Implementation Strategies Explained
By Dr. Julia E. Moore, Executive Director
5-min read
What are implementation strategies?
Many of us are engaging in implementing programs, policies, practices, guidelines or standards - what Geoff Curran (2020) refers to as a "THING". Implementation strategies are the intentional actions used to support individuals, organizations, and systems to adopt, implement, and sustain the THING (i.e., the programs, policies, practices, guidelines, or standards).
Implementation strategies include a wide range of approaches that address behavior, relationships, leadership, systems, culture, and context across the full implementation journey. We consider implementation strategies to be “Approaches” in theories, models, frameworks, and approaches (TMFAs).
Because implementation strategies can be used at different levels (individual, organizational, and system) and at different points in time, they can sometimes feel overwhelming. But when you select them intentionally and in alignment with the barriers and facilitators (this is an overview of how to select, combine, and backmap strategies), they become powerful tools for supporting meaningful and sustainable change.
Common examples of implementation strategies include training, coaching, educational materials, audit and feedback, reminders, nudges, and environmental restructuring.
Why implementation strategies matter
Understanding what implementation strategies are helps clarify why they play such a critical role in supporting real-world change. Since the entire premise of implementation science is that we want to support people, organizations, and systems to effectively implement new THINGs in order to improve outcomes, implementation strategies serve as the HOW – the approaches we use to support change. In fact, implementation strategies are a core aspect of understanding how change will occur – it is important to define WHO is being asked to change, WHAT they are being asked to do, and also HOW we will support them to change.
Without intentionally selecting strategies, implementation efforts often default to one-off training or information sharing — approaches that rarely lead to behavior change on their own. Note that people might also use other strategies without ascertaining their effect on encouraging and supporting change – things like opinion leaders are also commonplace but are never acknowledged as a key part of how change happens. Without articulating what implementation strategies were used, it is difficult to ascertain whether implementation was done with high quality (i.e., we are actually addressing key barriers and facilitators with strategies that are proven to work), and scale will be challenging because we haven’t specified the HOW of implementation.
Why we call “Implementation Strategies” “Change Strategies” at TCI
While the term “implementation strategies” is widely used in academic literature, it doesn’t always resonate with people doing the day-to-day work of change. This was particularly true for people with backgrounds in quality improvement. For several years, here at TCI, we have referred to them as “change strategies”.
As is our approach with terms in general, we think people should use the terms that resonate most with them and their audience. So, if you were working with an academic audience, the term implementation strategies is probably the way to go. If that term doesn’t seem to resonate, try something else, such as “change strategies”.
ERIC Implementation strategies: The original list of implementation strategies list
To understand how the concept of implementation strategies developed, it helps to look at where the original lists came from. The original list of implementation strategies is typically referred to as the “ERIC strategies.” This is a list of strategies that was compiled by experts in the field (Powell et al., 2015). While this is the original list from implementation strategies, there are other lists of strategies from adjacent fields that pre-existed this list (although they were not necessarily referred to as “implementation strategies”). These strategies have been widely used in research and practice, providing a shared language for describing how implementation efforts are delivered.
The list has been expanded and re-categorized several times, sometimes by the original authors, and sometimes by different groups. This list serves as the foundation for almost all conversations around implementation strategies. Yet there have been several critiques of the original list, which is now over 10 years old.
Some criticisms of the ERIC list have included how the list may not represent all of the different types of strategies used in low- and middle-income countries, how the list does not include as many relational strategies as are being used in practice, and the list does not have many system-level strategies.
Why we expanded the list of implementation strategies
Although the ERIC strategies provide a strong foundation, they do not fully reflect the range of strategies used in today’s complex implementation contexts. In our work across healthcare, education, social services, and community systems, we consistently observed strategies being used that were not well represented in existing taxonomies. For many years, we had used an adapted version of the ERIC strategies list, adding in elements from the EPOC taxonomy and behaviour change techniques (described in the Behaviour Change Wheel). This is what we have used as the foundation for the strategies in our StrategEase tool.
Note that if you are looking for other similar tools, you can check out the Theory and Techniques Tool and the CFIR-ERIC Matching Tool.
Despite the fact that we have been using this list, for several years, we felt like this existing list did not capture the totality of the strategies that we have been seeing and experiencing in practice. In the process of developing our new and updated version of the StrategEase tool, which will include strategies to address both individual and contextual barriers and facilitators, we decided it was the perfect opportunity to expand our list of implementation or change strategies.
This expanded list includes many more system-level strategies, some additional organization-level strategies, and many more strategies focused on relationships (for example, dealing with power and trust), more sensemaking strategies, and more individual strategies, particularly those focusing on being more reflective.
The expanded list of strategies was drawn from the academic literature, the gray literature, and information from implementation support practitioners around the world.
We do not believe that this is an exhaustive list of implementation strategies. In fact, we suspect there are still many more to be added, strategies that are currently being used, and new strategies that will likely be developed. For example, there are no AI-related strategies, but we can anticipate that some groups will develop AI-related strategies in the future.
Introducing TCI’s List of Change Strategies
Here is our updated list of implementation strategies that will be used in the updated version of the StrategEase tool.
Conclusion
Implementation strategies (or change strategies, as we call them at TCI) are the intentional actions that make change possible. They help bridge the gap between evidence and everyday practice by supporting people, organizations, and systems through the real work of change.
As the field of implementation science evolves, our work needs to evolve, too. That’s why we have decided to expand beyond the original ERIC list to include more relational, reflective, system-level, and context-specific strategies. We are looking to better reflect what change actually looks like in practice. Our growing list of change strategies is designed to be practical, flexible, and grounded in the realities of implementation work — supporting teams to move from intention to impact.
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