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

Maximising the impact of careers services on career management skills: a review of the literature

The review identified an international body of work on the development and implementation of competency frameworks in reaction to CMS, including the ‘Blueprint’ frameworks, which are a series of inter-related national approaches to career management skills (originating in the USA and taken up subsequently, and with different emphases, by Canada, Australia, England and Scotland). There is, as yet, little empirical evidence to support the overall efficacy of CMS frameworks, but they have the advantage of setting out what needs to be learned (usually as a clear and identifiable list of skills, attributes and attitudes) and, often, how this learning is intended to happen. The international literature emphasised the iterative nature and mixture of formal and informal learning and life experiences that people needed to develop CMS. It suggested that, though there was no single intervention or group of interventions that appeared most effective in increasing CMS, there were five underpinning components of career guidance interventions that substantially increased effectiveness, particularly when combined. These included the use of narrative/writing approaches; the importance of providing a ‘safe’ environment; the quality of the adviser-client relationship; the need for flexibility in approach; the provision of specialist information and support; and clarity on the purpose and aims of action planning. The review also identified a possible emergent hierarchy around the efficacy of different modes of delivery of career guidance interventions on CMS development. Interventions involving practitioner contact and structured groups appeared more effective than self-directed interventions or unstructured groups. Computer-based interventions were found to work better when practitioner input was provided during the intervention or when they were followed up by a structured workshop session to discuss and review the results.Skills Funding Agenc

Innovation dialogue - Being strategic in the face of complexity - Conference report

The Innovation Dialogue on Being Strategic in the Face of Complexity was held in Wageningen on 31 November and 1 December 2009. The event is part of a growing dialogue in the international development sector about the complexities of social, economic and political change. It builds on two previous events hosted the Innovation Dialogue on Navigating Complexity (May 2009) and the Seminar on Institutions, Theories of Change and Capacity Development (December 2008). Over 120 people attended the event coming from a range of Dutch and international development organizations. The event was aimed at bridging practitioner, policy and academic interests. It brought together people working on sustainable business strategies, social entrepreneurship and international development. Leading thinkers and practitioners offered their insights on what it means to "be strategic in complex times". The Dialogue was organized and hosted by the Wageningen UR Centre for Development Innovation working with the Chair Groups of Communication & Innovation Studies, Disaster Studies, Education & Competence Studies and Public Administration & Policy as co; organisers. The theme of the Dialogue aligns closely with Wageningen UR’s interest in linking technological and institutional innovation in ways that enable ‘science for impact’