1 What Implementation Science Is (and Is Not)

Question 1

What gap does implementation science address?

Answer 1

The gap between effective interventions and routine, sustained use in real systems.

• Evidence ≠ adoption
• Focus is on use, not invention
• Begins after effectiveness is plausible

Question 2

Why doesn’t strong evidence reliably change practice?

Answer 2

Because evidence reduces clinical uncertainty, not system or behavioural constraints.

• Workflow misfit
• Social norms
• Incentives and accountability
• Cognitive load

Question 3

What does implementation science focus on?

Answer 3

Adoption, use, and sustainment of effective practices.

• Not efficacy
• Not discovery
• Not awareness

Question 4

Implementation science vs quality improvement — key difference?

Answer 4

QI optimises locally; implementation explains uptake across contexts.

• QI = “better here”
• Implementation = “used reliably elsewhere”

Question 5

Implementation science vs research — key difference?

Answer 5

Research generates knowledge; implementation generates reliable use.

• Research asks “does it work?”
• Implementation asks “will it be used?”

Question 6

Why do pilots usually overestimate success?

Answer 6

Pilots suppress real-world constraints.

• Extra resources
• High motivation
• Protected environments

Question 7

What is the “last mile” in healthcare implementation?

Answer 7

The point where real work, constraints, and trade-offs collide.

• Fragmented workflows
• Competing priorities
• Improvisation

Question 8

Why is implementation fundamentally a social process?

Answer 8

Because adoption depends on norms, roles, power, and trust.

• Who changes
• Who bears burden
• Who absorbs risk

Question 9

A guideline is published but ignored — what kind of problem is this?

Answer 9

An implementation problem, not an evidence problem.

• Likely workflow or ownership issues
• Education alone won’t help

Question 10

What’s wrong with a “technically correct but unusable” solution?

Answer 10

It doesn’t fit real work.

• Timing mismatch
• Cognitive overload
• Role confusion

Question 11

Why do good organisations still fail at implementation?

Answer 11

Execution capacity is not the same as intent or expertise.

• Strong policy ≠ strong delivery
• Clinical excellence ≠ change capability

Question 12

Leadership support is strong but uptake is weak — what’s missing?

Answer 12

Local ownership and frontline sense-making.

• Endorsement ≠ legitimacy
• Authority ≠ usability

Question 13

When should you not implement an intervention?

Answer 13

When foundations for use are not in place.

• Unstable intervention
• Unclear ownership
• Undefined success

Question 14

Why is calling something a “compliance problem” risky?

Answer 14

Because non-use is often rational.

• System constraints
• Conflicting incentives
• Hidden costs

Question 15

What does implementation science assume about behaviour?

Answer 15

Behaviour is context-dependent and constrained.

• Limited attention
• Competing priorities
• Social influence

Question 16

Early adopters love it — why isn’t that success?

Answer 16

Early adopters hide system friction.

• High motivation
• Willing to workaround

Question 17

Who should own an implementation effort?

Answer 17

Those whose work and risk change.

• Not committees
• Not temporary project teams

Question 18

Why is implementation rarely linear?

Answer 18

Because systems adapt and push back.

• Feedback loops
• Drift
• Workarounds

Question 19

Why does scale often destroy early success?

Answer 19

Scale removes relationships and heroics.

• Less attention
• Fewer informal fixes

Question 20

What’s the first practical move in any implementation effort?

Answer 20

Map whose work must change and what they must stop doing.

• Behaviour change is subtraction as well as addition

Question 21

How does implementation science interpret resistance?

Answer 21

As information, not defiance.

• Signals misfit
• Reveals hidden costs

Question 22

Why is context not just a modifier?

Answer 22

Because context shapes meaning and feasibility.

• Determines trade-offs
• Constrains action

Question 23

Why is “we’ll think about sustainment later” a mistake?

Answer 23

Because sustainment requires early design decisions.

• Ownership
• Resources
• Routines

Question 24

Why doesn’t documentation change behaviour?

Answer 24

Because information doesn’t enable action.

• Awareness ≠ capability
• Instructions ≠ affordances

Question 25

How does implementation science complement **human factors**?

Answer 25

HF explains strain; implementation explains stickiness. ## Footnote * HF: why work is hard * IS: why change doesn’t last

Question 26

What does successful **implementation** look like?

Answer 26

Routine, predictable use without heroics. ## Footnote * Survives turnover * Needs minimal reminders

Question 27

Why is implementation **slower** than expected?

Answer 27

Because norms and routines change slowly. ## Footnote * Trust takes time * Habits lag intention

Question 28

What kind of **uncertainty** does implementation science address?

Answer 28

Practical and social uncertainty. ## Footnote * Not clinical uncertainty * Not statistical uncertainty

Question 29

Why do technically good ideas still **fail**?

Answer 29

Because systems select for fit, not correctness. ## Footnote * Competing priorities * Misaligned incentives

Question 30

In one sentence, what is **implementation science**?

Answer 30

The disciplined study of how effective practices become ordinary, reliable, and sustainable in real systems.