Table 3 Snippet of CFIR construct by facility matrix

Leadership engagement (LE)

^aOverall rating −2

Summary:

The implementation leader tried to brief the [Leadership Role 1] when she returned from the DoE Base Camp, but “she was very busy that week, so I was told to maybe meet with the [Mid-Level Leadership Role 1] instead.” The [Key Stakeholder 1] believes one of the biggest barriers to implementation was unstable and acting leadership; most of the leadership team was acting or missing during implementation, which has required them to brief and re-brief new leadership.

Rationale: Leadership was minimally engaged throughout implementation, which [Key Stakeholder 1] felt was a big barrier to implementation, warranting a −2 rating.

Overall rating +2

Summary:

^bP1: Leadership was very engaged.

P2: The [P2] was responsible for “dislodging” barriers up the chain as necessary, e.g., reaching out to leadership to support training. He states that site leadership “mandated” or “deeply inspired” them to set time aside to be trained.

P3: She felt leadership was very engaged based on (1) [Leadership Role 1] bidding; (2) [Leadership Role 2] encouraging staff to participate with [EBI Name] Day; (3) [Leadership Role 3] adding it to the pay-for-performance plan.

Rationale: Leadership provided ongoing tangible support and incentives, warranting a +2 rating.

Available resources (AR)

Overall rating: X

Summary:

Time was limited both for implementation and administration of the practice; it was a collateral duty for the implementation leader and given that [department] was short-staffed, [Role 1] had limited time to complete assessments. However, they did have funding to buy [equipment]; the [Key Stakeholder 1] was able to give them money from another VA program.

Rationale: Important resources were both available (funding) and unavailable (dedicated time), warranting an X rating.

Overall rating +1

Summary:

P1: It was hard for the implementation leaders to have time “carved out”; if there was one “pearl” from her, it is that bids should include time. She should not have to advocate for them to have time. Even if they were ultimately supported, she knows the implementation leader experienced frustration related to lack of time in the beginning.

P2: Site had equipment already in place.

Rationale: Although the implementation leader did not initially have dedicated time, important resources were ultimately available to support implementation (equipment, dedicated time), warranting a + 1 rating.