Commentary on “Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework”

Jan 22,2019 | Bryan Garner Featured Articles

As a part of their effort to advance a conceptual model of global factors affecting implementation in public service sectors (e.g., outer context, inner context, innovation characteristics), Aarons, Hurlburt, and Horwitz (2011)1 organized an array of potential influencing factors (e.g., funding, organizational characteristics, interorganizational networks, leadership) along four phases (i.e., exploration, adoption/preparation, implementation, and sustainment). Overshadowing the conceptual model of global factors affecting implementation in public service sectors, which may be due to similar factors having been highlighted earlier as part of the Consolidated Framework for Implementation Research (CFIR),2 these four phases evolved into the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Earlier this month, Moullin, Dickerson, Stadnick, Rabin, and Aarons (2019)3 published a systematic review of the EPIS framework, which is the focus of this commentary.

As noted by Moullin et al. (2019), “Until recently, this comprehensive framework has had limited prescriptive guidance for its use.” Despite this, Moulin et al.’s systematic review supports the EPIS framework as an innovation that has rapidly accelerated along the EPIS continuum. Indeed, according to their systematic review, the EPIS framework has been used by 49 unique research projects, which to date have cumulated in 67 articles. It is possible that some of the implementation strategies and/or contextual factors that have contributed to the EPIS frameworks’ rapid advancement along the EPIS continuum would help advance other innovations along the EPIS continuum. As such, I know I would find it interesting to learn what Aarons and colleagues believe might have been among the key strategies and/or factors.

Speaking of interesting things, I found it interesting that Figure 1 of Moullin et al. introduced a new version of the EPIS framework that integrates the two figures included in Aarons et al. (2011), as well as changes the four phases from a “recursive” perspective to a “cyclical” perspective. Having probably read the Aarons et al. (2011) article multiple times per year since it was published, I have long been aware of the components highlighted in Aaron’s and colleagues’ conceptual model of global factors affecting implementation in public health sections. For me, however, the EPIS framework’s primary advantage was its four-phase delineation of the implementation process, which I like and have therefore explicitly included as part of my implementation research. That said, it’s possible the new version of the EPIS framework will further increase its use. Given the emphasized integration of outer context factors, inner context factors, and innovation factors into the new EPIS framework, which as noted above are factors included in the CFIR, it will be interesting to see if there are any impacts on future use of the CFIR.

Understanding the extent to which the new EPIS framework progresses along the EPIS continuum will require time to pass. What is currently known, however, is that the original EPIS framework has had a significant impact on the field of implementation research over the past eight years.

Read the full abstract.


1Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research38(1), 4-23.

2Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation science4(1), 50.

3Moullin, J. C., Dickson, K. S., Stadnick, N. A., Rabin, B., & Aarons, G. A. (2019). Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implementation Science14(1), 1.