SPRINT: a structured pathway for real-world implementation

Abstract Background Getting evidence-based interventions and service innovations into routine practice remains one of the hardest problems in health and care. Practitioners tasked with leading change often lack a clear, sequenced approach that accounts for the realities of pressured services: limited staff capacity, competing priorities, and fragmented authority. We developed the SPRINT Implementation Pathway to address this gap. Methods SPRINT is a theory-informed, evidence-based implementation pathway that specifies what to do, in what order, and who needs to lead each piece of work. We applied process-tracing methods to qualitative evidence syntheses of high-quality international implementation studies informed by Normalisation Process Theory. We then examined how implementation strategies cluster and develop over time. We consolidated these into 22 general strategies organised within six sequenced stages of activity. Results SPRINT specifies three interlocking layers of implementation work. First, a practice bundle (the intervention components, interaction dynamics, rules and resources, and institutional logics) that must be stabilised before implementation can proceed. Second, six sequenced implementation activities , (mobilisation, fit-to-setting, staff participation, enabling action, learning and reconfiguration, and normalisation), operationalised through 22 strategies. Third, a leadership taxonomy distinguishing four forms of distributed leadership aligned to different implementation functions. Conclusion SPRINT reframes implementation as the sequence of work under pressure. By making authority, accountability, learning, and sustainment explicit, it provides a practical and disciplined pathway for implementing complex interventions in already pressured health and care settings. We demonstrate SPRINT across four contrasting cases: remote ventilation therapy for amyotrophic lateral sclerosis, psychosocial coaching for people living with HIV, treatment escalation planning at end of life, and orthopaedic teleconsultation. Finally, we provide a practical guide to SPRINT suitable for front-line health and care managers and practitioners.