Implementation Gap Task Force

What is Implementation Science? What could it be?

1. A) The public health field has created its version of “implementation science” and has made major advances in it. They have created infrastructure to support the further development of that science, including a journal Implementation Science (Wensing et al. 2021, Implementation Science 2022) and degree programs at a number of universities (e.g. University of Washington 2022).  Framing matters, and the framing in the medical and public health fields still derives from its history of seeking to put tested (“evidence-based”) interventions into broader practice.   Two definitions from the University of Washington website (2022) are typical:

• Implementation science is the scientific study of methods and strategies that facilitate the uptake of evidence-based practice and research into regular use by practitioners and policymakers.
• The field of implementation science seeks to systematically close the gap between what we know and what we do (often referred to as the know-do gap) by identifying and addressing the barriers that slow or halt the uptake of proven health interventions and evidence-based practices.

A similar definition appears on the NIH/National Cancer Center (2022) website.

1. B) Our framing is broader but no less instrumental:

• Implementation science seeks to describe and understand what happens in situations when an entity attempts to put into effect a project, a practice, or a policy; this is the normal situation in which implementation is observed; we call it “planned implementation.”
• But we also consider what happens when some people believe that a practice or policy should be put into effect; we call this “anticipatory implementation,” and seek to understand the initiating processes that lead or fail to lead to a planned implementation. Those initiating processes are also complex, merit study, and can have down-the-line implications in situations of “planned implementation”.

While the broader framing is less directly instrumental, over the long run we expect more, and more various, practical applications to emerge.  A comparison might be made with the difference between basic science and engineering.  While considerable progress can be made through engineering alone – Thomas Edison and the ancient Romans showed that – it is basic science that ultimately provides the tools and knowledge that enable effective engineering.

How are “implementation gaps” perceived?

1. In the public health view, the “gaps” of interest are the “know-do” gaps, the gap between what the practice should be (evidence-based) and what it actually is.
2. In the broader framing: “implementation gaps” represent the difference between expectations of various parties to the situation and what happens.

Noteworthy features of implementation gaps

1. For “Know-do” gaps:
   • One perspective, an ideal viewer of evidence, is dominant
   • Gaps represent deficiencies to be overcome
   • The nature and significance of a gap can change over time in response to the mode of implementation and/or external circumstances
2. In the broader framing:
   • There can be diverse perspectives on the nature and importance of gaps according to the variety of interests, concerns, perceptions, and values of the parties involved with the implementation situation
   • Not all gaps will be viewed as harmful by many or all of the parties: the evidence for “evidence-based” may be inadequate; plans may have deficiencies; things may go better than expected; unexpected resources may be found; obstacles may be less serious than anticipated; unanticipated opportunities may arise that can transform the effort.
   • Gaps as viewed by various parties, will change over time as implementation processes play out: the changes will reflect changes in expectations as well as what happens in the process.

What are goals for research/studies?

1. In the public health framing:
   • The key concept is “overcoming barriers” (to successful practice):
   • Objectives include identifying barriers of various types; identifying good practices that address barriers (of various types); success stories will be informative.
2. In a broader framing:
   • A starting point could be stories (narratives) of what happened (and what failed to happen)
   • Then observations of patterns: types of gaps, types of implementation processes; relationships between gaps and implementation processes; relationships among parties in an implementation process and convergence or divergence among the parties of perspectives on the gaps.

With this note we hope to encourage a broader discussion of implementation leading to a more robust “implementation science”.  We would be grateful for comments, critical or supportive, for suggestions, and for stories.  Please send such to any of the four of us.

Reference

Okada, N., Goble, R., Seo, K., & Han, G. (2023). Implementation gaps are persistent phenomena in disaster risk management: A perspective developed after discussions at IDRiM 2022. IDRiM Journal, 69–99. https://doi.org/10.5595/001c.90964