Many organizations struggle with the implementation of known best practices and quality improvement interventions. Much of the difficulty in implementing effective strategies stems from a lack of understanding organizational context. An intervention that is shown to be effective in one unit or hospital does not mean it is generalizable to other settings.
The complexity of health care delivery stresses the need to carefully examine interacting contextual variables (e.g. work setting, organizational culture) that could potentially impact implementation efforts. Laura Damschroder, MS, MPH, a researcher with the VA Center for Clinical Management Research, discusses the importance of these context variable and other important constructs in the Consolidated Framework for Implementation Research (CFIR).
“Use of a framework to guide your research promotes generalization of findings throughuse of theory. Specifically, a theoretical framework will enable systematic identification and understanding of drivers that predict success in different settings, guide adaption of targeted practice changes and mplementation strategies, and more quickly and confidently build the scientific knowledgebase.” says Damschroder. As many clinical sites struggle with implementing demonstrated interventions from one setting to the next, CFIR provides an opportunity to systematically evaluate the implementation process and promote effective strategies that generalize across units and/or hospitals.
Additionally, CFIR helps raise the rigor of improvement research by relying on clearly defined theoretical constructs that pave the way for quantitative measures to evaluate implementation. “The Seattle Implementation Research Collaborative (SIRC) is currently working on mapping published instruments using the CFIR and other complementary frameworks. In addition, new measures are being developed and tested by several researchers including Bryan Weiner as well as our own group. Our online CFIR Wiki site has the latest information about these and other efforts and will continue to be updated.” Such an approach is essential to improvement research and enhances the generalizability of interventions tested in systematic investigations. As the Improvement Science Research Network begins to roll out intervention studies, CFIR will become an important framework to evaluate context as it relates to the implementation of effective strategies.
To learn more about CFIR, consult the following references:
Damschroder, L., Aron, D., Keith, R., Kirsh, S., Alexander, J., & Lowery, J. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science, 4(1), 50.
Damschroder, L. J., & Lowery, J. C. (2013). Evaluation of a large-scale weight management program using the consolidated framework for implementation research (CFIR). Implement Sci, 8, 51.