Image
Image
Micro level
Characteristics of the individual providers, persons/patients, or clients.
Now that you have identified your stakeholders, you can engage them to assess the context in which the knowledge will be integrated. Assessing the local context can help you and your stakeholders understand more about how the knowledge can fit into the end-users' setting. This is important so that you can optimize the knowledge uptake.
Image
Knowledge created for one setting may not be suitable or feasible for your local context. For example, you may notice differences in scopes of practice or regional legislation. You may be concerned that best practices will be challenging to adopt due to a lack of skill, expertise, equipment, or staffing in your organization (Harrison et al., 2010). Furthermore, some recommendations may not be culturally appropriate or acceptable to staff or persons/patients (Harrison et al., 2013; RNAO, 2012).
Context Levels
Context can be viewed at three different levels (Nilsen et al., 2020):
Image
Meso level:
Characteristics of the organization (culture, climate, infrastructure and support)
Image
Macro level:
Characteristics of political and economic forces beyond an organization (e.g., legislation, funding, national guidelines, policies; collaborations with other organizations)
Context dimensions and their description
Context has been described and categorized by researchers in many different ways (Li et al., 2018; Nilsen & Bernhardsson, 2019; Squires et al., 2019a; Squires et al., 2019b) that span across the micro, meso and macro levels. The list below includes the 12 most commonly considered context dimensions to influence the implementation of a practice change or intervention (Nilsen & Bernhardsson, 2020).
Micro level
Image
Individuals
Persons/patients’, clients’, or clinicians’ preferences, expectations, attitudes, knowledge, needs and resources that can influence implementation
Meso level
Image
Organizational culture and climate
Shared visions, norms, values, assumptions and expectations in an organization that can influence implementation (i.e., organizational culture) and perceptions and attitudes concerning the observable aspects of culture (i.e., climate).
Organizational readiness for change
Influences on implementation related to an organization’s commitment or preparation to implement change, the organization’s prioritization of implementing change, the organization’s ability to implement change, practicality, and the organization’s flexibility and innovativeness.
Organizational support
Various forms of support that can influence implementation, including administration, planning and organization of work, availability of staff, staff workload, staff training, material resources, information and decision-support systems, consultant support and structures for learning.
Organizational structures
Influences on implementation related to structural characteristics of the organization in which implementation occurs, including size, complexity, specialization, differentiation and decentralization of the organization.
Macro level
Image
System-wide environment
External influences on implementation in health care organizations, including policies, guidelines, research findings, evidence, regulation, legislation, mandates, directives, recommendations, political stability, public reporting, benchmarking and organizational networks.
Multiple (micro, meso, macro) levels
Social relations and support
Influences on implementation related to interpersonal processes, including communication, collaboration and learning in groups, teams and networks, visions, conformity, identity and norms in groups, opinion of colleagues.
Financial resources
Funding, reimbursement, incentives, rewards, costs and other economic factors that can influence implementation.
Leadership
Influences on implementation related to formal and informal leaders, including managers, key individuals, change agents, opinion leaders, champions, etc.
Time availability
Time restrictions that can influence implementation evaluation, assessment and various forms of mechanisms that can monitor and feedback results concerning the implementation, which can influence implementation.
Feedback
Evaluation, assessment and various ways that can monitor and feedback results concerning the implementation, which can influence implementation.
Physical environment
Features of the physical environment that can influence implementation, e.g., equipment, facilities and supplies.
SOURCE: Nilsen & Bernhardsson, 2020
Interacting effects of contextual factors
Keep in mind that contextual factors are interrelated; these factors work synergistically to promote or hinder implementation efforts. For example, lack of staff time and insufficient funding will likely affect the organization’s readiness for change. On the other hand, enthusiastic leaders and the presence of champions can help create a positive organizational culture and climate (Nilsen & Bernhardsson, 2019).
"Deadly Combinations"
Different contextual factors that are unfavourable to your change initiative can work together to hinder or even halt implementation efforts (Johns, 2006; Li et al., 2018). For example, a culture that is not supportive of change, coupled with limited resources (time, funding) dedicated to the implementation effort, will likely negatively influence the outcome.
It is important to assess your context and consider the various factors that could affect the success of your initiative. You can assess your context based on the 12 common context dimensions listed above or you can refer to the validated tools for a more detailed assessment.
