Implementation Strategies and Frameworks

Implementation strategies are the methods and techniques used to adopt, integrate, and sustain evidence-based practices, while implementation frameworks are the conceptual structures used to plan, organize, and evaluate that work. Together they give implementation science a shared vocabulary for naming what is done to change practice and for understanding why it succeeds or fails.

Definition

An implementation strategy is a method or technique used to enhance the adoption, implementation, and sustainability of a clinical program or practice; an implementation framework is a conceptual model used to describe, guide, or evaluate the determinants, processes, or outcomes of implementation.

Scope

This topic covers discrete implementation strategies and their compilation (such as the ERIC list), and the main families of frameworks: determinant frameworks that identify what influences implementation, process models that describe its stages, and evaluation frameworks that specify outcomes. It is a methodological reference and does not prescribe interventions for individual patients.

Core questions

• What concrete strategies can be used to change practice?
• How are implementation frameworks categorized and what is each type for?
• What outcomes distinguish implementation success from clinical effectiveness?
• How are strategies matched to the barriers identified in a setting?

Key concepts

• Discrete implementation strategy
• ERIC compilation
• Determinant framework
• Process model
• Evaluation framework
• Implementation outcomes
• Strategy-barrier matching
• Fidelity and adaptation

Key theories

Consolidated Framework for Implementation Research (CFIR)

A determinant framework consolidating constructs across the intervention, the inner and outer setting, the individuals involved, and the implementation process, used to identify what influences whether implementation succeeds.

Implementation outcomes taxonomy

Proctor and colleagues distinguished implementation outcomes (such as acceptability, adoption, feasibility, fidelity, penetration, and sustainability) from service and clinical outcomes, giving the field measurable targets distinct from whether the practice itself works.

RE-AIM evaluation framework

Glasgow and colleagues proposed evaluating interventions on Reach, Effectiveness, Adoption, Implementation, and Maintenance, balancing internal validity with the dimensions that determine real-world public-health impact.

Mechanisms

Implementation work is organized around three framework functions. Determinant frameworks such as CFIR catalogue the contextual factors that help or hinder change, so that barriers can be assessed. Process models lay out the stages of implementation. Evaluation frameworks such as RE-AIM and the implementation-outcomes taxonomy specify what to measure, separating whether a practice was adopted and delivered with fidelity from whether the practice itself is effective. Discrete strategies, compiled and named in efforts such as the ERIC project, are the concrete actions selected and tailored to address the identified determinants.

Clinical relevance

Strategies and frameworks structure how quality and safety improvements are introduced and evaluated in services, distinguishing the success of getting a practice used from the clinical effectiveness of the practice itself. The topic describes how implementation is planned and assessed at the system level and provides no individualized treatment guidance.

Evidence & guidelines

The topic draws on widely cited compilations and frameworks rather than a clinical guideline. The ERIC compilation provides a common terminology for strategies, CFIR for determinants, the implementation-outcomes taxonomy for measurement, and RE-AIM for evaluation; reviews note that strong evidence linking specific strategies to outcomes across contexts is still developing.

History

As implementation science matured in the 2000s and 2010s, the field worked to standardize its language. Determinant and evaluation frameworks appeared first, the implementation-outcomes taxonomy (2011) distinguished implementation from clinical success, and the ERIC project (2015) produced a refined, expert-consensus list of discrete strategies, addressing earlier criticism that strategies were inconsistently named and reported.

Debates

Inconsistent naming and reporting of strategies

Strategies have historically been described in heterogeneous, poorly specified terms, hampering replication and synthesis; consensus compilations aim to standardize terminology, though debate continues over how precisely strategies must be specified and reported.

Key figures

• Byron Powell
• Enola Proctor
• Laura Damschroder
• Russell Glasgow
• JoAnn Kirchner

Seminal works

• damschroder-2009
• proctor-2011
• glasgow-1999
• powell-2015

Frequently asked questions

What is the difference between an implementation strategy and an implementation framework?

A strategy is a concrete method or technique used to change practice, such as audit and feedback or facilitation; a framework is a conceptual structure used to identify determinants, organize the process, or specify outcomes when planning and evaluating that change.

Why are implementation outcomes kept separate from clinical outcomes?

Because a practice can be effective yet poorly adopted, or well adopted yet delivered with low fidelity; measuring acceptability, adoption, fidelity, and sustainability separately shows whether implementation itself succeeded, independent of the practice's clinical effect.