Market Pressure

The original CFIR elaborated on this construct, recognizing that the need to compete with and/or imitate external peer entities can drive implementation and/or delivery of an innovation (Greenhalgh, Robert, et al., 2004); peer entities refers to any outside entity with which the Inner Setting feels some degree of affinity or competition (e.g., market competitors, other settings in the same network, a highly regarded institution). In competitive markets, Inner Settings may be more likely to implement new innovations (Frambach & Schillewaert, 2001).

The pressure to implement can be particularly strong for late adopters (Walston et al., 2001). If competitors or colleagues are all using an innovation, individuals and settings may feel compelled to do so too. This is referred to as “mimetic pressure” or “inter-organizational norm-setting” (Greenhalgh, Robert, et al., 2004). This pressure directly influences adoption decisions but can also trickle down to implementation if individuals are attuned to practices of outside entities.

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

Inclusion Criteria

Include statements about perceived pressure or motivation from other entities or organizations in the local geographic area or system to implement the innovation.

• “All the other clinics in our area are doing this so I want to be sure we’re doing it here too.”
• “Our facility is so far behind the other facilities in the system.”

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

Frambach, R. T., & Schillewaert, N. (2001). Organizational innovation adoption: A multi-level framework of determinants and opportunities for future research. Journal of Business Research, 55(2), 163–176.

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.

Walston, S. L., Kimberly, J. R., & Burns, L. R. (2001). Institutional and economic influences on the adoption and extensiveness of managerial innovation in hospitals: The case of reengineering. Med Care Res Rev, 58(2), 194–228; discussion 229-33.