Table 1 Published healthcare improvement frameworks

Context and Implementation of Complex Interventions (CICI)

Pfadenhauer et al. 2016 [13]

Facilitates conceptualisation and assessment of context in implementation of complex interventions. Focuses on understanding and/or explaining what influences implementation outcomes.

Three integrated dimensions—context, implementation and setting—which interact with one another and with the intervention dimension. Context comprises seven domains: geographical, epidemiological, socio-cultural, socio-economic, ethical, legal, and political.

The Model for Understanding Success in Quality (MUSIQ)

Kaplan et al. 2012 [29]

Attempts to embed context in QI efforts. Targeted at microsystem and organisational efforts.

Identifies 25 key contextual factors at different levels of the healthcare system that are likely to influence the success of quality improvement efforts. Five domains: microsystem, QI team, QI support and capacity, organisation, and external environment.

Consolidated Framework for Implementation Research (CFIR)

Damschroder et al. 2009 [6]

Implementation framework comprising of constructs from 19 published implementation theories.

For studying and planning implementation of health services research findings into practice. Provides a basis for studying context influences.

Integrates implementation, setting and context. Five domains: intervention, outer setting, inner setting, individuals, and process. Outer setting, inner setting and the characteristics of individuals are considered aspects of context.

Context Assessment Index (CAI)

McCormack et al. 2009 [28]

Validated instrument for QI context assessment in implementing evidence-based practice. Allows clinicians to assess and understand the context in which they work and the effect this has on using evidence in practice.

37-item instrument. Assesses three elements of context: culture, leadership and evaluation.

Promoting Action on Research Implementation in Health Services (PARiHS)

Kitson et al. 2008 [27]

Implementation framework targeted at implementation of evidence and innovations. Used to explain and/or predict success of evidence into practice implementation.

Presents successful research implementation as a function of the interactions between three key domains: evidence, context and facilitation.