INNER SETTING DOMAIN

The setting in which the innovation is implemented, e.g., hospital, school, city. There may be multiple Inner Settings and/or multiple levels within the Inner Setting, e.g., unit, classroom, team.
Project Inner Setting(s):

[Document the actual Inner Setting in the project, e.g., type, location, and the boundary between the Outer Setting and the Inner Setting.]

The Inner Setting is often the unit of analysis in an implementation study and can be divided into multiple levels (McEachern et al., 2019) to account for teams or units (Miake-Lye et al., 2020; Safaeinili et al., 2020). For example, Safaeinili et al. adapted the CFIR to accommodate three embedded levels: 1) pilot clinics, 2) peer clinics, and 3) the larger health system (Safaeinili et al., 2020). Constructs A – D below capture persistent general characteristics of the Inner Setting (e.g., Relational Connections), while Constructs E – K are specific to implementation and/or delivery of the innovation (e.g., Access to Knowledge & Information).

The original CFIR elaborated further on this domain, stating that the Inner Setting may be composed of tightly or loosely coupled entities (e.g., a loosely affiliated medical center and outlying contracted clinics or tightly integrated service lines within a health system). The Inner Setting is an active interacting force and not just a backdrop in implementation (Sue Dopson & Louise Fitzgerald, 2006). Objective descriptions of the Inner Setting may include its size, age, maturity, and specialization (the uniqueness of the niche or market for the organization’s products or services); each of these features may influence implementation (Greenhalgh, Robert, et al., 2004). Size and age are sometimes used as proxy measures and may be negatively associated with implementation when bureaucratic structure is increased as a result (Van de Ven, 1986; Walston et al., 2001).

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.

McEachern, B. M., Jackson, J., Yungblut, S., & Tomasone, J. R. (2019). Barriers and Facilitators to Implementing Exercise is Medicine Canada on Campus Groups.

Miake-Lye, I. M., Delevan, D. M., Ganz, D. A., Mittman, B. S., & Finley, E. P. (2020). Unpacking organizational readiness for change: An updated systematic review and content analysis of assessments. BMC Health Services Research, 20(1), 106. https://doi.org/10.1186/s12913-020-4926-z.

Safaeinili, N., Brown‐Johnson, C., Shaw, J. G., Mahoney, M., & Winget, M. (2020). CFIR simplified: Pragmatic application of and adaptations to the Consolidated Framework for Implementation Research (CFIR) for evaluation of a patient‐centered care transformation within a learning health system. Learning Health Systems, 4(1). https://doi.org/10.1002/lrh2.10201.

Sue Dopson, & Louise Fitzgerald. (2006). The active role of context. In S. Dopson & L. Fitzgerald (Eds.), Knowledge to action? Evidence-based health care in context (p. 223). Oxford University Press.

Van de Ven, A. H. (1986). Central Problems in the Management of Innovation. Management Science, 32(5), 590–607. https://doi.org/10.1287/mnsc.32.5.590.

Walston, S. L., Kimberly, J. R., & Burns, L. R. (2001). Institutional and economic influences on the adoption and extensiveness of managerial innovation in hospitals: The case of reengineering. Med Care Res Rev, 58(2), 194–228; discussion 229-33.