When Worldviews Collide: An attempt at integrating systems oriented design and implementation science

Dagfinn Mørkrid Thøgersen, Josina Vink, and Andreas Wettre

Implementation is very often complex and messy. It involves many stakeholders with a range of perspectives and frequently reveals unforeseen consequences of our intended design. Systems-oriented design (SOD) proposes engaged, open and iterative processes where complexities and emergence are embraced and accounted for. As such, SOD can inform a useful, alternative approach to implementation, although it has foundational differences when compared to implementation science. Implementation science provides phase-based, process-focused frameworks that aim to systematically identify and address contextual and systemic barriers and enablers. The focus of implementation science is on how a predefined, often research-driven innovation is to be delivered in practice in a way that is similar to its original design. With this, implementation science risks making systems rigid and inflexible by contributing to set, predetermined and known standards. This lies in contrast to a systems-oriented design approach, which aims to develop more adaptive, self-managed and emergent systems. This presentation discusses the fundamental assumptions in systems-oriented design and implementation science and explores how SOD can contribute to and benefit from implementation science. We analyze the application of integrating systems-oriented design and implementation science across varying levels of problem complexity, starting from well-defined and contained problems with a pre-existing solution to wicked problems at the societal level that are inherently unsolvable. We propose directions for future research and practice exploring the tensions and opportunities within and between these perspectives.