INNOVATION DOMAIN

Innovation: The “thing” being implemented (Curran, 2020), e.g., a new clinical treatment, educational program, or city service.

The original CFIR elaborated on this domain, stating that innovations usually come to a setting as a poor fit, requiring an active process to adapt the innovation and engage individuals to accomplish implementation. The innovation is often complex and multi-faceted, with many interacting components (Butler et al., 2017). Innovations can be conceptualized as having ‘core components’ (the essential and indispensable elements of the innovation) and an ‘adaptable periphery’ (adaptable elements, structures, and systems related to the innovation and setting into which it is being implemented) (Fixsen, 2007; Greenhalgh, Robert, et al., 2004). For example, a clinical reminder to screen for obesity has an alert that pops up on the computer screen at the appropriate time for the appropriate patient. This feature is part of the core of the innovation. However, depending on the work processes at individual clinics, the clinical reminder may pop up during the patient assessment by a nurse manager or during the visit with the primary care provider. This feature is part of the adaptable periphery of the innovation; these components can be modified to a particular setting and vice versa in a co-evolving and co-adaptive way (Kirsh et al., 2008; Plsek & Greenhalgh, 2001).

References

Butler, M., Epstein, R. A., Totten, A., Whitlock, E. P., Ansari, M. T., Damschroder, L. J., Balk, E., Bass, E. B., Berkman, N. D., Hempel, S., Iyer, S., Schoelles, K., & Guise, J.-M. (2017). AHRQ series on complex intervention systematic reviews—paper 3: Adapting frameworks to develop protocols. Journal of Clinical Epidemiology, 90, 19–27. https://doi.org/10.1016/j.jclinepi.2017.06.013

Curran, G. M. (2020). Implementation science made too simple: A teaching tool. Implementation Science Communications, 1, 27. https://doi.org/10.1186/s43058-020-00001-z

Fixsen, D. L. (2007). Implementation Research: A Synthesis of the Literature. University of South Florida, Louis de la Parte Florida Mental Health Institute.

Greenhalgh, T., Glenn Robert, Paula Bate, Olympia Kyriakidou, Fraser Macfarlane, & Richard Peacock. (2004). How to Spread Good Ideas (p. 424). National Co-ordinating Centre for NHS Service Delivery and Organisation R & D.

Kirsh, S. R., Lawrence, R. H., & Aron, D. C. (2008). Tailoring an intervention to the context and system redesign related to the intervention: A case study of implementing shared medical appointments for diabetes. Implement Sci, 3, 34. https://doi.org/1748-5908-3-34 [pii] 10.1186/1748-5908-3-34

Plsek, P. E., & Greenhalgh, T. (2001). Complexity science: The challenge of complexity in health care. Bmj, 323(7313), 625–628.