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Table 2 Consolidated Framework for Implementation Research: domains and constructs and operationalized descriptions

From: Local politico-administrative perspectives on quality improvement based on national registry data in Sweden: a qualitative study using the Consolidated Framework for Implementation Research

CFIR domains and domain descriptions CFIR constructs and sub-constructs Operationalized descriptions of the constructs and sub-constructs presented in the study
Intervention characteristics: characteristics of the intervention, which is often complex and multi-faceted, with many interacting components. Generally it has ‘core components’ and an ‘adaptable periphery’. • Intervention source Evidence strength and quality: validity and reliability, e.g., coverage and relevance of NQR variables
• Evidence strength and quality Relative advantage: not only the advantage of ‘the intervention versus alternative solutions’ but also advantages—and disadvantages—of the intervention, NQRs themselves
• Relative advantage Design quality and packaging: data input and data output (access) solutions
• Adaptability
• Trialability
• Complexity
• Design quality and packaging
• Cost
Outer setting: Generally, the outer setting includes the economic, political, and social context within which an organization resides. • Patient needs and resources Cosmopolitanism: networks and communications with actors external to the county council, i.e., with the NQR organizations, SALAR, public agencies, etc.
• Cosmopolitanism
• Peer pressure
• External policy and incentives
Inner setting: Generally, the inner setting includes features of structural, political, and cultural contexts through which the implementation process will proceed. • Structural characteristics Structural characteristics: the design of the politico-administrative organization (and the design of the clinical organization), e.g., the existence of quality improvement units
• Networks and communications Networks and communications: the presence of formal and informal communication regarding NQRs and care quality
• Culture Tension for change: current quality improvement efforts needs to be changed and based on NQRs
• Implementation climate: tension for change, compatibility, relative priority, organizational incentives and rewards, goals and feedback, learning climate Relative priority: Is the NQRs a prioritized data source when improving care?
• Readiness for implementation: leadership engagement, available resources, access to knowledge and information Organizational incentives and rewards: incentives and rewards intended to increase the quality of care through the use of NQRs
Goals and feedback: Are there goals linked to NQR variables?
Leadership engagement: commitment and involvement of politicians and administrators in the work related to NQRs and QI
Available resources: the level of resources available for work related to NQRs and QI
Characteristics of individuals: the individuals involved with the intervention and/or implementation process. Individuals have agency and are carriers of cultural, organizational, professional, and individual mindsets, norms, interests, etc. • Knowledge and beliefs about the intervention Not presented in the study
• Self-efficacy
• Individual stage of change
• Individual identification with organization
• Other personal attributes
Process: Implementation requires an active change process aimed to achieve individual and organizational level use of the intervention as designed. The implementation process may be an interrelated series of sub-processes that do not necessarily occur sequentially. • Planning Not presented in the study
• Engaging: opinion leaders, formally appointed internal implementation leaders, champions, external change agents
• Executing
• Reflecting and evaluating
  1. Source: Damschroder et al. [15].