The original CFIR (Laura J. Damschroder et al. 2009) highlighted that an intolerable situation where a need for change is acutely felt can be an important determinant of implementation outcomes (T. Greenhalgh, Robert, et al. 2004; Simpson and Dansereau 2007; Meyer and Goes 1988; VanDeusen Lukas et al. 2007). An acute sense of the need for change may trigger designing an innovation internally (see Innovation: Innovation Source).
Effective communication can foster tension for change by building dissatisfaction with status quo as well as announcing a change, cultivating commitment, and reducing resistance (T. Greenhalgh, Robert, et al. 2004). When individuals have first-hand experience with the problem, implementation is more likely to be successful (D. H. Gustafson et al. 2003). It is difficult to create a tension for change when none exists.