Complexity science

At the core of implementation science (IS) lies a disarmingly simple concept: to get more evidence into practice. One way to think about that is in relatively linear ways: do the studies, assemble the evidence, provide it to practitioners, and encourage adoption, take-up, and then widespread scaling across an entire organization or system. But healthcare is not well described with reference to linear depictions of the evidence-to-practice enterprise. It is a Complex Adaptive System (CAS) governed by the laws of complexity science rather than principles of linearity. In short, healthcare and the process of getting evidence into practice are convoluted, political, labyrinth-like, multifaceted, value-laden, and contested. Thus, it is never trivial or simplistic to get evidence into practice or create a science of implementation. This opening essay discusses these two paradigms as a way of understanding one core axis of IS.