implementation case study interview

Implementation Specialist Interview Questions

The most important interview questions for Implementation Specialists, and how to answer them

Getting Started as a Implementation Specialist

• What is a Implementation Specialist
• How to Become
• Certifications
• Tools & Software
• LinkedIn Guide
• Interview Questions
• Work-Life Balance
• Professional Goals
• Resume Examples
• Cover Letter Examples

Interviewing as a Implementation Specialist

Types of questions to expect in a implementation specialist interview, project management and process questions, technical proficiency and problem-solving questions, behavioral and situational questions, communication and collaboration questions, scenario-based and case study questions, preparing for a implementation specialist interview, how to prepare for an implementation specialist interview.

• Understand the Company's Implementation Needs: Research the company's history of system implementations, current technologies, and any upcoming projects. Knowing this will help you speak to how your skills and experience align with their specific needs.
• Review Implementation Methodologies: Be familiar with various implementation methodologies such as Waterfall, Agile, or PRINCE2. Discussing the pros and cons of different approaches can showcase your strategic thinking.
• Prepare for Technical Questions: Brush up on your technical skills, especially those relevant to the company's systems and tools. Be ready to discuss your experience with software such as ERP, CRM, or industry-specific platforms.
• Highlight Project Management Skills: Be prepared to discuss your experience with project management tools and techniques. This could include how you've managed timelines, resources, and stakeholder expectations in past roles.
• Practice Behavioral Questions: Reflect on past implementation experiences and prepare stories that demonstrate your problem-solving, teamwork, and leadership skills. Use the STAR method (Situation, Task, Action, Result) to structure your responses.
• Develop Insightful Questions: Prepare thoughtful questions about the company's implementation challenges, team structure, and expectations. This shows your proactive thinking and genuine interest in the role.
• Mock Interviews: Practice with a mentor or colleague to refine your answers, get feedback, and improve your delivery. This can also help you manage any interview nerves.

Stay Organized with Interview Tracking

Implementation Specialist Interview Questions and Answers

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Implementation Specialist Job Title Guide

Related Interview Guides

Bridging business needs with IT solutions, optimizing systems for strategic success

Driving tech solutions, analyzing data trends to optimize business performance

Driving tech projects from concept to completion, ensuring efficiency and quality

Optimizing business processes and systems, bridging the gap between technology and users

Solving tech issues, ensuring smooth operations, and enhancing user experience

Driving software solutions, ensuring seamless application performance and user experience

Start Your Implementation Specialist Career with Teal

47 case interview examples (from McKinsey, BCG, Bain, etc.)

One of the best ways to prepare for   case interviews  at firms like McKinsey, BCG, or Bain, is by studying case interview examples. 

There are a lot of free sample cases out there, but it's really hard to know where to start. So in this article, we have listed all the best free case examples available, in one place.

The below list of resources includes interactive case interview samples provided by consulting firms, video case interview demonstrations, case books, and materials developed by the team here at IGotAnOffer. Let's continue to the list.

• McKinsey examples
• BCG examples
• Bain examples
• Deloitte examples
• Other firms' examples
• Case books from consulting clubs
• Case interview preparation

Click here to practise 1-on-1 with MBB ex-interviewers

1. mckinsey case interview examples.

• Beautify case interview (McKinsey website)
• Diconsa case interview (McKinsey website)
• Electro-light case interview (McKinsey website)
• GlobaPharm case interview (McKinsey website)
• National Education case interview (McKinsey website)
• Talbot Trucks case interview (McKinsey website)
• Shops Corporation case interview (McKinsey website)
• Conservation Forever case interview (McKinsey website)
• McKinsey case interview guide (by IGotAnOffer)
• McKinsey live case interview extract (by IGotAnOffer) - See below

2. BCG case interview examples

• Foods Inc and GenCo case samples  (BCG website)
• Chateau Boomerang written case interview  (BCG website)
• BCG case interview guide (by IGotAnOffer)
• Written cases guide (by IGotAnOffer)
• BCG live case interview with notes (by IGotAnOffer)
• BCG mock case interview with ex-BCG associate director - Public sector case (by IGotAnOffer)
• BCG mock case interview: Revenue problem case (by IGotAnOffer) - See below

3. Bain case interview examples

• CoffeeCo practice case (Bain website)
• FashionCo practice case (Bain website)
• Associate Consultant mock interview video (Bain website)
• Consultant mock interview video (Bain website)
• Written case interview tips (Bain website)
• Bain case interview guide   (by IGotAnOffer)
• Bain case mock interview with ex-Bain manager (below)

4. Deloitte case interview examples

• Engagement Strategy practice case (Deloitte website)
• Recreation Unlimited practice case (Deloitte website)
• Strategic Vision practice case (Deloitte website)
• Retail Strategy practice case  (Deloitte website)
• Finance Strategy practice case  (Deloitte website)
• Talent Management practice case (Deloitte website)
• Enterprise Resource Management practice case (Deloitte website)
• Footloose written case  (by Deloitte)
• Deloitte case interview guide (by IGotAnOffer)

5. Accenture case interview examples

• Case interview workbook (by Accenture)
• Accenture case interview guide (by IGotAnOffer)

6. OC&C case interview examples

• Leisure Club case example (by OC&C)
• Imported Spirits case example (by OC&C)

7. Oliver Wyman case interview examples

• Wumbleworld case sample (Oliver Wyman website)
• Aqualine case sample (Oliver Wyman website)
• Oliver Wyman case interview guide (by IGotAnOffer)

8. A.T. Kearney case interview examples

• Promotion planning case question (A.T. Kearney website)
• Consulting case book and examples (by A.T. Kearney)
• AT Kearney case interview guide (by IGotAnOffer)

9. Strategy& / PWC case interview examples

• Presentation overview with sample questions (by Strategy& / PWC)
• Strategy& / PWC case interview guide (by IGotAnOffer)

10. L.E.K. Consulting case interview examples

• Case interview example video walkthrough   (L.E.K. website)
• Market sizing case example video walkthrough  (L.E.K. website)

11. Roland Berger case interview examples

• Transit oriented development case webinar part 1  (Roland Berger website)
• Transit oriented development case webinar part 2   (Roland Berger website)
• 3D printed hip implants case webinar part 1   (Roland Berger website)
• 3D printed hip implants case webinar part 2   (Roland Berger website)
• Roland Berger case interview guide   (by IGotAnOffer)

12. Capital One case interview examples

• Case interview example video walkthrough  (Capital One website)
• Capital One case interview guide (by IGotAnOffer)

13. Consulting clubs case interview examples

• Berkeley case book (2006)
• Columbia case book (2006)
• Darden case book (2012)
• Darden case book (2018)
• Duke case book (2010)
• Duke case book (2014)
• ESADE case book (2011)
• Goizueta case book (2006)
• Illinois case book (2015)
• LBS case book (2006)
• MIT case book (2001)
• Notre Dame case book (2017)
• Ross case book (2010)
• Wharton case book (2010)

Practice with experts

Using case interview examples is a key part of your interview preparation, but it isn’t enough.

At some point you’ll want to practise with friends or family who can give some useful feedback. However, if you really want the best possible preparation for your case interview, you'll also want to work with ex-consultants who have experience running interviews at McKinsey, Bain, BCG, etc.

If you know anyone who fits that description, fantastic! But for most of us, it's tough to find the right connections to make this happen. And it might also be difficult to practice multiple hours with that person unless you know them really well.

Here's the good news. We've already made the connections for you. We’ve created a coaching service where you can do mock case interviews 1-on-1 with ex-interviewers from MBB firms . Start scheduling sessions today!

The IGotAnOffer team

25 Implementation Specialist Interview Questions and Answers

Learn what skills and qualities interviewers are looking for from an implementation specialist, what questions you can expect, and how you should go about answering them.

An implementation specialist is responsible for the successful implementation of a software system. This may include tasks such as installing the software, configuring it to meet the customer’s needs, and training the customer’s staff on how to use it.

If you’re interviewing for an implementation specialist job, you can expect to be asked questions about your experience installing software, your knowledge of different types of software, and your ability to train users on how to use it. You may also be asked about your problem-solving skills and how you would handle difficult customer requests.

