I already knew that implementation frameworks provided academic knowledge that was generalizable and teachable. But I also felt intuitively that ‘doing’ implementation might require a different type of knowledge. This is what Professor Ioan Fazey at the University of York has been writing about in his work around climate change. As Ioan explained on the podcast, we’ve got very good at problem analysis (about 95% of climate change papers analyse the problem) but we are still learning how to generate practical knowledge to actually address the problem (about 2% of climate papers do this). In order to generate practical knowledge we need to go and ‘do’ implementation and through this process we will learn ‘how to’ implement. So we need both academic implementation knowledge and practical implementation knowledge. I interviewed Laura Damschroder, the first author of the Consolidated Framework for Implementation Research (CFIR), a very popular implementation framework used across the globe, and asked her what her thoughts were on practical knowledge. She explained to me that she can diagnose a context for implementation barriers using the CFIR but the actual process of overcoming these barriers involves a process of engaging and working with receptive teams in the target setting. She combines implementation science with improvement science techniques and ensures teams are able to continually optimise the intervention over time.

The Improvement Academy, which forms part of the YHARC, are experts in improvement science and over the last 7 years they have generated vast amounts of practical implementation knowledge. And what do they say about the practical side of implementation? They say that relationships are vital to any implementation strategy. In fact Allison Metz, one of the most cited implementation practitioners in the world told me on the podcast that “relationships might actually be more important then the implementation strategy you use”. Relating is a difficult concept to quantify and measure but anyone who has been involved in the practical side of implementation knows how important this concept can be. Dr Ali Cracknell, another Interviewee, working with the Improvement Academy, managed to get Safety Huddles, a patient safety intervention, into 136 wards across the Yorkshire area. For Ali, safety huddles would not have worked had they not been developed over time via a process of stakeholder engagement and psychological safety where NHS staff were able to adapt the huddle to their specific needs on the ward. Dr Elizabeth Taylor-Buck and Amanda Lane told a similar story and were able to implement a patient reported outcome measure into 80% of Trusts. High service user and clinician input to ensure high face validity from the start, stakeholder workshops, an advisory group to help with the knowledge transfer and dealing with the ‘churn’ after the initial testing phase were all key steps to ensuring successful implementation.