Despite well-designed plans, implementation efforts often fail due to powerful contextual factors that can undermine even the best strategies.

The challenge of implementation

While implementation is crucial for the success of health policies and programs, it remains poorly understood. Interest in implementation science has grown across multiple sectors as a bridge between research and practice. I have experience of appying implementation science to practice in ways which not only helps us to better understand implementation but also facilitates favourable implementation, service, and patient outcomes.

My approach to implementation science, research and practice

I believe that if implementation science is truly going to support client research and implementation outcomes, it should be deeply rooted in local, real-world contexts and focus on generating learning through direct action. Research needs to be more than just problem analysis. It needs to help those in practice in real time. Achieving successful implementation in the face of complexity requires a shift in approach for both researchers and policymakers, from "simplifying" (such as conducting controlled experiments aimed at generating more or less universal truths) to "complexifying" (which involves developing research strategies that are grounded in concrete real-world situations and faithful to complexity's inherent features). To do this we must acknowledge that uncertainty is a fundamental aspect of complex systems, meaning we should embrace uncertainty and find ways to work with it, rather than against it. We must enhance the external validity of our findings through methods that are closely connected to practice and that are capable of addressing complexity.

Connecting with people

The various stakeholders that exist within complex systems bring additional layers of complexity but they also hold our best chance of solving implementation. This is because if we choose to avoid seeking false consensus and instead celebrate and leverage the diverse, and often conflicting, perspectives that local stakeholders bring to collaborative efforts we can get far better results.

By focusing on the relational dynamics of partnerships, and by carefully examining and utilising the "frictions" that arise within them, we can better optimise the human actions necessary to navigate complexity, such as: engaging, connecting, understanding, learning, deliberating, making positive change, and managing conflict. These changes necessitate a reimagining of how we conceptualise complexity and implementation in practice, meaning we no longer conceptualise them as an abstract, mathematically grounded theory, but that it is realised through human action and interaction.

Our implementation research and our implementation overall must therefore remain firmly anchored in local, real-world action and be driven by the goal of learning through action. This is how I have already helped many clients achieve their goals and have supported implementation, patient, and service outcomes far and wide.