Contextual Analysis for Practical Action (CAPA): a framework for understanding how context works and how to apply it for practical learning and implementing change in complex systems

Abstract

Background: This concept paper presents Contextual Analysis for Practical Action or ‘CAPA’ as an action-oriented tool to understand and implement interventions in real-life service delivery contexts. Understanding how contexts work is a critical challenge for Health and Social Care Systems seeking to become more integrated. CAPA is a tool for understanding and empowering agents in local contexts. The local context is understood here as a key factor in implementation success. This concept paper offers rich theorising to underpin the translation of systems reform initiatives into meaningful local engagement and change. Methods: Analysis of the ‘implementation conundrum’ highlights the problem, while a review of the organisational learning literature identifies ‘sensemaking in organisation’ as a powerful mechanism to address it. Based on earlier phenomenological research the dynamics of organisational sensemaking are presented.  Finally, applications for CAPA are explored and next steps outlined. Results: CAPA makes tangible the implicit and interpretive nature of organisational life as ‘sensemaking in context’. This phenomenon is analysed as a determinant of implementation success. As such, CAPA opens a path to working with contextual complexity by framing it as a dialectic pattern of topical, ecological, dialogical, and pragmatic modes that ‘contextualise’. CAPA is a tool for researchers and practitioners to explore the complexity of local contexts and their implementation challenges, and working-with local agents for learning and change. Conclusions: Health reform needs new approaches for understanding implementation in context. CAPA is a tool for understanding and working-with contextual factors central to the complexity of policy or knowledge translation for example. This paper outlines its rationale, principles, and functionality. Possible applications are explored for co-designed practical learning experiences. It concludes with a call to policy makers, service managers and researchers to use the approach in specific settings so it can be developed and refined.