The individual(s) is committed to fulfilling Role.
Motivation includes brain processes that energize and direct behavior (Michie et al., 2011) and commitment, the act of binding oneself to a course of action intellectually and/or emotionally (Cane et al., 2012). This construct includes commitment of individuals to fulfill their role (Ashok et al., 2018; Dy et al., 2015). Perceptions of the commitment of leaders was captured in the original CFIR as part of the Inner Setting, but the updated CFIR recognizes the importance of capturing this theme for all individual roles. Enthusiastic use of an innovation is reflected by a positive affective response to the innovation (Klein & Sorra, 1996). Klein et al. define implementation outcomes based on measures of enthusiastic versus compliant use (Klein & Sorra, 1996); thus, care should be taken to clearly capture these concepts as determinants of implementation versus implementation outcomes; refer to the CFIR Outcomes Addendum for more detail (Damschroder et al., 2022). Often, subjective opinions obtained from peers based on personal experiences are convincing and help to generate enthusiasm (Pronovost et al., 2006). The converse is true as well, creating a negative source of active or passive resistance (Meyers et al., 1999; Saint et al., 2009). The degree to which new behaviors are positively or negatively valued heightens intention to change, which is a precursor to actual change (Gershon et al., 2004).
The following paragraphs provide further elaboration for individual-level constructs from the original CFIR that are included as themes within the new Motivation construct.
Championing as a behavior can be an important indicator of Motivation (Bonawitz et al., 2020; Miech et al., 2018). Individuals exhibiting this level of commitment are actively involved with the implementation and willing to risk informal status and reputation because they believe so strongly in the innovation (Schon, 1963). Such highly committed, championing behavior may occur across roles. For example, deliverers are most effective when they can defend and develop cross-functional coalitions of individuals who strongly believe in the innovation and are able to articulate the benefits in a way to move other individuals to fully embrace the innovation.
Individual stage of change reflects the phase an individual is in, as they progresses toward skilled, enthusiastic, and sustained use of the innovation (R. P. Grol et al., 2007; Klein et al., 2001). Prochaska’s trans-theoretical model characterizes stages of change as pre-contemplation, contemplation, preparation, and action and maintenance (Prochaska & Velicer, 1997). Rogers’ diffusion theory delineates five stages (E. Rogers, 2003). Grol et al. describe a five-stage model with ten sub-stages based on their synthesis of the literature (R. P. Grol et al., 2007).
How individuals perceive their organization (Inner Setting) and their relationship and commitment to the Inner Setting may affect willingness fully engage in implementation efforts or to use the innovation (Abraham, 2000; Cummings et al., 2007; Estabrooks et al., 2007; Greenberg, 1990). How strongly organizational identity is taken on by individuals may bolster implementation or delivery of the innovation (Pearce & Ensley, 2004; A. C. Smith et al., 1983). Within the Inner Setting, the alignment between the meaning individuals attach to the innovation versus the meaning communicated by upper management has a strong influence on whether key individuals will commit to the innovation (Greenhalgh, Robert, et al., 2004). For example, an innovation that leadership believes will improve performance may be perceived as a threat to autonomy in treatment decisions by physicians. Meaning in this context can be negotiated and reframed through discussions across organizational networks (Greenhalgh, Robert, et al., 2004).
Qualitative coding guidelines that are aligned with the Updated CFIR will be added in the future.
Regarding quantitative measurement for themes related to Motivation, in a systematic review of quantitative measures designed to assess individual characteristics in implementation, Stanick et al. found 2 measures of stage-of-change (Stanick et al., 2021) and 7 measures plus 3 subscale measures of individual identification with the organization. Using PAPERS criteria of measurement quality with an aggregate scale ranging from -9 to +36 (Lewis, Mettert, Stanick, et al., 2021), only one measure could be scored for stage of change and it received a 4 out of a maximum quality score of 36. The Work Environment Scale (Insel & Moos, 1974) achieved the highest PAPERS score for identification with the organization, scoring 7. These findings 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.
Abraham, R. (2000). Organizational cynicism: Bases and consequences. Genet Soc Gen Psychol Monogr, 126(3), 269–292.
