Implementation support practitioners – a proposal for consolidating a diverse evidence base

Albers, B., Metz, A. and Burke., K. (2020) Implementation support practitioners – a proposal for consolidating a diverse evidence base. BMC Health Services Research. 20:368. https://doi.org/10.1186/s12913-020-05145-1

 

Abstract

Background: Workforce development for implementation practice has been identified as a grand challenge in health services. This is due to the embryonic nature of the existing research in this area, few available training programs and a general shortage of frontline service staff trained and prepared for practicing implementation in the field. The interest in the role of “implementation support” as a way to effectively build the implementation capacities of the human service sector has therefore increased. However, while frequently used, little is known about the skills and competencies required to effectively provide such support.

Main body: To progress the debate and the research agenda on implementation support competencies, we propose the role of the “implementation support practitioner” as a concept unifying the multiple streams of research focused on e.g. consultation, facilitation, or knowledge brokering. Implementation support practitioners are professionals supporting others in implementing evidence-informed practices, policies and programs, and in sustaining and scaling evidence for population impact. They are not involved in direct service delivery or management and work closely with the leadership and staff needed to effectively deliver direct clinical, therapeutic or educational services to individuals, families and communities. They may be specialists or generalists and be located within and/or outside the delivery system they serve. To effectively support the implementation practice of others, implementation support practitioners require an ability to activate implementation-relevant knowledge, skills and attitudes, and to operationalize and apply these in the context of their support activities. In doing so, they aim to trigger both relational and behavioral outcomes. This thinking is reflected in an overarching logic outlined in this article.

Conclusion: The development of implementation support practitioners as a profession necessitates improved conceptual thinking about their role and work and how they enable the uptake and integration of evidence in real world settings. This article introduces a preliminary logic conceptualizing the role of implementation support practitioners informing research in progress aimed at increasing our knowledge about implementation support and the competencies needed to provide this support.

 

I’m not certain why this paper needed to be written. I am an implementation support practitioner (aka knowledge broker), I lead a network of similar folks (Research Impact Canada), collaborate with a sister network in the US (Advancing Research Impact in Society) and in February I returned from a week long program we called Mobilizing Melbourne (Australia). Maybe because I am living and breathing the implementation support role I don’t see the point of this article.

But maybe that is the point. The field needs to consolidate. The authors recognize existing terms for the role of implementation support practitioners including knowledge brokers and other terms familiar to knowledge mobilizers. They state, to both consolidate and progress the debate and research agenda in this particular area of implementation science, we therefore suggest unifying its rather diverse terminology – under the label “implementation support practitioner”.

However, despite citing 98 academic articles the paper thinks that even more research is needed. According to the authors we need greater synthesis of the existing literature, despite citing systematic reviews themselves.

I don’t disagree that yet more synthesis is possible. I just don’t know why we need a new term for folks who are already in the trenches performing these roles. And here’s the thing about inventing a new term. No one is going to use it except you. Karen Richie from Health Improvement Scotland famously said, “impact frameworks are like toothbrushes. Everyone has one and no one wants to use anyone else’s”. Same is true for terms. We need to stop inventing new terms and just use the ones that are already in use, sometimes for many years.

The article also indicates we need more research on competencies of the folks who are implementation practitioners. Well we’ve got that for KT practitioners and for research impact practitioners. If the authors can step away from a new term they can step away from thinking more research is needed and use the research already in hand.

What I think is important in this article is the reflection on individual as well as organizational responses to implementation support practitioners. The literature often focuses on individual functions and competencies but the organization (and beyond that the system) will have their own competencies, barriers and enablers to implementation.

I also think those 98 references are a valuable collection of literature. And it is representative of a much bigger corpus of work related to the practice of implementation (and related terms).

What I would have liked to see is a disclosure of the roles of the authors. Two are based at universities and one (Burke) is at the Centre for Effective Services (Dublin, Ireland). If Burke is an implementation support practitioner and the other two are implementation researchers then this combination is valuable as it links implement research and implementation practice, something the paper calls for.

 

Questions for brokers

  1. Implementation Support Practitioners: if you’re a knowledge broker will you change your title? Why or why not?
  2. It’s classic for researchers to demand “more research is needed” after all, that’s their job. But do practitioners (in any field) think that more research is needed? Or should we just get on with using the research we have?
  3. The paper is calling for greater linkage between implementation research and implementation practice. Is it ironic that implementation research is not being implemented?

 

Research Impact Canada is producing this journal club series to make evidence on KMb more accessible to knowledge brokers and to create online discussion about research on knowledge mobilization. It is designed for knowledge brokers and other knowledge mobilization stakeholders. Read this open access article. Then come back to this post and join the journal club by posting your comments

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