Iowa Implementation for Sustainability Framework©

Iowa Implementation for Sustainability Framework diagram

Implementing evidence-based practice (EBP) changes can be challenging. The Iowa Implementation for Sustainability Framework is an update to the Implementation Strategies for Evidence-Based Practice guide. The framework is based on Rogers Diffusion of Innovation theory and validated by users.

Phases in the Iowa Implementation for Sustainability Framework are identified across the top of the framework with implementation strategies in columns. The arrows at the top, point forward and backward, representing the non-linear nature of implementation within complex health systems in which clinicians work and patients receive healthcare. Implementation strategies are placed in the primary phase—where they best match the intended phase purpose. However, implementation strategies do not narrowly fit into a single point in time and the superscript indicates additional phases in which strategies may be effective. Clusters of related strategies are listed as domains across phases. Domain names are listed vertically on the far left (shaded). Use the domains to guide consideration of strategies by their intention and the potential function of their mechanism of action. Notice the strategies cascade across the phases and domains. The top domains reflect early needs for information (i.e., Marketing, Information, and Learning). The next domains are crucial to changing attitudes and behaviors to support adoption (i.e., Commitment, Change Agents, Decision Support, and Adaptation). Notice that strategies within the Decision Support and Adaptation domains are also key to uptake of the localized EBP protocol. The strategies in the lower three domains may support adoption and also function to sustain the change (i.e., Data, Organizational Infrastructure, and Reinforcement). Strategies in bold are supported by at least some empirical evidence in healthcare. Strategies need to be bundled from across phases and domains, no single strategy will be sufficient. Consider the intent of each phase and domain when developing your implementation plan. After creating your initial plan, confirm that you included strategies cascading across the Iowa Implementation for Sustainability Framework.

Implementation is an important step in the EBP process and the framework can fit synergistically within that step of an EBP process model. This resource has global reach and is a pragmatic resource to promote adoption and integration of evidence-based health care. Numerous implementation strategies are included to provide a large set of options for clinicians leading practice improvements.

Request for permission to use and/or reproduce the Iowa Implementation for Sustainability Framework


Cullen, L., Hanrahan, K., Edmonds, S. W., Schacht Reisinger, H., & Wagner, M. (2022). Iowa implementation for sustainability framework. Implementation Science, 17, 1-20.