Implementing and delivering the innovation is in line with the overarching commitment, purpose, or goals in the Inner Setting.
The original CFIR highlighted the importance of aligning the innovation with the Inner Setting mission (Kochevar & Yano, 2006; Simpson & Dansereau, 2007; VanDeusen Lukas et al., 2007) and other concurrent initiatives (Wagner et al., 2017).
Helfrich et al. found that perceived fit with mission was an important predictor of successful implementation (Helfrich, Weiner, et al., 2007). This alignment requires being well-informed and understanding the goals related to an innovation (Helfrich, Weiner, et al., 2007). From an organizational perspective, the degree to which goals (aligned with mission) are clearly communicated, acted upon, and measured, monitored, and reported is important for successful implementation (see also Engaging and Communications) (VanDeusen Lukas et al., 2007). Among the most effective ways to engage key individuals (e.g., leaders) is to have a change effort that is aligned with and contributes to achieving organizational goals (VanDeusen Lukas et al., 2007). A shared sense of responsibility as well as understanding organizational goals and believing task decisions are based on those goals, may contribute to implementation success (Simpson & Dansereau, 2007). The Chronic Care Model emphasizes the importance of relying on multiple methods of evaluation and feedback about achieving mission, including clinical, performance, economic evaluations, and experience (Bodenheimer, 2002; Bodenheimer et al., 2002).
Qualitative coding guidelines that are aligned with the Updated CFIR will be added in the future.
Include statements related to the (lack of) alignment of the innovation with larger Inner Setting goals. This alignment should continue beyond the point when implementation activities end.
Exclude statements that refer to the process or strategies used to implement. Specifically, exclude statements about the implementation team’s (lack of) on-going review of implementation progress and outcomes; code these statements to Reflecting & Evaluating, which is part of the implementation process. These activities usually end when active implementation efforts end.
Regarding quantitative measurement of this construct: In a systematic review of quantitative measures related to implementation, Powell et al. identified three measures for original CFIR’s Goals and Feedback (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), scores for two assessed measures ranged from 1 to 4. 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.
Bodenheimer, T. (2002). Improving Primary Care for Patients With Chronic Illness. JAMA, 288(14), 1775. https://doi.org/10.1001/jama.288.14.1775.
Bodenheimer, T., Wagner, E. H., & Grumbach, K. (2002). Improving Primary Care for Patients With Chronic Illness: The Chronic Care Model, Part 2. JAMA, 288(15), 1909. https://doi.org/10.1001/jama.288.15.1909.
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.
Kochevar, L. K., & Yano, E. M. (2006). Understanding health care organization needs and context. Beyond performance gaps. J Gen Intern Med, 21 Suppl 2, S25-9.
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.
Simpson, D. D., & Dansereau, D. F. (2007). Assessing Organizational Functioning as a Step Toward Innovation. NIDA Science & Practice Perspectives, 3(2), 20–28.
VanDeusen Lukas, C., Holmes, S. K., Cohen, A. B., Restuccia, J., Cramer, I. E., Shwartz, M., & Charns, M. P. (2007). Transformational change in health care systems: An organizational model. Health Care Management Review, 32(4), 309–320. https://doi.org/10.1097/01.HMR.0000296785.29718.5d.
Wagner, D. J., Durbin, J., Barnsley, J., & Ivers, N. M. (2017). Beyond quality improvement: Exploring why primary care teams engage in a voluntary audit and feedback program. BMC Health Services Research, 17(1), 803. https://doi.org/10.1186/s12913-017-2765-3.