To help you prepare for your interview, we’ve gathered some of the most common questions asked in interviews for implementation specialists and provided sample answers.

1. Are you comfortable working with a team to implement new systems or processes?

This question can help the interviewer determine how you interact with others and your ability to collaborate. Your answer should highlight your interpersonal skills, communication abilities and teamwork skills.

Example: “Absolutely! I am comfortable working with a team to implement new systems or processes. Throughout my career, I have had the opportunity to work on various projects that required collaboration and teamwork. I understand the importance of communication and how it can help ensure successful implementation.

I am also experienced in problem-solving and troubleshooting any issues that may arise during the process. I take initiative when needed and strive to provide solutions that are efficient and effective. My experience has enabled me to develop strong relationships with colleagues and clients alike, which is essential for successful implementations.”

2. What are some of the most important qualities for an implementation specialist?

This question can help the interviewer determine if you have the necessary skills and abilities to succeed in this role. Your answer can also tell them about your own personal values, so it’s important to be honest when answering. Consider what qualities you think are most important for an implementation specialist and describe why they’re important.

Example: “As an experienced Implementation Specialist, I believe the most important qualities for this role are strong problem-solving skills, excellent communication, and a commitment to customer satisfaction.

Problem solving is essential in this role because it requires quickly identifying issues and finding solutions that work best for the customer. My experience has taught me how to think outside of the box and use creative approaches to solve complex problems.

Communication is also key when working as an implementation specialist. You need to be able to clearly explain technical concepts to customers who may not have any prior knowledge. It’s also important to be able to listen carefully to customer feedback so you can adjust your approach accordingly.

Lastly, having a commitment to customer satisfaction is critical. As an implementation specialist, my goal is always to ensure that the customer is happy with the end result. I strive to provide the highest level of service possible and take pride in delivering results that exceed expectations.”

3. How would you go about training employees on a new system or process?

This question can give the interviewer insight into how you would approach training employees on a new system or process. Use examples from your experience to highlight your communication and interpersonal skills, as well as your ability to train others.

Example: “When it comes to training employees on a new system or process, I believe in taking a comprehensive approach. First and foremost, I would ensure that the employees have an understanding of the overall goals and objectives of the system or process. This will help them understand why they are being trained and how their efforts can contribute to achieving those goals.

Next, I would break down the system or process into its individual components, so that each employee has a clear understanding of what is expected of them. I would also provide step-by-step instructions for each component, as well as any relevant resources such as manuals or videos. Finally, I would make sure to provide ample opportunities for hands-on practice and feedback, so that employees can gain confidence in their ability to use the system or process effectively.”

4. What is your experience with using project management tools?

This question can help the interviewer understand your experience with using tools that are specific to implementation specialists. Use examples from previous projects where you used project management tools and how they helped you complete your work on time or within a certain deadline.

Example: “I have extensive experience working with project management tools. I have worked on projects that required the use of various software, including Microsoft Project and Trello. In my current role as an Implementation Specialist, I am responsible for managing multiple projects at once and ensuring they are completed on time and within budget. To help me do this, I rely heavily on project management tools to keep track of tasks, deadlines, resources, and progress.

I also have experience creating custom reports using project management tools. This allows me to quickly identify any issues or areas of improvement in a project’s timeline or budget. I’m comfortable troubleshooting any technical issues that arise when using these tools, and I always strive to find ways to improve their efficiency.”

5. Provide an example of a time when you identified and resolved an issue with a new system or process.

This question can help the interviewer gain insight into your problem-solving skills and ability to adapt to new situations. Use examples from previous roles that highlight your critical thinking, communication and collaboration skills.

Example: “I recently had the opportunity to identify and resolve an issue with a new system or process while working as an Implementation Specialist. The project involved implementing a new software platform for a large organization. During the implementation process, I noticed that certain features were not functioning properly. After further investigation, I discovered that there was an error in the code.

To resolve this issue, I worked closely with the development team to debug the code and make sure it was running correctly. Once the code was fixed, I tested the system again and verified that all of the features were now working properly. Finally, I provided detailed documentation on how to use the new system so that users could understand how to utilize it effectively.”

6. If hired, what would be your priorities during your first few weeks on the job?

This question helps the interviewer determine how you plan to get started and make an impact in your new role. Your answer should include a list of tasks that show your commitment to getting up to speed quickly, including any research or training you might need to complete before starting your job.

Example: “If hired, my first priority would be to become familiar with the company’s processes and procedures. I would take time to learn about the organization’s mission and goals, as well as its current projects and initiatives. This will help me understand how I can best contribute to the team and ensure that I am providing value from day one.

I would also spend time getting to know my colleagues and building relationships with them. By understanding their roles and responsibilities, I can better collaborate on projects and provide support when needed.

Lastly, I would prioritize learning the specific tools and technologies used by the organization. This includes any software or systems related to implementation, such as project management platforms, customer relationship management (CRM) solutions, and analytics tools. Understanding these tools is essential for successful implementation.”

7. What would you do if you noticed that some employees were resistant to using the new system or process you implemented?

This question can help interviewers understand how you might handle a challenging situation at work. Use your answer to highlight your problem-solving and interpersonal skills, as well as your ability to lead others through change.

Example: “If I noticed that some employees were resistant to using the new system or process I implemented, my first step would be to identify why they are having difficulty. This could include lack of training, unfamiliarity with the technology, or any other issues that may be causing resistance. Once I have identified the cause, I can then develop a plan to address it.

For example, if the issue is lack of training, I would create a comprehensive training program for all employees. This would involve providing detailed instructions on how to use the system and/or process, as well as offering additional resources such as videos, tutorials, and online help. If the issue is more related to unfamiliarity with the technology, I would provide one-on-one support and guidance to ensure everyone is comfortable with the new system or process.”

8. How well do you communicate verbally and in writing?

Communication is an important skill for implementation specialists because they often work with other IT professionals and business leaders to explain technical processes. Interviewers may ask this question to assess your communication skills and determine whether you can effectively communicate with others in the workplace. In your answer, try to show that you are confident speaking in front of a group and writing clearly and concisely.

Example: “I have excellent communication skills both verbally and in writing. I am able to clearly articulate my ideas and thoughts, as well as listen carefully to the needs of others. My written communication is clear and concise, allowing me to effectively convey complex information in a way that is easy for others to understand.

In addition, I have experience creating detailed documents such as implementation plans, user guides, and training materials. This has enabled me to develop strong organizational skills and an eye for detail which are essential when communicating with stakeholders. Finally, I am comfortable working with different types of technology and software, which allows me to quickly adapt to new systems and tools.”

9. Do you have experience using data analysis tools?

This question can help interviewers learn about your experience with specific tools that may be used in the role. Use examples from past roles to explain how you’ve used data analysis tools and what you learned from using them.

Example: “Yes, I have experience using data analysis tools. In my current role as an Implementation Specialist, I use a variety of data analysis tools on a daily basis to help clients understand their data and make informed decisions. For example, I often utilize Excel pivot tables to analyze customer data and identify trends or patterns that can be used to inform business decisions. I also have experience with SQL queries and Tableau for more complex data analysis tasks.”

10. When was the last time you updated your knowledge of industry trends and technologies?

This question can help the interviewer determine how committed you are to your career and whether you’re likely to stay with their company for a long time. Your answer should show that you’re dedicated to learning new things, but it’s also important to mention what you’ve learned recently.

Example: “I am constantly striving to stay up-to-date with the latest industry trends and technologies. I read industry publications, attend webinars, and follow relevant blogs to ensure that I have a comprehensive understanding of what’s happening in the field. Recently, I attended an online conference where I learned about the newest developments in implementation technology. This included new tools and strategies for streamlining processes and improving user experience. I also had the opportunity to network with other professionals and learn from their experiences.

In addition to staying informed on industry trends, I also make sure to keep my skills sharp by taking courses and certifications related to implementation. By doing this, I can ensure that I am always prepared to tackle any challenges that may arise during the implementation process.”

11. We want to improve our customer service through better communication between departments. How would you go about doing that using our new system or process?

This question is a great way to show your communication skills and how you can use them to help others. When answering this question, it’s important to explain the steps you would take to ensure everyone understands their role in customer service.

