Table 4 Themes derived from qualitative responses to open-ended comment boxes

Confidence in choices

I again have low confidence in my selections as a functional analysis of the low opinion [Evidence Strength & Quality] would be required to identify strategies to address.

Difficult to only choose 7. I have moderate confidence in my ranking.

Elaborating on choices

I think the items I chose are fairly strong supporters of adaptability. I think adaptability is dependent upon facilitation of inventiveness/adaptability by someone who knows both the setting and the intervention. Revising professionals’ roles supports adaptability, however, there is often such a struggle with understanding team roles, even without revision, this needs constant vigilance.

This order of steps presumes that there is already someone who is familiar with the organization and intervention who could be trained for leadership within a relatively short time. Items 1 and 2 would be reversed if there are no clear candidates who could be recruited and trained to be an implementation leader, and this process would be facilitated by having an implementation blueprint in place.

Issues related to CFIR barrier

This barrier is hard to envision, too. What exactly is the barrier? Is there an identified “champion” who is not supportive, creating passive resistance, or perhaps thinks he is helping but is actually hampering progress? Or is there just no champion. Again, involves very different processes.

It’s not entirely clear to me what this barrier description means. I can read it several ways. Is there a practice, owned by a hospital, that is trying to implement a change but the hospital’s staff is not helping, or is actively opposed? Or is this an organization that should be getting change management help from, for example, a regional extension center but the REC is just ignoring them? / / Lacking more detail, I approached this from the perspective that the outside entity is unhelpful so the organization has to compensate internally.

Issues related to context

The approach for these detail-less exercises would be easier to develop with more context or specific situation.

… it seems to me that unless one understands the factors that contribute to the lack of incentives, it is not possible to recommend with any confidence the utility of different strategies to address the issue. Similarly, the phase of implementation at which this problem is observed would have implications for the strategies likely to be effective. For example, at the early exploration phase, the extent to which such incentives, concrete or symbolic, could be cultivated in the organization and service system would be a point of discussion. Alternatively, if an innovative practice is implemented but does not reach sustainment, and the lack of incentives is identified as a factor contributing to the lack of sustainment, then the strategies to address the problem would likely differ.

Issues related to implementation strategies

Behavioral change strategies targeting motivation are lacking in the ERIC list.

Not sure any of these strategies would rectify poor communication and networks.

Technical issues

Website would not let me reorder this for some reason. Just an fyi. The order indicated here is close enough.

The drag and drop functionality is super hard to work with in this survey. I have done my best on rank ordering but OY! What a pain!

Nonspecific comments

OK

Proverbs 29:18. When there is no vision, the people perish. [peer pressure]