Framework for Research on Implementation of Process Redesigns

Hung, Dorothy; Smith, Lucia Rojas; Halpern, Michael T.; Harrison, Michael I.

doi:10.1097/qmh.0000000000000158

Cited by 15 publications

(23 citation statements)

References 7 publications

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“…Adapting the CFIR for specific uses or settings is not unprecedented. A 2014 report prepared for the Agency for Healthcare Research and Quality (AHRQ) by RTI International adapted the CFIR for use in three complex systems interventions: process redesign for improved efficiency and reduced costs, patient-centered medical homes, and care transitions between hospital and ambulatory care settings [47][48][49]. Across the three adapted frameworks, the report proposed the addition of two domains: a Measures of Implementation domain and an Outcomes domain to capture the effectiveness of implementation.…”

Section: Process Of Implementation Decision-makingmentioning

confidence: 99%

Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review

et al. 2020

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Background: The Consolidated Framework for Implementation Research (CFIR) is a determinants framework that may require adaptation or contextualization to fit the needs of implementation scientists in low-and middleincome countries (LMICs). The purpose of this review is to characterize how the CFIR has been applied in LMIC contexts, to evaluate the utility of specific constructs to global implementation science research, and to identify opportunities to refine the CFIR to optimize utility in LMIC settings.Methods: A systematic literature review was performed to evaluate the use of the CFIR in LMICs. Citation searches were conducted in Medline, CINAHL, PsycINFO, CINAHL, SCOPUS, and Web of Science. Data abstraction included study location, study design, phase of implementation, manner of implementation (ex., data analysis), domains and constructs used, and justifications for use, among other variables. A standardized questionnaire was sent to the corresponding authors of included studies to determine which CFIR domains and constructs authors found to be compatible with use in LMICs and to solicit feedback regarding ways in which CFIR performance could be improved for use in LMICs.Results: Our database search yielded 504 articles, of which 34 met final inclusion criteria. The studies took place across 21 countries and focused on 18 different health topics. The studies primarily used qualitative study designs (68%). Over half (59%) of the studies applied the CFIR at study endline, primarily to guide data analysis or to contextualize study findings. Nineteen (59%) of the contacted authors participated in the survey. Authors unanimously identified culture and engaging as compatible with use in global implementation research. Only two constructs, patient needs and resources and individual stages of change were commonly identified as incompatible with use. Author feedback centered on team level influences on implementation, as well as systems characteristics, such as health system architecture. We propose a "Characteristics of Systems" domain and eleven novel constructs be added to the CFIR to increase its compatibility for use in LMICs. Conclusions: These additions provide global implementation science practitioners opportunities to account for systemslevel determinants operating independently of the implementing organization. Newly proposed constructs require further reliability and validity assessments. Trial registration: PROSPERO, CRD42018095762

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Section: Process Of Implementation Decision-makingmentioning

confidence: 99%

Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review

et al. 2020

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“…Following abstract and full text review, 8 studies fit the inclusion criteria. Of those 8 studies, 6 were reports of research study results [17][18][19][20][21][22] and 2 were protocols for studies. 15,16 Two publications were from the same study, 19,20 leaving 7 distinct studies included.…”

Section: Included Studiesmentioning

confidence: 99%

“…All the included studies were published after 2013; 5 were conducted in the United States, [17][18][19][20]22 2 took place in Africa, 15,21 and 1 in Asia. 16 Table 1 provides an overview of the 8 studies and their inclusion of various lean thinking tools and implementation science determinants frameworks or checklists.…”

Section: Included Studiesmentioning

confidence: 99%

“…All included studies used CFIR, or a modified version, 23 as the implementation science determinants checklist. Four of the papers (3 total studies) used process mapping as one of their key lean thinking elements 15,16,19,21 ; 3 papers used some form of flow or process redesign [18][19][20] ; 2 papers used 5S standardization 18,19 ; 1 paper used continuous QI 21 ; and 1 paper used lean principles to guide the work. 22 With regard to continuous QI, Gimbel et al 21 used "planning, engagement, execution, and reflection phases" to allow the research teams to "consider their findings from systems analysis tools (e.g.…”

Section: Included Studiesmentioning

confidence: 99%

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Integrating Lean Thinking and Implementation Science Determinants Checklists for Quality Improvement: A Scoping Review

et al. 2019

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It is not known how often lean tools and implementation determinants frameworks or checklists are used concurrently in health care quality improvement activities. The authors systematically reviewed the literature for studies that used a lean tool along with an implementation science determinants framework (January 1999 through August 2018). Seven studies (8 publications) were identified, inclusive of 2 protocols and 6 research articles across multiple continents. All included studies used the consolidated framework for implementation research as their implementation science determinants framework. Lean tools included in more than 1 publication were process mapping (4 publications), process redesign (3 publications), and 5S standardization (2 publications). Only 1 study proposed using a lean tool concurrently with an implementation science determinants framework in the design and execution of the QI project. Few published studies utilize both an implementation science determinants framework or checklist and 1 or more lean tool in their study design.

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“…Then, leaders may take steps to adapt the program to its context or influence the context. Critical contextual domains include members' skills, experience, and attitudes; organizational structure, management system, and culture; informal politics; physical and technical infrastructure; and external operating environments …”

Section: Introductionmentioning

confidence: 99%

Learning from implementation setbacks: Identifying and responding to contextual challenges

Harrison

Grantham

2018

Learning Health Systems

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Introduction We address organizational learning about implementation context during setbacks to primary care redesign in an ambulatory system. The redesign expanded care teams and added a medical assistant assigned administrative and coordination tasks. The redesign was expected to improve care efficiency, prevention, and continuity. In response to setbacks, redesign and system leaders used understanding of context to plan system‐wide changes, as well as program adjustments. Doing so enhanced the redesign's prospects and contributed to system learning. Methods We conducted a 33‐month, mixed‐methods study. Qualitative data included quarterly calls with the redesign leaders and 63 activity log entries. There were three site visits; 73 interviews with practice leaders, providers, and medical assistants. Data analysis used categories from an implementation research framework; these were refined and then expanded inductively using log reports, debriefings with change leaders, and documents. Quantitative analysis used system operational data on chronic care, prevention, efficiency, productivity, and patient access. Results Redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped‐for gains in operational metrics. Interviews reported that team redesign was leading to improvements in chronic care and prevention and eased provider burden. Besides making small adjustments to cope with setbacks, redesign and system leaders engaged in more thorough organizational learning. They examined contextual challenges underlying setbacks and posing risks to the delivery system as a whole. Their responses to challenges helped strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value‐based care and population health. Conclusions This case points to benefits for both health care researchers and change practitioners of paying closer attention to how context affects implementation of organizational change, and to opportunities and conditions for learning from setbacks during change.

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Framework for Research on Implementation of Process Redesigns

Abstract: The PR framework helped guide the qualitative study and aided researchers in informing their leadership about critical issues affecting PR implementation.

Cited by 15 publications

References 7 publications

Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review

Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review

Integrating Lean Thinking and Implementation Science Determinants Checklists for Quality Improvement: A Scoping Review

Learning from implementation setbacks: Identifying and responding to contextual challenges

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