There are high quality formal and informal information sharing practices within and across Inner Setting boundaries (e.g., structural, professional).

The original CFIR elaborated that regardless of how an Inner Setting is structurally organized, the importance of communication across the setting is clear. This construct includes Greenhalgh’s intraorganizational communications (Greenhalgh, Robert, et al., 2004). Greenhalgh et al. cite strong or moderate influence of intraorganizational communication on implementation outcomes (Greenhalgh, Robert, et al., 2004). Communication failures are involved with the majority of sentinel events in US hospitals – most often between physicians and nurses (Pronovost et al., 2006). High quality formal communications contribute to effective implementation (Simpson & Dansereau, 2007). Strong intra-organizational communications are positively associated with implementation as it pushes decision-making to the front-line teams or individuals (Greenhalgh, Robert, et al., 2004; Meyers et al., 1999). Making staff feel welcome (good assimilation through communication), peer collaboration, open feedback and review among peers and across hierarchical levels, clear communication of mission and goals, and informal communication quality all contribute to effective implementation (Simpson & Dansereau, 2007).

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

Inclusion Criteria

Include statements about general communication in the Inner Setting to keep people informed.

  • “If I want to get something done, informal communications work the best. I just email or pick up the phone.”
  • “I wouldn’t go through formal communications to get anything done, that just takes too much documentation and nothing gets done… it’s better to stay under the radar.”

Regarding quantitative measurement of this construct: In a systematic review of quantitative measures related to implementation, Dorsey et al. identified 29 measures (Dorsey et al., 2021). These measures relate to both Relational Connections and Communications in the updated CFIR. Using PAPERS criteria of measurement quality with an aggregate scale ranging from -9 to +36 (Lewis, Mettert, Stanick, et al., 2021), five (17.24%) of the measures could not be scored. The Texas Christian University Organizational Readiness for Change (Lehman et al., 2002) achieved the highest score of 10. 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.

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.

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.

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.

Simpson, D. D., & Dansereau, D. F. (2007). Assessing Organizational Functioning as a Step Toward Innovation. NIDA Science & Practice Perspectives, 3(2), 20–28.