Evaluating broad-scale system change using the Consolidated Framework for Implementation Research: challenges and strategies to overcome them

Abstract

ObjectiveThe objective of this paper is to demonstrate the utility of the CFIR framework for evaluating broad-scale change by discussing the challenges to be addressed when planning the assessment of broad-scale change and the solutions developed by the evaluation team to address those challenges. The evaluation of implementation of Patient-centered Care and Cultural Transformation (PCC&CT) within the Department of Veterans Affairs (VA) will be used as a demonstrative example. Patient-Centered Care (PCC) is personalized health care that considers a patient’s circumstances and goals. The Department of Veterans Affairs (VA) is working towards implementing PCC throughout its healthcare system, comprised of multiple interventions with a singular long-term goal of cultural transformation, however little is known about the factors influencing its implementation. This paper discusses the issues that arose using CFIR to qualitatively assess the factors influencing implementation of cultural transformation.ResultsApplication of CFIR to this broad-scale evaluation revealed three strategies recommended for use in evaluating implementation of broad-scale change: (1) the need for adapted definitions for CFIR constructs (especially due to new application to broad-scale change), (2) the use of a mixed deductive-inductive approach with thematic coding to capture emergent themes not encompassed by CFIR, and (3) its use for expedited analysis and synthesis for rapid delivery of findings to operational partners. This paper is among the first to describe use of CFIR to guide the evaluation of a broad-scale transformation, as opposed to discrete interventions. The processes and strategies described in this paper provide a detailed example and structured approach that can be utilized and expanded upon by others evaluating implementation of broad-scale evaluations. Although CFIR was the framework selected for this evaluation, the strategies described in this paper including: use of adapted definitions, use of mixed deductive-inductive approach, and the approach for expedited analysis and synthesis can be transferred and tested with other frameworks.

Evaluating the implementation of a prisoner re-entry initiative for individuals with opioid use and mental health disorders: Application of the consolidated framework for implementation research in a cross-system initiative

“…A recent application of the CFIR framework to a Patient-Centered Care "cultural transformation" in the Department of Veterans Affairs (VA) found that the CFIR was a useful starting point but that adapted definitions and a mixed deductive-inductive approach were needed to accommodate the complexity of a broad-scale implementation (Hill et al, 2018). With the adaptations, key findings helped the researchers to understand the individual and organizational factors, barriers and facilitators, and the impact on implementation (Hill et al, 2018). Furthermore, the researchers were able to turn the findings into an easily understood and actionable set of findings and recommendations for stakeholders (Hill et al, 2018).…”

“…With the adaptations, key findings helped the researchers to understand the individual and organizational factors, barriers and facilitators, and the impact on implementation (Hill et al, 2018). Furthermore, the researchers were able to turn the findings into an easily understood and actionable set of findings and recommendations for stakeholders (Hill et al, 2018).…”

Using Implementation Science to Improve Transition for Adolescents and Young Adults with Sickle Cell Disease

“…15 While the CFIR framework offers a comprehensive taxonomy of factors influencing intervention planning and implementation, a mixed deductive-inductive approach has been used to address the challenge that CFIR domains and constructs may not capture all emergent themes in qualitative assessment. 16 The deductiveinductive approach integrates inductive, data-driven codes with deductive, theory-driven codes using an a priori code template and has proven rigor within qualitative research. 17 This approach expedites data analysis while providing comprehensive themes that otherwise would not be captured by CFIR constructs.…”

Transcreation: an implementation science framework for community-engaged behavioral interventions to reduce health disparities

“…The NIH Stage Model describes six general stages of translation (from basic research to implementation), but does not provide methodological details for implementing interventions [ 11 ]. Another model, the Consolidated Framework for Implementation Research focuses on a taxonomy used to classify characteristics of the intervention, the inner and outer settings, individuals, and implementation processes, rather than specifying practical methodological steps [ 12 ].…”