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(Re-)conceptualising implementation depth of healthcare innovations - A systematic review and concept analysis

Balayah, Z., Stavropoulou, C. ORCID: 0000-0003-4307-1848, Chen, Y. ORCID: 0000-0003-2549-8880 , Scarbrough, H. ORCID: 0000-0002-3820-8339, Nigam, A. ORCID: 0000-0002-6772-9643 & Ziemann, A. ORCID: 0000-0002-5996-8484 (2021). (Re-)conceptualising implementation depth of healthcare innovations - A systematic review and concept analysis. Implementation Science, 16, ISSN 1748-5908 doi: 10.1186/s13012-021-01163-7


Implementation depth, the extent to which innovations are implemented successfully, is a matter of great interest in healthcare practice. Yet, the way implementation depth is conceptualised varies between different studies, settings and contexts. The aim of this study is to report on the clarification and re-conceptualisation of implementation depth in healthcare, by synthesising the theoretic scientific literature from multiple disciplinary backgrounds.

We applied a pragmatic utility concept analysis approach, a metaanalytic and interpretative method aiming at providing new insights of partially mature concepts using literature as data source. We followed the BeHEMoTh (Behaviour or phenomenon of interest, Health context, Exclusions, Models and Theories) approach for systematically searching for and identifying a comprehensive compilation of concepts from the scientific literature. The following databases were searched: Medline, Embase, CINAHL, PsychInfo, Global Health, HMIC, Business Source Complete, and Social Policy and Practice. In addition to handsearching references of selected publications, key textbooks and citation tracking. First order-concepts’ definitions, characteristics/attributes and boundaries/allied concepts were extracted and analysed to derive second-order concepts of implementation depth.

We identified 66 publications that met our eligibility criteria. The preliminary results reveal the consolidated conceptualisation of implementation depth encompasses five concepts: low implementation depth (abandonment), high implementation depth (assimilation), normalising and sustaining innovation over time (sustainability), removal/reduction or substitution of an existing practice (deimplementation), and progression of implementation stages (stickiness of implementation stages). The second-order concepts of implementation depth clarify a unified structure to conceptualise the dynamic successes and/or failures of implementation efforts.

The consolidated framework of implementation depth delineates the type of implementation ‘success’. It offers a useful heuristic for operationalising shallow to deep implementation, that may be better suited for understanding challenge.

Publication Type: Conference or Workshop Item (Paper)
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Subjects: H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management
R Medicine > RC Internal medicine
Departments: Bayes Business School > Management
Text - Published Version
Available under License Creative Commons: Attribution International Public License 4.0.

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