Innovation Source

An innovation may be internally developed as a good idea, solution to a problem, or other grass-roots effort, or may be developed by an external entity (e.g., vendor or research group) (Greenhalgh, Robert, et al., 2004). However, whether the source is internal or external does not, in and of itself, determine implementation outcomes; it is the legitimacy or trustworthiness of the source that is an important implementation determinant (Damschroder, Aron, et al., 2009). This was highlighted by Ho et al. who found that in “resource-poor settings” an external source may “demonstrate the intervention value and increase likelihood of future local investment” (Ho et al., 2019).

The original CFIR elaborated further on this construct, stating that an externally developed innovation coupled with lack of transparency in the decision-making process may undermine legitimacy and lead to implementation failure (A. Kitson et al., 1998; Rycroft-Malone, Kitson, et al., 2002). Dissemination, “whose main mechanism of spread is centrally driven and controlled,” is negatively associated with implementation (Greenhalgh, Robert, et al., 2004), page 604; emphasis added). Though there is empirical evidence of a positive association with an authoritative decision to use the innovation, there is a negative relationship with fully implementing or routinizing the innovation (Greenhalgh, Robert, et al., 2004). If the decision to adopt and implement is made by leaders higher in the hierarchy who edict change with little user input in the decision to implement an innovation, implementation is less likely to be effective (Helfrich, Weiner, et al., 2007; Klein et al., 2001). In effect, how the Innovation Source engages individuals that will be implementing, delivering, and/or receiving the innovation, influences implementation outcomes (see Implementation Process: Engaging).

Qualitative coding guidelines that are aligned with the Updated CFIR will be added in the near future.

Lewis et al 2021 did not identify any measures for Innovation Source in their review of Innovation Characteristics as defined by the 2009 CFIR.

As we become aware of additional measures specific to this construct, we will post them here. Please contact us with updates.

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science: IS, 4, 50. https://doi.org/10.1186/1748-5908-4-50

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.

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.

Ho, M., Livingston, P., Bould, M. D., Nyandwi, J. D., Nizeyimana, F., Uwineza, J. B., & Urquhart, R. (2019). Barriers and facilitators to implementing a regional anesthesia service in a low-income country: A qualitative study. Pan African Medical Journal, 32. https://doi.org/10.11604/pamj.2019.32.152.17246

Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence based practice: A conceptual framework. Quality and Safety in Health Care, 7(3), 149–158. https://doi.org/10.1136/qshc.7.3.149

Klein, K. J., Conn, A. B., & Sorra, J. S. (2001). Implementing computerized technology: An organizational analysis. Journal of Applied Psychology, 86(5), 811–824.

Rycroft-Malone, J., Kitson, G., Harvey, B., McCormack, K., Seers, A. T., & C. Estabrooks. (2002). Ingredients for change: Revisiting a conceptual framework. (Viewpoint). Quality and Safety in Health Care, 11(2), 174–180.