. 2025 Jul 31;25:1006. doi: 10.1186/s12913-025-13170-1

Table 2.

Example of framework method

CFIR Domain	Code Summary	Example Excerpt
Innovation The “thing” being implemented, e.g. the Navigator Program.	Innovation Cost Extensive donor funding meant the hospital was only required to invest in-kind contributions of staff time and desk space.	“No one at the hospital has to pay for the program. It is essentially a free gift to the hospital, supported by donor funds. I mean, what's not to like about that?” (Implementation_1)
Innovation Design HOCs are hired as hospital employees, which allows easy access to in-patients and electronic medical records. They split their time evenly between the hospital and community.	“If you’re not embedded in the hospital, you’re virtually useless. This [ID badge] is what gets you into every door in the building.” (HOC_2)
Outer Setting The setting in which the Inner Setting exists, e.g. City of Toronto.	Critical Incidents The beginning of the COVID-19 pandemic disrupted Program implementation and prevented the HOC role from functioning as intended.	“I think COVID really threw us off… the program grinded to a halt in a lot of ways. [HOC_2] was not allowed to go from the hospital into the community. He was only in the hospital.” (Implementation_4)
Local Conditions Emergency homeless shelters are at capacity across the City of Toronto and shelter staff are not resourced to support clients with medical needs.	"Some places have more support than others, right? And unfortunately at our site we don't have a lot of support, we don't have a lot of staff."(CSP_2)
Inner Setting The setting in which the innovation is implemented.	Culture Staff at this hospital tend to be interested in providing care for patients facing disadvantage or marginalisation.	“I think we all chose to be at this hospital because we like the nitty gritty. These are our people. These are the people that we serve.” (Implementation_2)
Tension for Change Hospital staff lacked the time or expertise to encourage patients experiencing homelessness to stay in hospital or help patients to follow their discharge plan after hospitalisation.	“Our team identified the gaps before and needed help. And we couldn’t fulfill all of the support that sometimes our patients needed.” (Implementation_3).
Individuals The roles and characteristics of individuals (e.g. leaders, implementation team, innovation deliverers).	High- and Mid- Level Leaders General Internal Medicine (GIM) physicians in leadership roles supported the Program and advocated to secure buy-in from hospital leadership and donors.	“We’ve had some real strong support from the physicians. That’s the other thing: the physicians on [GIM ward] are a different breed."(HOC_2)
Capability Individuals hired as HOCs have extensive experience working with people experiencing homelessness and leverage community resources for their clients.	“I’ve been doing this job for a long time… So my ability to connect with people is very different than when I started many, many, many years ago.” (HOC_1)
Implementation Process The activities and strategies used to implement the innovation.	Tailoring Strategies The implementation process was intentionally flexible. Implementers and HOC collaborated to refine the program as the pilot progressed.	“I did plan it as we’ll hire someone, we’ll get it going, we’ll experiment and just see how it goes. Kind of fix it as we go.” (Implementation_1)
Teaming Implementers promoted collaboration between HOCs and other staff on GIM by inviting HOCs to shadow medical teams and attend rounds.	"They [HOCs] did shadow a medical team, getting to know what their routines were, what their thought process was around our patients and medical conditions. They do attend our morning bullet rounds pretty much daily.” (Implementation_3) “Totally part of the team. Yeah, like they're not really a consulting service. Like Addictions feels like a separate team… they don't feel like they're integrated within my team specifically. Whereas the Homeless Outreach Counsellors feel like they're integrated into the team as one of the health disciplines.” (Hospital_7)

CFIR Domain

Code Summary

Example Excerpt

Innovation

The “thing” being implemented, e.g. the Navigator Program.

Innovation Cost

Extensive donor funding meant the hospital was only required to invest in-kind contributions of staff time and desk space.

“No one at the hospital has to pay for the program. It is essentially a free gift to the hospital, supported by donor funds. I mean, what's not to like about that?” (Implementation_1)

Innovation Design

HOCs are hired as hospital employees, which allows easy access to in-patients and electronic medical records. They split their time evenly between the hospital and community.

“If you’re not embedded in the hospital, you’re virtually useless. This [ID badge] is what gets you into every door in the building.” (HOC_2)

Outer Setting

The setting in which the Inner Setting exists, e.g. City of Toronto.

Critical Incidents

The beginning of the COVID-19 pandemic disrupted Program implementation and prevented the HOC role from functioning as intended.

“I think COVID really threw us off… the program grinded to a halt in a lot of ways. [HOC_2] was not allowed to go from the hospital into the community. He was only in the hospital.” (Implementation_4)

Local Conditions

Emergency homeless shelters are at capacity across the City of Toronto and shelter staff are not resourced to support clients with medical needs.

"Some places have more support than others, right? And unfortunately at our site we don't have a lot of support, we don't have a lot of staff."(CSP_2)

Inner Setting

The setting in which the innovation is implemented.

Culture

Staff at this hospital tend to be interested in providing care for patients facing disadvantage or marginalisation.

“I think we all chose to be at this hospital because we like the nitty gritty. These are our people. These are the people that we serve.” (Implementation_2)

Tension for Change

Hospital staff lacked the time or expertise to encourage patients experiencing homelessness to stay in hospital or help patients to follow their discharge plan after hospitalisation.

“Our team identified the gaps before and needed help. And we couldn’t fulfill all of the support that sometimes our patients needed.” (Implementation_3).

Individuals

The roles and characteristics of individuals (e.g. leaders, implementation team, innovation deliverers).

High- and Mid- Level Leaders

General Internal Medicine (GIM) physicians in leadership roles supported the Program and advocated to secure buy-in from hospital leadership and donors.

“We’ve had some real strong support from the physicians. That’s the other thing: the physicians on [GIM ward] are a different breed."(HOC_2)

Capability

Individuals hired as HOCs have extensive experience working with people experiencing homelessness and leverage community resources for their clients.

“I’ve been doing this job for a long time… So my ability to connect with people is very different than when I started many, many, many years ago.” (HOC_1)

Implementation Process

The activities and strategies used to implement the innovation.

Tailoring Strategies

The implementation process was intentionally flexible. Implementers and HOC collaborated to refine the program as the pilot progressed.

“I did plan it as we’ll hire someone, we’ll get it going, we’ll experiment and just see how it goes. Kind of fix it as we go.” (Implementation_1)

Teaming

Implementers promoted collaboration between HOCs and other staff on GIM by inviting HOCs to shadow medical teams and attend rounds.

"They [HOCs] did shadow a medical team, getting to know what their routines were, what their thought process was around our patients and medical conditions. They do attend our morning bullet rounds pretty much daily.” (Implementation_3)

“Totally part of the team. Yeah, like they're not really a consulting service. Like Addictions feels like a separate team… they don't feel like they're integrated within my team specifically. Whereas the Homeless Outreach Counsellors feel like they're integrated into the team as one of the health disciplines.” (Hospital_7)