Example: “I understand the importance of improving customer service through better communication between departments. To achieve this, I would first assess the current system or process in place and identify any areas that need improvement. This could include looking at how information is shared between departments, as well as how quickly it’s being exchanged.

Once I have identified these areas for improvement, I would then look to implement a new system or process that addresses them. This could involve introducing new software tools to facilitate faster and more efficient communication, or creating a streamlined workflow to ensure all relevant parties are kept up-to-date with progress. I would also look to introduce measures to track performance and measure success, such as setting KPIs and monitoring customer satisfaction surveys.”

12. Describe your experience with working with databases.

This question can help the interviewer understand your experience with working with a variety of data and how you organize it. Use examples from past projects to highlight your skills in database management, including your ability to create new databases and manage existing ones.

Example: “I have extensive experience working with databases. I’ve been an Implementation Specialist for the past five years and during that time, I’ve worked on a variety of projects involving database management. My primary focus has been creating and maintaining SQL databases, but I’m also familiar with other types such as Oracle and MySQL.

In my current role, I’m responsible for designing and implementing data models to meet business requirements. This includes developing tables, views, stored procedures, triggers, and functions. I’m also experienced in writing complex queries and optimizing existing ones. In addition, I’m able to troubleshoot any issues related to performance or security.”

13. What makes you stand out from other candidates for this position?

This question can help the interviewer get to know you better and understand what makes you a good fit for their company. Use your answer to highlight any skills, experiences or qualifications that make you an excellent candidate for this role.

Example: “I believe my experience as an Implementation Specialist makes me stand out from other candidates for this position. I have been working in the field of implementation for over five years and have gained a wealth of knowledge and expertise. During that time, I have successfully implemented numerous projects on-time and within budget. My success is due to my strong organizational skills, attention to detail, and ability to work well with teams.

In addition, I am highly motivated and take initiative when it comes to problem solving. I am able to quickly identify areas of improvement and develop strategies to address them. Furthermore, I stay up-to-date on industry trends and best practices so that I can bring fresh ideas and solutions to the table. Finally, I am passionate about helping clients achieve their goals and objectives through successful implementations.”

14. Which industries do you have the most experience working in?

This question can help the interviewer understand your experience level and how it may relate to their company. Use this opportunity to highlight any relevant skills you have that are applicable to the role, such as communication or teamwork.

Example: “I have extensive experience working in a variety of industries, ranging from healthcare to finance. In the healthcare industry, I have worked on projects related to patient care management systems and electronic health records. My experience includes developing implementation plans, training users, and troubleshooting any technical issues that may arise.

In the financial sector, I have implemented software solutions for banks, credit unions, and other financial institutions. This has included helping them transition to new technology platforms, as well as providing support during their onboarding process. I am also familiar with regulatory compliance requirements, which is essential when dealing with financial data.”

15. What do you think is the most important thing to remember when implementing a new system or process?

This question can help the interviewer get a better idea of your experience and expertise in this field. Your answer should include an example from your past that shows you know how to implement new systems or processes successfully.

Example: “The most important thing to remember when implementing a new system or process is that the end user experience should always be the top priority. It’s essential to ensure that the implementation is designed with the users in mind, and that it meets their needs and expectations. This means taking into consideration how the system will be used by them, what features they need, and any potential challenges they may face.

In addition, it’s also important to have a clear plan for the implementation process. This includes understanding the scope of the project, setting realistic timelines, and ensuring that all stakeholders are on board with the changes. Finally, it’s critical to provide ongoing training and support throughout the implementation process so that users can get up to speed quickly and easily. By following these steps, I’m confident that I can successfully implement any new system or process.”

16. How often do you think implementation specialists should update their knowledge and skills?

This question can help interviewers understand how much you value your own professional development. It’s important to show that you’re willing to learn new things and improve your skills, especially if the role requires a lot of technical knowledge.

Example: “I believe that implementation specialists should be constantly updating their knowledge and skills. In this ever-evolving industry, it is important to stay on top of the latest trends and technologies in order to provide the best service possible. I strive to keep up with the newest developments by attending conferences, reading relevant publications, and participating in online courses. This helps me stay informed about new products and services as well as changes in regulations or standards.

In addition, I also make sure to keep my certifications current. As an experienced professional, I understand the importance of having valid credentials and staying up-to-date with the most recent certification requirements. By keeping my certifications current, I am able to demonstrate my commitment to providing quality service and staying ahead of the competition.”

17. There is a new technology that could improve our system or process. What would you do to learn more about it and potentially integrate it into our workflow?

This question is a great way to assess your ability to learn new technologies and apply them to the company’s workflow. When answering this question, it can be helpful to mention specific steps you would take to research the technology and how you would present your findings to management.

Example: “If I were presented with a new technology that could potentially improve our system or process, my first step would be to research the technology. This would involve reading any available documentation and researching online for reviews from other users. Once I have a good understanding of the capabilities of the technology, I would then look into how it can be integrated into our current workflow.

I would also reach out to colleagues who may have experience using the technology, as well as vendors who provide support for the product. By talking to people who are already familiar with the technology, I can gain insights on best practices for implementation and integration. Finally, I would create a plan outlining the steps needed to integrate the technology into our existing processes and systems.”

18. What strategies do you use when troubleshooting a problem with a new system or process?

Troubleshooting is an important skill for implementation specialists to have. Employers ask this question to make sure you know how to solve problems and complete your work efficiently. In your answer, explain what steps you would take when troubleshooting a problem with a new system or process. Explain that you will first try to fix the issue yourself before asking someone else for help.

Example: “When troubleshooting a problem with a new system or process, I use a systematic approach to identify and address the issue. First, I take time to understand the system or process in question. This includes researching any available documentation and talking to stakeholders to get an understanding of how it works and what is expected from it.

Next, I break down the problem into smaller components so that I can focus on each part individually. By doing this, I am able to isolate the root cause of the problem more quickly and accurately. Once I have identified the source of the issue, I develop a plan of action to resolve it. This may involve making changes to the system or process, testing different solutions, or working with other teams to find a solution. Finally, I document my findings and provide feedback to the stakeholders involved.”

19. Describe a situation where you had to work within tight deadlines and how did you handle it?

An interviewer may ask this question to assess your ability to work under pressure and meet deadlines. Use past experiences where you had to work within tight deadlines, but also highlight how you managed to complete the project on time.

Example: “Working within tight deadlines is something I’m very familiar with. In my current role as an Implementation Specialist, I have had to work on multiple projects at once and ensure that each one was completed in a timely manner.

One particular situation stands out in my mind where I had to complete a project within two weeks. To handle this situation, I created a timeline for the project and broke it down into smaller tasks. This allowed me to prioritize certain tasks and focus my energy on completing them first. I also leveraged resources such as online tutorials and forums to help me understand any complex concepts quickly. Finally, I kept my team members informed of my progress throughout the entire process so they could provide feedback and support when needed.”

20. How do you stay organized when working on multiple projects at once?

This question can help the interviewer understand how you plan your work and prioritize tasks. Your answer can also reveal how well you manage time, which is an important skill for this role. Showcase your organizational skills by describing a system that helps you stay on top of multiple projects at once.

Example: “Staying organized is an important part of my job as an Implementation Specialist. I have developed a system that helps me keep track of multiple projects at once. First, I create a timeline for each project and set realistic deadlines for completion. This allows me to prioritize tasks and ensure that all projects are completed on time. I also use task management software to help me stay on top of everything. This software allows me to assign tasks to team members, monitor progress, and provide feedback in real-time. Finally, I make sure to take regular breaks throughout the day to clear my head and refocus. This helps me stay focused and organized while working on multiple projects simultaneously.”

21. Do you have experience leading user acceptance testing?

User acceptance testing is a process that involves the client and other stakeholders reviewing the final product to ensure it meets their needs. The interviewer may ask this question to learn more about your leadership skills and how you’ve used them in previous roles. In your answer, describe a time when you led user acceptance testing for a project and what steps you took to make sure everyone was on the same page.

