Commentary on “Specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory.”

Efforts such as the Expert Recommendations for Implementing Change (ERIC) project—designed to compile, define, and categorize implementation strategies—are monumental, both in terms of importance and size.  Due to the size of such efforts, they cannot be finalized in short order but, instead, are works in progress spanning many years.  Perry et al. test the ERIC compilation of strategies within seven regional cooperatives, spanning twelve states in the US, to propose modifications that should prove useful for implementation researchers.  More specifically, the authors propose enhanced definitions of some existing strategies, new strategies (i.e., not included in previous ERIC studies), and modified categories of strategies based on qualitative data obtained from the regional cooperatives.  In some instances, the proposed enhancements to the definition of a strategy have implications for the scope of the strategy as well.  For example, the authors rename and narrow the scope of the facilitation strategy to implementation facilitation, while simultaneously illustrating the complexity that remains even within this narrower scope.  Also noteworthy are the new strategies identified, for example, assess and define workflow, which is particularly important given the prominence of team-based care, and engage community resources, which is vital for efforts focused on health-related social needs and the delivery of complex services, such as medication-assisted treatment/therapy for opioid use disorder.  Finally, the proposed new categories of strategies highlight the interrelation between broader organizational-level infrastructure (e.g., health IT) and capabilities (e.g., quality improvement capacity) and the intervention-specific implementation strategies being employed.  Future efforts to refine the strategies compilation clearly could be informed by the focus and design of this study, and implementation researchers also could benefit from using the methods and specification table (Additional File 1 in the article) as an example of implementation strategy tracking.  More generally, the study by Perry and colleagues illustrates the value of advancing knowledge about concepts and frameworks through systematically testing them “on the ground”—in other words, not just drawing upon concepts and frameworks but also conducting rigorous studies to determine their applicability and usefulness and, ultimately, to contribute to the monumental efforts that require years of “work in progress.”

Perry, C. K., Damschroder, L. J., Hemler, J. R., Woodson, T. T., Ono, S. S., & Cohen, D. J. (2019). Specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory. Implement Sci, 14(1), 32. doi:10.1186/s13012-019-0876-4

Read the full abstract.