Translating evidence in complex systems: a comparative review of implementation and improvement frameworks
File(s)
Published version
Author(s)
Reed, JE
Green, Stuart
Howe, Cathy
Type
Journal Article
Abstract
Purpose
An increasing number of implementation and improvement frameworks seek to describe and explain how change is made in healthcare. This paper aims to explore how existing frameworks conceptualize the influence of complexity in translating evidence into practice in healthcare.
Data sources
A database was interrogated using a search strategy to identify publications that present frameworks and models for implementation and improvement.
Study selection
Ten popular implementation and improvement frameworks were purposively selected.
Data extraction
Comparative analysis was conducted using an analytical framework derived from SHIFT-Evidence, a framework that conceptualizes complexity in implementation and improvement initiatives.
Results
Collectively the frameworks accounted for key concepts of translating evidence in complex systems: understanding the uniqueness of each setting; the interdependency of practices/processes and the need to respond to unpredictable events and emergent learning. The analysis highlighted heterogeneity of the frameworks in their focus on different aspects of complexity. Differences include the extent to which problems and solutions are investigated or assumed; whether endpoints are defined as the uptake of interventions or achievement of goals; and emphasis placed on fixed-term interventions versus continual improvement. None of the individual frameworks reviewed incorporated all the implications of complexity, as described by SHIFT-Evidence.
Conclusion
This research identifies the differences in how implementation and improvement frameworks consider complexity, suggesting that SHIFT-Evidence offers a more comprehensive overview compared with the other frameworks. The similarity of concepts across the frameworks suggests growing consensus in the literature, with SHIFT-Evidence providing a conceptual bridge between the implementation and improvement fields.
An increasing number of implementation and improvement frameworks seek to describe and explain how change is made in healthcare. This paper aims to explore how existing frameworks conceptualize the influence of complexity in translating evidence into practice in healthcare.
Data sources
A database was interrogated using a search strategy to identify publications that present frameworks and models for implementation and improvement.
Study selection
Ten popular implementation and improvement frameworks were purposively selected.
Data extraction
Comparative analysis was conducted using an analytical framework derived from SHIFT-Evidence, a framework that conceptualizes complexity in implementation and improvement initiatives.
Results
Collectively the frameworks accounted for key concepts of translating evidence in complex systems: understanding the uniqueness of each setting; the interdependency of practices/processes and the need to respond to unpredictable events and emergent learning. The analysis highlighted heterogeneity of the frameworks in their focus on different aspects of complexity. Differences include the extent to which problems and solutions are investigated or assumed; whether endpoints are defined as the uptake of interventions or achievement of goals; and emphasis placed on fixed-term interventions versus continual improvement. None of the individual frameworks reviewed incorporated all the implications of complexity, as described by SHIFT-Evidence.
Conclusion
This research identifies the differences in how implementation and improvement frameworks consider complexity, suggesting that SHIFT-Evidence offers a more comprehensive overview compared with the other frameworks. The similarity of concepts across the frameworks suggests growing consensus in the literature, with SHIFT-Evidence providing a conceptual bridge between the implementation and improvement fields.
Date Issued
2018-07-27
Date Acceptance
2018-06-22
Citation
International Journal for Quality in Health Care, 2018, 31 (3), pp.173-182
ISSN
1353-4505
Publisher
Oxford University Press (OUP)
Start Page
173
End Page
182
Journal / Book Title
International Journal for Quality in Health Care
Volume
31
Issue
3
Copyright Statement
© The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.or
g/licenses/by-nc/4.0/),
which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re
-use, please contact
journals.permissions@oup.com
g/licenses/by-nc/4.0/),
which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re
-use, please contact
journals.permissions@oup.com
Sponsor
Chelsea & Westminster Hospital NHS Foundation Trust
The Health Foundation
Identifier
https://academic.oup.com/intqhc/article/31/3/173/5060301
Grant Number
N/A
6595
Subjects
Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Health Policy & Services
complex systems
quality improvement
evidence translation
implementation
framework
CARE
complex systems
evidence translation
framework
implementation
quality improvement
Delivery of Health Care
Evidence-Based Practice
Humans
Program Development
Quality Improvement
Quality of Health Care
Humans
Program Development
Delivery of Health Care
Quality of Health Care
Evidence-Based Practice
Quality Improvement
11 Medical and Health Sciences
17 Psychology and Cognitive Sciences
Health Policy & Services
Publication Status
Published
Date Publish Online
2018-07-27