Marlot Kuiper

21 The challenge of working with checklists the newest Audi or Mercedes and operating patients, not in the least because of varying patient conditions (Hales & Pronovost, 2006). In spite of that, the dominant conviction in the health care domain, has been – and partly still is – that “effective implementation”; an adequate preparation and comprehensible information provision to its intentional users, will lead to the envisioned results: rule compliant behaviour (Bliss et al., 2012; Conley et al., 2011; Haynes et al., 2009; McLachlan, 2019). Consequently, if implementation does not lead to compliant behaviour, the explanation is searched for in either the characteristics of the tool itself – for example a lack of efficiency or evidence, or in the process of implementation – for example a lack of preparation, training or information dissemination. Or as Gawande puts it: “The checklist works – as long as it is implemented well” (Gawande quoted by Anthes, 2015, p. 517). The past decade, a new booming field of implementation science has emerged. 4 Many implementation theories and frameworks have been published to help promote effective implementation. These theories overlap considerably, while terminology and definitions are not consistent (Zuiderent-Jerak, 2007). There have been multiple attempts to put all the implementation theories together and construct one comprehensive integrated framework (see e.g. Damschroder et al., 2009; Francke, Smit, de Veer, & Mistiaen, 2008). Still, these attempts remain exhaustive lists of ‘determinants’, ‘factors’, and ‘variables’ influencing implementation. Implementation is assumed to progress in a linear way (Melo & Bishop, 2020; Bauer, Damschroder, Hagedorn, Smith, & Kilbourne, 2015) . Moreover, these factors are seen as equations; the sum of all the ‘facilitators’ minus the ‘barriers’ should lead to successful implementation (Zuiderent-Jerak, 2007). Increasingly, scholars who have identified barriers and facilitators for implementation develop ‘lessons for implementers’ that should make the implementation process more effective and successful. Identified lessons for example suggest that; “Management should be seen to be involved and supportive” and “A system that holds people accountable for improper behaviour or use of the initiative should be considered” (Russ et al., 2015, p.89). These ambitious lessons however, with all their good intentions, leave professionals in the field with vital 4 In 2006, the first issue of Implementation Science was published, a journal with the specific aim “to publish research relevant to the scientific study of methods to promote the uptake of research findings into routine healthcare in clinical, organizational or policy contexts.” (Im - plementation Science, 2019, n.d.) 1