London plays The Implementation Game

London plays The Implementation Game and grabs the Tiger by the Tail……Or the bull by the horns, depending on where you hail from.

Deborah Ghate reports on the final event of Implementation Week 2019 on Friday, July 19th, which took place in London N1 – and was definitely worth waiting for.

Melanie Barwick, Senior Scientist at the Hospital for Sick Children in Toronto (internationally known as SickKids) and professor at the University of Toronto led a day-long workshop ably assisted by her long-time colleague Jacquie Brown, introducing UK implementation audiences to Melanie’s latest educational tour de force, The Implementation Game.

The Implementation Game, based around the idea of a board game with playing cards, is essentially a simulation tool for innovation and implementation teams to think through implementation challenges and principles of effective practice using implementation science (IS) knowledge as a navigation process.

It’s not really a game as such (there are no winners and losers) but the play element makes the process a lot more fun than many other ways of learning about implementation.

You can create your own example or (recommended) use any of the exemplar scenarios provided for health, social care, education, or public policy settings and away you go, working through dimensions of planning, design, implementation factors and steps, and evaluation aspects prompted by questions designed to trigger discussion, debate and problem-solving based in evidence-based implementation knowledge.

Carefully anchored to a mix of respected evidence-derived (North American) frameworks in IS, including Wandersman’s Quality Implementation Framework (QIF), Damschroder’s Consolidated Framework for Implementation Research (CFIR) and others, the Game provides a way for newbies to learn about and play with implementation thinking, but it also serves well as a projective tool for more experienced implementation teams to think through realistic policy and practice challenges and solutions in an engaged, interactive way.

One of Melanie’s refreshingly pragmatic key take-home messages was that you always need more than one theoretical and research framework when thinking about implementation projects in the real world - sticking religiously to one much-loved framework probably isn’t going to serve all purposes equally well. Another - amply demonstrated when we all started to play the Game ourselves - was just how much time needs to be set aside for the preparation or pre-implementation stage of work. A lot, ie.

My table of battle-hardened innovators, managers and clinicians on the NHS front line had very meaty conversations throughout the day and were keen to try the Game out back in the trenches. I’m looking forward to hearing feedback and reflections on how the US-developed frameworks fit to UK systems, and whether any necessary tweaks or adaptions for context will emerge. If the Game now is used more widely by UK practitioners, as Melanie hopes it will be, she will welcome feedback that will help to develop the game even further. Join in, and be part of the cutting edge of implementation science in practice!

Participants came to the day from all over the UK, and from a wide range of employing bodies including health, social care, academia, and the voluntary sector. So the day also provided a great way to listen to and learn from colleagues in both familiar and different settings, with lively debates heard all over the room.

By the end of the day we were tired, but jam-packed with thoughts about better implementation in the complex settings in which we all work, and where we are trying in different ways and from different positions to apply implementation science leaning and know-how to improve services.

"We bought a few copies of the game to use in Leeds and recently played the game to assist our planning for scaling up our work on social work assessments. It was both helpful and reassuring in using the game to review our implementation approach to date, and planning our next steps. The worksheets are extremely comprehensive and thought provoking …and at the end of the worksheet are the various implementation factors that can be circled to identify those which are most relevant to the implementation project…No doubt, the Implementation Game will be invaluable to us.”

Gill Parkinson, Participant, Leeds City Council Children and Families service.

And finally - Melanie kindly left with the UK-IS office four Implementation Game playing kits, complete with boards, flash cards and worksheets to guide players through the process – if you’d like to get hold of one, please let Penny Matthews at UK-IS know. We can send them at UK carriage rates, which will reduce the cost to you substantially.

Find out more about The Game at Melanie’s website:

Dr Deborah Ghate was reporting on a day workshop delivered by Melanie Barwick and hosted by the UK Implementation Society held at NCVO, London N1.


Deborah is Chair of the UK Implementation Society and is based at the Colebrooke Centre for Evidence and Implementation (

References and related reading

Damshroder L, Aron D.C., Keith R. E. , Kirsch S.R., Alexander J.A and Lowery J.C (2009) ‘Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science’ Implementation Science 4:50 doi:10.1186/1748-5908-4-50


Meyers DC, Durlak JA and Wandersman A. (2012) ‘The Quality Implementation Framework: a synthesis of critical steps in the implementation process’ American Journal of Community Psychology DOI 10.1007/s10464-012-9522- Abstract ONLY at

**NOTE: this article is not open access. UK-IS prefers to cite only articles that are open access. If you are not able to get access to this paper but would like to read it, please contact the authors to request a copy of the pdf:

© UK Implementation Society, 2019

All views expressed are the author's own and not those of the UK Implementation Society.

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