Example: “Yes, I have extensive experience leading user acceptance testing. In my current role as an Implementation Specialist, I am responsible for ensuring that the software meets customer requirements and expectations. To do this, I lead a team of testers to conduct rigorous tests on the system before it is released to the public. We use both manual and automated testing methods to ensure that all features are working correctly and that there are no bugs or errors in the code. This helps us identify any issues early on so they can be addressed quickly and efficiently. My experience has taught me how to effectively manage a testing process from start to finish, making sure that all stakeholders are informed throughout the process.”

22. Are you comfortable giving presentations to large groups of people?

This question can help interviewers understand how you feel about public speaking and whether or not you would be comfortable with the responsibilities of this role. Use your answer to highlight any experience you have giving presentations, including what types of audiences you’ve spoken to in the past and how you prepared for these events.

Example: “Absolutely! I have extensive experience giving presentations to large groups of people. In my current role as an Implementation Specialist, I am responsible for presenting new software implementations and updates to teams of up to 50 people. I’m comfortable speaking in front of large audiences, and I enjoy the challenge of keeping everyone engaged throughout the presentation.

I also understand that it is important to tailor each presentation to the audience. Before beginning a presentation, I take the time to research the group so I can customize the content to their specific needs. This helps ensure that everyone understands the information and leaves with actionable items they can use.”

23. What techniques do you use to ensure that all stakeholders are informed and engaged throughout the implementation process?

The interviewer may ask you this question to gauge your communication skills and ability to collaborate with others. Use examples from past experiences where you successfully communicated important information to stakeholders, clients or other team members.

Example: “I understand the importance of keeping all stakeholders informed and engaged throughout the implementation process. To ensure this, I use a variety of techniques. First, I make sure to communicate clearly with each stakeholder group about their specific roles in the project. This helps them feel included and that their input is valued. Second, I provide regular updates on progress and any changes or challenges that arise during the implementation process. This keeps everyone up to date and allows for quick problem solving if needed. Finally, I encourage open dialogue between stakeholders so they can share ideas and collaborate on solutions. By using these techniques, I am able to keep all stakeholders engaged and informed throughout the entire implementation process.”

24. What methods do you use to measure the success of an implementation project?

This question can help the interviewer understand your ability to evaluate a project’s success and determine whether it met its goals. Use examples from past projects where you used metrics or other methods to measure the success of a project.

Example: “When measuring the success of an implementation project, I use a variety of methods. First and foremost, I like to measure customer satisfaction. This can be done through surveys or interviews with customers who have used the new system. It’s important to get feedback from those who are using the system on a daily basis in order to understand how successful the implementation has been.

I also look at metrics such as time savings, cost savings, and increased efficiency. These can all be measured by tracking data before and after the implementation. Finally, I look at user adoption rates. If users are not adopting the new system, it is likely that the implementation was not successful. By monitoring usage statistics, I am able to determine if the implementation was successful or not.”

25. Are there any particular challenges that you anticipate when implementing a new system or process?

This question can help the interviewer gain insight into your problem-solving skills and ability to anticipate potential issues. Your answer should highlight your critical thinking skills, as well as your ability to identify possible challenges before they occur.

Example: “Yes, there are several challenges that I anticipate when implementing a new system or process. The first challenge is understanding the current system and processes in place. It’s important to understand how the existing system works before making any changes. This will help ensure that all changes made are beneficial and don’t cause disruption.

The second challenge is ensuring that stakeholders are on board with the implementation. It’s essential to involve key stakeholders throughout the process so they can provide feedback and guidance. Finally, it’s important to have a plan for training users on the new system or process. Without proper training, users may not be able to use the system effectively.”

25 Validation Engineer Interview Questions and Answers

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Hacking the Case Interview

PwC (including Strategy&) interviews consist of case interviews, written case interviews, group case interviews, and behavioral or fit interview questions. The office and group that you are interviewing for will determine which of these types of interview questions you will get.

If you have an upcoming interview with PwC or Strategy&, we have you covered. In this article, we’ll go through in detail:

• PwC and Strategy& interview processes
• The 6 steps to solve any PwC (Strategy&) case interview
• PwC (Strategy&) case interview examples
• The PwC (Strategy&) group case interview
• The PwC (Strategy&) written case interview
• PwC (Strategy&) behavioral or fit interview questions
• Recommended PwC (Strategy&) case interview resources

If you’re looking for a step-by-step shortcut to learn case interviews quickly, enroll in our case interview course . These insider strategies from a former Bain interviewer helped 30,000+ land consulting offers while saving hundreds of hours of prep time.

PwC and Strategy& Interview Processes

Strategy& interview process.

If you are applying to Strategy&, the interview process typically consists of two rounds. Each round has two to three 45-minute interviews.

These interviews will be focused on case interviews and behavioral or fit interview questions. Roughly half of the time will be spent on the case interview. Your interviewers will try to save the last 5 to 10 minutes of each interview for your questions.

Here is what a Strategy& interview process could look like:

• Strategy& first round interview : Two 45-minute interviews. For both interviews, roughly 10 minutes will be spent on behavioral or fit questions, 30 minutes will be spent on the Strategy& case interview, and the last 5 minutes will be time for you to ask questions.
• Strategy& final round interview : Three 45-minute interviews. One interview will be more heavily focused on behavioral or fit interview questions. The other two interviews will be primarily focused on Strategy& case interviews.

It is important to know that Strategy& emphasizes behavioral and fit interview questions much more than the average consulting firm. You’ll spend a bit more time answering these questions than you would at firms such as Bain, BCG, Deloitte, or Accenture.

Interviewers want to ensure that candidates that are interviewing for Strategy& actually want to work there. They want to screen out candidates that are treating Strategy& as a backup firm to McKinsey, BCG, and Bain.

PwC Consulting Interview Process

If you are applying to Management Consulting,  Technology Consulting , or Risk Consulting, you may have an online assessment and up to three rounds of interviews.  

• PwC Assessment Test : online assessment used to evaluate cognitive skills and overall competency
• PwC first round interview : One 30-minute interview with a recruiter focused on behavioral or fit interview questions
• PwC second round interview : Two interviews focused on case interviews and behavioral or fit interview questions
• PwC third round interview : Three to five interviews focused on case interviews, behavioral or fit interview questions, a written case interview, and/or a group case interview

There is a lot of variability in the types of interviews you could get in your last round of interviews. Depending on the office and group, some candidates may get a written case interview or a group case interview. Others may just get normal case interviews.

The 6 Steps to Solve Any PwC (Strategy&) Case Interview

PwC and Strategy& case interviews are all candidate-led. This means that you will be expected to drive the direction of the case. You will suggest what areas to explore, what analyses to do, and what the next step should be.

On Strategy&’s case prep website , they state that there is no single correct way to answer a case. If you show your thought process and develop logical and reasonable conclusions, you will have successfully solved the case.

Follow these six steps to solve any case interview.

1. Understand the case

The case will begin with the interviewer giving you the case information. While the interviewer is speaking, make sure that you are taking meticulous notes on the most important pieces of information. Focus on understanding the context of the situation, the company, and the objective of the case.

2. Verify the objective

Understanding the business problem and objective of the case is the most important part of the case interview. Not addressing the right business question is the quickest way to fail a case interview.

Make sure that you ask clarifying questions to better understand the business situation and problem. Then, confirm that you understand the case objective with the interviewer. This ensures that you start the case on the right track.

3. Create a framework

Develop a framework to help you tackle the business problem. A framework is a tool that helps you structure and break down complex problems into smaller, more manageable components. With a framework, you’ll be brainstorming different ideas and organizing them into different categories.

Afterwards, walk the interviewer through your framework. They may ask a few questions or provide some feedback to you.

For a complete guide on how to create tailored and unique frameworks for each case, check out our article on case interview frameworks .

4. Develop a hypothesis

After creating a framework, you should develop a hypothesis. A hypothesis is an educated guess on the answer based on the data and information that you have so far.

Your hypothesis does not need to be correct. You’ll be continuously testing and refining your hypothesis throughout the case. The purpose of having a hypothesis is to guide your analysis and ensure that you are spending your time answering the right questions.

5. Test your hypothesis

The majority of the case will be spent testing your hypothesis.

