The innovation fits with workflows, systems, and processes.
The original CFIR elaborated by saying that this construct includes the tangible fit between the innovation and existing workflows and systems (Greenhalgh, Robert, et al., 2004; Klein & Sorra, 1996); compatibility between innovation and delivery context has a positive association with implementation (Aubert & Hamel, 2001; Greenhalgh, Robert, et al., 2004; Klein & Sorra, 1996) and is a key driver of sustained outcomes (Chambers et al., 2013; Lennox et al., 2018; von Thiele Schwarz et al., 2019).
Helfrich et al. found that perceived fit with core competencies and experience was an important predictor of successful implementation (Helfrich, Weiner, et al., 2007). In contrast, changes seen as incompatible with current conditions will be resisted (Gustafson et al., 2003). The radicalness and magnitude of difference between the innovation and status quo, i.e., the disruptiveness of the innovation, may influence implementation (Greenhalgh, Robert, et al., 2004; R. P. Grol et al., 2007); radical innovations or innovations affecting core work processes may require reorientation and produce fundamental changes in the Inner Setting, (Greenhalgh, Robert, et al., 2004; R. P. Grol et al., 2007)
Qualitative coding guidelines that are aligned with the Updated CFIR will be added in the future.
Include statements that demonstrate the level of fit between the innovation and Inner Setting work processes. Include statements that the innovation did not need to be adapted to improve fit.
- “We already had a weight loss clinic so when MOVE! was mandated, we were glad to finally have a way of getting others on board.”
Exclude or double code statements to Relative Priority, regarding the priority of the innovation based on compatibility e.g., if an innovation is not prioritized because it is not compatible with work processes.
Regarding quantitative measurement of this construct: In a systematic review of quantitative measures related to implementation, Powell et al. identified six measures (Powell et al., 2021). Using PAPERS criteria of measurement quality with an aggregate scale ranging from -9 to +36 (Lewis, Mettert, Stanick, et al., 2021), measures had scores ranging from -1 to 5. 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.
Aubert, B. A., & Hamel, G. (2001). Adoption of smart cards in the medical sector: Social Science & Medicine, 53(7), 879–894. https://doi.org/10.1016/S0277-9536(00)00388-9.
Chambers, D. A., Glasgow, R. E., & Stange, K. C. (2013). The dynamic sustainability framework: Addressing the paradox of sustainment amid ongoing change. Implementation Science, 8(1), 117.
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.
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.
Helfrich, C. D., Weiner, B. J., McKinney, M. M., & Minasian, L. (2007). Determinants of implementation effectiveness: Adapting a framework for complex innovations. Med Care Res Rev, 64(3), 279–303.
Klein, K. J., & Sorra, J. S. (1996). The Challenge of Innovation Implementation. The Academy of Management Review, 21(4), 1055–1080.
Lennox, L., Maher, L., & Reed, J. (2018). Navigating the sustainability landscape: A systematic review of sustainability approaches in healthcare. Implementation Science, 13(1), 27. https://doi.org/10.1186/s13012-017-0707-4.
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.
Powell, B. J., Mettert, K. D., Dorsey, C. N., Weiner, B. J., Stanick, C. F., Lengnick-Hall, R., Ehrhart, M. G., Aarons, G. A., Barwick, M. A., Damschroder, L. J., & Lewis, C. C. (2021). Measures of organizational culture, organizational climate, and implementation climate in behavioral health: A systematic review. Implementation Research and Practice, 2, 263348952110188. https://doi.org/10.1177/26334895211018862.
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.