Table 1 Definitions for 5 primary CFIR domains and domain operationalization

Innovation Domain

“The ‘thing’ being implemented, e.g., a new clinical treatment, educational program, or city service”*

A nudge to inform surgeons’ behaviors around post-surgical opioid prescribing

Outer Setting Domain

“The setting in which the Inner Setting exists, e.g., hospital system, school district, state. There may be multiple Outer Settings and/or multiple levels within the Outer Setting, e.g., community system, state”*

The larger Sutter Health healthcare system; California’s regulatory policies and requirements; national context (USA)

Inner Setting Domain

“The setting in which the innovation is implemented, e.g., hospital, school, city. There may be multiple Inner Settings and/or multiple levels within the Inner Setting, e.g., unit, classroom, team”*

Three surgical departments (ob/gyn, general, orthopedic) within the 19 Sutter Health hospitals included in the study

Individuals Domain

“The roles and characteristics of individuals”*

Sutter Health leaders and their involvement; surgeons’ professional roles and engagement in the intervention

Implementation Process Domain

“The activities and strategies used to implement the innovation”*

Composition of the research team; shaping of the study design; expanding the innovation’s reach through planning and engagement