Table 9.

Summary of identified tensions and implementation fidelity trajectories

Tensions	Cluster 1 Stable high fidelity	Cluster 2 Moderate and improving fidelity
1. Organization’s vision and program’s fidelity	Organization’s vision focused - Mainly high or moderate starting positions - Generally more experienced at start	Program’s fidelity focused - Mainly low starting positions
2. Active engagement of physicians and buffering physicians’ engagement	Active engagement of physicians - Mainly small organizations - Mainly stable organizational circumstances	Buffering physicians’ engagement - Mainly large organizations - Relatively more reorganizations
3. High fidelity and cost-efficient implementation	High fidelity implementation - Stable/linear trajectory - Mainly high or moderate starting position - Mainly small organizations	Cost-efficient implementation - Developmental/incremental trajectory - Mainly low starting positions - Mainly large organizations