Iowa Implementation for Sustainability Framework

Background An application-oriented implementation framework designed for clinicians and based on the Diffusion of Innovations theory included 81 implementation strategies with suggested timing for use within four implementation phases. The purpose of this research was to evaluate and strengthen the framework for clinician use and propose its usefulness in implementation research. Methods A multi-step, iterative approach guided framework revisions. Individuals requesting the use of the framework over the previous 7 years were sent an electronic questionnaire. Evaluation captured framework usability, generalizability, accuracy, and implementation phases for each strategy. Next, nurse leaders who use the framework pile sorted strategies for cultural domain analysis. Last, a panel of five EBP/implementation experts used these data and built consensus to strengthen the framework. Results Participants (n = 127/1578; 8% response) were predominately nurses (94%), highly educated (94% Master’s or higher), and from across healthcare (52% hospital/system, 31% academia, and 7% community) in the USA (84%). Most (96%) reported at least some experience using the framework and 88% would use the framework again. A 4-point scale (1 = not/disagree to 4 = very/agree) was used. The framework was deemed useful (92%, rating 3–4), easy to use (72%), intuitive (67%), generalizable (100%), flexible and adaptive (100%), with accurate phases (96%), and accurate targets (100%). Participants (n = 51) identified implementation strategy timing within four phases (Cochran’s Q); 54 of 81 strategies (66.7%, p < 0.05) were significantly linked to a specific phase; of these, 30 (55.6%) matched the original framework. Next, nurse leaders (n = 23) completed a pile sorting activity. Anthropac software was used to analyze the data and visualize it as a domain map and hierarchical clusters with 10 domains. Lastly, experts used these data and implementation science to refine and specify each of the 75 strategies, identifying phase, domain, actors, and function. Strategy usability, timing, and groupings were used to refine the framework. Conclusion The Iowa Implementation for Sustainability Framework offers a typology to guide implementation for evidence-based healthcare. This study specifies 75 implementation strategies within four phases and 10 domains and begins to validate the framework. Standard use of strategy names is foundational to compare and understand when implementation strategies are effective, in what dose, for which topics, by whom, and in what context. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01157-5.


Background
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There are numerous process models that describe the necessary steps for evidence-based practice in nursing. 'Implementation' is a critical step in each of these models, yet there has traditionally been limited guidance on how best this is achieved. The Evidence-Based Practice Implementation Model (implementation model) was first published in 2012 as an application-oriented resource for nurses to plan evidence-based practice implementation in complex healthcare systems.
The implementation model aides in the selection of implementation strategies that are suitable to the phase of implementation and specific target groups.
The implementation phases are displayed as columns progressing from awareness and interest to integration and sustained use. Each column includes strategies based on the goal for that implementation phase. Implementation strategies also target two distinct groups and are arranged in rows accordingly. The first row specifically targets the clinicians and organizational leaders, including key stakeholders. The second row builds support for the practice change at the organization or systems level. Project leaders select implementation strategies for their EBP initiative that are appropriate for their particular unit and organization.

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Implementation Strategies for EBP After seven years of use it is time to evaluate the Evidence-Based Practice Implementation Models usefulness, validity and impact on adoption of EBP. This survey seeks feedback on the implementation model from users to ascertain its strengths, limitations and content validity.
The following questions relate to you and your experience using the Evidence-Based Practice Implementation Model (implementation model).
What is your professional discipline? What was your purpose for using the implementation model? (select all that apply) How did you use the implementation model? (select all that apply) Which model did you use in conjunction with another model for EBP?
How would you rate your experience with the implementation model?
The following questions seek your opinion on the usefulness, usability, generalizability, and adaptability of the implementation model.
How useful do you find the implementation model as a resource for EBP?
What changes would you recommend to increase the implementation models usefulness?
How easy do you find the implementation model to use?
What changes would you recommend to increase the implementation models ease of use? What changes would you recommend to increase ease of use for novice users?
Do you believe the model is generalizable to different disciplines, settings, and populations?
What changes would you recommend to make the model more generalizable?
Do you believe the model is flexible and adaptive enough to be used in conjunction with other EBP models and frameworks?
What changes would you recommend to make the model more flexible and adaptive?
How likely are you to use the implementation model in the future?
What changes would you recommend that would increase the likelihood you would use it again? The following questions seek your opinion on the components of the implementation model (the implementation strategies, implementation phases, and socioecological levels).
Do you believe the implementation model phases (creating awareness and interest, building knowledge and commitment, promoting action and adoption, and pursuing integration and sustainability) accurately represent the stages of implementation?
What changes would you recommend to the phases of the implementation model?
Do you believe that the target groups identified in the implementation model (clinicians and organizational leaders, including key stakeholders; and organizational and systems support) accurately represent the socio-ecological levels associated with implementation?
What changes would you recommend to the target groups?
Would adding a target group for patients/care givers be an important socio-ecological level to add?
Do you believe the implementation model contains a comprehensive selection of implementation strategies?
What changes would you recommend to the implementation strategies?

Block 1
For each implementation strategy please select all of the phase(s) and target group(s) that you believe the strategy can be applied to. For each new implementation strategy you chose, please select all of the phase(s) and target group(s) that you believe the strategy can be applied to.
Please list any additional implementation strategies you recommend and select all of the phase(s) and target group(s) that you believe the strategy can be applied to.

Block 2
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