Implementation Gap Task Force

Discussion notes on implementation science 

What is Implementation Science? What could it be?

1) 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.

2) 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.

What are our goals in seeking stories about implementation situations and gaps?

As stated in our earlier discussion note on possibilities for developing “implementation science”, “we hope to encourage a broader discussion of implementation leading to a more robust ‘implementation science’”.  We particularly wish to encourage widespread participation in developing a rich information base that will be suitable for the broad and diverse explorations that can lead to a suitably comprehensive “implementation science”.

Why do we emphasize “stories”?

Implementation proceeds through processes that take place in a complex yet specific situation. Without exception, those processes involve multiple actors. For both the process, results, and consequences of any particular implementation situation, the views and perspectives of the actors often vary. Thus,  creating a narrative is not only an effective approach for teasing out how a process plays out over time, but also for reflecting the diverse perspectives and key aspects of the complexity for characterizing the “implementation gaps” that we have identified as critical elements of an “implementation science”.

• A reminder: an “implementation gap” represents the difference between an expectation a party to an implementation situation might have and their perception of what actually happens.
• In telling a story, you almost necessarily will describe who the story is about and, likely enough, what expectations they might have.
• You will also describe what happens over time, so you will describe the dynamics of the situation. Implementation gaps will naturally emerge as part of the narrative.

Why we don’t specify a detailed template for stories about implementation

It is still early days in developing an information base for studies of implementation.  In our view, it is premature to try to provide rigid categories for organizing the information.  Instead, we expect categories to be found organically and refined as the collection process continues. We consider the information collection process as a broad collaboration.  Thus, every participant contributes information but also contributes analysis.  Each participant’s assessment of the most salient aspects of their stories can inform the choice of categories.  We also don’t expect every story to be a finished project.  Stories can be updated with new information or new perspectives.

There are some kinds of information that we will be looking for in implementation stories

While we don’t specify a template for stories, we have reasons for seeking specific sorts of information:

• We know that it is important to pay attention to the various participants in an implementation situation, those acting and those affected. So, the “cast of characters” matters in a story. Unlike a play or work of fiction, the characters might or might not have names or be individuals: residents of a community might be “cast members” or employees of a business, or officials of an agency.
• Their relationships matter: how well or poorly connected are the parties with each other? Do they share perspectives or are there conflicts?
• We have an interest in “implementation gaps”, differences between people’s expectations and their perceptions of what happened, so we want to learn about various participant’s expectations, how they changed over time (part of the narrative), and how did the story end.
• Planning focuses expectations. In the first discussion note, we distinguished between “planned implementation”, situations in which an entity has a plan to put in effect a project, a practice, or a policy, and “anticipatory implementation”, situations in which there is a belief that “something ought to be done”, but no detailed planning has taken place.  Intermediate cases are also possible; the degree of planning will be of interest.
  • Many stories are stories of encountering obstacles, overcoming them, or working around them, or being deterred by them. Obstacles/barriers come in many forms:
  • Resource limits – these may appear as financial, or human (manpower, expertise), or information deficiencies
  • Legal or political constraints
  • Public opposition
• More generally: stories can be about challenges faced and outcomes (as perceived by various parties).
• We note that there can be different stories about a situation depending on when the story begins and when it ends: shorter stories can be embedded in longer ones.
• What was your role in the story?
  • How did you collect the information? First-hand? Or Second-hand?
  • What was the nature of your involvement? A participant? Only an observer?
  • Is more information needed? Might there be a continuation of the story?
• We expect a title: that might provide a first step in characterization

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