Table 1

Description of the three theoretical perspectives guiding the case study



Promoting Action on Research Implementation in Health Services (PARiHS)


'[K]nowledge derived from a variety of sources that has been subjected to testing and has found to be credible' [85]. Four sources of evidence are research, clinical experience, patient experience, and local information.


The 'environment or setting in which people receive healthcare services, or... the environment or setting in which the proposed change is to be implemented' [86]. Context consists of:

• Culture manifests itself through the values, beliefs, and assumptions embedded in organizations and is reflected in 'the way things are done around here' [86].

• Leadership 'summarizes the nature of human relationships such that effective leadership gives rise to clear roles, effective teamwork, and effective organizational structures' [86].

• Evaluation includes performance monitoring and feedback at the individual, team, and system levels.


A 'technique by which one person makes things easier for others' [60]. Facilitation models range from doing for others to enabling others.

Organizational framework of innovation implementation

Management support

Managers' commitment to the implementation process, including investments in quality implementation policies and practices.

Financial resource availability

The actual or potential resources that allow an organization or team adapt to, implement, and sustain change.

Implementation policies and practices

'[T]he formal strategies (i.e., the policies) the organization uses to put the innovation into use and the actions that follow from those strategies (i.e., the practices)' [59].

Implementation climate

'Employees' shared perceptions of the importance of innovation implementation within the organization' [87]. The extent to which employees view innovation use is 'rewarded, supported, and expected within their organization' [88].

Innovation-values fit

'[T]he perceived fit between the innovation and professional or organizational values, competencies and mission' [59].


'Charismatic individuals with significant personal authority who identify with the innovation and throw their weight behind its adoption and implementation' [59].

The need for systems change*

Nature of knowledge

'The way in which participants (individuals) in the system understand the nature and characteristics of the new piece of knowledge and accept it' [49].

Local autonomy

The extent to which individuals, team, and the unit involved 'can make informed, autonomous decisions about how they can use the new knowledge to improve outcomes' [49].


How individuals 'negotiate and renegotiate relations with others (individuals, teams, internal, external relations) in their system' [49].


How individuals 'attract necessary resources to sustain the changes/improvements in practice' [49]. Involvement of key stakeholders at various levels of the system is critical to controlling and attracting resources.

*In this recent theoretical paper, Kitson [49] critiqued the critical social science, action science, diffusion of innovations, practice development, management of innovations, and learning organizations and systems theories literature to explore the underlying assumptions and theories used to describe healthcare systems and how knowledge is translated into practice.

Urquhart et al. Implementation Science 2012 7:12   doi:10.1186/1748-5908-7-12

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