The EPIS model acknowledges the interrelated nature of the outer context and inner context constructs. Reflective of this, EPIS classifies those factors that span the outer and inner contexts as bridging factors. Bridging factors include structures and processes such as community-academic partnerships, existing and developing relations between policy and practice entities (e.g., government and health care provider organizations), formal and informal influence and directives, and work of purveyors/intermediaries. These issues and processes can be complex. For example, a better understanding of the process of collaboration is needed so that collaboration management and navigation can help to keep focus on long term goals and outcomes that keep partners and stakeholders engaged and involved.

Inter-connections, interactions, linkages, relationships

As exemplified by the bridging factors, the outer and inner contexts are dynamic and interactive, with elements from both having a significant impact on the innovation and the implementation process such that you often see the impact across contextual levels. For example, leadership is a factor that spans both the inner and outer contexts and has an impact within and across levels. Further, innovation/EBP fit is a critical multilevel factor that encompasses the fit to the system, organization, provider and/or patient or client. Factors unique to the inner or outer context also interact and impact one another. Policy and sustained funding (outer context), for instance, interact with one another and are needed in order to promote optimal organizational readiness and climate and support ongoing training and fidelity monitoring (inner context).