Contradictions Associated With the Process of Conducting Embedded Implementation Science and Case Study Examples of Strategies for Resolving Contradictions
| Attribute | Core Strategies of Implementation Science | Strategic Adjustments of Embedded Science | Contradictions Encountered by Embedded Implementation Science | Implications for Resolving Contradictions |
|---|---|---|---|---|
| Teamwork | Constitute teams according to technical functions. | Delineate implementation and research teams. | Research teams and implementation teams have contrasting skills, orientations, and roles. | Configure at each level of the system “learning localities” where the pursuit of excellence is a collaborative endeavor that integrates implementation with investigation. |
| Simplicity | Develop measureable indicators of endpoints and possible confounders. | Focus on indicators that are commensurate with host organizational data capture, analysis, and communication capabilities. | Research and implementation integration is complex to undertake, but simplicity is often essential for fostering organizational change.105,106 | Employ mixed methods research and knowledge management to promote understanding of essential processes and outcomes.44,45,98 |
| Replicability | End of project terminates further research on replication or scale-up. | Design projects to facilitate subsequent replication and scale-up. | Developing learning systems requires focused inquiry in localities where interventions can be tractably managed. Managers often seek investigation that is immediately relevant to large-scale operations.44,45 | Plan phases in advance99 that (i) diagnose systems requirements, (ii) test impact, (iii) test replication, and (iv) scale up based on replication lessons. |
| Fidelity | Fidelity of interventions to themes appearing in the scientific literature. | For longitudinal research on scaling up, develop communication mechanisms that ensure widespread host agency understanding of the evidence justifying change. | Primary science generates knowledge about impact without providing knowledge about change processes.90 Adapting to unanticipated changes is essential to scale-up.100 Fidelity to research outcomes is often incompatible with flexibility. | Develop “learning localities” for catalyzing the geographic spread of implementation. Integrate learning into national systems planning processes. Avoid advocacy focusing solely on “success” without also publicizing challenges and failure.88 |