Iowa Implementation for Sustainability Framework

Abstract

Background An application-oriented implementation framework designed for clinicians and based on the Diffusion of Innovations theory included 81 implementation strategies with suggested timing for use within four implementation phases. The purpose of this research was to evaluate and strengthen the framework for clinician use and propose its usefulness in implementation research. Methods A multi-step, iterative approach guided framework revisions. Individuals requesting the use of the framework over the previous 7 years were sent an electronic questionnaire. Evaluation captured framework usability, generalizability, accuracy, and implementation phases for each strategy. Next, nurse leaders who use the framework pile sorted strategies for cultural domain analysis. Last, a panel of five EBP/implementation experts used these data and built consensus to strengthen the framework. Results Participants (n = 127/1578; 8% response) were predominately nurses (94%), highly educated (94% Master’s or higher), and from across healthcare (52% hospital/system, 31% academia, and 7% community) in the USA (84%). Most (96%) reported at least some experience using the framework and 88% would use the framework again. A 4-point scale (1 = not/disagree to 4 = very/agree) was used. The framework was deemed useful (92%, rating 3–4), easy to use (72%), intuitive (67%), generalizable (100%), flexible and adaptive (100%), with accurate phases (96%), and accurate targets (100%). Participants (n = 51) identified implementation strategy timing within four phases (Cochran’s Q); 54 of 81 strategies (66.7%, p < 0.05) were significantly linked to a specific phase; of these, 30 (55.6%) matched the original framework. Next, nurse leaders (n = 23) completed a pile sorting activity. Anthropac software was used to analyze the data and visualize it as a domain map and hierarchical clusters with 10 domains. Lastly, experts used these data and implementation science to refine and specify each of the 75 strategies, identifying phase, domain, actors, and function. Strategy usability, timing, and groupings were used to refine the framework. Conclusion The Iowa Implementation for Sustainability Framework offers a typology to guide implementation for evidence-based healthcare. This study specifies 75 implementation strategies within four phases and 10 domains and begins to validate the framework. Standard use of strategy names is foundational to compare and understand when implementation strategies are effective, in what dose, for which topics, by whom, and in what context.

Development and Evaluation of the Fuld Institute Evidence-based Implementation and Sustainability Toolkit for Health Care Settings

“…Specifically, within the field of implementation science, a number of TMFs have been refined on the basis of end-user evaluations of feasibility, complexity, appropriateness, and acceptability. 13,51,52 Because implementation science seeks to identify optimal methods for increasing uptake of EBPs within practice settings, it is important that tools to support implementation are useful and meaningful to those leading and participating in implementation efforts. Continued use of this toolkit by nurse leaders will contribute valuable information on usefulness for guiding implementation efforts, as well as degree of implementation success among clinical teams.…”

“…Evaluation and refinement of implementation toolkits and established TMFs are inherently a best practice, as knowledge development is often dynamic and rarely static, particularly in health care settings. Specifically, within the field of implementation science, a number of TMFs have been refined on the basis of end-user evaluations of feasibility, complexity, appropriateness, and acceptability 13,51,52. Because implementation science seeks to identify optimal methods for increasing uptake of EBPs within practice settings, it is important that tools to support implementation are useful and meaningful to those leading and participating in implementation efforts.…”

“…[13][14][15][16][17] These strategies have been aligned for use at various stages of change in some studies, recognizing that the stage of change may require different strategies depending on readiness, resources, leadership support, and complexity of the context and setting. 13,14,18 While this important knowledge is critical for advancing uptake of EBPs, what remains essential and underdeveloped is how the frontline clinician in real-world, complex, and resource-limited settings can use this knowledge to bring about practice change and improved patient outcomes. 1 The COVID-19 pandemic harshly illuminated this reality where health care organizations slipped backward with regard to hospitalacquired conditions [19][20][21] that had previously been improved through EBP changes.…”

“…Some of the published TMFs focus on a process to change going through specific steps, others identify key facilitators of change, some adopt classic frameworks of behavior and organizational change, while others use evaluation frameworks to guide change 12. Another major contribution from the scientific field is the identification of evidence-based implementation strategies 13–17. These strategies have been aligned for use at various stages of change in some studies, recognizing that the stage of change may require different strategies depending on readiness, resources, leadership support, and complexity of the context and setting 13,14,18…”

“…12 Another major contribution from the scientific field is the identification of evidence-based implementation strategies. [13][14][15][16][17] These strategies have been aligned for use at various stages of change in some studies, recognizing that the stage of change may require different strategies depending on readiness, resources, leadership support, and complexity of the context and setting. 13,14,18 While this important knowledge is critical for advancing uptake of EBPs, what remains essential and underdeveloped is how the frontline clinician in real-world, complex, and resource-limited settings can use this knowledge to bring about practice change and improved patient outcomes.…”