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Implementation science as an organizational process

Birken, Sarah, A., PhD; Nilsen, Per, PhD

doi: 10.1097/HMR.0000000000000212
Department: Editorial

Sarah A. Birken, PhD, University of North Carolina at Chapel Hill.

Per Nilsen, PhD, Linköping University, Sweden.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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We are delighted that Health Care Management Review (HCMR) has gathered this collection of research on implementation in health care organizations. The articles in this themed issue demonstrate that health care organizations are striving to implement interventions to address a wide range of problems and using research to inform subsequent efforts.

Debates exist about what qualifies as implementation science, who is an implementation scientist, and whether implementation science is a methodology or a discipline. Despite such debates, the studies in this issue underscore that scholars concerned with implementing interventions to improve health care are generating knowledge about what works and does not work within health care organizations using rigorous implementation research. Such knowledge contributes directly to an enhanced ability to translate evidence into best clinical and managerial practices.

The goal of implementation science is to generate knowledge to facilitate translation of evidence into practice. We believe that accomplishing that goal depends on four core activities.

One, understanding determinants of implementation is a necessary first step toward developing strategies to promote the use of interventions in practice. Several of the articles in this issue contribute to this knowledge base.

Two, identifying determinants of implementation requires careful selection, adaptation, and application of theory. We have argued that implementation science researchers need to consider the theories from across a multiple disciplines (Birken et al., 2017), including organization science. Consistent with this core activity, diverse and multidisciplinary theories are used in the studies in this issue.

Three, developing and using innovative research methods is required to understand the challenges of implementation from the perspectives of diverse stakeholders. The studies in this issue rely on common study designs. Implementation science may be enhanced with less-often used methods, such as configurational comparative methods, intervention mapping, and ethnography. Such designs have the potential to yield fuller understanding and explanation, thus enhancing implementation science.

Four, implementation science can achieve its goal of facilitating the translation of evidence into practice by developing, testing, and evaluating implementation strategies. Scholars have identified and classified implementation strategies (Leeman, Birken, Powell, Rohweder, & Shea, 2017). However, these strategies are unlikely to be effective in practice if they do not address determinants of implementation. Addressing determinants of implementation requires developing strategies rooted in relevant theories to understand and explain the “how and why” of relationships among implementation strategies and outcomes (Nilsen, 2015). The influence of implementation strategies on outcomes must be tested in rigorous studies conducted in diverse contexts.

HCMR is in an excellent position to support implementation science in achieving its goals. HCMR is committed to state-of-the art methods for generating evidence, to research that is driven by theory, and to translating findings into strategies that are actionable in practice. Implementation science depends upon these commitments to ensure a future in which efforts are more effective and efficient.

Sarah A. Birken, PhD

University of North Carolina at Chapel Hill

Per Nilsen, PhD

Linköping University, Sweden

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References

Birken S. A., Bunger A. C., Powell B. J., Turner K., Clary A. S., Klaman S. L., … Weiner B. J. (2017). Organizational theory for dissemination and implementation research. Implementation Science,12(1), 62. doi:10.1186/s13012-017-0592-x
Leeman J., Birken S. A., Powell B. J., Rohweder C., & Shea C. M. (2017). Beyond “implementation strategies”: Classifying the full range of strategies used in implementation science and practice. Implementation Science,12(1), 125. doi:10.1186/s13012-017-0657-x
Nilsen P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science,10, 53. doi:10.1186/s13012-015-0242-0
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