Abstract
Implementation research often fails to have its intended impact on what programs actually do. Embedding research within target organizational systems represents an effective response to this problem. However, contradictions associated with the approach often prevent its application. We present case studies of the application of embedded implementation research in Bangladesh, Ghana, and Tanzania where initiatives to strengthen community-based health systems were conducted using the embedded science model. In 2 of the cases, implementation research standards that are typically embraced without question were abandoned to ensure pursuit of embedded science. In the third example, statistical rigor was sustained, but this feature of the design was inconsistent with embedded science. In general, rigorous statistical designs employ units of observation that are inconsistent with organizational units that managers can control. Structural contradictions impede host institution ownership of research processes and utilization of results. Moreover, principles of scientific protocol leadership are inconsistent with managerial leadership. These and other embedded implementation science attributes are reviewed together with contradictions that challenged their pursuit in each case. Based on strategies that were effectively applied to offsetting challenges, a process of merging research with management is proposed that is derived from computer science. Known as "agile science," this paradigm combines scientific rigor with management decision making. This agile embedded research approach is designed to sustain scientific rigor while optimizing the integration of learning into managerial decision making.
Highlights
Implementation science is often applied to developing health policies.[1,2,3] In a recent review of the expanding application of this paradigm, Peters et al.[4] defined implementation research as:. . . the scientific inquiry into questions concerning implementation—the act of carrying an intention into effect, which in health research can be policies, programmes, or individual practices.As they noted, research utilization is critical to ensuring that implementation science results have their intended impact
The embedded science that guided communitybased primary health care development in Bangladesh, Ghana, and Tanzania attests to the value of subordinating the generation of research results to researching the process of changing the www.ghspjournal.org way that programs work
Doing so requires a system of action and decision making that integrates the tools of science into the process of managerial planning and decision making.[14,15,100,105]
Summary
Implementation science is often applied to developing health policies.[1,2,3] In a recent review of the expanding application of this paradigm, Peters et al.[4] defined implementation research as:. Coverage achieved by 2008 was concentrated in the 32 districts where implementation teams had experienced on-site orientation visits in Nkwanta and had received start-up grants for launching CHPS in 1 or 2 demonstration communities.[53] By establishing demonstration communities, equipped with seed revenue, district managers could undertake activities that catalyzed the diffusion of implementation within their districts This approach was successful in participating districts, the Nkwanta CHPS development exchange strategy was terminated in 2004 because contracting mechanisms of donor agencies were inconsistent with the Nkwanta embedded research model. Unlike district systems development interventions in Bangladesh and Ghana, Tanzanian policy questions concerned the value of adding community-level doorstep care in an existing community-based system of fixed-facility dispensary services In this instance, research advisors to MOHSW believed that a randomized controlled trial of CHW deployment would be appropriate because randomization of community catchment areas was both organizationally and statistically feasible. Connect has contributed learning to the national program, but its operational design has not been scaled up
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
