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Fig. 2 | BMC Health Services Research

Fig. 2

From: Context, complexity and process in the implementation of evidence-based innovation: a realist informed review

Fig. 2

Tunnel model of Implementation Context, Complexity and Process: The figure depicts an evidence-based innovation as it is introduced and moves into an acute care system. As the innovation moves into the system it is exposed to the context of that system. The innovation has intended and unintended impacts on the context of that system as a result of that exposure. The innovation is also impacted by that system as implementers and knowledge users seek to refine and ‘fit’ it to the practice reality. Complexity is represented in the textured background of the context as it is a characteristic of that context. Complexity is also generated in the relationship between the innovation, implementation process and the context. The circular arrows indicate this evolving complexity at the point of interaction between the evidence-based innovation and implementation process and the implementation process and the context. Implementation processes are situated within the context of the system. Some implementation processes refine the context of the system for improved innovation adoption while others are shaped by the existing context. As the innovation is moved through the phases of preparation, introduction, activation and integration towards adoption, intentional and organic implementation process are initiated shaping the context, the implementation processes and the evidence-based innovation. As the innovation moves further towards adoption the reciprocal relationship between context and process and process and innovation alter the shape and fit of the innovation in the new space as it is taken up. The processes fade as adoption is approached and implementation processes are less active. As adoption is achieved the innovation is transformed into an element of the system and becomes part of the context fading as it is normalized

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