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Table 1 Model constructs and examples of survey and interview questions and administrative data

From: Measurement of a model of implementation for health care: toward a testable theory

Construct Operational definition Example of survey question Example of interview question Example of administrative data
Relative advantage Degree to which the innovation is considered superior to existing practices. [The treatment] is more effective than the other therapies I have used. N/A N/A
Compatibility Innovations’ consistency with existing values, experiences, and needs of adopter and system. Using [the treatment] fits well with the way I like to work. N/A N/A
Complexity Level of difficulty to understand and use the innovation. [The treatment] is easy to use. N/A N/A
Trialability Ability to experiment with the innovation on a limited or trial basis. It is easy to try out [the treatment] and see how it performs. N/A N/A
Observability Innovations’ results are observable to others. [The treatment] produces improvements in my patients that I can actually see. N/A N/A
Potential for reinvention Ability to refine, elaborate and modify the innovation. [The treatment] can be adapted to fit my treatment setting. N/A N/A
Risk Risk or uncertainty of outcome associated with the innovation. Using [the treatment] includes a risk of worsening patients’ symptoms. N/A N/A
Task issues Concerns about the innovation that need to be focused on to accomplish implementation. Using [the treatment] improves the quality of work that I do. How effective is [the treatment] when presenting problems are more acute, severe or complicated? N/A
Nature of knowledge Information about the innovation can be codified and transferred from one context to another. The knowledge required to learn [the treatment] can be effectively taught. N/A N/A
Technical support Available support components (e.g., training, manuals, consultation help desk). There is adequate consultation to support me in implementing [the treatment] in my setting. What are some of the supports or structures that are helpful in implementing [the treatment]? N/A
Adopter Characteristics
Needs Observed or experienced deficit in an adopter’s practice or organizational setting. I feel the need to learn additional therapies to help my patients with their symptoms. N/A N/A
Motivation Adopter’s interest and willingness to learn new things. I am actively working on improving my therapy techniques. What was your interest in attendance and involvement with training in [the treatment]? N/A
Values and goals What adopters place value in and what are their intended goals for treatment. I think it is important that providers use evidence-based treatments. N/A N/A
Skills Adopter’s context specific skill set. Level of training in evidence-based treatment. Have you been trained in [the treatment]?; How far along in the training process did you go? N/A
Learning style Adopter’s consistent patterns in perceiving, remembering, judging and thinking about new information. I learn effectively through experience, such as role-play or work with actual patients. What is your preferred way of learning a new approach to treatment? N/A
Locus of control Adopter’s belief that events are under one’s personal control (internal) or that events are largely a matter of chance or due to external events (external). My life is determined by my own actions. N/A N/A
Tolerance of ambiguity Adopter’s ability to accept uncertainty. I am comfortable not being able to predict how a new treatment will work for a particular patient. N/A N/A
Knowledge-seeking Adopter’s autonomous efforts to attain knowledge/information. I regularly try to improve my psychotherapy skills. Can you describe the experience of learning [the treatment]? Were there elements that were more or less difficult to learn? N/A
Tenure Length of employment in setting and in field. Number of years with program. Year provider received highest professional degree. N/A N/A
Cosmopolitan Adopter’s strong connections with professional network; Engagement and attendance at professional meetings and other informational venues. I attend national conferences related to my work with patients. N/A N/A
Communication and Influence
Social networks Structure and quality of social network, both formal and informal. When you need information or advice about psychotherapies, to which other providers in your treatment setting do you usually turn? N/A N/A
Homophily Degree of similarity (e.g., experiences, values, social status) among providers targeted for implementation. N/A *See pre-existing knowledge and skills N/A
Information compiled across each setting to assess for similarity among degree, discipline and theoretical orientation.
Peer opinion leader Internal member of the social network able to exert influence on providers’ beliefs and actions through representativeness and credibility (can be positive or negative). I have at least one colleague in my treatment setting who I trust as a resource of information regarding [the treatment]. N/A N/A
Marketing Process of promoting, selling and distributing a treatment. N/A How were you persuaded [the treatment] would meet your clinical needs and those of your patients? N/A
Expert opinion leader Senior or high status formal authority with reputable expertise. I am a consultant or trainer in an evidence-based psychotherapy. Do you have access to an expert consultant? N/A
Champions Individuals who support and promote the innovation through its critical stages. N/A Were there key individuals in your program that rallied to support and promote [the treatment]? N/A
Boundary spanner An individual who is part of the work environment and part of the innovation technology (e.g., trainer in the innovation). I have at least one readily accessible person who enables me to connect with experts. N/A N/A
Change agents An individual who is a facilitator of change in various stages from problem identification or translation of intent into action. N/A Was there an individual(s) responsible for facilitating implementation of [the treatment]? N/A
System Antecedents for Innovation
Size/Maturity Number and experience of providers; Date of program inception. N/A N/A Details of the program such as number of available beds, past-year patients served and number of full-time providers at various educational levels.
