Table 1.

Operationalizing Proctor implementation outcomes for COVID-19.

Implementation outcome	Proctor definition	Level of operationalization	Specific application to COVID-19	Determinants	Distal clinical outcomes
Acceptability	Perception among implementation stakeholders that a given treatment, service, practice, or innovation is agreeable, palatable, or satisfactory	Individual consumer Individual provider	Public agreement and personal values aligning with social distancing policies Health worker satisfaction with new hospital PPE guidelines	Race, class, and ability to social distance Management support, effective communication with health workers	Public trust and uptake of policies, community transmission reduction Perceived safety and health worker burnout
Adoption	Intention, initial decision, or action to try or employ an innovation or evidence-based practice	Individual provider Organization or setting	Attempted use of national testing guidelines City decision to adopt a regional policy of “shelter in place” or “stay home, stay healthy”	Clarity of guidelines, test kits available Acceptability of behavior changes to community members	Identification of positive cases and linkage to clinical management Community transmission reduction
Appropriateness	Perceived fit, relevance, or compatibility of the innovation or evidence based practice for a given practice setting, provider, or consumer; and/or perceived fit of the innovation to address a particular issue or problem	Individual consumer Individual provider Organization or setting	Compatibility between mask wearing and public life Perceived compatibility of PPE guidelines with actual need given hospital census and local epidemiology Perceived compatibility between existing and new pandemic-specific infrastructure, including supervisory systems and material distribution for COVID-19 response	Stigma associated with mask use, clarity of government guidance Trajectory of local outbreak, management support, effective communication with health workers Leadership knowledge of existing functioning systems prior to the outbreak	Community transmission reduction Perceived safety and health worker burnout Depending on type of materials being distributed, has implications for community transmission reduction, testing coverage, and subsequent positive case management
Feasibility	Extent to which a new treatment, or an innovation, can be successfully used or carried out within a given agency or setting	Individual provider Organization or setting	Extent to which health workers can accurately apply rapidly evolving virologic testing guidelines Degree to which hospital infrastructure can accommodate surges in patients requiring intensive care	Clarity of guidelines, effective management support, test kit, and PPE resource availability Number of staff available and allowed to perform intensive care, hospital beds and ventilators, availability of resources	Efficient test kit allocation to maximize identification of cases and link to clinical management, ability for health workers to return to work to perform clinical management for patients Reducing morbidity and mortality associated with severe cases
Fidelity	Degree to which an intervention was implemented as it was prescribed in the original protocol or as it was intended by the program developers	Individual provider	Public health practitioners implement supply chain for test kits, specimens, and case follow-up activities as designed	Availability of necessary resources, appropriate alignment between tasks and tasked personnel, effective communication that accounts for practitioner input	Reduction in community transmission
Implementation cost	The cost impact of an implementation effort	Provider or providing institution	Change in resource use at health facilities associated with social distancing	Political and economic pressure not to introduce “stay at home” restrictions	Increased resources for acutely ill (ex. ventilators), and reduction in morbidity and mortality
Penetration	Integration of a practice within a service setting and its subsystems	Organization or setting	Integrating processes (such as microplanning) for allocating resources across institutions and government offices, resulting in a harmonized approach to pandemic preparedness with multi-level consensus regarding leadership, communication, and management structures to be activated in an emergency	Leadership engagement, formal interorganizational networks, new resources made available for pandemic preparedness	Reduced community transmission, reduced hospital transmission
Sustainability	Extent to which a newly implemented treatment is maintained or institutionalized within a service setting's ongoing, stable operations	Administrators Organization or setting	Degree to which hospital leadership and government leadership do or do not maintain free coronavirus testing policies after the peak of the epidemic Degree to which innovative resource allocation modeling tools are institutionalized in public health and health facility planning practices, during stable operations	Coordination between policymaker and scientists, resource availability Learning climate, organizational culture, and political directives	Risk of future case surges Risk of future case surges