Note: This construct captures the complexity of the innovation, not the complexity of implementation of the innovation.
Complexity may be related to length (the number of sequential sub-processes or steps for using an innovation) and breadth (the number of choices presented at decision points) (Kochevar and Yano 2006). Complexity is increased with higher numbers of potential target units (teams, clinics, departments) or types of people in the Inner Setting (Kochevar and Yano 2006). The updated definition of complexity aligns with other published conceptualizations of complex innovations (Butler et al. 2017; Moecker et al. 2021; Lewin et al. 2017).
The original CFIR (Laura J. Damschroder et al. 2009) elaborated on this construct, stating that appropriately diagnosing and assessing complexity is thought to benefit implementation by avoiding unintended consequences (Kochevar and Yano 2006). Simple innovations are more likely to be effective (T. Greenhalgh, Robert, et al. 2004; D. H. Gustafson et al. 2003) because they increase deliverer satisfaction and the speed required to be competent in using the innovations (Klein, Conn, and Sorra 2001).
The type of innovation, whether a technical (e.g., a new computer module) or administrative (behavioral change) change, can contribute to perceptions of complexity. Technical innovations may include a purchased product, packaged service, or an automated production process (e.g., computerized order entry). Administrative innovations primarily affect social structures or processes within settings. Most innovations are a hybrid of both. Technical innovations tend to be more tangible and administrative innovations tend to be more complex and difficult to implement (T. Greenhalgh, Robert, et al. 2004). On the other hand, complex behavioral change innovations can generate heightened commitment when they are viewed as a welcomed fundamental change compared to settings that regard the innovation as a simple “plug-in” (A. C. Edmondson, Bohmer, and Pisana 2001). Edmondson et al. describe a "technological frame" of thinking that influences implementation effectiveness. In their study of a new cardiac surgical approach involving behavior change and teaming, the sites with less successful implementation viewed the innovation as an (oversimplified) “plug-in technology” while those with better implementation effectiveness regarded the innovation "as fundamental change for the [operating] team," (A. C. Edmondson, Bohmer, and Pisana 2001) despite its complexity.