Table 3 CFIR Domain - Inner Setting
CFIR Constructsa | Ranking | Reason for Assigned Ranking | Score |
|---|---|---|---|
Structural Characteristics | F | The intervention took place within the L&D unit, which is a world-leading center of excellence in obstetrics and in anesthesia, and well-established division within the medical center. They have clear processes in place to facilitate quality improvement. | 1 |
Networks & Communications | Change over time B to F | Clear lines of communication were not initially evident within the organization regarding this innovation; it was an initial source of frustration for where to locate the most up to date resource. This was rectified over the course of implementation and communicated through the hospital’s COVID intranet. Further communication improvements at the local departmental levels, via intranet, email and teleconferencing permitted inter-professional collaborative work. | 0 |
Culture | Change over time B to F | While the culture within the L&D unit was accustomed to the use of checklists, standard operating procedures, and iterative cycle improvement. Additional internal forces along with external pressures of fears and anxiety, were present that affected the cohesion of the unit. Pre-existing egotism and individuality initially impacted implementation negatively. In view of the urgency of COVID-19, recognition that assistance outside of the L&D unit was required, sought and later welcomed over the course of the implementation. | 0 |
Implementation Climate | F | Within the organization and within the L&D unit, there was clear receptivity to implementing the innovation. It aligned with existing frameworks already in place, including the use of cognitive aids, checklists, team training and iterative process improvement. Although the checklist and processes were developed quickly, limiting stakeholder buy-in, the implementation climate supported the innovation and valued its use. | 1 |
Tension for Change | F | The innovation was absolutely necessary, as the outbreak revealed gaps in our workflow for the COVID-19 parturient. | 1 |
Compatibility | F | The innovation was based upon frameworks already used within the organization (e.g.: cognitive aids, checklists) and therefore demonstrated compatibility with organizational values and work processes | 1 |
Relative Priority | F | There was clarity in the priority and urgency of this innovation. Given the anticipated surge of potential COVID-19 patients on L&D, implementing this workflow was a priority for all staff. | 1 |
Organizational Incentives & Rewards | NA | This innovation was not associated with an external policy or incentive, financial or otherwise. | NA |
Goals and Feedback | F | This innovation was aligned with organizational and departmental goals, and feedback was obtained to help understand if any gaps existed between the current organizational status and the perceived goal. | 1 |
Learning Climate | Change over time B to F | The time pressure resulted, initially, in insufficient time to for reflective thinking and evaluation. Leaders within L&D valued the input of all inter-professional team members and, over time, staff members involved in the implementation felt like a valued partner in the change process. | 0 |
Readiness for Implementation | F | The L&D leadership demonstrated a readiness to change; they sought out assistance and innovation. | 1 |
Leadership Engagement | F | Organizational leaders demonstrated a dedicated level of engagement and invested adequate time and resource to the innovation. This included the Director of L&D, division director of maternal-fetal-medicine, division direction of OB anesthesia, Anesthesia Executive Vice Chair, and the Vice Chair for quality and safety | 1 |
Available Resources | F | Resources, including time, were allocated specifically to the innovation being implemented. Resources in particular: implementation team released from clinical duties to develop and implement this innovation | 1 |
Access to Knowledge & Information | B | Access to information regarding the innovation was difficult initially, due to version updates. All information was eventually made readily available throughout the organization through the intranet | 0 |