Tension for Change
The current situation is intolerable and needs to change.
The original CFIR highlighted that an intolerable situation where a need for change is acutely felt can be an important determinant of implementation outcomes (Greenhalgh, Robert, et al., 2004; Meyer & Goes, 1988; Simpson & Dansereau, 2007; VanDeusen Lukas et al., 2007). An acute sense of the need for change may trigger designing an innovation internally (see Innovation Source).
Effective communication can foster tension for change by building dissatisfaction with status quo as well as announcing a change, cultivating commitment, and reducing resistance (Greenhalgh, Robert, et al., 2004). When individuals have first-hand experience with the problem, implementation is more likely to be successful (Gustafson et al., 2003). It is difficult to create a tension for change when none exists.
Qualitative coding guidelines that are aligned with the Updated CFIR will be added in the future.
Include statements that (do not) demonstrate a strong need for the innovation and/or that the current situation is untenable or intolerable, e.g., statements that the innovation is absolutely necessary or that the innovation is redundant with other programs. Note: If a participant states that the innovation is redundant with a preferred existing program, (double) code lack of Innovation Relative Advantage.
- “We had a weight management clinic before but the situation was impossible because we were not able to follow up with any patients…”
- “We really need to do something to get patients to take their meds.”
- “The current system is down all the time and I can’t get what I need…to do any good.”
Exclude statements regarding specific needs of individuals that demonstrate a need for the innovation, but that do not represent an untenable status quo, and code to Need in the Individual Domain for the appropriate Role.
Exclude statements that demonstrate the innovation is better (or worse) than existing programs and code to Innovation Relative Advantage.
Regarding quantitative measurement of this construct: In a systematic review of quantitative measures related to implementation, Powell et al. identified two 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), both measures had scores of 2. 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.
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.
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.
Meyer, A. D., & Goes, J. B. (1988). Organizational Assimilation of Innovations: A Multilevel Contextual Analysis. Academy of Management Journal, 31(4), 897–923. https://doi.org/10.5465/25634.
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.