Table 4.

Implementation Degree across Practices and Consolidated Framework for Implementation Research Domains

DomainDefinitionFully ImplementedPartially ImplementedDid Not Implement
Inner Setting
Baseline Adaptive Reserve (mean, SD)Practice capacity for change0.63 (0.08)0.56 (0.07)0.55 (0.08)
Implementation climateCommitment to implement change∙ BHCs interested in improving BH documentation in EHR∙ BHC interested in improving BH documentation in EHR∙ BHCs satisfied with current system and resistant to new tool
∙ Upper management advocated for using a new tool tailored to BHC needs∙ Interest in tool from upper management∙ Little buy-in from upper management
∙ Epic specialist available to assist with implementation.∙ Epic site specialist did not assist with implementation∙ Integration model did not facilitate use of the tool, as these clinics focused on long mental health appointments, rather than brief interventions with BHCs
Readiness for implementationOrganizational capacity to implement change∙ Step-by-step guides produced by BHC leadership on how to use the tool∙ Unstable BHC workforce/turnover; no written BHC workflows∙ No time allocated for training and educating BHCs about tool although Epic site specialist available
∙ Stable BHC workforce, written BHC workflows in place
Process Characteristics
PlanningTasks and methods conducted to prepare for implementation∙ Had introductory implementation meeting before rolling out the tool∙ No implementation plan aside from one introductory implementation meeting before rolling out the tool∙ Had introductory implementation meeting before rolling out tool
∙ Lead BHC acted as opinion leader and champion of tool implementation∙ No follow-up by clinics to implement∙ MH manager felt the tool was not useful to them and declined implementing the tool
EngagingInvolvement of staff in the change process∙ Familiarized other clinical staff, including front desk staff and PCPs, with the new tool∙ BHC supervisor left this role; loss of champion derailed implementation∙ No clinic champion or formally appointed internal implementation leader
Reflecting and evaluatingTeam debriefing about process and experience∙ Dedicated agenda time at BHC monthly meeting to discuss the tool and provide feedback to tool developer∙ Feedback given to tool developers, but no follow through by practice∙ No reflection or evaluation because tool was not implemented
Individual Characteristics
Knowledge/beliefs about interventionIndividuals' attitudes toward and value placed on intervention∙ Believed tool enhanced EHR use (simplified it)∙ Newly hired BHCs reported receiving limited (1 hour), and inadequate training in the tool∙ Did not find the tool to be useful
∙ Consensus view: tool was a step of progress∙ BHCs did not know how to use tool
Self-efficacyBelief in one's ability to execute implementation tasks∙ BHCs felt they received sufficient training to use tool
  • BH, behavioral health; BHC, behavioral health clinician; MH, mental health; PCP, primary care provider; EHR, electronical health record; SD, standard deviation.