• By Laura Whybra
  • Posted on Wednesday 28th May, 2014

So you’ve got a great idea. How do you make it happen?

strong>For four decades, two separate bodies of research have been trying to explain how implementation does – or doesn’t – work. But because one grew from the natural sciences and the other from the social sciences, they’ve developed separately. And their separate histories mean that the two strains of work come with different perspectives on the ways that evidence becomes part of policy and practice. Now it’s time for implementation science and policy implementation research to learn from each other, a group of academics from Sweden and Scotland argue.The authors are interested in healthcare practice and policy, but their insights could apply to many fields. Addressing health problems involves two distinct strands of action: healthcare practitioners acting on research findings, and government agencies implementing political measures. Each of these two strands of action has its own tradition of research. Implementation science examines when and why practitioners take up a clinical practice that is supported by research, like washing their hands or ordering particular lab tests. Policy implementation research describes what happens when government policies are rolled out in the real world. These two sets of ideas clearly overlap. However, there has been little exchange of knowledge between these two fields, despite their common focus on the challenges of successfully putting ideas into practice in the real world. Policy implementation research, which comes from a social science background, is the more established field. Implementation science, which owes its origins to the natural sciences and the evidence-based medicine movement, is the relative newcomer. Until now, the two fields have been very separate despite the many parallels between them. The field of policy implementation research has been developing since the 1970s, refining and rejecting theories and becoming more multidisciplinary and diverse. Implementation science, by comparison, has a much narrower focus, examining specific clinical practices and identifying particular determinants and their causal links to outcomes and outputs. Creative mixing: what the two fields can offer each otherThe authors identified a number of key areas in which learning could occur, and particularly what the narrower, newer field of implementation science can gain from policy implementation research. First, the concept of context is prominent in policy implementation research. To be successful, the influence of new knowledge must be considered alongside the enduring effect of the implementers’ longstanding practices. For example, organizational characteristics should be considered when new healthcare practices are designed.Second, policy implementation research highlights that practitioners use discretion and often don’t implement all top-down recommendations. They want to preserve their sense of professional autonomy and to be able to respond to variable situations.Third, policy implementation research recognizes the importance of the wider policy environment. For example, the political and cultural settings in which healthcare is carried out do have an influence, and this should be recognized when planning implementation.The authors also think that specific theories from the field of policy implementation can be useful to implementation science. For example, the “Advocacy Coalition Framework” rejects the idea that implementation is a discrete stage in the policy cycle and instead explores the interactions and negotiations among large number of actors at multiple levels over an extended period of time. It argues that different stakeholders have different ideas about what good evidence is and can influence the implementation of practices and guidelines. As a result, the widespread implementation of a particular treatment such as cognitive behavioral therapy may occur through the lens of a different belief system than the one in which it was originally researched and designed.By looking to policy implementation research, implementation science can gain a different perspective on the challenges of implementing evidence in healthcare, by, for example, considering the context in which implementation occurs and the impact of the values held by the health care practitioners delivering the program. *********Reference:Nilsen, P., Ståhl, C., Roback, K., & Cairney, P. (2013). Never the twain shall meet? - a comparison of implementation science and policy implementation research. Implementation Science, 8(1), 63.

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