June Journal Club Feedback
The new UK-IS Journal Club held its second meeting on 29th June. Hosted by UK-IS Trustee Annette Boaz, the group reviewed A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project by Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, Proctor EK, Kirchner JE.
The group who attended – a mix of researchers, practitioners and post-graduate students – had a really interesting discussion, and this blog contains a summary of the take home messages from the meeting.
Identifying, developing, and testing implementation strategies are important goals of implementation science. However, these efforts have been complicated by the use of inconsistent language and inadequate descriptions of implementation strategies in the literature. The Expert Recommendations for Implementing Change (ERIC) study aimed to refine a published compilation of implementation strategy terms and definitions by systematically gathering input from a wide range of stakeholders with expertise in implementation science and clinical practice.
The reason we focused on this paper is that it is a widely cited and thorough review of the wide range of implementation strategies (some well-known, others less so). The authors set out to improve the conceptual clarity, relevance, and comprehensiveness of implementation strategies that can be used in isolation or combination in implementation research and practice. The study maps out the 73 strategies more commonly used to promote implementation, based on a methodology for building consensus among experts.
The participants highlighted key take home messages from our discussion:
This is an important and useful paper. The authors have undertaken a substantial effort to map a wide range of potential implementation strategies, as well as a really good attempt to bring some clarity and simplicity to the attempt to sharpen thinking and use of terms. The list of 73 provides useful building blocks for thinking about how to develop and apply strategies in real life implementation projects.
It is useful to have a taxonomy particularly to surface the range of implementation strategies that might be at play, and to encourage taking a wide lens to considering what might be appropriate, particularly emphasising that implementation is not only about training.
The group discussed some challenges in terms of applying the paper in implementation projects. They questioned how useful would it be in practice to consider strategies divorced from context. It could be counterproductive to encourage people to think in this way – unless used with a clear understanding of the limitations, it could lead us to minimise the importance of context, systems-awareness, as well as ethics and equity and of course the quality and sensitivity of the application by implementation practitioners and policy makers.
The real nuance lies in how you work with people who know the context and challenges more personally than you do to build a sense together of what the challenges to change are and which strategies might be most usefully employed.
Whilst the taxonomy is important it is not an end in itself, it should not limit us in how we think or describe experiences but provide a starting point for learning and exploration. The risk as described in the discussion is in decontextualising implementation when the messy reality is much more than this.
Is there a danger that the strategies approach feeds into a “toolkit” approach. It focuses on the strategies, without us thinking about the expertise of the person selecting and using the strategies, or the context in which they are to be used. A different metaphor (such as choosing which sort of boat to navigate a particular river) might give more emphasis in the discussion about understanding the dynamics of the implementation context, and the skill of the captain in navigating through and around implementation hazards.
The distinction between the intervention and the implementation strategy isn’t as straightforward as it might appear, especially for some aspects, like training those who deliver the intervention.
The strategies emerge from a consensus exercise involving 97% academics/academic affiliates, in health and mental health only, from one time zone in one country, and yet aspires to provide a framework for the whole field. At the end they say the list might ‘possibly’ have looked different if it had been generated by a more diverse/international group.
It was also helpful to reflect upon the fact that the paper and the strategies in it may reflect a specific time in the field of implementation and there have been a lot of developments in the past few years in terms of applying implementation tools in different policy areas.
With thanks to Deborah Ghate, Nick Sevdalis, Tom Jefford, Janet Grauberg, Jane Lewis, Yulia Shenderovich, Lesley Smith and Sophie Varian-Nuttall and hosted/summarised by Annette Boaz.
© UK Implementation Society, 2021
All views expressed are the author's own and not those of the UK Implementation Society.