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) (T. 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 (Laura J. Damschroder 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 (Laura J. Damschroder et al. 2009) elaborated 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, Harvey, and McCormack 1998; Rycroft-Malone, Kitson, et al. 2002). Dissemination, “whose main mechanism of spread is centrally driven and controlled,” is negatively associated with implementation (T. 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 (T. 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 input in the decision to implement an innovation, implementation is less likely to be effective (C. D. Helfrich et al. 2007; Klein, Conn, and Sorra 2001). In effect, how the Innovation Source engages individuals that will be implementing and/or delivering the innovation, influences implementation outcomes (see Implementation Process: Engaging).