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Power Isn’t Neutral: What Every Implementation Practitioner Needs to Know

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Power Isn’t Neutral: What Every Implementation Practitioner Needs to Know 

In the world of implementation science, we often focus on frameworks, strategies, and outcomes, but rarely do we pause to examine the power dynamics shaping every step of the process. Yet, understanding who holds power, how it's distributed, and how it influences implementation success is essential for creating meaningful and equitable change. 

What Do We Mean by "Power Dynamics"? 

Power dynamics refer to the ways authority, influence, and decision-making are distributed between people or groups. In implementation, this includes: 

  • Who gets to decide which problems matter 

  • Whose knowledge is valued 

  • Who benefits from interventions, and who might be left out 

A New Typology of Power 

A 2022 paper by Stanton and colleagues introduced a powerful (pun intended) framework that breaks power down into three categories: 

  • Discursive Power: Who frames the narrative? For example, labeling a community as "hard to reach" shapes how we design solutions. 

  • Epistemic Power: Whose knowledge counts? Is clinical expertise valued as much as academic credentials? 

  • Material Power: Who controls the money, time, staff, and resources that make implementation possible? 

These forms of power show up across every phase of implementation from exploring the problem to sustaining a solution. 

Why This Matters 

Another insightful article by Douglas et al. (2022) highlights how a longstanding power differential between researchers and clinicians contributes to the “research-to-practice gap.” Researchers often generate knowledge without clinician input, while clinicians are left to implement solutions that may not align with their real-world context. This imbalance can lead to frustration, poor adoption, and missed opportunities for improvement. 

What Practitioners Can Do 

Whether you're a facilitator, clinician, or implementation lead, here are a few actions you can take: 

  • Ask who’s at the table and who’s missing 

  • Value diverse expertise, especially from those with lived or frontline experience 

  • Create feedback loops that center the voices of those most affected 

  • Use implementation frameworks alongside questions that interrogate power 

Final Thoughts 

If implementation is about getting evidence into practice, we must also address who defines the evidence and who shapes the practice. When we ignore power, we risk reinforcing the very inequities we're trying to solve. 

Let’s shift the focus, not just to what gets implemented, but how and with whom we implement it. 

Are you interested in learning more about how to navigate power dynamics during implementation?  Consider the Essential Skills for the Knowledge Translation Practitioner offered by the Institute for Knowledge Translation.   

 References

Douglas, N., Hinckley, J., Grandbois, K., Schliep, M., Wonkka, A., Oshita, J., & Feuerstein, J. (2022). How a power differential between clinicians and researchers contributes to the research-to-practice gap. American Journal of Speech-Language Pathology, 32(2), 803–810. https://doi.org/10.1044/2022_AJSLP-22-00207 

Roura, M. (2021). The social ecology of power in participatory research. Qualitative Health Research, 31(2), 203–214. https://doi.org/10.1177/1049732320941838 

Stanton, M. C., Ali, S. B., & the SUSTAIN Center Team. (2022). A typology of power in implementation: Building on the exploration, preparation, implementation, sustainment (EPIS) framework to advance mental health and HIV health equity. Implementation Research and Practice, 3, 1–16. https://doi.org/10.1177/26334895211064250