Electronic versions


  • Christopher Burton
  • Lynne Williams
  • Tracey Bucknall
    Deakin University, Victoria
  • Stephen Edwards
    Bangor University
  • Denise Fisher
  • Beth Hall
  • Gill Harris
    Betsi Cadwaladr University Health Board
  • Peter Jones
  • Matthew Makin
    The Pennine Acute Hospitals NHS Trust
  • Anne McBride
    Manchester University
  • Rachel Meacock
    Manchester University
  • John Parkinson
  • Jo Rycroft-Malone
  • Justin Waring
    Nottingham University

BACKGROUND: Strategies to improve the effectiveness and quality of health and care have predominantly emphasised the implementation of new research and evidence into service organisation and delivery. A parallel, but less understood issue is how clinicians and service leaders stop existing practices and interventions that are no longer evidence based, where new evidence supersedes old evidence, or interventions are replaced with those that are more cost effective. The aim of this evidence synthesis is to produce meaningful programme theory and practical guidance for policy makers, managers and clinicians to understand how and why de-implementation processes and procedures can work.

METHODS AND ANALYSIS: The synthesis will examine the attributes or characteristics that constitute the concept of de-implementation. The research team will then draw on the principles of realist inquiry to provide an explanatory account of how, in what context and for whom to explain the successful processes and impacts of de-implementation. The review will be conducted in four phases over 18 months. Phase 1: develop a framework to map the preliminary programme theories through an initial scoping of the literature and consultation with key stakeholders. Phase 2: systematic searches of the evidence to develop the theories identified in phase 1. Phase 3: validation and refinement of programme theories through stakeholder interviews. Phase 4: formulating actionable recommendations for managers, commissioners and service leaders about what works through different approaches to de-implementation.

DISCUSSION: This evidence synthesis will address gaps in knowledge about de-implementation across health and care services and ensure that guidance about strategies and approaches accounts for contextual factors, which may be operating at different organisational and decision-making levels. Through the development of the programme theory, which explains what works, how and under which circumstances, findings from the evidence synthesis will support managers and service leaders to make measured decisions about de-implementation.


Original languageEnglish
Article number194
JournalSystematic Reviews
Issue number1
Publication statusPublished - 5 Aug 2019
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