. 2022 Aug 13;17:55. doi: 10.1186/s13012-022-01226-3

Table 1.

Threats that might stymie progress in the field of implementation science: Themes, causes, and solutions

Pre-mortem threat theme	Cause of threat	Solutions to address threat
We did not impact population health or health equity	• Structural factors have only recently become a focus in the field of IS, despite being critical to population health and health equity impacts • It takes a long time and substantial resources to change determinants of implementation at multiple levels, and these changes are critical to population health and health equity impacts • Misalignment between metrics used to judge IS researcher success (e.g., publications, grants) and metrics of population impact	• Document impact at organizational, community, and policy levels in IS publications • Efficiently include health outcomes in IS studies by leveraging routinely collected heath outcome data and other pragmatic measures • Use multidisciplinary team science approaches in IS to address structural and social determinants of implementation • Prioritize focus on implementation strategies and EBPs that have the most potential to promote health equity • Routinely measure the impacts of implementation strategies on health equity outcomes • Generate more evidence about associations between implementation outcomes and health outcomes, the impacts of implementation efforts on health equity outcomes, and economic return on investment of implementation strategies • Translate findings from IS research into useable tools for practitioners and clearly communicate the value of IS to the public and policymakers
We over anchored on becoming a “legitimate” science	• Lack of critical thinking about which IS frameworks to use and IS outcomes to focus on for a specific context • Holding too firmly to the belief that there needs to be an EBP—as opposed to a program that meets a community’s need but has not yet demonstrated effectiveness—in order to conduct IS • Tendency to borrow from fields and disciplines outside of IS to maximize innovation without fully leveraging the body of knowledge in those areas	• Embrace critiques of the field of IS and reflect on them to advance thinking and the field • Focus on adapting existing frameworks, theories, and outcomes within IS to place greater emphasis on health equity • Bring in experts from adjacent disciplines and strive for transdisciplinary approaches to meaningfully innovate
We recreated the research-to-practice gap	• Prioritizing researcher over practitioner perspectives in IS and prioritizing the production of generalizable knowledge over knowledge that has practical applications in a “real word” context • Many IS frameworks and methods lack utility for practical application beyond a research study	• Refine IS frameworks to place greater emphasis on pragmatism and application • Develop modular implementation strategies that can be easily tailored and have broad applicability across practice settings • Better integrate the perspectives of researchers and practitioners and promote opportunities for meaningful collaboration
We could not balance making implementation science available to everyone while retaining the coherence of the field	• Implementation scientists act as gatekeepers to the field because they seek to establish IS as a coherent field	• Consider the IS training needs of three different groups: (1) those who should have general awareness of IS but are unlikely to incorporate it into their work, (2) those who will use IS as part of their broader toolkit, and (3) those who will narrowly focus on IS and advancing the field • Create divisions and departments of IS within institutions, comprised of individuals with extensive IS expertise who apply it to help address implementation challenges/research questions across the institution
We could not align our timelines, incentives, or priorities with our partners	• By the time a IS research study is complete, the practice context surrounding implementation has changed and there is a misalignment between the knowledge produced and the context in which it was intended to be applied • The incentive structures for researchers—imposed by universities, funders, and health systems—are often misaligned with those of the community partners needed to conduct impactful IS	• Embrace an embedded IS researcher model that prioritizes partner needs and priorities over researcher interests and co-creates evidence together • Co-design funding mechanisms that are aligned with community timelines and needs • Use rapid IS methods
Our implementation strategies and processes were too complex and not well matched to partner needs	• Taxonomies of implementation strategies and behavior-change methods and techniques are not exhaustive and may not be readily understandable by community partners • Pressure to prioritize innovation can lead to rebranding and reinventing the wheel rather than conceptual and empirical investment • The language of “implementation mechanisms” may make our science feel less relevant to community-based collaborators • Methods to design, select, and tailor implementation strategies can be resource intensive, leading to partner burden	• Embrace approaches that prompt implementers to consider what multilevel changes are required to implement, scale, and sustain interventions; what might help or hinder those changes; and how changes can be feasibly measured • Determinants could be more feasibly identified through systematic reviews, rapid approaches to contextual inquiry, or existing data, and approaches to rapidly prioritize determinants could be identified and evaluated • Prioritize pragmatic approaches to implementation strategy design, selection, and tailoring • Create and improve tools to help implementers identify, develop, and apply implementation strategies • Consider the mechanisms through which strategies operate to ensure that they are designed as efficiently as possible and to inform adjustments for poorly performing strategies • Leverage user-centered designs and approaches such as the Multiphase Optimization Strategy (MOST), Learn as You Go (LAGO), and Sequential Multiple Assignment Randomized Implementation Trial (SMART) designs that prioritize adaptation and efficiency • Improve reporting of implementation strategies to avoid pseudoinnovation and move toward the identification of “common elements” of effective implementation strategies • Embrace approaches to efficiently build the evidence for implementation strategies, such as the Audit and Feedback Metalab [6, 11]