After stating your hypothesis, it is up to you to lead the direction of the case. Depending on the context of the case, you may want to ask for data to do some analysis. You may also want to explore qualitative questions that you have. As you uncover more information, your hypothesis will likely have to change. 

Sometimes, your hypothesis will be completely wrong and you’ll need to develop a completely new hypothesis to test. Other times, your hypothesis may be on the right track, but you’ll need to refine or narrow it down further.

Throughout the rest of the case, you’ll be answering a mix of quantitative and qualitative questions. Make sure that after each question, you explain how your answer impacts your hypothesis or answer to the case.

6. Deliver a recommendation

In the last step of the case interview, you’ll present your recommendation and provide the major reasons that support it. You do not need to recap everything that you have done in the case, so focus on summarizing only the facts that are most important.

It is also good practice to include potential next steps that you would take if you had more time or data. These can be areas of your framework that you did not have time to explore yet or lingering questions that you do not have great answers for.

PwC (Strategy&) Case Interview Examples

We've compiled examples of PwC and Strategy& case interviews below that were given to candidates in the past.

Example #1 : How can Royal Caribbean cruises double revenue over the next five years?

Example #2 : Your client is a national packaging manufacturing company that makes cardboard boxes in various sizes. How can they improve profitability?

Example #3 : The top two concrete suppliers in South America are considering a merger. Should they merge? What considerations would you think through when making this decision?

Example #4 : A fast food chain based in Alabama is considering introducing fresh meat hamburgers into their menu. They previously have only served hamburgers made from frozen meat patties. What will be the impact of introducing fresh meat hamburgers?

Example #5 : A construction company is considering increasing their prices for road maintenance services. Should they increase prices? If so, by how much should they increase prices by?

Example #6 : A national insurance company is looking for opportunities to cut costs. What recommendations would you have for them?

Example #7 : A prestigious undergraduate university in the northeast is considering launching online learning classes that would be available for students that are not enrolled in their on-campus classes. What considerations would you think through in order to determine if this is a good idea?

Example #8 : A local airline is considering adding alcoholic beverages to their menu of in-flight food and drink. What will be the impact on profitability for this business decision?

For more practice, check out our article on 23 MBA consulting casebooks with 700+ free practice cases .

The PwC (Strategy&) Group Case Interview

For some offices, PwC (Strategy&) uses a group case interview in their final round of interviews. This special type of case interview focuses on assessing how well you can collaborate and work with other people. Teamwork is an essential skill to have.

Here’s what you should expect:

• You’ll be put into a group with 3 to 5 other candidates
• The interviewer will hand out the case background materials
• You’ll have 10 to 15 minutes to review the materials and prepare
• The group will have an open discussion for 15 to 20 minutes
• During this discussion, interviewers will be observing candidates and will not interfere
• Afterwards, the interviewer will ask the group specific questions for 15 to 20 minutes

Your goal in a group case interview is to add value to the group. There are six different ways that you can do this:

• Lead or facilitate the discussion : You can propose what topics to discuss, the order they should be discussed in, and how much time should be allocated towards each topic. If the group gets off track, you can bring the group’s focus back together.
• Expand upon other people’s ideas : If a group member suggests a great idea or raises a good point, build upon it and make it even better.
• Synthesize information : You can summarize information that other people have said and reconcile different viewpoints and ideas together.
• Keep track of time : You can volunteer to keep track of time and make sure that the group is on track.
• Play devil’s advocate : You can help your group develop strong ideas by testing the team’s thinking by considering potential risks or downsides of their ideas.
• Take notes:  You can keep track of what other people are saying so that you can recall what has been discussed if any group members have questions.

An important thing to remember about group case interviews is to treat your group members as teammates instead of competition. This is not an exercise in which you are competing with others.

Interviewers are trying to determine whether you would be a great teammate. Multiple people or even all people in your group can receive job offers. Therefore, focus on adding value to the group rather than on making yourself look better than your group members.

For a full guide on group case interviews, check out our consulting group case interview step-by-step guide .

The PwC (Strategy&) Written Case Interview

For some offices, PwC (Strategy&) uses a written case interview in their final round of interviews. This special type of case interview focuses on assessing how well you can analyze information and communicate your insights.

• PwC (Strategy&) will provide you with case background material
• You will have an hour to review the material and prepare 3 to 5 slides
• You will have 30 minutes to present and discuss your recommendation with the interviewer, who will challenge your assumptions and ask follow-up questions

To solve any written case interview, follow these eight steps.

1. Understand the business problem and objective

The first step in completing a written case interview is to understand what the objective is. What is the primary business question you are trying to answer with the data and information provided?

2. Read the list of major questions

Some written case interviews will provide you with a list of 3 – 4 key questions that you will be expected to address or answer. Read through these questions first since these will be the questions that you will want to prioritize.

If the written case interview is more open-ended and does not provide you with a list of key questions, skip this step and move onto the next step.  

3. Skim the materials

Next, flip through the information packet that is provided to see what information is available. Identify what data you have and what data you do not have.

The goal in this step is not to read and analyze every slide. That would take too much time. Instead, by seeing what information exists, you will be able to better prioritize what you spend your time reading and analyzing.

4. Create a framework

Before you begin reading and analyzing the information in the slides in more detail, you should create a basic framework to help guide your analysis. If you are provided with a list of key questions or pre-filled slide templates, then this will likely be the foundation of your framework.

Otherwise, based on what information exists in the information packet, identify the three to four key questions you need to answer or investigate.

5. Read and analyze the material 

Afterwards, read and analyze the information that is relevant to each area of your framework. As you begin answering questions and drawing insights, make sure to write a one or two sentence summary. This will make it easier to decide on a recommendation later.

6. Decide on a recommendation

Review the list of key takeaways that you have summarized from answering all of the major questions in your framework. Decide on what recommendation these findings collectively support.

Remember that there is typically no right or wrong recommendation. As long as your recommendation is supported by data and evidence, you will be in great shape.

7. Create your slides

Once you have a recommendation, it is time to start filling in your slides. You should use the following structure when creating your slides:

• Slide 1: Present your recommendation and the three reasons that support it
• Slide 2: Present your first reason and the data that supports it
• Slide 3: Present your second reason and the data that supports it
• Slide 4: Present your third reason and the data that supports it
• Slide 5: Summarize everything that you’ve covered so far
• Slide 6: Propose potential next steps

8. Prepare for potential questions

If you have any time remaining, brainstorm potential questions the interviewer may ask you during your presentation. They may want to know how you performed your analysis or how you reached your conclusions.

Preparing for these potential questions will help your presentation go much more smoothly. You will also feel much more confident while presenting.

For a full guide on written case interviews, check out our consulting written case interview step-by-step guide .

PwC (Strategy&) Behavioral or Fit Interview Questions

In addition to case interviews, you will likely be asked a few behavioral or fit interview questions. There are ten questions that are most commonly asked.

1. Why are you interested in working at PwC or Strategy&?

How to answer: Have at least three reasons why you’re interested in working at PwC or Strategy&. You could mention that you loved the people that you have met from the company so far. You can talk about PwC’s massive global presence and expertise in nearly any industry or function. You can speak to how PwC provides strategy and implementation, so you can see the impact of your work.

2. Why do you want to work in consulting?

How to answer: Again, have three reasons why you’re interested in consulting. You could mention the fast career growth opportunity, the opportunity to develop soft and hard skills, or the level of impact that you can make by working with large companies on their most challenging issues.

3. Walk me through your resume

How to answer: Provide a concise summary of your work experience, starting with the most recent. Focus on emphasizing your most impressive and unique accomplishments. At the end, tie your experiences to why you are interested in consulting.

4. What is your proudest achievement?

How to answer: Choose your most impressive, unique, or memorable accomplishment. Structure your answer by providing information on the situation, the task, the actions you took, and the results of your work.

5. What is something that you are proud of that is not on your resume?

How to answer: This is a great opportunity to highlight an accomplishment that is not related to your professional work experience. Perhaps there is a non-profit that you volunteer at, a side project or business that you work on, or a hobby that you have won awards or recognition for. Choose something that is impressive and interesting.

