Conceptualizing Context and Intervention as a System in Implementation Science: Learning From Complexity Theory Comment on "Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-country Analysis"

Abstract

In implementation science, implementation has been widely theorized and assessed. Context, on the other hand, usually played a minor role in the field and was usually conceptualized in a rather positivist way. Despite some promising efforts, there is a strong need to continue building theory on context and operationalizing the concept in implementation practice. I argue for the benefit of integrating complexity theory into our understanding of context in order to further our thinking about context and intervention as a system. This should be reflected by the way in which we build theory as well as apply this theory by employing methods that adequately account for complexity in systems.

Context Matters, So How Do We Get Better at Working With Context in Implementation Research and Practice? Comment on "Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-country Analysis"

“… 14 This concurs will calls for a ‘plurality of methods’ and viewing context in a more processual (as opposed to deterministic) way, whereby interventions and context evolve in an organic way. 1 , 15 …”

If It Is Complex, Let It Be Complex – Dealing With Institutional Complexity in Hospitals Comment on "Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?"

“…The problem is that since it is complex, actions based in only one logic will have a lot of unintended consequences. 14 There have been many studies on how managers and physicians fail to acknowledge the institutional complexity of healthcare, but Waitzberg and colleagues' contribution instead focused on the perhaps rare occasion when they do succeed in reconciling and balancing competing logics and what strategies they use in these situations. This is important since it paves a way for how to better deal with institutional complexity in healthcare.…”

“…The problem is that since it is complex, actions based in only one logic will have a lot of unintended consequences. 14 …”

Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Response to Recent Commentaries

“…Many of the commentaries raised the issue of how worldview influences the development and proliferation of particular forms of knowledge. 2 - 6 , 10 Particularly, some authors stated that the formation of a list of attributes and features of context aligns with a post-positivist paradigm, 2 - 6 whereas other authors acknowledged our inductive and constructivist approach in identifying context attributes and features by interviewing system stakeholders. 6 , 10 Our development of the ICON framework was rooted in a pragmatist paradigm.…”

“…Many authors commenting on our paper about stakeholder perceptions of context 1 have recommended the use of complexity theory 2 - 6 as a frame for understanding context as a complex system comprising many interrelated parts of a larger implementation system 7 . This larger system can be seen as composed of multiple elements (eg, context, knowledge translation [KT]) or implementation strategies (eg, facilitation), and interventions (eg, evidence-informed practices, programs, or policies) that may moderate and influence one another.…”