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

Gestalt structures in multi-person intersubjectivity

In this paper I argue that there are gestalt principles underlying intersubjective interactions and that this means that intersubjective ‘units’, can be recognised as unified gestalt wholes. The nub of the claim is that interactions within a ‘plural subject’ can be perceived by others outside this plural subject. Framed from the first-person perspective: I am able to recognise intersubjective interactions between multiple others who are not me. I argue that the terminology of gestalt structures is helpful in framing and understanding the non-reducible make-up of these relational units. I consequently defend the legitimacy of the claim that we can attend to more than one other person at once, holding multiple others as a single focus of attention insofar as we can attend to multiple others as a gestalt whole. I argue that it is therefore legitimate to talk about attending to, perceiving and addressing multiple others at the same time, in the second-person plural. I argue that this can be identified in the phenomenology of such interactions and in an analysis of the core underlying structures of these interactions

IT Infrastructures Sourcing Challenges and Practices of Exploration-for-Exploitation in Public Sector Organizations: A Delphi Study

Managing information technology infrastructures (ITI) in an effective manner represents a major challenge for any organization and even more for public sector organizations (PSOs) that often lack IT resources and are constrained by tight budgets. Despite the importance of these challenges for practitioners, there is a limited number of studies in this field. Applying the organizational ambidexterity (AO) lens to analyze IT managers’ practices of ITI in public sector, with a specific emphasis on sourcing practices, the present study seeks to fill this gap. We present the outcomes of a Delphi study that involved 40 ITI experts from three sectors: public, private, and academic. Public sector practices of exploration-for-exploitation sourcing are discussed in this paper

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In a multi-source study, we examine how frequent change interacts with ethical leadership to reduce turnover intentions. We argue that ethical leaders enhance employees’ state self-esteem, which explains the moderating effect of ethical leadership. Results from 124 employee-coworker-supervisor triads revealed that ethical leadership moderated the relationship between frequent change and turnover intention such that the relationship was positive only when ethical leadership was low. The moderating relationship could be shown to be mediated by employees’ state self-esteem