6. Tell me about a time when you led a team.

How to answer: If possible, choose a time when you directly managed a person or a team. For this question and the following questions, make sure that you structure your answer. Structure your answer by providing information on the situation, the task, the actions you took, and the results of your work. This is known as the STAR method and is commonly used to answer behavioral or fit interview questions.

7. Give an example of a time when you faced conflict or a disagreement.

How to answer: When answering this question, focus on emphasizing the steps you took to resolve the conflict or disagreement. Speak to the interpersonal skills you had to use in order to mediate the situation. Interviewers want to know that you are a great mediator and that you can handle conflict in a constructive way.

8. Tell me about a time when you had to persuade someone.

How to answer: Choose a time when you were able to change someone’s mind. Focus on emphasizing the steps that you took to persuade that person and what impact and results this had. Interviewers want to know that you are a great communicator and a good people person.

9. Describe a time when you failed.

How to answer: Choose a time when you failed to meet a deadline or did not meet expectations. Focus on emphasizing what you learned from the experience and how you used that experience to deliver even better results in the next opportunity that you got. Interviewers want to see that you don’t get discouraged from failure and that you treat those experiences as learning opportunities.

10. What questions do you have for me?

How to answer: This is a great opportunity to get to know the interviewer on a more personal level. Ask them questions about their experience in consulting or their career. Express genuine interest in what they have to share and ask follow-up questions. The more you can get the interviewer talking about themself, the more likely they will have a positive impression of you.

For a step-by-step guide on how to best answer all of these questions and more, check out our complete guide on consulting behavioral interview questions .

Recommended PwC (Strategy&) Case Interview Resources

Here are the resources we recommend to learn the most robust, effective case interview strategies in the least time-consuming way:

• Comprehensive Case Interview Course (our #1 recommendation): The only resource you need. Whether you have no business background, rusty math skills, or are short on time, this step-by-step course will transform you into a top 1% caser that lands multiple consulting offers.
• Hacking the Case Interview Book   (available on Amazon): Perfect for beginners that are short on time. Transform yourself from a stressed-out case interview newbie to a confident intermediate in under a week. Some readers finish this book in a day and can already tackle tough cases.
• The Ultimate Case Interview Workbook (available on Amazon): Perfect for intermediates struggling with frameworks, case math, or generating business insights. No need to find a case partner – these drills, practice problems, and full-length cases can all be done by yourself.
• Case Interview Coaching : Personalized, one-on-one coaching with former consulting interviewers
• Behavioral & Fit Interview Course : Be prepared for 98% of behavioral and fit questions in just a few hours. We'll teach you exactly how to draft answers that will impress your interviewer
• Resume Review & Editing : Transform your resume into one that will get you multiple interviews

Land Multiple Consulting Offers

Complete, step-by-step case interview course. 30,000+ happy customers.

20 Implementation Manager Interview Questions and Answers

Common Implementation Manager interview questions, how to answer them, and sample answers from a certified career coach.

If you’re an Implementation Manager, you know how to get things done. But when it comes time for your job interview, do you know what questions to expect and how to answer them?

Don’t worry—we’ve got you covered. Read on to learn about the most common implementation manager interview questions, plus tips and example answers that will help you stand out from the competition.

• What experience do you have with project management and implementation?
• Describe a time when you had to manage multiple projects simultaneously.
• How do you ensure that all stakeholders are kept informed of the progress of an implementation project?
• Explain your understanding of the software development lifecycle and how it applies to implementations.
• What strategies do you use to identify potential risks or issues during the implementation process?
• How do you handle difficult conversations with clients who may be unhappy with the progress of their implementation?
• Are you familiar with Agile methodology and its application in implementation projects?
• Describe a situation where you had to troubleshoot a problem with an implementation project.
• What is your experience with developing user training materials for new systems?
• How do you ensure that all team members understand their roles and responsibilities in an implementation project?
• What strategies do you use to motivate teams working on long-term implementation projects?
• How do you handle unexpected changes to the scope of an implementation project?
• What metrics do you use to measure the success of an implementation project?
• How do you approach setting realistic timelines for implementation projects?
• What strategies do you use to ensure successful communication between different departments involved in an implementation project?
• Do you have any experience with post-implementation reviews?
• How do you handle customer feedback about an implementation project?
• What strategies do you use to stay organized while managing multiple implementation projects?
• How do you ensure that data security protocols are followed throughout the implementation process?
• Describe a time when you had to adjust your strategy mid-project due to unforeseen circumstances.

1. What experience do you have with project management and implementation?

Implementation managers are responsible for leading the successful rollout of new products, services, and strategies. It’s a job that requires strong leadership, organizational, and problem-solving skills. By asking this question, the interviewer is trying to get a sense of how you’ve applied those skills in the past and how you might apply them to the job at hand.

How to Answer:

Start by talking about any experience you have leading projects, such as planning and executing a successful product launch or implementation. If you don’t have direct experience in this area, talk about other experiences that demonstrate your ability to manage complex tasks, lead teams, and solve problems. You can also mention any certifications you have in project management or related topics. Finally, focus on how you would apply the skills you have to the role of an implementation manager at the company you’re interviewing with.

Example: “I have extensive experience in project management and implementation. I’ve managed the successful rollout of several products for my current company, including a new mobile app that was released last year. In addition, I have a PMP certification from the Project Management Institute, which has helped me to develop strong organizational and problem-solving skills. I am confident that I can apply these skills to successfully lead the implementation of your new product or service at this company.”

2. Describe a time when you had to manage multiple projects simultaneously.

Implementation managers often have to juggle multiple projects and tasks at once. They need to be able to prioritize tasks, manage deadlines, and handle unexpected changes. This question is designed to determine if you have the organizational skills and flexibility to handle multiple projects at once.

Talk about any project management or implementation experience you have, such as leading a team to complete a project on time and within budget. You can also discuss any software tools or techniques you use to manage projects. If you don’t have direct experience with project management or implementation, talk about other experiences that show your organizational skills and ability to handle multiple tasks simultaneously.

Example: “I have extensive experience managing multiple projects simultaneously. In my current role as an implementation manager, I oversee the development of several software applications at once. To ensure that all projects are completed on time and within budget, I use project management tools such as Trello and Asana to track progress and prioritize tasks. I also communicate regularly with team members and stakeholders to make sure everyone is aware of any changes in scope or timeline. Additionally, I am comfortable making quick decisions when unexpected issues arise.”

3. How do you ensure that all stakeholders are kept informed of the progress of an implementation project?

Implementation managers need to be able to keep a wide variety of stakeholders informed of the progress of a project. They need to be able to develop and maintain relationships with stakeholders and ensure that everyone is on the same page. Additionally, they need to be able to handle any and all issues that arise during the course of an implementation project. This question will help the interviewer get a better understanding of your communication and management skills.

To answer this question, you should discuss the strategies and techniques that you use to keep stakeholders informed of progress. You can mention things like regular status updates, project dashboards, one-on-one meetings with key stakeholders, or any other methods you might have used in the past. Additionally, you can talk about how you ensure that everyone is on the same page by establishing clear expectations at the beginning of a project and making sure all stakeholders are aware of deadlines and milestones. Finally, you can discuss how you handle issues as they arise by being proactive and addressing them quickly and efficiently.

Example: “I always make sure to keep stakeholders informed throughout the course of an implementation project. To do this, I provide regular status updates that detail progress, any issues that have arisen, and what needs to be done next. Additionally, I create a project dashboard which is accessible by all stakeholders so they can quickly check in on the progress of the project at any time. Finally, I also hold one-on-one meetings with key stakeholders to ensure that everyone is on the same page and that expectations are being met. If any issues arise during the process, I address them proactively and take steps to resolve them as quickly and efficiently as possible.”

4. Explain your understanding of the software development lifecycle and how it applies to implementations.

Implementation managers are responsible for overseeing the entire software development process, from the initial planning stages to the launch of the product. They must have a thorough understanding of the software development lifecycle and the various stages within it, from coding and testing to deployment and maintenance. This question tests the candidate’s knowledge of this process and how it can be applied to their work as an implementation manager.

Start by explaining the software development lifecycle and its various stages, such as planning, design, coding, testing, deployment, and maintenance. Then, explain how you would apply this process to an implementation project. Talk about your experience with each stage of the cycle, and provide examples of successful implementations that you have overseen in the past. Finally, highlight any additional methods or processes you use to ensure a successful launch.

