Implementation science: why using evidence doesn’t guarantee success

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Using evidence in policy making is not a new concept. In recent years it has become commonplace across all areas of policy in the UK, with the introduction of the What Works centres being just one example of this. Policy makers also use evidence to defend the rationale of their initiatives and programmes. But a large evidence base does not necessarily guarantee a successful outcome for a programme or initiative. Without an effective implementation strategy, evidence might as well not exist.

Linking evidence use to implementation within policy is one of the key challenges for policy-makers and those on the frontline of service delivery. Implementation science is an emerging discipline which looks at the nature of implementation, and how it can affect the success of a programme or policy.

Introducing the Hexagon Tool

This tool was developed by the National Implementation Research Network. It outlines six broad factors that should be considered to promote effective implementation of programmes. Designed in a US context for application at state and district levels, many of the ideas about what makes for good implementation are relevant more broadly.

  1. Needs (of service user) – consider how well the programme or practice being implemented might meet identified needs.
  2. Fit – with current and pre-existing initiatives, priorities, structures, support, and local community values and context.
  3. Resource availability – for training, staffing, technology supports, data systems, and administration
  4. Evidence – indicating the outcomes that might be expected if the programme practices are implemented well (assessment criteria)
  5. Readiness for replication – including any expert assistance available, the number of existing replications, examples of best practice for observation, and how well the programme is operationalised.
  6. Capacity to implement – as intended, and to sustain and improve implementation over time
The Hexagon Tool How to cite: Blase, K., Kiser, L. and Van Dyke, M (2013) The Hexagon Tool: Exploring context. Chapel Hill, NC: National Implementation Research Network, FPG Child Development Institute, University of North Carolina.

The Hexagon Tool
Blase, K., Kiser, L. and Van Dyke, M (2013) The Hexagon Tool: Exploring context. Chapel Hill, NC: National Implementation Research Network, FPG Child Development Institute, University of North Carolina.

In addition to the hexagon, other useful frameworks for implementation exist. Some are more practical and others are more conceptual. These may link to theories underpinning the practice of implementation of programme strategies, or discuss the idea of values within systems.

However, frameworks only provide some of the knowledge and infrastructure for implementation. They do not take account of the skills, abilities, values and existing experience of “implementers”. All of these can have a significant impact on how a programme or strategy is implemented.Solution and business words jigsaw

Systems change and innovation

Implementation science has previously focused on changing the behaviour of individual practitioners. However, unless you change the understanding of the wider structures and systems, and implement whole system change, you won’t achieve practitioner change.

Alignment within systems, both within organisations in a hierarchical sense, but also across systems in order to create coherence across services, is important. Many service users have experience of receiving support simultaneously from a number of different organisations. Implementation scientists stress that it is important to align funding, outcomes, compliance and overall goals of parallel organisations in order to effectively implement programmes. This can be a major challenge.

One reason why this can be so challenging is the difference in values and experiences of the individual front line workers implementing a new programme on the ground. Teachers have a very different understanding, training and set of experiences relating to children than those of social workers, or those who work in youth criminal justice. The inherent and fundamental philosophical beliefs which drive the practice of different professionals will have an impact on how they implement a programme, regardless of how thorough guidelines are.

This, implementation scientists suggest, needs to be taken account of, and steps taken to try and more closely align the thinking of different professionals and agencies (interagency working) in order to effectively, and coherently implement new programmes.

Evidence is contextual

Implementation science raises some interesting points about how to facilitate change and implement new initiatives. It reminds us that no intervention – no matter how much evidence is produced in support of its effectiveness elsewhere – is guaranteed to be a success. It highlights the often overlooked elements to intervention strategies, such as the need to be context aware, and aware of the values of the people who are implementing the changes, and those affected by the changes.

Finally, it highlights the need to encourage wider structural and systems change, rather than just changing the behaviour of individual practitioners. This is the way to ensure lasting, sustainable and successful implementation of evidence-informed policy interventions and programmes.


Read some of our other blogs on evidence use in policy:

2 thoughts on “Implementation science: why using evidence doesn’t guarantee success

  1. Pingback: Creating sustainability in health and social care | The Knowledge Exchange Blog

  2. Pingback: Why a holistic approach to public health and social care needs a wider evidence base … and how Social Policy and Practice can help | The Knowledge Exchange Blog

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