Towards a general theory of implementation

Abstract

Understanding and evaluating the implementation of complex interventions in practice is an important problem for healthcare managers and policy makers, and for patients and others who must operationalize them beyond formal clinical settings. It has been argued that this work should be founded on theory that provides a foundation for understanding, designing, predicting, and evaluating dynamic implementation processes. This paper sets out core constituents of a general theory of implementation, building on Normalization Process Theory and linking it to key constructs from recent work in sociology and psychology. These are informed by ideas about agency and its expression within social systems and fields, social and cognitive mechanisms, and collective action. This approach unites a number of contending perspectives in a way that makes possible a more comprehensive explanation of the implementation and embedding of new ways of thinking, enacting and organizing practice.

Improvement Science: conceptual and theoretical foundations for its application to healthcare quality improvement

“…The literature presents a set of studies identifying theories 35,58,66,67,68,69 for the prediction and explanation of mechanisms of change associated with healthcare quality improvement interventions at the macro political, organizational and social context and individual behavior levels (Table 1).…”

“…Based on these theories, a more comprehensive explanation of these elements constituing implementation process could be built 35 . The implementation process is explained as the interaction between "emerging expressions of agency" (or what people do in order to make something happen, and how they deal with different components of a complex intervention) and the context's dynamic elements (the socio-structural and socio-cognitive resources people draw on to perform their actions of agency).…”

“…The implementation will imply changes that can impact individual, organizational, and societal behavior. Agents, individuals or groups engaged in the mobilization of material and cultural resources, seek to ensure the consent, cooperation, and knowledge of other agents that coexist in the context in which implementation of the practice takes place 35 .…”

“…And within these emerging structural conditions, mechanisms operate, defined as the processes that promote or hinder a change in an actual system, unfolding over time and expressing contributions by the agency (human intervention). The focus on the mechanisms helps understand the means for promotion of changes projected in the interventions, the circumstances in which they act, and how they attempt to shape them 35 . In short, based on the above-mentioned theory, the effective implementation of a healthcare quality improvement intervention is conditioned by human behavior and the functioning of groups and organizations and their contexts, and can be explained from different points of view.…”

“…33 . It overlaps with disciplines, such as Implementation Science 27,34,35,36 and Translational Research 35,37,38 .…”