Implementation Degree across Practices and Consolidated Framework for Implementation Research Domains
| Domain | Definition | Fully Implemented | Partially Implemented | Did Not Implement |
|---|---|---|---|---|
| Inner Setting | ||||
| Baseline Adaptive Reserve (mean, SD) | Practice capacity for change | 0.63 (0.08) | 0.56 (0.07) | 0.55 (0.08) |
| Implementation climate | Commitment 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 implementation | Organizational 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 | ||||
| Planning | Tasks 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 | ||
| Engaging | Involvement 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 evaluating | Team 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 intervention | Individuals' 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-efficacy | Belief 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.