Outcome Measurement Program Case Studies

Appendix A:
Adaptation of the CFIR

The Consolidated Framework for Implementation Research (CFIR) framework was used as the basis for this case study’s approach. The CFIR is intended to represent a cohesive group of constructs that identify factors that promote or deter effective implementation of programs, interventions, and instruments.   Each construct used in the framework is supported by a base of research evidence that supports its role as a factor in effective implementation.  CFIR constructs related to ethnographic analyses of user organizational characteristics or the management style of the organization staff were eliminated in our adaptation of CFIR as they were beyond the scope of this project. This involved the elimination of most of Section III, “Inner Setting” constructs, and Section IV constructs applying to the “Characteristics of Individuals” within organizations that affect implementation.  

One construct in the “Inner Setting” section was preserved, Access to Knowledge and Information, that addresses the end-user organization’s degree of access to useful information about the OM tool (the intervention), and how to incorporate the OM process into the flow of organizational routines and work tasks.  The team retained this focus as it relates to the level of technical assistance and the quality of technical assistance provided by OM program staff to end-users.  This appears to be an essential component in OM programs and did not require an intensive end-user organizational analysis to assess.  Minor adaptations were made to construct labels to fit the context of this study better.

Appendix A: Modified Consolidated Framework for Implementation Research Constructs


Short Description

I. Intervention Characteristics


Intervention Source

Perception of key stakeholders about whether the intervention is externally or internally developed.


Evidence Strength and Quality

Stakeholders’ perceptions of the quality and validity of evidence supporting the belief that the intervention will have desired outcomes.


Relative Advantage

Stakeholders’ perception of the advantage of implementing the intervention versus an alternative solution.



The degree to which an intervention can be adapted, tailored, refined, or reinvented to meet local needs.



The ability to test the intervention on a small scale in the organization, and to be able to reverse course (undo implementation) if warranted.



Perceived difficulty of implementation, reflected by duration, scope, radicalness, disruptiveness, centrality, and intricacy and number of steps required to implement. 


Design Quality and Packaging

Perceived excellence in how the intervention is bundled, presented, and assembled.



Costs of the intervention and costs associated with implementing the intervention, including investment, supply, and opportunity costs.

II. Outer Setting


Individual Needs and Resources

The extent to which individual needs, as well as barriers and facilitators to meet those needs, are accurately known and prioritized by the organization.


Alignment with Current Research, Practice, and Regulation

The degree to which an organization is networked with other external organizations.


Peer Pressure

Mimetic or competitive pressure to implement an intervention, typically, because most or other key peer or competing organizations have already implemented or are in a bid for a competitive edge.


External Policy and Incentives

A broad construct that includes external strategies to spread interventions, including policy and regulations (governmental or other central entity), external mandates, recommendations and guidelines, pay-for-performance, collaboratives, and public or benchmark reporting.

III. Inner Setting


Access to Knowledge and Information

Ease of access to digestible information and knowledge about the intervention and how to incorporate it into work tasks.

V. Process



The degree to which a scheme or method of behavior and tasks for implementing an intervention are developed in advance, and the quality of those schemes or methods.



Attracting and involving appropriate individuals in the implementation and use of the intervention through a combined strategy of social marketing, education, role modeling, training, and other similar activities.


Formally Appointed Internal Implementation Leaders

Individuals from within the organization who have been officially appointed with responsibility for implementing an intervention as coordinator, project manager, team leader, or other similar roles.



“Individuals who dedicate themselves to supporting, marketing, and ‘driving through’ an [implementation]” [101] (p. 182), overcoming indifference or resistance that the intervention may provoke in an organization.


External Change Agents

"Individuals who are affiliated with an outside entity who formally influence or facilitate intervention decisions in a desirable direction.



Carrying out or accomplishing the implementation according to plan. (Degree to which critical components are present and applied as developers intended – traditional fidelity)


Reflecting and Evaluating

Quantitative and qualitative feedback about the progress and quality of implementation accompanied by regular personal and team debriefing about progress and experience.