, C., N. Lenfestey, A. Roussel, J. Amoozegar, & A. Sorensen. (2008). Will It Work Here? A Decisionmaker’s Guide to Adopting Innovations. Agency for Healthcare Research & Quality (AHRQ). https://www.ahrq.gov/innovations/will-work/index.html.
Damschroder, L. J., Reardon, C. M., Opra Widerquist, M. A., & Lowery, J. (2022). Conceptualizing outcomes for use with the Consolidated Framework for Implementation Research (CFIR): The CFIR Outcomes Addendum. Implementation Science, 17(1), 7. https://doi.org/10.1186/s13012-021-01181-5.
Dorsey, C. N., Mettert, K. D., Puspitasari, A. J., Damschroder, L. J., & Lewis, C. C. (2021). A systematic review of measures of implementation players and processes: Summarizing the dearth of psychometric evidence. Implementation Research and Practice, 2, 263348952110024.
Dy, S. M., Ashok, M., Wines, R. C., & Rojas Smith, L. (2015). A Framework to Guide Implementation Research for Care Transitions Interventions: Journal for Healthcare Quality, 37(1), 41–54. https://doi.org/10.1097/01.JHQ.0000460121.06309.f9.
Estabrooks, C. A., Thompson, D. S., Lovely, J. J., & Hofmeyer, A. (2006). A guide to knowledge translation theory. J Contin Educ Health Prof, 26(1), 25–36.
Glisson, C., & Schoenwald, S. K. (2005). The ARC organizational and community intervention strategy for implementing evidence-based children’s mental health treatments. Ment Health Serv Res, 7(4), 243–259.
Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Q, 82(4), 581–629.
Grol, R. P., Bosch, M. C., Hulscher, M. E., Eccles, M. P., & Wensing, M. (2007). Planning and studying improvement in patient care: The use of theoretical perspectives. Milbank Q, 85(1), 93–138.
Grol, R., Wensing, M., & Eccles, M. (2005). Improving Patient Care: The Implementation of Change in Clinical Practice. Elsevier.
Gustafson, D. H., Sainfort, F., Eichler, M., Adams, L., Bisognano, M., & Steudel, H. (2003). Developing and testing a model to predict outcomes of organizational change. Health Serv Res, 38(2), 751–776.
Institute for Healthcare Improvement. (2003). The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement (Innovation Series 2003, p. 20). Institute for Healthcare Improvement.
Institute for Healthcare Improvement. (2005). Going Lean in Health Care (IHI Innovation Series White Paper).
Lewis, C. C., Mettert, K. D., Stanick, C. F., Halko, H. M., Nolen, E. A., Powell, B. J., & Weiner, B. J. (2021). The psychometric and pragmatic evidence rating scale (PAPERS) for measure development and evaluation. Implementation Research and Practice, 2, 263348952110373. https://doi.org/10.1177/26334895211037391.
Mendel, P., Meredith, L. S., Schoenbaum, M., Sherbourne, C. D., & Wells, K. B. (2008). Interventions in organizational and community context: A framework for building evidence on dissemination and implementation in health services research. Adm Policy Ment Health, 35(1–2), 21–37.
Rogers, E. (2003). Diffusion of innovations: 5th ed. Free Press.
Valente, T. W., Chou, C. P., & Pentz, M. A. (2007). Community Coalitions as a System: Effects of Network Change on Adoption of Evidence-Based Substance Abuse Prevention. American Journal of Public Health, 97(5), 880–886. https://doi.org/10.2105/AJPH.2005.063644.
von Thiele Schwarz, U., Aarons, G. A., & Hasson, H. (2019). The Value Equation: Three complementary propositions for reconciling fidelity and adaptation in evidence-based practice implementation. BMC Health Services Research, 19(1), 868. https://doi.org/10.1186/s12913-019-4668-y.