Background
Evidence translation and improvement research indicates that healthcare contexts are complex systems, characterised by uncertainty and surprise, which often defy orchestrated intervention attempts. This research aims to advance understanding of the implication of complexity on attempts to translate evidence, and to produce a comprehensive, practically relevant and actionable conceptual framework.

Methods
A UK based research programme (NIHR CLAHRC NWL) was studied over a 5 year period using an ethnographic approach. Learning was assimilated from observations and documentary analysis of 22 evidence translation projects, and extensive literature review. Data was analysed using a grounded theory approach to develop a conceptual framework and identify “simple rules”.

Results
The framework for Successful Healthcare Improvement From Translating Evidence in complex systems (SHIFT-Evidence) positions the challenge of evidence translation within the complex and evolving context of healthcare, and recognises the wider issues practitioners routinely face. SHIFTevidence is summarised by three principles designed to be intuitive and memorable: act scientifically and pragmatically; embrace complexity; and engage and empower. Common challenges and strategies to overcome them are summarised in 12 “simple rules” that provide actionable guidance.

Conclusion SHIFT-Evidence provides a practical tool to guide practice and research of evidence translation and improvement within complex dynamic healthcare settings: improvement initiatives and research study designs need to take into account the unique initial conditions in each local setting; conduct needs to respond to unpredictable effects and address dependent problems; and evaluation needs to be sensitive to evolving priorities and the emergent range of activities required to achieve improvement.