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

A Farewell to the Business : Championing exit and continuity in entrepreneurial family firms

What factors influence exit from the founder's business and subsequent entrepreneurial renewal in a generational family firm? Guided by this research question, we trace the development of the Italian Falck Group from its inception as a steel company in 1906 – ascension as the largest privately owned steel producer in Italy – losses in the 1970s and 1980s leading to business exit from steel industry in the 1990s – followed by successful entry in the renewable energy business. A combination of insights from the literature and triangulation of data from multiple primary and secondary sources leads to the development of a model describing how inhibitors of exit from the founder's business can be transformed into facilitators of change. The critical role of farsighted ‘family champion of continuity’ is found central in redirecting the family from its anchoring in past activities to focus on future entrepreneurial endeavours. While the commitment to the founder's business continues, the family champion aided by business savvy and astute non-family executives ably modifies its meaning of ‘continuity of the founder's business’ from ‘steel production’ to ‘continuity of the entrepreneurial spirit of the family’, hence preserving the institutional identity. Insights from this study can help generational family firms which plan to exit from a failing course of action to regenerate so as to create trans-generational value

What Motivates ICT4D Champions?

Part 2: Digital Platforms for DevelopmentInternational audienceThe paper seeks to identify the factors that motivate a person who champions ICT4D initiatives. Given the important contributions of ICT4D champions to initiative success, better understanding of their motivations holds the potential to identify, develop and deploy such individuals more effectively, harnessing their potential positive contributions to ICT4D initiative success. A multiple case study strategy is used to explore the motivational factors of three successful ICT4D champions in the South African context. The Work Preference Inventory (WPI) of personal motivations was used to design in-depth interviews with the champions and semi-structured interviews with 29 other stakeholders. It found ICT4D champions are motivated by the need for personal actualization, business success and to address social concerns – origins of these motives could be traced to various internal and environmental stimuli. Practical implications drawn from the research are that profiling of stakeholder motivations in an ICT4D initiative is feasible and that organizations can use such information to create a conducive environment for grooming and empower new and existing champions to function more effectively. This first investigation of ICT4D champion motivations shows its importance and the potential thereof towards improving initiative success and emphasizes the need for further research of this nature