Pre-mortem threat theme

Cause of threat

Solutions to address threat

We did not impact population health or health equity

• Structural factors have only recently become a focus in the field of IS, despite being critical to population health and health equity impacts

• It takes a long time and substantial resources to change determinants of implementation at multiple levels, and these changes are critical to population health and health equity impacts

• Misalignment between metrics used to judge IS researcher success (e.g., publications, grants) and metrics of population impact

• Document impact at organizational, community, and policy levels in IS publications

• Efficiently include health outcomes in IS studies by leveraging routinely collected heath outcome data and other pragmatic measures

• Use multidisciplinary team science approaches in IS to address structural and social determinants of implementation

• Prioritize focus on implementation strategies and EBPs that have the most potential to promote health equity

• Routinely measure the impacts of implementation strategies on health equity outcomes

• Generate more evidence about associations between implementation outcomes and health outcomes, the impacts of implementation efforts on health equity outcomes, and economic return on investment of implementation strategies

• Translate findings from IS research into useable tools for practitioners and clearly communicate the value of IS to the public and policymakers

We over anchored on becoming a “legitimate” science

• Lack of critical thinking about which IS frameworks to use and IS outcomes to focus on for a specific context

• Holding too firmly to the belief that there needs to be an EBP—as opposed to a program that meets a community’s need but has not yet demonstrated effectiveness—in order to conduct IS

• Tendency to borrow from fields and disciplines outside of IS to maximize innovation without fully leveraging the body of knowledge in those areas

• Embrace critiques of the field of IS and reflect on them to advance thinking and the field

• Focus on adapting existing frameworks, theories, and outcomes within IS to place greater emphasis on health equity

• Bring in experts from adjacent disciplines and strive for transdisciplinary approaches to meaningfully innovate

We recreated the research-to-practice gap

• Prioritizing researcher over practitioner perspectives in IS and prioritizing the production of generalizable knowledge over knowledge that has practical applications in a “real word” context

• Many IS frameworks and methods lack utility for practical application beyond a research study

• Refine IS frameworks to place greater emphasis on pragmatism and application

• Develop modular implementation strategies that can be easily tailored and have broad applicability across practice settings

• Better integrate the perspectives of researchers and practitioners and promote opportunities for meaningful collaboration

We could not balance making implementation science available to everyone while retaining the coherence of the field

• Implementation scientists act as gatekeepers to the field because they seek to establish IS as a coherent field

• Consider the IS training needs of three different groups: (1) those who should have general awareness of IS but are unlikely to incorporate it into their work, (2) those who will use IS as part of their broader toolkit, and (3) those who will narrowly focus on IS and advancing the field

• Create divisions and departments of IS within institutions, comprised of individuals with extensive IS expertise who apply it to help address implementation challenges/research questions across the institution

We could not align our timelines, incentives, or priorities with our partners

• By the time a IS research study is complete, the practice context surrounding implementation has changed and there is a misalignment between the knowledge produced and the context in which it was intended to be applied

• The incentive structures for researchers—imposed by universities, funders, and health systems—are often misaligned with those of the community partners needed to conduct impactful IS

• Embrace an embedded IS researcher model that prioritizes partner needs and priorities over researcher interests and co-creates evidence together

• Co-design funding mechanisms that are aligned with community timelines and needs

• Use rapid IS methods

Our implementation strategies and processes were too complex and not well matched to partner needs

• Taxonomies of implementation strategies and behavior-change methods and techniques are not exhaustive and may not be readily understandable by community partners

• Pressure to prioritize innovation can lead to rebranding and reinventing the wheel rather than conceptual and empirical investment

• The language of “implementation mechanisms” may make our science feel less relevant to community-based collaborators

• Methods to design, select, and tailor implementation strategies can be resource intensive, leading to partner burden

• Embrace approaches that prompt implementers to consider what multilevel changes are required to implement, scale, and sustain interventions; what might help or hinder those changes; and how changes can be feasibly measured

• Determinants could be more feasibly identified through systematic reviews, rapid approaches to contextual inquiry, or existing data, and approaches to rapidly prioritize determinants could be identified and evaluated

• Prioritize pragmatic approaches to implementation strategy design, selection, and tailoring

• Create and improve tools to help implementers identify, develop, and apply implementation strategies

• Consider the mechanisms through which strategies operate to ensure that they are designed as efficiently as possible and to inform adjustments for poorly performing strategies

• Leverage user-centered designs and approaches such as the Multiphase Optimization Strategy (MOST), Learn as You Go (LAGO), and Sequential Multiple Assignment Randomized Implementation Trial (SMART) designs that prioritize adaptation and efficiency

• Improve reporting of implementation strategies to avoid pseudoinnovation and move toward the identification of “common elements” of effective implementation strategies

• Embrace approaches to efficiently build the evidence for implementation strategies, such as the Audit and Feedback Metalab [6, 11]

IS implementation science, EBP evidence-based practice