Phase 3
Ongoing Structure
Using all of the information collected and organized in Phase 1 of the implementation process, the newly developed implementation team and other stakeholders need to  build a plan for how they will successfully implement the intervention. This plan should outline the tasks to be completed, the people working on the tasks, what support will be available, and how that support will intersect with the teams doing the work. 
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For this step, the implementing organization needs to:
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create a clear plan that includes specific tasks and timelines to enhance accountability during implementation. 
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determine the challenges to effective implementation and how they can proactively address them. 
Toolkit Home | Phase 1 | Phase 2 | Phase 3 | Phase 4
pCAT
The Pragmatic Context Assessment tool (pCAT) is a brief data collection instrument to help implementation teams identify barriers and facilitators to implementing changes within their healthcare settings. The tool was designed to be used with frontline healthcare staff and quality improvement or implementation teams, and it was developed as an initial, planning tool to (1) assess local context; (2) prioritize areas that need attention prior to implementation; and (3) inform implementation strategy selection or development. ​
Who should use pCAT?
pCAT is useful for teams trying to gain initial insight to the potential implementation barriers. It does not always capture the complexity of large organizations or projects. This tool is specifically useful for teams with simpler projects or systems or teams that are using pCAT in tandem with other tools to capture a larger picture of the implementation context.
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How does the tool help with Implementation?
The pCAT supports work an implementation team may do to develop their implementation plan in Phase 2 of the QIF. Specifically, when working through the Model for Implementation, the pCAT can be a useful tool for identifying and prioritizing implementation barriers.
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Resources recommended:
Time: The pCAT is designed to be easy to use and should not take teams long to complete the assessment. Time light resource.
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People: The more people who assess the implementation context, the more useful the pCAT will be for the team. Personnel medium resource.
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Funding: The only cost for the tool itself is the personnel time to complete the assessment. Funding medium resource.
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Pragmatic Context Assessment Tool
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Slide deck with introduction to the tool along with a template with all 16 contextual assessment questions.
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CFIR
The Consolidated Framework for Implementation Research (CFIR) provides a comprehensive overview for assessing contextual factors that influence implementation of effective interventions. CFIR has been used to guide systematic evaluation of potential implementation barriers, and it can be used to help implementation teams develop tailored implementation strategies. ​CFIR includes 39 constructs organized into five domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process.
Who should use CFIR?
Teams that have identified potential barriers or facilitators in earlier assessments that may have large impacts on the interventions they are trying to implement.
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How does the tool help with Implementation?
Within the second phase of the QIF, implementation teams will focus on developing their implementation plan, guided by walking through the questions of the Model for Implementation. CFIR, and associated data collection tools, provides a framework to gather insights about implementation factors (i.e., barriers and facilitators) that they can then develop strategies or approaches to address. Teams could use the pCAT to collect information about factors at a high level, or they could adapt the CFIR interview guide to conduct qualitative data collection with multiple stakeholders to achieve a deeper understanding of the implementation context. ​
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Resources recommended:
Time: To fully engage 39 constructs that make up CFIR, the team will need to spend considerable time working with the tool. These constructs can inform a conversation around barrier, facilitators, and potential adaptations to the interventions. Time heavy resource.
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People: The more people who assess the implementation context, the more useful the CFIR will be for the team. Personnel medium resource.
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Funding: The only cost for the tool itself is the personnel time to complete the review. Funding medium resource.
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Slide deck that includes an introduction to CFIR, information on each construct, and examples of how teams can apply these constructs.
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Detailed information about CFIR and the full list of constructs.
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HEIF
The HEIF was developed by adapting the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to incorporate three additional health equity domains: (1) culturally relevant factors of recipients (e.g., implicit bias, SES, race/ethnicity, language, health literacy, trust in providers); (2) patient-provider interactions; and (3) social determinants of health or societal context (e.g., economy, physical structures, sociopolitical factors). The framework can be used by implementation teams to assess potential barriers and facilitators to implementation, develop tailored implementation strategies that account for and address inequities, and guide evaluation of the implementation process through an equity lens. ​
Who should use HEIF?
Teams should be approaching their interventions while being mindful of equity. Even for projects that are not immediately focused on equitable outcomes, teams should take time to consider their interventions through this framework.
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How does the tool help with Implementation?
The HEIF can be used in conjunction with CFIR to identify barriers and facilitators to implementation in the initial phases of the QIF. Implementation teams might consider referencing the HEIF as they determine relevant implementation determinants (e.g., factors, barriers, facilitators) or as they develop an implementation mechanistic logic model. Strengths of the HEIF include providing a framework that explicitly addresses health equity in implementation, and building on an established IS framework. The HEIF has limited empirical testing and therefore may not capture all relevant equity factors in certain settings, but it offers an important frame for understanding barriers to implementation from an equity lens.
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Resources recommended:
Time: Teams should take time to think through the HEIF and use it to inform a nuanced discussion on implementation determinants. Time medium resource.
