Outer Setting Domain

Performance-Measurement Pressure

The degree to which quality or benchmarking metrics or established service goals drive implementation and/or delivery of the innovation.

Performance measurement can influence implementation and/or delivery of the innovation (Mendel et al. 2008). This construct includes formal mechanisms of performance accountability, audit and feedback, outcome goals (Raghavan, Bright, and Shadoin 2008), benchmarking (Nilsen and Bernhardsson 2019), and public reporting (Nilsen and Bernhardsson 2019).

The original CFIR (Laura J. Damschroder et al. 2009) stated that the threat or reality of public reporting may motivate Inner Settings, especially late-adopters, to implement an innovation in an effort not to look bad compared to their competitors (see Outer Setting: External Pressure: Market Pressure). However, public reporting can also have a negative influence if there is an adversarial relationship between the reporting entity and the Inner Setting. In this context, people may cover-up (compliant implementation) (Klein and Sorra 1996) or engage in “box-checking” rather than true committed use.

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