Tracking implementation strategies using the Iowa Implementation for Sustainability Framework (IISF) in real world settings: VA Office of Rural Health enterprise-wide initiatives

The VA Office of Rural Health (ORH) funds initiatives to improve the health of rural Veterans. A practical approach to examine patterns of implementation strategies use is needed. A specified taxonomy of implementation strategies has been applied in healthcare settings, and may provide insights into strategies selected, timing, and domains. The purpose of this study was to apply this taxonomy to examine patterns of implementation strategies used in evaluation reports from 26 enterprise-wide initiatives (EWIs) in real-world settings. This descriptive study used deductive content analysis to identify strategies used according to the Iowa Implementation for Sustainability Framework (IISF). Secondary analysis involved identifying strategies according to the IISF and examining patterns of utilization by phases, domains, RE-AIM (Reach, Adoption, Implementation, and Maintenance) dimensions, and rurality. Data were summarized using descriptive statistics. In 26 EWI reports, 1,032 strategies were catalogued. Sixty of 75 IISF strategies were reported. Across four IISF implementation phases, strategies were most frequently used in Phase 3- Promote Action & Adoption, 55.6% (f = 564) and in domains for Data (f = 390, 38.4%), Adaptation (f = 205, 20.2%), and Commitment (f = 197, 19.4%). EWIs applied an average of 39.7 (range 12–87) total strategies. Most strategies were reported in the Implementation (f = 397, 39.1%) dimension of the RE-AIM framework and in non-rural initiatives (average 45.3 vs. 33.8). The IISF proved to be a useful and pragmatic approach to identify implementations strategies from diverse real-world reports. Results further understanding of implementation strategies used by phase, and domain, potentially bridging understanding to mechanisms of action.