Table 3. Intervention mapping.

CFIR construct	Facilitator/barrier	Manifestation	Strategy to mitigate barrier leverage facilitator	Desired outcome
Outer setting domain—patients’ needs and resources construct	SURPAS provides individualized, patient-centered care to patients	SURPAS provides patients with information, increased engagement with providers, and enhances patients’ surgical experience	Conduct local meetings with key stakeholders (i.e., patients) to build collaboration and awareness of SURPAS	Increased patient satisfaction and improved clinical outcomes
Intervention characteristic domain—evidence strength and quality construct	Empirical evidence that SURPAS was grounded in the ACS NSQIP database and the statistical methodologies utilized	No one questioned the empirical evidence	Ongoing educational meetings with stakeholders, individual meeting with clinical champions and implementation facilitators	Providers and patient confident with data provided by SURPAS
Complexity construct	SURPAS’ ease of use	Simplicity of understanding SURPAS’ message	Develop an implementation manual to ensure appropriate implementation and use of tool	Successful implementation of SURPAS
Design quality and packaging construct	SURPAS’ data display and patient handouts	Provided a concise mechanism to estimate and document the risk of surgery, supportive to populate clinical notes, and useful for sharing the anticipated surgical risk with patients	Create a learning collaborative	Increased patient’s knowledge of risk assessment of surgical complications
Adaptability construct	Limited CPT codes in SURPAS and lack of specific comorbidities	Provider frustration that specific surgical CPT codes were not available	Work with technical experts to continually update SURPAS and sharing surrogate codes between providers and promote adaptability	Provider utilize new specific CPT code or a similar (surrogate) one
Inner setting domain—implementation climate construct	Highly supported by administrators and surgical care key stakeholders and providers	Established integration of SURPAS in the EHR	Identification and preparation of local clinical champions	Fully implemented in all surgical clinics
Implementation climate construct	Tension between low-risk patients’ preference of SURPAS and providers’ concern about additional clinic time required to discuss risks	Providers only use SURPAS with high-risk patients	Utilization of patient and family feedback	Providers use SURPAS with all patients
Compatibility sub-construct	Contextual and technological variations affecting implementation	Clinic room environment does not provide computers for assessment of SURPAS	Utilization of facilitation and technical experts—internal and external	Experts work with clinic to provide access to computers or change of process to perform SURPAS before entering clinic room
Characteristics of individuals domain—knowledge and beliefs about the intervention construct	Provider believes his/her complication rates better than those reported by SURPAS	Provider chooses not to use SURPAS	Utilization of outcomes rates audit and feedback	Provider sees that their complication rates are similar to SURPAS
Process domain—planning construct	Planning ahead with identified teams responsible for the implementation of the tool and technical support	Providers unable to access SURPAS from the local computer	Utilization of facilitation and technical experts - internal and external	Fully implemented in all surgical clinics
Engaging construct	Factors to encourage adoption of SURPAS	Provider chooses not to use SURPAS	Conduct ongoing education, training, evaluation, and consultation	Integrated into all pre-surgical patient-provider interactions

SURPAS, SUrgical Risk Preoperative Assessment System; ACS, American College of Surgeons; NSQIP, National Surgical Quality Improvement Program; CPT, Current Procedural Terminology.