Implementation science at the crossroads

Martin Marshall and colleagues1 take themselves to task for the suboptimal design of a complex (multicomponent) intervention to improve safety of services for people in care homes. The authors make much of the complexity of the intervention—service interventions are 'not like a pill'. Interventions must be adapted—when first promulgated the intervention in question had nine components, and this inflated to 15 over the course of the project. Contrast all of these with a financial incentive promulgated by the Specialist Services Commissioning authority for the West Midlands, England. Hospitals were simply given a financial incentive to promote a switch from facility to home haemodialysis.2

So here we have accounts of what appear to be two very different types of interventions; Marshall's intervention encapsulates 15 components, while the commissioning agent's intervention was of one component only. One might think that Marshall's intervention was complex and the commissioning agent's...

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