Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Abstract Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.http://deepblue.lib.umich.edu/bitstream/2027.42/78272/1/1748-5908-4-50.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/2/1748-5908-4-50-S1.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/3/1748-5908-4-50-S3.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/4/1748-5908-4-50-S4.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/5/1748-5908-4-50.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/6/1748-5908-4-50-S2.PDFPeer Reviewe

When Learning Counts: Rethinking Licenses for School Leaders

Recommends restructuring state licensing systems to focus on the skills and knowledge leaders need to improve learning, and better aligning licenses with the current job demands on principals

What can management theories offer evidence-based practice? A comparative analysis of measurement tools for organisational context

Background: Given the current emphasis on networks as vehicles for innovation and change in health service delivery, the ability to conceptualise and measure organisational enablers for the social construction of knowledge merits attention. This study aimed to develop a composite tool to measure the organisational context for evidence-based practice (EBP) in healthcare. Methods: A structured search of the major healthcare and management databases for measurement tools from four domains: research utilisation (RU), research activity (RA), knowledge management (KM), and organisational learning (OL). Included studies were reports of the development or use of measurement tools that included organisational factors. Tools were appraised for face and content validity, plus development and testing methods. Measurement tool items were extracted, merged across the four domains, and categorised within a constructed framework describing the absorptive and receptive capacities of organisations. Results: Thirty measurement tools were identified and appraised. Eighteen tools from the four domains were selected for item extraction and analysis. The constructed framework consists of seven categories relating to three core organisational attributes of vision, leadership, and a learning culture, and four stages of knowledge need, acquisition of new knowledge, knowledge sharing, and knowledge use. Measurement tools from RA or RU domains had more items relating to the categories of leadership, and acquisition of new knowledge; while tools from KM or learning organisation domains had more items relating to vision, learning culture, knowledge need, and knowledge sharing. There was equal emphasis on knowledge use in the different domains. Conclusion: If the translation of evidence into knowledge is viewed as socially mediated, tools to measure the organisational context of EBP in healthcare could be enhanced by consideration of related concepts from the organisational and management sciences. Comparison of measurement tools across domains suggests that there is scope within EBP for supplementing the current emphasis on human and technical resources to support information uptake and use by individuals. Consideration of measurement tools from the fields of KM and OL shows more content related to social mechanisms to facilitate knowledge recognition, translation, and transfer between individuals and groups

Middle-out approaches to reform of university teaching and learning: Champions striding between the top-down and bottom-up approaches

In recent years, Australian universities have been driven by a diversity of external forces, including funding cuts, massification of higher education, and changing student demographics, to reform their relationship with students and improve teaching and learning, particularly for those studying off-campus or part-time. Many universities have responded to these forces either through formal strategic plans developed top-down by executive staff or through organic developments arising from staff in a bottom-up approach. By contrast, much of Murdoch University's response has been led by a small number of staff who have middle management responsibilities and who have championed the reform of key university functions, largely in spite of current policy or accepted practice. This paper argues that the "middle-out" strategy has both a basis in change management theory and practice, and a number of strengths, including low risk, low cost, and high sustainability. Three linked examples of middle-out change management in teaching and learning at Murdoch University are described and the outcomes analyzed to demonstrate the benefits and pitfalls of this approach

A framework for the successful implementation of food traceability systems in China

Implementation of food traceability systems in China faces many challenges due to the scale, diversity and complexity of China’s food supply chains. This study aims to identify critical success factors specific to the implementation of traceability systems in China. Twenty-seven critical success factors were identified in the literature. Interviews with managers at four food enterprises in a pre-study helped identify success criteria and five additional critical success factors. These critical success factors were tested through a survey of managers in eighty-three food companies. This study identifies six dimensions for critical success factors: laws, regulations and standards; government support; consumer knowledge and support; effective management and communication; top management and vendor support; and information and system quality

Mayo Clinic: Multidisciplinary Teamwork, Physician-Led Governance, and Patient-Centered Culture Drive World-Class Health Care

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Management consulting.

Including a lengthy, comprehensive introduction, this important collection brings together some of the most influential papers that have contributed to our understanding of management consultancy work. The two-volume set encompasses the breadth of conceptual and empirical perspectives and explores those key ideas that have helped to advance our knowledge of this intriguing area. The volumes are divided into a series of thematic sections, affording the reader easy access to a great resource of information. Professors Clark and Avakian have written an original introduction which provides a comprehensive overview of the literature

Interpreting an ERP implementation from a stakeholder perspective

ERP systems are software packages that enable the integration of transactions oriented data and business processes throughout an organization. ERP implementation can be viewed as an organizational change process: many problems related to ERP implementation are related to a misfit of the system with the characteristics of the organization. This article uses the evidence of a case study to uncover some important dimensions of the organizational change issues related to ERP implementation. The study shows how ERP implementation can impact the interests of stakeholders of the ERP-system and how these groups may react by influencing the course of events, for example by altering the design and implementation in ways that are more consistent with their interests. Understanding the possible impact of ERP on particular interests of stakeholders may help project managers and others to manage ERP implementations more effectively.

Organizing for Higher Performance: Case Studies of Organized Delivery Systems

Offers lessons learned from healthcare delivery systems promoting the attributes of an ideal model as defined by the Fund: information continuity, care coordination and transitions, system accountability, teamwork, continuous innovation, and easy access

Knowledge management : Emerging roles and challenges of library and information professionals

With globalization the credibility of the workforce is determined by how best they can accommodate themselves in the growing challenges of k-economy. Knowledge Management (KM) has been in operation for quite some time. Its close affinity to library and information management is undeniable. Library has not relinquished its role and interest as information and knowledge providers. It is fitting then to recognize that a well planned strategy, involving the library and the management of the institution could provide significant influence to achieve the KM objectives. Librarians and information professionals (IPs) should be dedicated to fulfilling the varied information needs of the users, amidst the k-economy by providing accurate and relevant bibliographic and physical access and offer referral to the multidimensional range of information within the library premise and outside. KM is a challenge to the information professionals and for the fields of librarianship and information science and needs to be taken seriously to leverage the intellectual assets and to facilitate knowledge utilization and creation