Example: “I understand the software development lifecycle and how it applies to implementations very well. My experience in this field has taught me that each step of the cycle is important, from planning and design to coding and testing. I am able to use my knowledge of the process to ensure a successful launch by making sure all of the necessary steps are taken and that the team sticks to the timeline. Additionally, I have implemented quality assurance processes to ensure that the product meets the customer’s expectations. For example, when I oversaw the implementation of XYZ Software for ABC Corporation, I worked closely with the developers throughout the entire process to make sure the product was bug-free and ready for deployment on time.”

5. What strategies do you use to identify potential risks or issues during the implementation process?

Effective implementation managers need to anticipate problems before they arise and be proactive in addressing them. This question allows the interviewer to gauge your ability to plan for potential risks and devise strategies to mitigate them.

Start by outlining the steps you take when beginning a new implementation project. This might include things like researching the client’s industry, gathering data about their current process, and identifying areas of improvement. Then explain how you use this information to develop strategies for mitigating potential risks or issues. You can also discuss any processes you have in place to monitor progress throughout the implementation process. Finally, emphasize your ability to think ahead and anticipate problems before they occur.

Example: “I always start by researching the client’s industry and gathering data about their current process. This helps me identify areas of improvement that can be addressed during the implementation process. I also use this information to develop strategies for mitigating potential risks or issues. For example, if I anticipate a certain issue could arise due to a lack of resources, I might recommend ways to acquire additional resources or suggest alternative solutions. Additionally, I have processes in place to monitor progress throughout the implementation project and review any changes made along the way. By taking these steps, I’m able to anticipate problems before they occur and proactively address them as needed.”

6. How do you handle difficult conversations with clients who may be unhappy with the progress of their implementation?

Implementations can be complex and involve a lot of moving parts. When things don’t go as planned or a client finds themselves dissatisfied with the progress, it is the implementation manager’s job to navigate these conversations. The interviewer wants to know that you understand the importance of these conversations, can remain cool and collected under pressure, and can find solutions that both parties can agree on.

When answering this question, it is important to emphasize your ability to remain calm and collected under pressure. Talk about how you have approached similar conversations in the past and explain the steps you take to ensure that both parties are satisfied with the outcome. Be sure to mention any techniques or strategies you use to de-escalate a situation and find common ground between the two parties. Additionally, talk about how you work to stay proactive and prevent issues from arising by staying on top of implementation deadlines and keeping clients informed throughout the process.

Example: “I understand that implementations can be complex and there are a lot of moving parts involved. When I’m faced with a client who is unhappy with the progress of their implementation, my first priority is to remain calm and collected. I take the time to listen to their concerns and try to get a better understanding of what has gone wrong. From there, I work to come up with solutions that both parties can agree on in order to move forwards. I also make sure to stay proactive by staying on top of deadlines and keeping clients informed throughout the process. This helps to prevent issues from arising in the future.”

7. Are you familiar with Agile methodology and its application in implementation projects?

Agile methodology is a popular project management framework that many companies use for projects, big and small. It’s an iterative approach that emphasizes collaboration and communication between stakeholders to ensure successful project delivery. By asking this question, the interviewer wants to see if you have an understanding of Agile and how it can be applied to implementation projects.

If you have experience with Agile methodology, then you should be able to explain what it is and how it works. Talk about the different roles involved in an Agile project, such as product owners, scrum masters, and stakeholders. Explain how you’ve used Agile in your past projects and how it has helped ensure successful project delivery. If you don’t have any experience with Agile, talk about how you would go about learning more about it and applying it to implementation projects.

Example: “Yes, I’m familiar with Agile methodology and its application in implementation projects. In my current role as an Implementation Manager, I’ve been responsible for the successful delivery of numerous projects using Agile methods. I’ve managed cross-functional teams to ensure that user stories are well defined, sprints are tracked accurately, and stakeholders have a clear understanding of progress. My experience has taught me the importance of communication between team members and clients, and how important it is for everyone involved to be on the same page. I look forward to leveraging my knowledge of Agile methodology to help your organization achieve success.”

8. Describe a situation where you had to troubleshoot a problem with an implementation project.

An implementation manager is expected to be able to anticipate, identify and solve any problems that come up during an implementation project. This question is designed to assess your problem-solving skills and your ability to think on your feet. The interviewer will want to know what steps you took to identify and resolve the problem, and whether it was successful.

Start by describing the situation and then explain what steps you took to troubleshoot the problem. You should emphasize the process you used, such as gathering data and analyzing it, talking to stakeholders and team members, investigating possible solutions, and so on. Show that you identified the root cause of the issue, and how you worked with others to come up with a solution. Finally, be sure to talk about the outcome—did your efforts resolve the problem? If not, what did you learn from the experience?

Example: “I recently had to troubleshoot an issue with an implementation project at my previous job. The project was running behind schedule and I had to figure out why. I started by gathering data on the project and talking to team members to get their perspectives. After analyzing the data and talking to stakeholders, I identified the root cause of the issue—a lack of communication between the development and design teams. I worked with the teams to develop a plan for better communication and collaboration. As a result, the project was back on track and completed successfully. It was a great learning experience for me and I am confident that I can apply the same process to any future implementation projects.”

9. What is your experience with developing user training materials for new systems?

An implementation manager is responsible for ensuring that a new system or process is properly set up and that everyone is equipped with the tools they need to use it. Developing good user training materials is an important part of this process, as it provides the necessary information and guidance that users need to understand the new system. This question allows the interviewer to gauge your experience and knowledge in this area.

You should explain your experience with developing user training materials, including any successes you have had in the past. Be sure to highlight any special techniques or approaches that you used to make the process more efficient and effective. If you don’t have much experience in this area, focus on how you would approach it if given the opportunity. Talk about what research you would do, who you would consult with, and how you would ensure that the material was comprehensive and easy to understand.

Example: “I have extensive experience in developing user training materials for new systems. In my current role, I have successfully created comprehensive user training materials for a variety of new software and processes. My approach is to first research the system in order to understand how it works and any potential challenges that users may encounter. I then consult with key stakeholders and subject matter experts to ensure that all of the necessary information is included. Finally, I work to create materials that are easy to understand and provide a step-by-step guide to using the system. I also like to include visuals and examples to help users better understand the material.”

10. How do you ensure that all team members understand their roles and responsibilities in an implementation project?

This question is a great opportunity to demonstrate your leadership and project management skills. An interviewer wants to know that you can clearly communicate expectations, define roles and responsibilities, and support team members as they work to complete their tasks. You should be able to discuss how you create and communicate a project plan, identify areas of risk, and ensure that all team members understand what is expected of them.

The interviewer is looking for an answer that demonstrates your ability to effectively manage a team and ensure everyone understands their role in an implementation project. You can start by explaining the steps you take to ensure all team members understand their roles and responsibilities. This could include having regular meetings with the team, setting clear expectations, providing feedback on performance, or using tools such as task boards or project management software. Additionally, it’s important to emphasize how you communicate these roles and responsibilities. For example, you might explain how you use visuals to illustrate each team member’s tasks and timelines, or how you provide written summaries of each team member’s duties. Ultimately, this question allows you to showcase your leadership skills and organizational abilities.

Example: “When I’m managing an implementation project, I ensure that all team members understand their roles and responsibilities by creating a detailed project plan and communicating it to the team in clear and concise language. I also use visuals, such as task boards, to help team members easily visualize their tasks and timelines. Additionally, I provide written summaries of each team member’s duties and objectives, so that everyone is clear on what is expected of them. I also have regular meetings with the team to discuss progress and any changes to the project plan. Finally, I provide feedback and encouragement to team members to help them stay motivated and on track. By taking these steps, I’m able to ensure that everyone understands their roles and responsibilities and is working towards a successful project completion.”

11. What strategies do you use to motivate teams working on long-term implementation projects?

Implementation managers often have to motivate teams that are working on long-term projects that can take anywhere from months to years to complete. To be successful in this role, it’s important to have strategies in place to keep teams engaged and motivated over the long haul. An interviewer will want to know what strategies you have in place to ensure teams stay on track and remain productive.