Formalization Degree to which an organization is run by rules and procedures. N/A Do you feel that the rules are clear in your organization for making decisions and implementing changes? National monitoring data concerning program adherence to patient admission, discharge and readmission procedures.
Differentiation Complexity of the program in terms of structure, departments or hierarchy. N/A How do different levels of care communicate and share treatments? (e.g., outpatient and residential care) N/A
Decentralization Extent to which locus of authority and decision-making are dispersed throughout an organization. N/A How did the program make the decision to implement [the treatment] (or not)? N/A
Slack resources Actual versus spent budget and/or the total potential hours each provider is available versus actual time spent working. N/A N/A Staff to patient ratio; Program capacity (number of unique patients, number of unique visits).
Absorptive Capacity for Knowledge
Preexisting knowledge/skill base Adopters’ level of preexisting knowledge and skills. Adopters’ professional discipline and degree. What is your professional background? N/A
Ability to learn and integrate new information Adopters’ capacity to take in new data and incorporate it with existing knowledge. N/A *See Knowledge-seeking N/A
Enablement of knowledge sharing Creation of venues for sharing information. There are adequate communication systems to support information exchange in my treatment setting. N/A N/A
Receptive Context for Change
Leadership and vision Style of leadership and presence of identified and articulated trajectory with guided direction toward implementation. Program leaders in my treatment setting are actively involved in supporting the evidence-based therapy initiatives. To what extent is [the treatment] supported by program leaders and supervisors? N/A
Managerial relations Relationship between staff and program leadership. Program leaders and staff in my treatment setting have good working relationships. Do program leaders and staff work well together? N/A
Risk-taking climate A work environment that encourages experimentation with new practices, ideas and technologies. My work environment encourages experimentation with new practices. Does your work environment allow opportunities to experiment with new treatments? N/A
Clear goals and priorities Explicitness of organizational purposes and aims. The goals and priorities of my treatment setting are clear and consistent. N/A Program mission statement or related document(s).
High quality data capture Utilization of context specific data in implementation process. Outcome data are routinely used in my treatment setting for quality improvement. N/A N/A
System Readiness for Innovation
Tension for change Perceived need for change to an organization’s current provision of services. N/A Did other providers in your setting see a need to make changes to the program and treatment approaches? N/A
Innovation-system fit Compatibility of the innovation with the organizational setting and structure. N/A To what extent does [the treatment] fit with the interventions offered in your treatment setting? N/A
Power balances Relative power of groups invested in implementation (e.g., program staff, director, management). N/A Was there agreement among providers, director and management regarding implementation? N/A
Assessment of implications Estimation of perceived benefits and consequences of implementation. N/A Have there been any unintended benefits or consequences to implementing [the treatment]? N/A
Dedicated time and resources Available means needed to implement an innovation (e.g., funding, time, access, administrative support, etc.). There is adequate time to implement [the treatment] in my treatment setting. Was there sufficient time and resources available to implement [the treatment]? N/A
Monitoring feedback Providers’ formal and informal opinions on efforts to implement. N/A Were there opportunities for you to provide and receive feedback about the implementation process? N/A
Outer Context
Socio-political climate Social and political factors within the organization affecting implementation. N/A Did you feel pressure to adopt [the treatment]? N/A
Incentives and mandates Implicit or explicit inducements, encouragements, or directives to implement. I am expected to use [the treatment] as part of my job. N/A National mandates in provider handbooks.
Inter-organizational norm-setting and networks Implicit or explicit rules defining acceptable behavior; How information is exchanged within the larger organization. N/A What is your understanding of expectations in regards to [the treatment] implementation and the associated rewards and penalties? N/A
Environmental stability Status of funding and persistence of goals. N/A What staffing or funding changes have occurred in the recent past? N/A
Implementation Process
Decision-making Evaluative process in selecting a treatment from available options. N/A *See Decentralization N/A
Hands-on approach by leaders Direct involvement and oversight of procedure and policy. Program leaders in my treatment setting are actively involved in daily program activities. N/A N/A
Human resources issues Adequacy of education and training at all levels of the program workforce. N/A N/A Information on staff degree status and clinical training; Clinical position vacancies.
Internal communication Process by which information is exchanged between individuals within the program. N/A Did you seek consultation from someone in your setting regarding [the treatment] or its implementation process? N/A
External communication Process by which information is exchanged between providers within the program and outside stakeholders. N/A Did you seek consultation from someone outside your setting regarding [the treatment] or its implementation process? N/A
Reinvention Extent to which the innovation can be changed in the process of implementation. N/A How do you (or your program) use [the treatment)? Do you use the full protocol (exact number of sessions, in order, including all content), or have the protocols required modification? N/A
Feedback Information exchange between program staff and external stakeholders. N/A *See Monitoring feedback N/A