A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework
Review
1 Graduate School of Health, Pharmacy, University of Technology Sydney, Broadway, Ultimo 2007, NSW, Australia
2 Academic Centre in Pharmaceutical Care, Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Granada, 18071, Spain
3 Institute for Medicines Research (iMed.UL), Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon, Avda. Prof. Gama Pinto, Lisbon, 1649-019, Portugal
Health Research Policy and Systems 2015, 13:16Â
doi:10.1186/s12961-015-0005-z
Published: 14 March 2015
Abstract (provisional)
Background Implementation science and knowledge translation have developed across
multiple disciplines with the common aim of bringing innovations to practice. Numerous
implementation frameworks, models, and theories have been developed to target a diverse
array of innovations. As such, it is plausible that not all frameworks include the
full range of concepts now thought to be involved in implementation. Users face the
decision of selecting a single or combining multiple implementation frameworks. To
aid this decision, the aim of this review was to assess the comprehensiveness of existing
frameworks. Methods A systematic search was undertaken in PubMed to identify implementation
frameworks of innovations in healthcare published from 2004 to May 2013. Additionally,
titles and abstracts from Implementation Science journal and references from identified
papers were reviewed. The orientation, type, and presence of stages and domains, along
with the degree of inclusion and depth of analysis of factors, strategies, and evaluations
of implementation of included frameworks were analysed. Results Frameworks were assessed
individually and grouped according to their targeted innovation. Frameworks for particular
innovations had similar settings, end-users, and ‘type’ (descriptive, prescriptive,
explanatory, or predictive). On the whole, frameworks were descriptive and explanatory
more often than prescriptive and predictive. A small number of the reviewed frameworks
covered an implementation concept(s) in detail, however, overall, there was limited
degree and depth of analysis of implementation concepts. The core implementation concepts
across the frameworks were collated to form a Generic Implementation Framework, which
includes the process of implementation (often portrayed as a series of stages and/or
steps), the innovation to be implemented, the context in which the implementation
is to occur (divided into a range of domains), and influencing factors, strategies,
and evaluations. Conclusions The selection of implementation framework(s) should be
based not solely on the healthcare innovation to be implemented, but include other
aspects of the framework’s orientation, e.g., the setting and end-user, as well as
the degree of inclusion and depth of analysis of the implementation concepts. The
resulting generic structure provides researchers, policy-makers, health administrators,
and practitioners a base that can be used as guidance for their implementation efforts.