Table 1 Description and operational definitions of constructs in the Consolidated Framework for Implementation Research

 Complexity

Perceived difficulty of implementation, reflected by duration, scope, radicalness, disruptiveness, centrality, and intricacy and number of steps required to implement.

Challenges, expected and unexpected, to implementing the HBPC pilot

 Cost

Costs of the intervention and costs associated with implementing the intervention including investment, supply, and opportunity costs.

Financial costs of the program affecting the decision to implement, the initial plan for implementation, and/or program sustainability

II. OUTER SETTING

 Patient Needs & Resources

The extent to which patient needs, as well as barriers and facilitators to meet those needs, are accurately known and prioritized by the organization.

Knowledge of 1) American Indian patients’ medical needs and eligibility for VA, IHS/THP services, 2) IHS/THP and other regional health resources

 Cosmopolitanism

The degree to which an organization is networked with other external organizations.

Relationship and clinical collaborations between VAMC and IHS/THP

 External Policy & Incentives

A broad construct that includes external strategies to spread interventions, including policy and regulations (governmental or other central entity), external mandates, recommendations and guidelines, pay-for-performance, collaborative, and public or benchmark reporting.

Policies and incentives that impacted HBPC implementation

III. INNER SETTING

 Structural Characteristics

The social architecture, age, maturity, and size of an organization.

Organizational characteristics of HBPC

 Networks & Communications

The nature and quality of webs of social networks and the nature and quality of formal and informal communications within an organization.

Sharing of patient in HBPC interdisciplinary team and other communications, such as referrals, within VAMC

 Implementation Climate

The absorptive capacity for change, shared receptivity of involved individuals to an intervention, and the extent to which use of that intervention will be rewarded, supported, and expected within their organization, including the subconstructs of Tension for change, Compatibility, Relative Priority, Organizational incentives and rewards, Goals and feedback and Learning climate.

The degree of compatibility (i.e., tangible fit) between meaning and values attached to the intervention by involved individuals, how those align with individuals’ own norms, values, and perceived risks and needs, and how the intervention fits with existing workflows and systems.

 Knowledge & Beliefs about the Intervention

Individuals’ attitudes toward and value placed on the intervention as well as familiarity with facts, truths, and principles related to the intervention.

Opinions about HBPC

 Other Personal Attributes

A broad construct to include other personal traits such as tolerance of ambiguity, intellectual ability, motivation, values, competence, capacity, and learning style.

Personal traits of individuals involved in HBPC implementation

V. PROCESS

 Executing

Carrying out or accomplishing the implementation according to plan.

Roles of VAMC, IHS/THP in identifying potential patients and delivering services

 Reflecting

Quantitative and qualitative feedback about the progress and quality of implementation accompanied with regular personal and team debriefing about progress and experience.

Lessons learned and recommendations