Innovation Relative Advantage

Alternatives to the innovation can include the status quo, e.g., the practice, treatment, or program that the innovation supersedes (E. Rogers, 2003). The original CFIR elaborated further on this construct, stating that relative advantage must be recognized and acknowledged by all individuals for effective implementation (Greenhalgh, Robert, et al., 2004). If users perceive a clear, unambiguous advantage in effectiveness or efficiency of the innovation, it is more likely the implementation will be successful. In fact, relative advantage is sine qua non for adoption and implementation (Greenhalgh, Robert, et al., 2004).

Benefits of the innovation must be clearly visible (observable) to assess relative advantage; efforts to demonstrate benefits of the innovation clearly will help implementation (Denis et al., 2002; Dopson et al., 2010; Greenhalgh, Robert, et al., 2004; R. P. Grol et al., 2007; Meyer & Goes, 1988). Although Greenhalgh et al., the PRISM model, and Grol et al.’s implementation model include observability as a separate construct (Feldstein & Glasgow, 2008; Greenhalgh, Robert, et al., 2004; R. P. Grol et al., 2007), observability (or visibility) of benefits is tightly coupled with relative advantage and it is challenging to measure them separately in the real world. As a result, we consolidated the two factors.

The extent to which the innovation is codifiable may also influence relative advantage; many innovations contain significant tacit components and may have significant benefits that are more difficult to understand or discern (Berta & Baker, 2004; Tucker et al., 2007) and thus evaluate for relative advantage.

Inclusion Criteria

Include statements that demonstrate the innovation is better (or worse) than existing programs.

• “We evaluated a lot of systems and this one is clearly better for our clinic.”

Exclusion Criteria

Exclude statements that do or do not demonstrate a strong need for the innovation and/or that the current situation is untenable, e.g., statements that the innovation is absolutely necessary or that the innovation is redundant with other programs, and code to Tension for Change.

Exclude statements regarding specific needs of individuals that demonstrate a need for the innovation and code to Need for the appropriate Role(s) within the Individuals Domain.

Regarding quantitative measurement of this construct: In a systematic review of quantitative measures related to implementation, Lewis et al. identified nine measures (Lewis, Mettert, & Lyon, 2021). Using PAPERS measurement quality criteria with an aggregate scale ranging from -9 to +36 (Lewis, Mettert, Stanick, et al., 2021), the highest score was 4, indicating the need for continued development of high-quality measures.

Note: As we become aware of measures, we will post them here. Please contact us with updates.

Berta, W. B., & Baker, R. (2004). Factors that Impact the Transfer and Retention of Best Practices for Reducing Error in Hospitals: Health Care Management Review, 29(2), 90–97. https://doi.org/10.1097/00004010-200404000-00002

Denis, J.-L., Hébert, Y., Langley, A., Lozeau, D., & Trottier, L.-H. (2002). Explaining Diffusion Patterns for Complex Health Care Innovations: Health Care Management Review, 27(3), 60–73. https://doi.org/10.1097/00004010-200207000-00007

Dopson, S., FitzGerald, L., Ferlie, E., Gabbay, J., & Locock, L. (2010). No magic targets! Changing clinical practice to become more evidence based. Health Care Management Review, 35(1), 2–12. https://doi.org/10.1097/HMR.0b013e3181c88e79

Feldstein, A. C., & Glasgow, R. E. (2008). A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. Jt Comm J Qual Patient Saf, 34(4), 228–24Greenhalgh, 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.

Lewis, C. C., Mettert, K., & Lyon, A. R. (2021). Determining the influence of intervention characteristics on implementation success requires reliable and valid measures: Results from a systematic review. Implementation Research and Practice, 2, 263348952199419. https://doi.org/10.1177/2633489521994197

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/10.5465/256344Rogers, E. (2003). Diffusion of innovations: 5th ed. Free Press.

Tucker, A. L., Nembhard, I. M., & Edmondson, A. C. (2007). Implementing New Practices: An Empirical Study of Organizational Learning in Hospital Intensive Care Units. Management Science, 53(6), 894–907. https://doi.org/10.1287/mnsc.1060.0692