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