Implementing Implementation: Integrating the Measurement of Implementation and Effectiveness in Complex Service Systems

Implementation science is concerned with the effective deployment and sustainment of evidence-based practices in service delivery systems, with the ultimate goal of providing services to bring about optimal outcomes for clients. As the field of implementation science matures and research moves towards sustainment of implementation strategies within complex dynamic systems of care, the integration of implementation research into real-life practice settings will become increasingly important. Such an integrated approach relies on the ability to measure implementation success over time and to learn about causal mechanisms of implementation in service delivery systems. However, despite a continuing emphasis on the importance of high-quality data to support successful implementation efforts, data collection for implementation practice remains an under-researched frontier of implementation science. To this end, this chapter describes a causal approach of implementation research predicated on recognising implementation as a system component, with interventions and their implementation forming integral parts of dynamic systems of care with multiple stakeholders. This approach is facilitated by a 5-step implementation research framework, with a high-quality data system that integrates research with operational components to enable a holistic view of stakeholder incentives in what we denote as the Implementation Space. By considering the full implementation space from the beginning, data can be purposefully collected, stored and used. Such data systems will enable a process of learning by supporting a cascading and dynamic model of continuous quality improvement and practice optimisation through the Plan-Do-Study-Act (PDSA) cycle across all domains of the implementation space.