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 |
---|---|---|---|---|
Innovation | ||||
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 | ||||
Structure | ||||
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 |