Furthering Implementation Management: A Pragmatic Scoping Review with Emphasis on Practical Recommendations

Background:
Many OHP initiatives fail to have the desired effects because of problems relating to implementation (Biron & Karanika-Murray, 2015). Implementation issues are important to address because they lead to waste of time and other workplace resources, while allowing the targeted OHP issues to continue affecting employees’ health and well-being negatively. During the last decades, process evaluation has become an integral aspect of OHP intervention research in the form of increasingly sophisticated evaluation frameworks (e.g., Abildgaard & Nielsen, 2013), and in the application of such frameworks in empirical studies, where a range of factors that may affect implementation positively or negatively have been identified (Havermans et al., 2016). However, while we have increasing knowledge of why specific interventions “go wrong”, relatively little research addresses how implementation processes can be managed so that they “go right”. This question is the focus of our study.

Method:
The study employs a pragmatic scoping review approach. Based on findings from a large-scale review of workplace implementation processes (Greenhalgh & Peacock, 2005), a combined backwards and forwards snowballing search strategy was chosen (Wohlin, 2014). To identify a wider range of implementation approaches and factors affecting implementation quality, studies relating to various comparable intervention types were included (OHP, ergonomics, workplace health promotion, patient quality). 115 relevant papers were identified and reviewed. A subset of 38 papers (primarily reviews) focusing on empirical studies of specific factors affecting implementation success were included in a descriptive quantitative analysis of the range and frequency of specific factors influencing implementation success.

Results:
The identified papers focus on one or more of three themes: 1) process-oriented approaches to designing and managing implementation processes, 2) role-based approaches to managing implementation processes, and 3) other circumstances affecting implementation success, such as features of the organizational context or the intervention in question. Among our notable findings are that while a wide range of factors can potentially affect implementation processes, certain challenges are highly recurrent, suggesting the relevance of a preventive management approach. Also, collaborative implementation management approaches involving both employees and managers have received limited attention, although these are recommended in the literature (Nielsen et al., 2010) and are the norm in certain geographical (e.g., Scandinavian) contexts. Third, compared to other workplace initiatives, health and safety initiatives seem especially vulnerable to circumstances which draw attention away from the implementation process, such as periods with high workload or employee turnover.

Conclusion:
Based on the literature, it is plausible that many implementation issues can be managed or mitigated through a proactive and preventive research-based approach. We suggest that such an approach should include carefully designing the intervention process, clarifying the roles of persons involved (e.g., as steering group members or champions of the initiative towards staff), and identifying and taking relevant measures against other circumstances that are likely to challenge implementation success before implementation is initiated. Besides entailing better management of implementation challenges, systematic preparation may also prove beneficial by helping to identify when intervention content should be altered to enable a better fit with the given conditions.