Integrating the Consolidated Framework for Implementation Research (CFIR) and Tensions into a Novel Conceptual Model for Telehealth Advancement in Healthcare Organizations

Telehealth services have potential to enhance access to quality healthcare, reduce costs, and increase satisfaction for both patients and providers. As a disruptive healthcare innovation, telehealth disorders old systems and creates a new hybrid model of care that delivers significant value to stakeholders. However, the failure rate of innovation implementation in healthcare ranges from 30% to 90%, depending on the complexity involved. While researchers have conducted extensive studies on the barriers and facilitators to widespread innovation implementation, the root causes of innovation implementation failure in health services (eg, telehealth implementation failure) are not fully understood. The Consolidated Framework for Implementation Research (CFIR) introduced in 2009 has become increasingly popular as a framework for informing successful innovation implementation in health services. The CFIR identifies barriers and facilitators to innovation implementation across five domains of implementation-the innovation, individual, inner, outer, and process domains. However, it lacks a mechanism to capture the complex social challenges (tensions) underlying the barriers and facilitators that affect implementation success or failure. The Tensions framework supplies a foundation beyond barriers and facilitators to provide a dynamic understanding of the role of social conflicts impacting the implementation process. This paper presents a novel conceptual model, Tensions in Innovation Implementation Processes (TIIPs), which integrates tensions and management strategies within the CFIR framework. A key contribution of TIIPS is its ability to visualize the social conflicts within and across implementation domains, offering a clearer understanding of the challenges and opportunities involved in innovation implementation. We apply TIIPs to telehealth implementation, drawing implications for practice, policy, and research to enable successful telehealth implementation in healthcare organizations. This approach advances existing frameworks, aligning with the systems thinking essential for today's healthcare leadership.