Summary:

Rugged landscapes: complexity and implementation science

The authors report the development of an agent-based computational model to explore how complexity hinders effective implementation. The model incorporates three distinct complexities faced in public health practice: dimensionality, ruggedness, and context-specificity. Agents in the model attempt to solve problems using one of three approaches—Plan-Do-Study-Act (PDSA), evidence-based interventions (EBIs), and evidence-based decision-making (EBDM).The model demonstrates that the most effective approach to implementation and quality improvement depends on the underlying nature of the problem. Rugged problems are best approached with a combination of PDSA and EBI. Context-specific problems are best approached with EBDM.

Authors: Ornstein, Joseph T; Hammond, Ross A; Padek, Margaret; Mazzucca, Stephanie; Brownson, Ross C