TABLE 1.
Constructing the multilevel framework
| Frameworks and relevant domains a | ||||
|---|---|---|---|---|
| Multilevel framework | CFIR | Socio‐ecological | Organizational change | Rationale for including level and/or domains in multilevel framework |
| General environment | Outer Setting (external policies and incentives; patient needs/resources) | System | Environment (political economy, markets, institutional forces) | Examine influences of slower‐to‐change, more distant environmental conditions (eg, policies, institutional norms, patient expectations). |
| Operating environment | Outer Setting (links to other organizations; peer pressure for implementation) | Community | Environment (incentives, relations to other organizations) | Distinguish immediate, more dynamic influences (eg, payment incentives, competitors, cooperating and allied organizations). |
| Organization | Inner Setting—service, unit, team levels. (structural characteristics, culture; learning climate; leadership engagement; resources; knowledge/information) | Organization | Overall organization (core properties: leadership, culture, team development, information technology) | Adopt widely used term; focus on total organization; emphasize alignment among core properties likely to have major effects on learning; distinguish leadership from culture. |
| Mid‐management | Not distinguished as separate level. Implementation Processes (planning, engaging; executing; reflecting and evaluating; actions of formal implementation leaders) | Not distinguished as level | Not included as separate level. (Core properties apply. | Focus on shared learning processes (vs change implementation); highlight strong influence of mid‐level managers. |
| Team/u | Inner Setting (variation across teams); (Implementation) Process (opinion leaders, formal leaders; champions, reflecting and evaluating) | Not included | Group/team (core properties) | Note how team processes affect organizational, as well as individual learning. |
| Individual | Involved Individuals (attributes; knowledge and beliefs about intervention; identification with organization; behavior) | Individual | Individual skills, motivation, behavior (eg, teamwork, technology use) | Indicate that individual learning may contribute to group learning; individuals can act as champions of organizational learning, engage patients in process/results of organizational learning. |
Abbreviation: CFIR, Consolidated Framework for Implementation Research.
a
CFIR domains are capitalized. CFIR constructs and organization change framework properties are in parentheses.