James M. Anderson Center for Health Systems Excellence
Cincinnati Children’s Hospital Medical Center
Evidence-based practices often fail to be implemented or sustained due to barriers at multiple levels of an organization (e.g., system-level, practitioner-level). A growing cadre of implementation strategies can help mitigate challenges at these multiple levels, but significant heterogeneity exists in whether, and to what extent, organizations—and the practitioners who deliver treatment within them—respond to different strategies. However, it is impractical to provide all (or even most) of these strategies to all levels, at all times. This suggests the need for an approach that sequences and adapts the provision of implementation strategies to the changing context and needs of practitioners within the multiple levels of an organization. A multi-level adaptive implementation strategy (MAISY) offers a replicable, approach to precision implementation that guides implementers in how best to adapt and re-adapt (e.g., augment, intensify, switch) implementation strategies based on the changing context and changing needs at multiple levels.