Rugged landscapes: complexity and implementation science

Sep 29, 2020 | Ornstein

BACKGROUND: Mis-implementation-defined as failure to successfully implement and continue evidence-based programs-is widespread in public health practice. Yet the causes of this phenomenon are poorly understood.

METHODS: We develop an agent-based computational model to explore how complexity hinders effective implementation. The model is adapted from the evolutionary biology literature and incorporates three distinct complexities faced in public health practice: dimensionality, ruggedness, and context-specificity. Agents in the model attempt to solve problems using one of three approaches-Plan-Do-Study-Act (PDSA), evidence-based interventions (EBIs), and evidence-based decision-making (EBDM).

RESULTS: The model demonstrates that the most effective approach to implementation and quality improvement depends on the underlying nature of the problem. Rugged problems are best approached with a combination of PDSA and EBI. Context-specific problems are best approached with EBDM.

CONCLUSIONS: The model’s results emphasize the importance of adapting one’s approach to the characteristics of the problem at hand. Evidence-based decision-making (EBDM), which combines evidence from multiple independent sources with on-the-ground local knowledge, is a particularly potent strategy for implementation and quality improvement.

PubMed Abstract

Ornstein, J. T., Hammond, R. A., Padek, M., Mazzucca, S., & Brownson, R. C. (2020). Rugged landscapes: complexity and implementation science. Implement Sci, 15(1), 85. doi:10.1186/s13012-020-01028-5