Shifting Implementation Science Theory to Empower Primary Care Practices
Open accessAbstract
Observers of the past 10 to 15 years have witnessed the simultaneous growth of dramatic changes in the practice of primary care and the emergence of a new field of dissemination and implementation science (D&I). Most current implementation science research in primary care assumes practices are not meeting externally derived standards and need external support to meet these demands. After a decade of initiatives, many stakeholders now question the return on their investments. Overall improvements in quality metrics, utilization cost savings, and patient experience have been less than anticipated. While recently conducting a research project in primary care practices, we unexpectedly discovered 3 practices that profoundly shifted our thinking about the sources and directionality of practice change and the underlying assumptions of D&I. Inspired by these practices—along with systems thinking, complexity theory, action research, and the collaborative approaches of community-based participatory research—we propose a reimagining of D&I theory to empower practices. We shift the emphasis regarding the source and direction of change from outside-in to inside-out. Such a shift has the potential to open a new frontier in the science of dissemination and implementation and inform better health policy.
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Involving stakeholders in defining local health system needs and selecting EBP(s) and/or implementation strategies enhances their collaboration and ownership of the implementation effort.
“having them involved in defining the local health system needs and selecting EBP(s) and/or implementation strategies in the EPIS implementation phase, as these are important to enhance their collaboration and ownership of the implementation effort [26].”
From Ten recommendations for using implementation frameworks in research and practice (2020) · cites this paper as [26]
Stakeholder engagement is an integral component of implementation.
“Stakeholder engagement is an integral component of implementation [25, 26].”
From Ten recommendations for using implementation frameworks in research and practice (2020) · cites this paper as [26]
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Ten recommendations for using implementation frameworks in research and practice
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- Authors
- Miller, W. L., Rubinstein, E. B., Howard, J., & Crabtree, B. F.
- Affiliations
- University of South Florida (US)
- North Dakota State University (US)
- Rutgers, The State University of New Jersey (US)
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2019-05
- Volume
- 17
- Issue
- 3
- Pages
- 250-256
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC6827625
- OpenAlex
- W2945692682
- Cited by
- 36
- References
- 53
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 9 · 2023: 5 · 2022: 3 · 2021: 11 · 2020: 1 · 2019: 1
- FWCI
- 5.45
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (R01CA176545)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- dissemination and implementation research, primary care practices, practice change, empowerment, systems thinking, complexity theory, action research, community-based participatory research, health policy, quality improvement
- MeSH terms
- Implementation Science, Humans, Practice Patterns, Physicians', Primary Health Care, Qualitative Research, Community-Based Participatory Research
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