Table 2 Study site descriptions by consolidated framework for implementation research domains and constructsa
From: Implementation and modification of an organizational-level intervention: a prospective analysis
DOMAIN, Construct | Brief description | Study site | ||
|---|---|---|---|---|
A | B | |||
I. Intervention characteristics | ||||
A | Evidence Strength & Quality | “Stakeholders’ perceptions of the quality and validity of evidence supporting the belief that the intervention will have desired outcomes.” (p. 6) | Generally lacks but one administrator has knowledge | Lacks knowledge |
B | Relative Advantage | “Stakeholders’ perception of the advantage of implementing the intervention versus an alternative solution.” (p. 6) | Less perceived relative advantage because of similar programs | Greater perceived relative advantage because of lower living kidney donation numbers |
C | Complexity | “Perceived difficulty of implementation, reflected by duration, scope, radicalness, disruptiveness, centrality, and intricacy and number of steps required to implement.” (p. 6) | This is a complex intervention in terms of involving multiple interacting intervention components, stakeholders, and interactions with different groups of patients (see Additional file 1) | |
II. Outer setting | ||||
A | 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.” (p. 7) | Similar perception | |
B | Cosmopolitanism | “The degree to which an organization is networked with other external organizations.” (p. 7) | Similar level | |
III. Inner setting | ||||
A | Structural Characteristics | “The social architecture, age, maturity, and size of an organization.” (p. 7) | Similarly large and high volume | |
B | Networks & Communicationsb | “The nature and quality of webs of social networks and the nature and quality of formal and informal communications within an organization.” (p. 8) | The Site-A collaboration with the community nephrology organization was a challenge, but posed little red tape | Bureaucratic red tape and relationships with the "mothership" |
C | Culture | “Norms, values, and basic assumptions of a given organization.” (p. 8) | Decision making is centralized at the transplant division level | Decision making is diffused throughout the enterprise, which values physician led initiatives |
D | 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.” (p.8) | ||
1 | Tension for Change | “The degree to which stakeholders perceive the current situation as intolerable or needing change.” (p. 8) | Less need for change because other similar programs are perceived as good | Greater perceived need for change because of lower living kidney donation numbers |
2 | Compatibility | "The degree of 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.” (p. 8) | Greater compatibility with HKTP because of similar programs in place, and because a greater number of resources were available to make this work. Similar marketing challenge | Greater compatibility challenge because no similar program existed and a large change to current workflow. Similar marketing challenge |
3 | Relative Priority | “Individuals’ shared perception of the importance of the implementation within the organization.” (p. 8) | Some competing priorities, particularly in the implementation of human resources system update | Greater competing priorities, including Breeze updates that require coordination of all three enterprise sites |
4 | Goals and Feedback | “The degree to which goals are clearly communicated, acted upon, and fed back to staff, and alignment of that feedback with goals.” (p. 9) | Comparable levels | |
5 | Learning Climate | “A climate in which: a) leaders express their own fallibility and need for team members’ assistance and input; b) team members feel that they are essential, valued, and knowledgeable partners in the change process; c) individuals feel psychologically safe to try new methods; and d) there is sufficient time and space for reflective thinking and evaluation.” (p. 9) | Differing levels of seniority on large volume of providers | More team-based culture |
E | Readiness for Implementationc | “Tangible and immediate indicators of organizational commitment to its decision to implement an intervention.” (p. 9) | Similar support commitment | |
1 | Leadership Engagement | "Commitment, involvement, and accountability of leaders and managers with the implementation.” (p. 9) | Greater leadership support | More diffused leadership support. |
2 | Available Resources | “The level of resources dedicated for implementation and ongoing operations, including money, training, education, physical space, and time.” (p. 9) | Greater resources including: space, time, education materials in Spanish, Spanish-speaking staff (initially lacked coordinator and marketing budget) | Fewer resources including: overwork of staff, lack of Spanish-speaking staff, lack of capacity to handle greater patient volume, website and patient materials not in Spanish, space difficult to schedule, and general perception of lack of time |
IV. Characteristics of individuals | ||||
A | Knowledge & Beliefs about the Interventiond | “Individuals’ attitudes toward and value placed on the intervention as well as familiarity with facts, truths, and principles related to the intervention.” (p. 9) | Hispanic identity, academic goals, and perceptions of underserved group motivated stakeholders to deploy the intervention | |
B | Self-efficacye | “Individual belief in their own capabilities to execute courses of action to achieve implementation goals.” (p. 9) | Greater self-efficacy because more experience implementing similar organizational-level interventions. They had more confidence in being able to do it | Less experience implementing similarly sized interventions |
C | Individual Stage of Changef | “Characterization of the phase an individual is in, as he or she progresses toward skilled, enthusiastic, and sustained use of the intervention.” (p. 10) | Similar levels of change commitment | |