Applying a Race(ism)-Conscious Adaptation of the CFIR Framework to Understand Implementation of a School-Based Equity-Oriented Intervention

Objectives: To use the Consolidated Framework for Implementation Research (CFIR) adapted to a race-conscious frame to understand ways that structural racism interacts with intervention implementation and uptake within an equity-oriented trial designed to enhance student-school con­nectedness.Design: Secondary analysis of qualitative implementation data from Project TRUST (Training for Resiliency in Urban Students and Teachers), a hybrid effectiveness-imple­mentation, community-based participatory intervention.Setting: Ten schools across one urban school district.Methods: We analyzed qualitative ob­servational field notes, youth and parent researcher reflections, and semi-structured interviews with community-academic re­searchers and school-based partners within CFIR constructs based on framing questions using a Public Health Critical Race Praxis approach.Results: Within most CFIR constructs and sub-constructs, we identified barriers to implementation uptake not previously recognized using standard race-neutral definitions. Themes that crossed constructs included: 1) Leaders’ willingness to examine Black, Indigenous, People of Color (BIPOC) student and parent experiences of school discrimination and marginalization had a cascading influence on multiple factors related to implementation uptake; 2) The race/ethnicity of the principals was related to intervention engagement and interven­tion uptake, particularly at the extremes, but the relationship was complex; 3) External change agents from BIPOC communities facilitated intervention uptake in indirect but significant ways; 4) Highly networked implementation champions had the ability to enhance commitment to intervention uptake; however, perceptions of these indi­viduals and the degree to which they were networked was highly racialized.Conclusions: Equity-oriented interventions should consider structural racism within the CFIR model to better understand inter­vention uptake.Ethn Dis. 2021;31(Suppl 1):375-388; doi:10.18865/ed.31.S1.375

How do apprentices moderate the influence of organizational innovation on the technological innovation process?

This paper contributes to the literature on non-monetary benefits of Vocational Education and Training (VET) by investigating its influence on a firm’s innovation process. While an increasing number of studies finds positive effects of VET on innovation in firms, the role that apprentices play in this mechanism has largely been unexplored. To analyze this role, we use the distinction between technological and organizational innovation, two complementary forms of innovation. When investigating the initiators of organizational innovation, to date, research has primarily focused on internal and external change agents at upper echelons. We conceptualize apprentices as hybrid (a combination of internal and external) change agents at lower echelons. We examine how apprentices in the Swiss VET system are key to integrating external knowledge (through school-based education) with internal knowledge (through on-the-job training) and moderating the influence of organizational innovation on technological innovation. Drawing on a sample of 1240 firms from a representative Swiss Innovation Survey, we show that apprentices leverage the positive association between innovations in a firm’s business processes and organization of work with incremental innovations. With the description of a new mechanism that shows the significant role of apprentices on firms’ technological innovation activities and evidence for supportive associations between key variables, we contribute to the understanding of the influence of VET on innovation in firms.

Understanding the processes that Federally Qualified Health Centers use to select and implement colorectal cancer screening interventions: a qualitative study

Colorectal cancer (CRC) screening is highly effective at reducing cancer-related morbidity and mortality, yet screening rates remain suboptimal. Evidence-based interventions can increase screening rates, particularly when they target multiple levels (e.g., patients, providers, health care systems). However, effective interventions remain underutilized. Thus, there is a pressing need to build capacity to select and implement multilevel CRC screening interventions. We report on formative research aimed at understanding how Federally Qualified Health Center (FQHC) staff select and implement CRC screening interventions, which will inform development of capacity-building strategies. We report the qualitative findings from a study that used a mixed methods design, starting with a quantitative survey followed by a qualitative study. In-depth interviews were conducted with 28 staff from 14 FQHCs in 8 states. The Consolidated Framework for Implementation Research (CFIR) guided interview questions and data analysis. Related to the CFIR process domain, few respondents described conducting formal assessments of factors contributing to low screening rates prior to planning their interventions. Many described engaging champions, implementation leaders, and external change agents. Few described a systematic approach to executing implementation plans beyond conducting plan-do-study-act cycles. Reflection and evaluation consisted primarily of reviewing Uniform Data System performance measures. Findings also include themes related to factors influencing these implementation processes. Although FQHCs are implementing CRC screening interventions, they are not actively targeting the multilevel factors influencing their CRC screening rates. Our findings on gaps in FQHCs’ implementation processes will inform development of strategies to build capacity to select and implement multilevel CRC screening interventions.

