Implementation Science

The Key Concepts

Frances Rapport, Robyn Clay-Williams, Jeffrey Braithwaite, Frances Rapport, Robyn Clay-Williams, Jeffrey Braithwaite

• Publisher: Routledge
• Year: 2022
• ISBN:
  9781000583458
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This accessible textbook introduces a wide spectrum of ideas, approaches, and examples that make up the emerging field of implementation science, including implementation theory, processes and methods, data collection and analysis, brokering interest on the ground, and sustainable implementation.

Containing over 60 concise essays, each addressing the thorny problem of how we can make care more evidence-informed, this book looks at how implementation science should be defined, how it can be conducted, and how it is assessed. It offers vital insight into how research findings that are derived from healthcare contexts can help make sense of service delivery and patient encounters. Each entry concentrates on an important concept and examines the idea's evidence base, root causes and effects, ideas and applications, and methodologies and methods. Revealing a very human side to caregiving, but also tackling its more complex and technological aspects, the contributors draw on real-life healthcare examples to look both at why things go right in introducing a new intervention and at what can go wrong. Implementation Science: The Key Concepts provides a toolbox of rich, contemporary thought from leading international thinkers, clearly and succinctly delivered.

This comprehensive and enlightening range of ideas and examples brought together in one place is essential reading for all students, researchers, and practitioners with an interest in translating knowledge into practice in healthcare.

Part I Principles and concepts of implementation science

Setting the scenePrinciples and concepts of implementation science

Frances Rapport, Robyn Clay-Williams, and Jeffrey Braithwaite

DOI: 10.4324/9781003109945-2

In this very first section of the book, Part I, authors, individually or in collaboration, examine a wide range of issues that are fundamental to the reader’s understanding of the principles and concepts of implementation science. This includes essays on how to get evidence into practice and the theories, models, and frameworks supporting evidence implementation. As Jeffrey Braithwaite reminds us in his opening essay, this is not as simple as it sounds. Moving evidence into practice, irrespective of its source, is not a “linear proposition”, and as a result, implementation science is a considerably complex science – sometimes, infuriatingly so. Evidence often needs to be carefully deconstructed and intelligently reconstructed to ensure that a composite and comprehensive body of knowledge is put forward from which to build an implementation science study.

In this section authors also investigate the background to implementation science, not only to the benefit of newcomers to the subject but also to remind those more familiar with the topic as to where the “science” in implementation science derives and which key principles and practices drive the implementation. In Part I, authors examine the evidence that is vital for planning and preparing a coherent study, with essays from Ellen and Perlman and Woods and Rayo, taking a systems-view approach to understand potential improvement and sustained service delivery. Woods and Rayo, for example, consider how systems support resilient performance in enabling healthcare professionals to deal with both “successes and setbacks”.

In examining the principles of implementation science in this first section, we learn from Kilbourne what implementation science really stands for; how it can most usefully function, flex, and adapt to different healthcare scenarios; and what purpose this serves. Clark takes us another step along the road to enquiry, describing humanism, in particular his expert understanding of medical humanism, to expand implementation science’s strength of character. Clark describes the scope of implementation science as part of a medical humanism paradigm, which has the capacity to nurture the next generation of healthcare professionals and encourage them to uphold qualities of compassion and care.

Part I also pays homage to theory-building – seeing theory as the mainstay of methodological development while linking implementation science to the translation of research findings in real-world scenarios in clinical and non-clinical practice. In discussing theory, Kislov and Wilson and Nilsen adeptly present cases for implementation science models and frameworks which can guide the implementation of research findings, and which can also expand ideas and create knowledge, while helping others understand the effects of implementation outcomes. This section follows a clear pathway of discovery, through specific implementation science frameworks to implementable interventions. Damschroder describes the Consolidated Framework for Implementation Research (CFIR); Lorencatto updates us on the Theoretical Domains Framework (TDF); Birken explores Organization Theory; Moullin and Aarons, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework; and Yu, Diffusion of Innovation theory. All these authors offer clarifying depictions of ways of organizing and delivering healthcare and guiding implementation research, processes, and practices. Some frameworks, such as the TDF, for example, according to Lorencatto, concentrate on contextual influencers of behaviour, both “current and desired”. Others, such as the CFIR, from Damschroder, guide the “assessment of context” and “constructs that have the potential to significantly affect implementation outcomes”.

