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Table 6 Definitions of EPIS factors

From: Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework

 

EPIS constructs

Definition

Examples

Outer context

Service environment/policies*

State and federal sociopolitical and economic contexts that influence the process of implementation and delivery/use of the innovation

Policies; legislation; monitoring and review; auditing; mandates

Funding/contracting

Fiscal support provided by the system in which implementation occurs. Fiscal support can target multiple levels (e.g., staff training, fidelity monitoring, provision of the innovation/EBP) involved in implementation and delivery/use of the innovation

Contracting arrangements; grants; fee-for service, addition to formulary; capitation fees, incentives

Leadership

Characteristics and behaviors of key decision-makers pertinent at all levels who are necessary but not sufficient to facilitate or promote the implementation process and delivery/use of the innovation

Transformational leadership; Implementation leadership

Inter-organizational environment and networks

Relationships of professional organizations through which knowledge of the innovation/EBP is shared and/or goals related to the innovation/EBP implementation are developed/established

Inter-organizational collaboration, commitment, competition, co-opetition

Patient/client characteristics*

Demographics and individual characteristics of the target population/end user

Socioeconomic status, health condition, comorbidities, age, gender, motivation

Patient/client advocacy*

Support or marketing for system change based on consumer needs, priorities and/or demographics

Client advocacy; class-action lawsuits, consumer organizations

Innovation factors*

Innovation/EBP developers

Characteristics of the individuals or team(s) responsible for the creation of the EBP/innovation that may be the subject of implementation efforts

Engagement in implementation, continuous quality improvement, rapid-cycle testing, prototyping

Innovation/EBP Characteristics

Features or qualities of innovations to be implemented

Complexity, ease of learning, cost, burden, reporting requirements

Innovation/EBP fit*

The extent to which the innovation/EBP fits the needs of the population served or context in which it is implemented

Innovation/EBP structural and process fit with system, organizations, providers, patients/clients

Bridging factors*

Community-academic partnerships*

Active partnerships between researchers and key community stakeholders, who can represent multiple levels involved in implementation (e.g., system representatives, organizational leaders, providers, consumers), that can facilitate successful implementation and delivery/use of the innovation

Community participation; partnerships; ongoing positive relationships; valuing multiple perspectives

Purveyors/intermediaries

Organizations or individuals providing support or consultation for implementation and/or training in the innovation

Implementation readiness assessment, strategy development, training support

Inner Context

Organizational characteristics

Structures or processes that take place and/or exist in organizations that may influence the process of implementation

Culture; climate; readiness for change; structure; leadership; receptive context; absorptive capacity; social network support

Leadership

Characteristics and behaviors of individuals involved in oversight and/or decision-making related to EBP implementation within an organization

Competing priorities; use of climate/culture embedding mechanisms; transformational leadership; implementation leadership

Quality and fidelity monitoring/support*

Processes or procedures undertaken to ensure adherence to active delivery of the innovation/EBP and/or an implementation strategy

Fidelity support system; quality assurance evaluation; continuous quality improvement

Organizational staffing processes

The processes or procedures in place at an organization related to the hiring, review, and retention of staff involved in the active delivery of the innovation/EBP and/or its implementation

Professional training and qualification related to EBI delivery; staff turnover

Individual characteristics

Shared or unique characteristics of individuals (e.g., provider, supervisor, director) that influence the process of implementation

Attitudes towards EBP; demographics and/or background; client characteristics; job demands

  1. *Represents factors that are new or adaptations based on the original EPIS 2011 paper