The generation process of internal-driven management innovation in companies in transitional economies

Purpose The purpose of this paper is to analyze how internal-driven management innovation (IDMI) takes shape, which highlights the objective-oriented and problem-oriented property of the innovation. Design/methodology/approach Based on a case study of a new practice called 11X integration strategy in Guangzhou Pharmaceutical Holdings Limited, a Chinese pharmaceutical group in Guangdong province, through applying Grounded Theory the authors get a concise systematic framework of generation process that is more practical and more understandable than the counterparts in current literature. Findings First, this paper uncovers five stages and two parallel sub processes in the generation process of IDMI. The sub processes involves practical exploration process (i.e. primary activities) carried out by the internal change agents and theoretical support process (i.e. support activities) carried out by the external change agents. Second, by adopting a process perspective the authors are able to demonstrate how the different activities in both types of processes are combined over time in an intertwined way. Research limitations/implications First, the case the authors studied is embedded in the context of China’s transitional economy, and the single case study limits us to make comparisons of the generation process of management innovation between different market economies. Second, the external-driven management innovation is still a field untouched. Third, in the research the authors explore the issues of how new management innovation is generated and implemented, but the authors do not systematically research on why different companies exhibit different levels of management innovativeness. Practical implications First, the findings suggest that firms should consciously and systematically invest in IDMI to create sustainable competitive advantage. Second, the process framework provides a clear guidance to the managers in Chinese state-owned enterprises who are engaged in developing or adopting management innovation. Third, the study indicates the managers in Chinese company should be aware of the importance of external change agents to IDMI. Fourth, this study could facilitate the enterprises to develop or adopt management innovation based on their real needs rather than just “jumping on the bandwagon” when adopting certain new management skills. Originality/value This study offers a new generation framework by identifying possible facilitators of IDMI that does not yet exist in extant literatures, and the two sub processes – the practical exploration process and the theoretical support process – deepen the understanding of the generation mechanisms of IDMI. Furthermore, the study contributes to reaching a better understanding of management innovation in the context of transitional economy such as China.

Structuring collective change agency internally

Purpose The purpose of this paper is to identify, describe and evaluate the different ways in which formal collective change agency is structured in specialist units inside 25 diverse organisations. As such it is oriented towards a range of practitioners operating in HR, project management or with responsibility for delivering change in public and private sectors. Design/methodology/approach Using a qualitative design, exploratory interview and case study research was conducted in organisations across the UK public and private sectors to explore how different change agency units operate within organisational structures. Findings Four dominant types of internal change agency unit are identified, varying in terms of their change impact scope and degree of structural embeddedness in the organisation. These units are described as transformers, enforcers, specialists and independents and share key concerns with securing client credibility and added value, effective relationship management and the use of consulting tools. Their roles and the tensions they experience are outlined along with hybrid forms and dynamic shifts from one type to another. Research limitations/implications The study could be extended outside of the UK and conducted longitudinally to help identify outcomes more precisely in relation to context. Practical implications Each of the four types of change agency unit identified is shown to be suited to certain conditions and to present particular challenges for collective change agency and for specialist management occupations engaged in such work. The analysis could usefully inform organisation design decisions around internal change agency. Originality/value The authors extend debates around the nature of internal change agency which has typically focussed on comparisons with external change agents at the level of the individual. Developing the work of Caldwell (2003), the authors reveal how emergent, team-based or collective approaches to change agency can be formalised, rather than informal, and that structural considerations of change need to be considered along with traditional concerns with change management.