Smith and Durcinoska, taking a different angle, peer inside the health-related quality of life (HRQOL) black box and eloquently present the reader with the value of Patient Reported Outcome Measures, or PROMs, to evaluate HRQOL “in research, investigating the experience and treatment of various health conditions”. They examine how implementation frameworks can guide PROM implementation as well as help overcome PROM implementation barriers and leverage enablers according to context and implementation stages. From this essay, we move on to Elwyn’s strong reflection on the value of shared decision-making and Lamprell’s considered view of “nudge” as a behaviour-change paradigm. Both Elwyn and Lamprell challenge us to think about who is making the decisions in the healthcare context and for what reason healthcare professionals hold on to old habits. In the case of Elwyn’s essay, this refers to the lack of shared decision-making with patients and unresolved management of differing views of healthcare professionals and patients. In the case of Lamprell’s essay, this refers to how compliance in workplace behaviour can be achieved and leads to commentary on the need to find adaptive processes to positively affect decision goals.

Finally, Part I turns to the challenge of moving from the theoretical to evidence building, design, and application. To link to Part II, Methodology and Methods of Implementation Science, Part I concludes with Hill and Knox’s essay on pipeline and cyclical models of evidence building. In this piece the authors consider evidence building as a pipeline, moving from developing evidence to expanding knowledge, and somewhere at the end of the line, developing, testing, and creating an effective, long-lasting intervention.

Introduction to the book

This book is a compilation of 60 essays, each tackling a very different, unique, and singular “key concept” in implementation science, from the viewpoint of the author or authors. Collectively, the book aims to document the field’s state of the art and convey the vocabulary of modern-day implementation science. The book has been carefully crafted so that every essay not only is a personalized piece about a topic close to the heart of the author but also represents a fascinating journey through the complex labyrinth that is implementation science.

Each essay, from brief 500-word testimonials to lengthier 1,000-word tomes, is expressive but is still able to distil wisdom for the widest of audiences – students, teachers, researchers, social scientists, implementation scientists, healthcare professionals, policymakers, and allied healthcare professionals.

The book has been edited to stand as a companion piece to the research literature as a compendium, expressing a multitude of theoretical, methodological, and practical insights. The way it has been written, including a mapping system to guide different audiences through the book, emphasizes essays of particular appeal to readers who are new to the topic and those more au fait with the subject.

It has been written for maximum interest by many of the “glitterati” of implementation science, brought together from the corners of the globe to discuss pure implementation science topics, such as translation, adoption, dissemination, diffusion, and take-up, through to many related and highly practical matters such as how to prepare for implementation, the politics and cultures of implementation settings, and the processes and practices involved in engagement. While authors have not shied away from deeply theoretical topics, some have reflected on tried and tested methods, while others have brought to attention new frameworks underpinning implementation science.

Writers have joined together from Australia and the United Kingdom, North America and Canada, South America, Europe, and Asia. Together this book delivers thoughtful and thought-provoking contributions that are versatile and inventive, academic and clinically excellent, and theoretically diverse. They include examples and case studies that illustrate a multitude of new ideas or take a fresh approach to an old concept. The book shines a light on Complex Adaptive...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• List of figures
• List of tables
• List of boxes
• List of contributors
• Foreword
• Acknowledgements
• List of abbreviations
• List of models, theories, frameworks, and tools
• Part I Principles and concepts of implementation science
• Part II Methodology and methods of implementation science
• Part III Challenges with evidence into practice: translation, evaluation, sustainability
• Index