Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis.

BACKGROUND: The fields of implementation science and knowledge translation have evolved somewhat independently from the field of policy implementation research, despite calls for better integration. As a result, implementation theory and empirical work do not often reflect the implementation experience from a policy lens nor benefit from the scholarship in all three fields. This means policymakers, researchers, and practitioners may find it challenging to draw from theory that adequately reflects their implementation efforts. METHODS: We developed an integrated theoretical framework of the implementation process from a policy perspective by combining findings from these fields using the critical interpretive synthesis method. We began with the compass question: How is policy currently described in implementation theory and processes and what aspects of policy are important for implementation success? We then searched 12 databases as well as gray literature and supplemented these documents with other sources to fill conceptual gaps. Using a grounded and interpretive approach to analysis, we built the framework constructs, drawing largely from the theoretical literature and then tested and refined the framework using empirical literature. RESULTS: A total of 11,434 documents were retrieved and assessed for eligibility and 35 additional documents were identified through other sources. Eighty-six unique documents were ultimately included in the analysis. Our findings indicate that policy is described as (1) the context, (2) a focusing lens, (3) the innovation itself, (4) a lever of influence, (5) an enabler/facilitator or barrier, or (6) an outcome. Policy actors were also identified as important participants or leaders of implementation. Our analysis led to the development of a two-part conceptual framework, including process and determinant components. CONCLUSIONS: This framework begins to bridge the divide between disciplines and provides a new perspective about implementation processes at the systems level. It offers researchers, policymakers, and implementers a new way of thinking about implementation that better integrates policy considerations and can be used for planning or evaluating implementation efforts.

Understanding the supports needed for policy implementation: a comparative analysis of the placement of intermediaries across three mental health systems.

BACKGROUND: Intermediaries are organisations or programmes that work between policy-makers and service providers to facilitate effective implementation of evidence-informed policies, programmes and practices. A number of intermediaries now exist in well-established mental health systems; however, research on them, and how they may be optimised to support implementation is lacking. This research seeks to understand the puzzling variation in the system placement of intermediaries supporting policy implementation in the mental health systems of Canada (Ontario), New Zealand and Scotland. METHODS: Using a comparative case study approach, the analytic goal was to compare intermediaries across jurisdictions and explain differences in their placement using explanatory frameworks from political science. Data for this analysis were derived from several sources, including key informant interviews, a literature search of published and grey literature on intermediaries and on policy implementation in mental health systems, a review of relevant policy documents and websites, as well as documents and websites relating to the various intermediaries and other interest groups within each system. RESULTS: Through the analysis, we argue that the placement of intermediaries supporting policy implementation can be explained through an understanding of the political structures, the policy legacies leading to the current public/private mix of mental health service delivery, and the differing administrative capacities of mental health systems. CONCLUSIONS: This research contributes to our growing understanding of policy-related intermediaries supporting implementation at scale and how we might build appropriate infrastructure in systems to support the implementation of policy and achieve better outcomes for citizens.

A Fresh Approach to Reform? A Policy Analysis of the Development and Implementation of Ontario's Mental Health and Addictions Strategy.

Background: Open Minds, Healthy Minds, Ontario's Comprehensive Mental Health and Addictions Strategy commits to the transformation of mental health and addictions services for all Ontarians. Objective: We analyzed the formulation and implementation of this Strategy to address the question: What are the prospects for transformative change in Ontario's current approach to mental health and addictions? Methods: Qualitative policy analysis using interpretive description of key documents of the policy process, drawing on policy network and horizontal governance theory. Results: Three features set this policy process apart from previous reform efforts: (1) expansion of the state pluralist network to those outside of health, (2) extension of the policy network approach into the Strategy's implementation stage and (3) the combined presence of political and policy leadership. Conclusions: There is reason for optimism that the approach of the Strategy has increased the prospects for the transformation of Ontario's mental health and addictions system.

Identifying and assessing core components of collaborative-care models for treating mental and physical health conditions

Improvements in science, technology, nutrition and social care have meant that with few exceptions, populations in low-, medium- and high-income countries are living longer, and this trend is expected to continue into the future. This increase in life expectancy has resulted in more people living with chronic and complex conditions, which means that health systems need to be equipped to deal with these conditions along with acute and episodic conditions. A review of projections of global mortality and burden of disease shows that mental illness and non-communicable chronic illness will continue to be among the leading causes of mortality and morbidity across the globe.(1) Furthermore, most people with chronic conditions are living with multiple chronic conditions (often referred to as multimorbidity).(2) In general, people living with multiple chronic conditions have greater healthcare needs and use more services, but have worse health and social outcomes (e.g., quality of life, ability to work, employability, disability and mortality) than the general population

Examining the impact of and approaches to addressing the needs of people living with mental health issues

Mental health presents one of the highest disability burdens on the planet, but it has not historically received a corresponding amount of attention in research and policy arenas. Developing mental health strategies and other policies with an understanding of what the research evidence on the issue says will help strengthen the policy actions being taken in the area, and could lead to improved population mental health and better outcomes for people living with mental health issues