Context, complexity and process in the implementation of evidence-based innovation: a realist informed review

Abstract

Background: This review of scholarly work in health care knowledge translation advances understanding of implementation components that support the complete and timely integration of new knowledge. We adopt a realist approach to investigate what is known from the current literature about the impact of, and the potential relationships between, context, complexity and implementation process. Methods: Informed by two distinct pathways, knowledge utilization and knowledge translation, we utilize Rogers' Diffusion of Innovations theory (DOI) and Harvey and Kitson's integrated-Promoting Action on Research Implementation in Health Service framework (PARIHS) to ground this review. Articles from 5 databases; Medline, Scopus, PsycInfo, Web of Science, and Google Scholar and a search of authors were retrieved. Themes and patterns related to these implementation components were extracted. Literature was selected for inclusion by consensus. Data extraction was iterative and was moderated by the authors. Results: A total of 67 articles were included in the review. Context was a central component to implementation. It was not clear how and to what extent context impacted implementation. Complexity was found to be a characteristic of context, implementation process, innovations and a product of the relationship between these three elements. Social processes in particular were reported as influential however; descriptions of how these social process impact were limited. Multiple theoretical and operational models were found to ground implementation processes. We offer an emerging conceptual model to illustrate the key discoveries. Conclusions: The review findings indicate there are dynamic relationship between context, complexity and implementation process for enhancing uptake of evidence-based knowledge in hospital settings. These are represented in a conceptual model. Limited empiric evidence was found to explain the nature of the relationships.

Professionals’ perceptions of the establishment of a specialized brief therapy unit in a district psychiatric centre - a qualitative study.

“…Although brief therapy is shown to be e cient for several patient groups [5,[16][17][18] this does not guarantee that knowledge will be successfully implemented in practice [10,21]. Implementing a new service or unit in an organization usually faces many potential barriers and facilitators embedded in the characteristics of the new effort; the setting, the individuals involved, and the implementation process [21,22]. In fact, one of the most critical issues in mental health services research is the gap between what is known about effective treatment and what is provided to consumers in routine care [10].…”

Professionals’ perceptions of the establishment of a specialized brief therapy unit in a district psychiatric centre - a qualitative study.

“…Although brief therapy is shown to be e cient for several patient groups [5,[16][17][18] this does not guarantee that knowledge will be successfully implemented in practice [10,21]. Implementing a new service or unit in an organization usually faces many potential barriers and facilitators embedded in the characteristics of the new effort; the characteristics of the intervention, the external conditions, the internal environment, the characteristics of the individuals involved, and the implementation process [21,22]. In health services, barriers to implementation seems to arise at several levels, such as at the patient level, at the treatment team level, at the organizational level and at the market or policy level [22].…”

“…In fact, one of the most critical issues in mental health services research is the gap between what is known about effective treatment and what is provided to consumers in routine care [10]. Context, complexity and process have been described as aspects that in uence the outcomes from implementation efforts [13,21]. Some studies infer implementation success by measuring clinical outcomes at the client or patient level, while other studies measure the actual targets of the implementation [13].…”

Everyday work, working culture and patient care. A qualitative study on professionals’ perceptions of the establishment of a specialized brief therapy unit in a district psychiatric center.

“…Although brief therapy is shown to be an efficient treatment approach for several patient groups [5,[11][12][13] evidence does not guarantee that knowledge will be successfully implemented in practice [16].…”

“…Implementing a new service or unit in an organization usually faces many potential barriers and facilitators embedded in the characteristics of the intervention; the setting, the individuals involved, and the implementation process [17]. Context, complexity and process have been described as aspects that influence the outcomes from implementation efforts [16]. The establishment of a new treatment unit providing a specialized service, such as brief therapy, to a specific patient group, might thus influence the organization in several ways.…”