Breaking Down the EPIS Process Model & Framework
By Dr. Julia E. Moore, Executive Director
3-min read
We have been getting a lot of questions lately about the EPIS (Exploration, Preparation, Implementation, Sustainment) framework. EPIS is interesting because it is both a process model and a framework. As a reminder, a process model outlines the steps or stages of implementation, and a framework explains factors that affect implementation.
EPIS as a process model
EPIS is a four-stage process model. Its four stages (outlined in its name) are exploration, preparation, implementation, and sustainment.
EPIS is a process model that outlines the stages of implementation – it helps people plan for implementation. It assumes they have already done the work of selecting the THING, understanding barriers and facilitators, and selecting change strategies to address those barriers and facilitators. If you have not yet done this first part of designing what you would like to implement, process models like implementation mapping, the knowledge to action, and StrategEase are very helpful.
The EPIS phases
Here’s an overview of the four phases of EPIS.
EPIS: Exploration Phase
In the exploration phase, teams evaluate needs and decide whether to adopt the THING. This phase ends with the decision to adopt a THING. Depending on your role in the system, you may identify which THING best addresses local needs and gaps, or you might be working with a THING and trying to identify sites open and willing to adopt the THING.
EPIS Preparation Phase
The preparation phase is all about planning for implementation. That involves understanding potential barriers and facilitators at the contextual level (this includes the inner and outer context – see below). This phase also involves setting up implementation supports, in an effort to make implementation and sustainability go more smoothly. This phase ends when implementation begins.
EPIS Implementation Phase
The implementation phase is about putting that plan into action and actually implementing. This involves using those implementation supports and includes continuous assessment of the contextual factors. This phase ends when the THING is being delivered with fidelity.
EPIS Sustainment Phase
The sustainment phase focuses on the continued delivery of the THING. This might involve adapting the THING, continuously examining the inner and outer context, and adapting processes and supports.
Note: There is a distinction between sustainability and sustainment in the implementation research literature. “At its core, sustainment addresses the continued use of the practice that is the target of the implementation, whereas sustainability addresses whether the factors are in place to promote that ongoing use. Thus, sustainment can be considered “an outcome of a sustainability effort”.” (Moullin et al., 2021). If you are looking to write academic papers, this distinction is important. Our experience working with practitioners is that they prefer the term sustainability for both.
EPIS framework constructs
EPIS is also a framework because it includes inner and outer contextual factors to consider throughout the implementation process. These factors are divided into four categories: outer context, inner context, bridging factors, and innovation factors.
Moullin, J.C., Dickson, K.S., Stadnick, N.A. et al. Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implementation Sci 14, 1 (2019). https://doi.org/10.1186/s13012-018-0842-6
EPIS: Outer context constructs
The outer context describes factors outside of the organization or setting that could impact implementation. We sometimes refer to these as system-level factors. These include things like funding, the service environment, patient/client characteristics…
EPIS: Inner context constructs
The inner context focuses on factors within the setting that can impact implementation. This includes a combination of organizational characteristics and individual adaptor characteristics, such as leadership, organizational policies, and staffing…
EPIS: Bridging factors
One of the things that makes EPIS unique is that it also highlights bridging factors, which are not explicitly described in many other frameworks. This acknowledges the interrelated nature of factors of the inner and outer setting levels.
EPIS: Innovation factors
Innovation factors are characteristics of the innovation that make it easier or more difficult to adopt, implement, and sustain the THING.
Who can use EPIS?
EPIS can be used by anyone planning for implementation, assuming they have already done the work of selecting the THING, and identifying barriers and facilitators to select implementation strategies. In our experience, researchers from other fields (i.e., not implementation researchers, but researchers interested in applying implementation science to their research projects) are particularly drawn to EPIS. We have heard that they appreciate the level of complexity and the nuance in the different inner, outer, and bridging factors.
EPIS-inspired adaptation
We have seen and used so many EPIS-inspired adaptations to the four phases of implementation. For example, we created the Implementation Checklist in direct response to practitioner requests to have a checklist by phase.
Learn more about EPIS
If you are interested in learning more about EPIS, there are many great resources on their website.
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