Table 1:
Potential barriers identified by the nurses were mapped onto the CFIR framework. The CFIR Expert Recommendations for Implementation Change (CFIR-ERIC) tool was used to identify potential strategies. Some potential strategies may not be feasible, and it is up to an implementation team to pick the strategies that target multiple barriers and are feasible and applicable to their setting and intervention. Topic and descriptions are reproduced with permission from Waltz, et al 2019.
| Topic | Description | Potential Strategies |
|---|---|---|
| INTERVENTION CHARACTERISTICS | ||
| Adaptability | Stakeholders do not believe that the innovation can be sufficiently adapted, tailored, or re-invented to meet local needs. | Promote adaptability; Conduct local needs assessment; Facilitation; Identify champions |
| OUTER SETTING | ||
| Peer Pressure | There is little pressure to implement the innovation because other key peer or competing organizations have not already implemented the innovation nor is the organization doing this in a bid for a competitive edge. | Alter incentive/allowance structures; Identify champions; Increase demand; Involve patients and their family members. |
| External Policy & Incentives | External policies, regulations (governmental or other central entity), mandates, recommendations or guidelines, pay-for-performance, collaborative, or public or benchmark reporting do not exist or they undermine efforts to implement the innovation. | Alter incentive/allowance structures; Involve executive boards; Build a coalition; Inform local opinion leaders |
| INNER SETTING | ||
| Culture | Cultural norms, values, and basic assumptions of the organization hinder implementation. | Identify champions; Conduct local consensus discussions; Inform local opinion leaders; Facilitation; Tailor Strategies |
| Tension for Change | Stakeholders do not see the current situation as intolerable or do not believe they need to implement the innovation. | Identify champions; Conduct local consensus discussions; Inform local opinion leaders; Promote adaptability; Involve patients and family members |
| Relative Priority | Stakeholders perceive that implementation of the innovation takes a backseat to other initiatives or activities. | Conduct local consensus discussions; Alter incentive/allowance structures; Increase demand; Mandate change by leadership |
| Organizational Incentives & Rewards | There are no tangible (e.g., goal-sharing awards, performance reviews, promotions, salary raises) or less tangible (e.g., increased stature or respect) incentives in place for implementing the innovation. | Alter incentive/allowance structures; Identify champions; Audit and feedback; Develop tools for quality monitoring. |
| CHARACTERISTICS OF INDIVIDUALS | ||
| Self-efficacy | Stakeholders do not have confidence in their capabilities to execute courses of action to achieve implementation goals. | Identifying champions; Creating a learning collaborative; Facilitation; Making training dynamic; Ongoing training |
| Individual Stage of Change | Stakeholders are not skilled or enthusiastic about using the innovation in a sustained way. | Identifying champions; Making training dynamic; Alter allowance/incentive structure; Promote adaptability |