Proposing a “PICO” for evidence implementation projects: the Problem, Implementation/Intervention, Evaluation, Context, and Engagement (PIECE) approach

This article explores the development and utility of the PIECE (Practice/Problem of interest, Intervention/Implementation, Evaluation, Context, and Engagement) planning and question framework as a structured approach for planning and conducting evidence implementation projects. Traditionally, the PICO model has been used as a guiding framework for formulating clinical questions and structuring systematic reviews; however, the elements of PICO do not suit the unique requirements of evidence implementation projects in real-world settings. Each element of PIECE addresses a critical component of implementation: selecting a problem grounded in evidence, choosing effective interventions, defining evaluation metrics, assessing contextual factors, and engaging relevant stakeholders. Through examples of successful JBI implementation projects, we illustrate how PIECE can be used to conceptualize and execute implementation efforts. The proposed framework provides a structured yet flexible roadmap, allowing health care teams to initiate and sustain meaningful improvements. PIECE supports the planning phase of implementation projects, fostering better alignment with organizational goals and greater stakeholder engagement. As implementation science continues to evolve, PIECE offers a grounded approach for clinicians seeking to embed evidence into daily practice.