Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
Department of Computer Science, University of Southern Maine, Portland, ME, USA.
Glob Health Sci Pract. 2021 Mar 31;9(1):55-77. doi: 10.9745/GHSP-D-20-00169.
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.
实施研究往往未能对项目实际执行的情况产生预期影响。将研究嵌入目标组织系统中是解决这一问题的有效方法。然而，该方法常常受到各种矛盾的阻碍。本文通过孟加拉国、加纳和坦桑尼亚的案例研究，介绍了嵌入式实施研究的应用，这些案例采用嵌入式科学模式来加强基于社区的卫生系统。在其中 2 个案例中，为了确保嵌入式科学的实施，放弃了通常被不假思索地接受的实施研究标准。在第三个案例中，保持了统计严谨性，但设计的这一特点与嵌入式科学不一致。一般来说，严格的统计设计采用的观测单位与管理者可以控制的组织单位不一致。结构性矛盾阻碍了宿主机构对研究过程的所有权和对研究结果的利用。此外，科学协议领导原则与管理领导原则不一致。本文一并审查了这些嵌入式实施科学属性，以及在每个案例中阻碍其实施的矛盾。基于成功应用于克服挑战的策略，提出了一种源自计算机科学的将研究与管理相结合的方法，称为“敏捷科学”。该范式将科学严谨性与管理决策相结合。这种敏捷的嵌入式研究方法旨在保持科学严谨性，同时优化将学习融入管理决策的过程。