Ashok, M., Hung, D., Rojas-Smith, L., Halpern, M. T., & Harrison, M. (2018). Framework for Research on Implementation of Process Redesigns: Quality Management in Health Care, 27(1), 17–23. https://doi.org/10.1097/QMH.0000000000000158.
Cane, J., O’Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science, 7(1), 37. https://doi.org/10.1186/1748-5908-7-37.
Bonawitz, K., Wetmore, M., Heisler, M., Dalton, V. K., Damschroder, L. J., Forman, J., Allan, K. R., & Moniz, M. H. (2020). Champions in context: Which attributes matter for change efforts in healthcare? Implementation Science, 15(1), 62. https://doi.org/10.1186/s13012-020-01024-9.
Cummings, G. G., Estabrooks, C. A., Midodzi, W. K., Wallin, L., & Hayduk, L. (2007). Influence of Organizational Characteristics and Context on Research Utilization. Nursing Research, 56(4), S24–S39. https://doi.org/10.1097/01.NNR.0000280629.63654.95.
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.
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., Midodzi, W. K., Cummings, G. G., & Wallin, L. (2007). Predicting research use in nursing organizations: A multilevel analysis. Nurs Res, 56(4 Suppl), S7-23.
Gershon, R., Stone, P. W., Bakken, S., & Larson, E. (2004). Measurement of Organizational Culture and Climate in Healthcare. Journal of Nursing Administration, 34(1), 33–40.
Greenberg, J. (1990). Organizational justice: Yesterday, today, and tomorrow. Journal of Management, 16(2), 399–432.
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.
Insel, P. M., & Moos, R. H. (1974). Work environment scale. Consulting Psychologists Press.
Klein, K. J., & Sorra, J. S. (1996). The Challenge of Innovation Implementation. The Academy of Management Review, 21(4), 1055–1080.
Klein, K. J., Conn, A. B., & Sorra, J. S. (2001). Implementing computerized technology: An organizational analysis. Journal of Applied Psychology, 86(5), 811–824.
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.
Meyers, P. W., Sivakumar, K., & Nakata, C. (1999). Implementation of Industrial Process Innovations: Factors, Effects, and Marketing Implications. Journal of Product Innovation Management, 16(3), 295–311. https://doi.org/10.1111/1540-5885.1630295.
Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science : IS, 6, 42. https://doi.org/10.1186/1748-5908-6-42.
Miech, E. J., Rattray, N. A., Flanagan, M. E., Damschroder, L., Schmid, A. A., & Damush, T. M. (2018). Inside help: An integrative review of champions in healthcare-related implementation. SAGE Open Medicine, 6, 205031211877326. https://doi.org/10.1177/2050312118773261.
Pearce, C. L., & Ensley, M. D. (2004). A reciprocal and longitudinal investigation of the innovation process: The central role of shared vision in product and process innovation teams (PPITs). Journal of Organizational Behavior, 25(2), 259–278.
Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. Am J Health Promot, 12(1), 38–48.
Pronovost, P. J., Berenholtz, S. M., Goeschel, C. A., Needham, D. M., Sexton, J. B., Thompson, D. A., Lubomski, L. H., Marsteller, J. A., Makary, M. A., & Hunt, E. (2006). Creating high reliability in health care organizations. Health Serv Res, 41(4 Pt 2), 1599–1617.
Rogers, E. (2003). Diffusion of innovations: 5th ed. Free Press.
Saint, S., Christine P. Kowalski, Jane Banaszak-Holl, Jane Forman, Laura Damschroder, & Sarah L. Krein. (2009). How Active Resisters and Organizational Constipators Affect Health Care–Acquired Infection Prevention Efforts. The Joint Commission Journal on Quality and Patient Safety, 35(5), 239–246.
Schon, D. A. (1963). Champions for radical new inventions. Harvard Business Review, 41, 77–86.
Smith, A. C., DW Organ, & JP Near. (1983). Organizational Citizenship Behavior: Its Nature and Antecedents. Journal of Applied Psychology, 68(4), 653–663.
Stanick, C. F., Halko, H., Mettert, K., Dorsey, C., Moullin, J., Weiner, B., Powell, B., & Lewis, C. C. (2021). Measuring characteristics of individuals: An updated systematic review of instruments’ psychometric properties. Implementation Research and Practice, 2, 263348952110004. https://doi.org/10.1177/26334895211000458.