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People: The more people who assess the implementation determinants, the more useful the HEIF will be for the team. Personnel medium resource.
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Funding: The only cost for the tool itself is the personnel time to complete the review. Funding medium resource.
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Slide Desk introducing the Health Equity Implementation Framework.
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Fidelity Checklist
The Fidelity Checklist is an assessment tool used to determine the extent to which the intervention was implemented with Fidelity. The slides associated with this tool include step-by-step directions for developing a fidelity checklist relevant to your intervention. This tool also includes examples of existing fidelity checklists, and some information for how you might begin to interpret your fidelity data. ​
Who should use Fidelity Checklist?
Any team new to working on implementation projects would find value in creating and completing a Fidelity Checklist to assess their project. The more complicated the implementation process is, the more useful developing a formal checklist becomes.
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How does the tool help with Implementation?
Results from a fidelity checklist are useful at multiple points along the QIF. During the second phase, fidelity assessments can help operationalize how the intervention should be delivered, thus informing the implementation plan. Fidelity assessment results can also be helpful in the third QIF phase, as implementation teams can use the data to guide ongoing learning and opportunities for coaching or additional training. Finally, fidelity is a key implementation outcome and informs the summative evaluation of an implementation effort in the final stage of the QIF. One strength of a developed fidelity assessment is that it provides teams with a standardized way to gather fidelity data. Unfortunately, there may not be an existing, validated fidelity checklist for every intervention being implemented. Another weakness of fidelity checklists is that they do not always capture the nuance and/or context of an implementation setting. ​
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Resources recommended:
Time: The time it will take teams to create and use a Fidelity Checklist will depend on the complexity of the implementation process and the outcomes they hope to measure. Time medium resource.
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People: The core implementation team will be primarily in charge of working on Fidelity Checklist. Personnel medium resource.
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Funding: The only cost for the tool itself is the personnel time to complete the review. Funding medium resource.
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The tool is a slide deck with an introduction slide, directions for developing a checklist, and details on how to interpret fidelity data.
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RE-AIM
Training that focuses on how to use the RE-AIM framework to evaluate an intervention. Specifically, RE-AIM can be used to assess interventions' translatability and public health impact. Re-AIM specifically evaluates: 
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Reach into the target population
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Effectiveness or efficacy
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Adoption by target staff, settings, systems and communities
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Implementation – consistency and cost of delivery of intervention
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Maintenance/sustainment of intervention effects in individuals and settings over time.
Who should use RE-AIM?
All implementation teams would benefit from working through the RE-AIM training. In particular teams working with complicated or untested interventions would benefit from working through the full RE-AIM framework to build a comprehensive evaluation process. 
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How does the tool help with Implementation?
As teams develop their interventions, they should use RE-AIM to develop a summative evaluation plan to assess the validity of the interventions throughout the implementation process. Using a thorough evaluation method like RE-AIM will ensure that the intervention meets the needs of all care centers in real time.
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Resources recommended:
Time: Using the RE-AIM framework to design and implement a full evaluation process for the team's intervention can be time intensive depending on the needs of the team. Time heavy resource.
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People: Most of the implementation planning team should be involved in developing the evaluation process with input from those directly working with the interventions. Personnel medium resource.
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Funding: The only cost for the tool itself is the personnel time to create and implement the evaluation process. Funding heavy resource.
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Slide deck with introduction to the RE-AIM framework along with training slides that describes each component of the framework along with examples.
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NoMad
The measure captures how the work involved in an intervention must be understood, acted upon, and monitored by various stakeholders involved in the intervention. ​NoMad includes four sets of questions that line up with the four components of the Normalization Process Theory.​
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Coherence (C1) – What is the intervention?​
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Participation (C2) – Who does the work of the intervention​
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Action (C3) – How does the intervention get done? ​
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Monitoring (C4) – reflecting on why the intervention was carried out in a particular way. ​
Who should use NoMad?
The NoMAD helps teams measure how integrated an intervention is into organizational practice, helping the team understand how that the intervention might be sustained beyond the initial implementation.
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How does the tool help with Implementation?
For the QIF, the NoMAD should be administered during phase 4 as teams are assessing the implementation process, though the information informs the sustainability of the intervention beyond the scope of the QIF. ​The NoMAD can be paired with the PSAT to provide more details on how the intervention is functioning within an organization to gain a full view on the extent to which an intervention may be sustained and the factors that impact sustainability. ​
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Resources recommended:
Time: Filling out NoMad questionnaire itself should not take the implementation teams long, but they will need to set time aside tor review and analyzing their findings. Time light resource.
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People: The core implementation team will be primarily in charge of working on the NoMad. Personnel light resource.
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Funding: The only cost for the tool itself is the personnel time to complete the review. Funding light resource.
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Slide deck with introduction to the RE-AIM framework along with training slides that describes each component of the framework along with examples.
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