Measuring implementation: development of the implementation process assessment tool (IPAT)

M Hartveit; E Hovlid; M H A Nordin; J Øvretveit; G R Bond; E Biringer; J Assmus; G H Mariniusson; T Ruud

doi:10.1186/s12913-019-4496-0

Measuring implementation: development of the implementation process assessment tool (IPAT)

BMC Health Serv Res. 2019 Oct 21;19(1):721. doi: 10.1186/s12913-019-4496-0.

Authors

M Hartveit^{1

2}, E Hovlid^{3

4}, M H A Nordin⁵, J Øvretveit⁶, G R Bond⁷, E Biringer⁸, J Assmus⁹, G H Mariniusson¹⁰, T Ruud^{10

11}

Affiliations

¹ Department of Research and Innovation, Helse Fonna Local Health Authority, Haugesund, Norway. miriam.hartveit@helse-fonna.no.
² Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway. miriam.hartveit@helse-fonna.no.
³ Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
⁴ Department of Social Science, Western Norway University of Applied Sciences, Sogndal and Norwegian Board of Health Supervision, Oslo, Norway.
⁵ Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.
⁶ Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
⁷ IPS Employment Center, Westat, Rivermill Commercial Center, Lebanon, USA.
⁸ Department of Research and Innovation, Helse Fonna Local Health Authority, Haugesund, Norway.
⁹ Haukeland University Hospital, Centre for Clinical Research, Bergen, Norway.
¹⁰ Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
¹¹ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Abstract

Background: Implementation science comprises a large set of theories suggesting interacting factors at different organisational levels. Development of literature syntheses and frameworks for implementation have contributed to comprehensive descriptions of implementation. However, corresponding instruments for measuring these comprehensive descriptions are currently lacking. The present study aimed to develop an instrument measuring care providers' perceptions of an implementation effort, and to explore the instrument's psychometric properties.

Methods: Based on existing implementation literature, a questionnaire was designed with items on individual and team factors and on stages of change in an implementation process. The instrument was tested in a Norwegian study on implementation of evidence based practices for psychosis. Item analysis, factor structure, and internal consistency at baseline were examined.

Results: The 27-item Implementation Process Assessment Tool (IPAT) revealed large variation between mean score of the items. The total scale scores were widely dispersed across respondents. Internal consistency for the total scale was high (Cronbach's alpha: .962), and all but one item contributed positively to the construct. The results indicated four underlying constructs: individual stages for behavioural change, individual activities and perceived support, collective readiness and support, and individual perceptions of the intervention.

Conclusions: The IPAT appears to be a feasible instrument for investigating the implementation process from the perspective of those making the change. It can enable examination of the relative importance of factors thought to be essential for implementation outcomes. It may also provide ongoing feedback for leaders tailoring support for teams to improve implementation. However, further research is needed to detect the instrument's properties later in the implementation process and in different contexts.

Trial registration: ClinicalTrials.gov code NCT03271242 (retrospective registered September 5, 2017).

Keywords: Implementation; Quality improvement; Readiness.

MeSH terms

Female
Health Services Research
Humans
Implementation Science
Male
Process Assessment, Health Care / methods*
Psychometrics
Surveys and Questionnaires

Associated data

ClinicalTrials.gov/NCT03271242