What is the core mental shift in implementation science?
From “Is this a good idea?” to “Will this be used, by whom, and under what constraints?”
Key points:
* Quality ≠ uptake
* Correctness ≠ feasibility
In practice: Good ideas fail when fit is ignored.
What is the correct order of determinants, strategies, outcomes?
Determinants → strategies → outcomes.
Key points:
* Determinants explain why
* Strategies respond
* Outcomes reflect effects
In practice: Choosing strategies without diagnosis is guessing.
What is a determinant in implementation science?
A factor that influences whether an intervention is adopted, used, or sustained.
Key points:
* Not just “barriers”
* Can enable or constrain
In practice: Determinants explain patterns, not complaints.
Why are barriers the wrong starting question?
Because barriers are symptoms, not explanations.
Key points:
* Often subjective
* Often incomplete
In practice: Ask “what makes this hard?” not “what went wrong?”
What does context is a system mean?
Context consists of interacting constraints, not independent variables.
Key points:
* Workload
* Incentives
* Norms
* Infrastructure
In practice: Changing one part often shifts pressure elsewhere.
Why doesn’t changing behaviour start with motivation?
Because motivation is often already present.
Key points:
* People usually want to do the right thing
* Systems block follow-through
In practice: Low uptake often reflects low opportunity, not low will.
What does work-as-imagined vs work-as-done highlight?
The gap between how work is designed and how it actually happens.
Key points:
* Plans assume ideal conditions
* Reality involves trade-offs
In practice: Designs fail when they only fit work-as-imagined.
Why is subtraction as important as addition?
Because attention and time are finite.
Key points:
* New tasks displace old ones
* Overload kills adoption
In practice: If nothing stops, something breaks.
What does fit mean in implementation?
Alignment between the intervention and existing workflows, roles, and incentives.
Key points:
* Temporal fit
* Role fit
* Cognitive fit
In practice: Poor fit shows up as workarounds.
Why are interventions judged socially, not just technically?
Because people assess legitimacy, fairness, and burden.
Key points:
* Who benefits?
* Who pays the cost?
In practice: Perceived unfairness drives quiet resistance.
What does normalisation mean?
When a practice becomes the default way work is done.
Key points:
* No special effort
* No reminders
In practice: If reminders stop and use collapses, it wasn’t normalised.
Why are champions necessary but insufficient?
Because systems cannot rely on exceptional people.
Key points:
* Champions mask fragility
* Turnover reveals gaps
In practice: Design for average users, not heroes.
What does implementation is nonlinear imply?
Expect feedback, drift, and adaptation.
Key points:
* Progress isn’t smooth
* Setbacks are normal
In practice: Rigid plans fail in adaptive systems.
Why do incentives sometimes backfire?
Because they signal priorities and distort behaviour.
Key points:
* Crowd out intrinsic motivation
* Encourage gaming
In practice: Incentives change what people optimise for.
What is burden shifting in implementation?
When workload is moved without being removed.
Key points:
* Often invisible to designers
* Felt sharply by users
In practice: Burden accumulates until adoption collapses.
Why is ownership more important than enthusiasm?
Because ownership determines sustainment.
Key points:
* Enthusiasm fades
* Ownership persists
In practice: Ask who will still care in 12 months.
What does intervention complexity really mean?
The number of interactions it has with people and systems.
Key points:
* More touchpoints = more failure modes
In practice: Simple interventions scale more reliably.
Why does variability matter in implementation?
Because systems operate under uneven conditions.
Key points:
* Different staff
* Different days
* Different pressures
In practice: Design for bad days, not ideal ones.
What is local rationality?
People act sensibly given their constraints and goals.
Key points:
* Non-use is often rational
* Context shapes decisions
In practice: Blame disappears when constraints are visible.
Why does standardisation sometimes fail?
Because it ignores meaningful local differences.
Key points:
* One size rarely fits all
* Blind standardisation increases workarounds
In practice: Standardise the core, adapt the edges.
What is implementation debt?
Unresolved design and workflow problems that accumulate over time.
Key points:
* Hidden until scale
* Paid later with interest
In practice: Shortcuts today become failures tomorrow.
Why is timing a determinant in implementation?
Because capacity, priorities, and attention vary over time.
Key points:
* Right idea, wrong moment
* Competing initiatives dilute uptake
In practice: Bad timing often looks like resistance.
What does sense-making mean for users?
Understanding why the change exists and how it fits their work.
Key points:
* More than instructions
* Requires narrative and rationale
In practice: People disengage when changes feel arbitrary.
Why is sustainment designed, not achieved?
Because sustainment depends on routines, resources, and ownership.
Key points:
* Early design decisions matter
* Handover is a failure point
In practice: If sustainment isn’t planned, decay is guaranteed.
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*MASTER 101101
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*Intervention vs Implementation Mapping84
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*Implementation Frameworks — What’s in the Box?75
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Refresher102
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CFIR56
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1 What Implementation Science Is (and Is Not)30
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2 Core Implementation Mental Models30
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3 Implementation Outcomes (and Why They Matter)30
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4 CFIR for Practitioners30
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5 EPIS & Phase-Based Thinking30
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6 Determinants vs Barriers vs Root Causes30
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7 Implementation Strategies That Actually Work30
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8 Engagement, Buy-In, and Trust30
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9 Adaptation vs Fidelity30
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10 Theory of Change & Logic Models for Practice30
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11 Implementation Evaluation & Learning30
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12 RE-AIM in Real Life30
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13 Common Implementation Failure Modes30
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14 Sustainment Is Not a Phase30
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15 Digital Health Implementation30
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16 Implementation × Human Factors30
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17 Scaling, Spread, and National Rollouts30
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18 Safety, Risk, and Escalation in Implementation30
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19 Leadership for Implementation30
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20 Implementation in High-Reliability Organisations (HROs)30
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21 Implementation Under Resource Constraints30
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22 Teaching & Coaching Implementation Science30
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23 Implementation Playbooks & Checklists (Done Right)30
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24 Diagnosing Stuck Implementations30
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ERIC — Strategy Selection & Misuse (Practitioner Diagnostic Deck)21
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Implementation Metrics — What Misleads, What Matters20
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Executive Mini Deck25