You’ll want to come prepared with specific strategies that you have used in the past to motivate teams working on long-term projects. You can talk about how you set clear milestones and expectations, provide regular feedback on progress, give team members autonomy over their work, recognize individual achievements, and reward successful outcomes. Additionally, explain how you use communication tools such as team meetings, emails, and phone calls to keep everyone informed of project updates and deadlines.

Example: “I believe it’s important to set clear milestones with achievable goals and deadlines. This helps to keep the team motivated and on track. I also work to make sure everyone understands the importance of their individual contributions to the success of the project. I also strive to provide regular feedback and recognition for a job well done. I also use a variety of communication tools such as team meetings, emails, and phone calls to keep everyone up to date on project updates and deadlines. Additionally, I like to provide team members with a certain degree of autonomy over their work so that they can take ownership of their tasks and feel more invested in the project. Finally, I make sure to reward successful outcomes with recognition and incentives.”

12. How do you handle unexpected changes to the scope of an implementation project?

Unexpected changes are a fact of life in implementation, so it’s important for a potential implementation manager to know how to handle them. Your interviewer wants to make sure you’re able to think on your feet and adjust the timeline, budget, and other factors in a way that keeps the project on track. They also want to know that you can communicate changes to stakeholders and negotiate with them when necessary.

Begin by talking about your experience with handling scope changes on projects. Describe how you assess the situation, identify potential solutions, and develop a plan of action to address the issue. Talk about how you communicate these changes to stakeholders, negotiate when necessary, and adjust timelines and budgets accordingly. Finally, emphasize that you always strive to keep the project on track and deliver the best results for the client.

Example: “Whenever there are unexpected changes to the scope of an implementation project, I take a step back to assess the situation and develop a plan of action. I look at what additional resources or expertise might be needed, and then I communicate the changes to all stakeholders and negotiate with them when necessary. I also make sure to adjust the timeline and budget accordingly to ensure that the project is still on track. My goal is always to deliver the best results for the client, and I’m comfortable working with stakeholders to make sure that happens.”

13. What metrics do you use to measure the success of an implementation project?

This question is looking for more than a simple “Yes, I measure success.” It’s looking for a deeper understanding of how you will measure success and how you will use those measurements to help guide the project. This is an important question because it can help the interviewer determine how well you understand the project and how well you can assess the project’s progress and success.

You should be prepared to answer this question with specific metrics that you have used in the past. You can talk about key performance indicators (KPIs) such as time-to-implementation, customer satisfaction ratings, and cost savings. You can also discuss how you use these metrics to track progress and adjust plans if necessary. Ultimately, your answer should demonstrate your ability to think strategically and measure success in a way that is useful for both the client and the organization.

Example: “I typically measure success by tracking key performance indicators such as time-to-implementation, customer satisfaction ratings, and cost savings. I also look at user adoption rates, as well as the impact the project has had on the overall organization. For example, I recently implemented a new software system for a client and tracked the user adoption rate over the first few months. I used this metric to adjust our approach and ensure that the system was being utilized by the end users. I also tracked customer satisfaction ratings and cost savings to measure the project’s success. By tracking these metrics, I was able to ensure that the project was on track and that the client was satisfied with the results.”

14. How do you approach setting realistic timelines for implementation projects?

Setting realistic timelines for implementation projects is a critical skill for an implementation manager, as it ensures that projects are completed on time and that all stakeholders are kept up to date with progress. The interviewer wants to understand your process for setting realistic timelines and your ability to manage multiple projects at once.

You should emphasize your experience in setting realistic timelines for implementation projects and how you manage multiple projects at once. Explain the process that you use to set timelines, such as breaking down tasks into smaller chunks, estimating how long each task will take, and accounting for external factors that could affect the timeline. Additionally, provide examples of successful projects where you have successfully managed multiple projects simultaneously and delivered on time. Finally, discuss any processes or tools that you use to ensure deadlines are met.

Example: “I approach setting realistic timelines for implementation projects by breaking down tasks into smaller chunks, estimating how long each task will take, and accounting for external factors that could affect the timeline. I also use a project management tool to track progress and ensure deadlines are met. For example, on a recent project, I broke down the implementation process into smaller tasks and estimated how long each would take. I then accounted for external factors such as delays in vendor deliverables and changes in scope. This enabled me to set realistic timelines for each task and the overall project. I also used a project management tool to track progress and ensure deadlines were met. As a result, the project was completed on time and on budget.”

15. What strategies do you use to ensure successful communication between different departments involved in an implementation project?

When it comes to implementing a new initiative, project, or process, communication is key. It’s the job of the implementation manager to ensure that all stakeholders involved in the project are on the same page. This means having a strategy to ensure effective communication between departments, from the IT team to the finance team, and everyone in between. The interviewer wants to know that you understand the importance of this and have a plan in place to ensure successful implementation.

The best way to answer this question is to provide specific examples of strategies you have used in the past. You can talk about how you create a timeline and plan for all stakeholders involved, as well as how you ensure that everyone has access to the same information at all times. Additionally, mention any methods or tools you use to facilitate communication between departments, such as project management software, team meetings, or email updates. Finally, emphasize your ability to be flexible and adaptable when needed, as changes often occur throughout the implementation process.

Example: “I understand that successful communication between departments is essential for successful implementation projects. In the past, I have used a variety of strategies to ensure that everyone is on the same page. I create a timeline and plan for all stakeholders involved, ensuring that everyone has access to the same information. I also use project management software to keep track of progress, and I hold regular team meetings to ensure that everyone is updated on the project’s progress. Additionally, I am flexible and adaptable when necessary, as changes often occur throughout the implementation process.”

16. Do you have any experience with post-implementation reviews?

Post-implementation reviews are an important part of the implementation process. They allow the people in charge to evaluate the success of the implementation and identify any areas that may need improvement. This question is also a good indicator of how well the potential hire understands the importance of evaluating the success of their work, as well as their experience with the process of post-implementation reviews.

If you have experience with post-implementation reviews, talk about how you conducted them and the areas that were evaluated. If you don’t have any direct experience, explain what your understanding of post-implementation reviews is and why they are important in the implementation process. Showing enthusiasm for learning more about this process and conducting successful post-implementation reviews can also go a long way.

Example: “I have had direct experience with post-implementation reviews in my previous role as an implementation manager. When conducting these reviews, I would evaluate the success of the implementation based on customer satisfaction, project timeline, and budget. I also understand the importance of these reviews as they allow us to identify any areas that need improvement and ensure that the implementation was successful and met the customer’s needs. I am eager to learn more about post-implementation reviews and am confident that I can successfully conduct them at Design Your Space.”

17. How do you handle customer feedback about an implementation project?

Implementation managers are responsible for making sure the customer’s needs are met while also ensuring that their company’s product or service meets the customer’s expectations. This question allows the interviewer to gauge how you handle customer feedback and how you apply it to the project. It also shows them how well you can work with a customer in a collaborative way, as well as how quickly you can make changes and adapt to customer requests.

You should demonstrate your ability to handle customer feedback in a professional, timely manner. Talk about how you have listened to customer feedback and then implemented changes or adjusted the project accordingly. Explain that you take customer feedback seriously and always strive to meet their needs while also ensuring that the product or service meets their expectations. Show that you are able to work collaboratively with customers, as well as adjust quickly when necessary.

Example: “I take customer feedback very seriously, and I strive to ensure that the customer’s needs are met while also making sure that their expectations are met. When I receive customer feedback, I listen to their concerns or requests and then make adjustments to the project accordingly. I am able to work collaboratively with customers and I am also able to adjust quickly when necessary. I understand the importance of customer satisfaction and I strive to meet their needs in a timely manner.”

18. What strategies do you use to stay organized while managing multiple implementation projects?

As an implementation manager, you’ll be juggling multiple projects at once, from different teams, with different timelines and goals. The interviewer wants to know that you have the organizational skills to handle all of these moving parts. They’ll be looking for an answer that shows you have a system in place for tracking progress and making sure deadlines are met.

Talk about any strategies you’ve used in the past to stay organized while managing multiple projects. This could include setting up project management software, creating a timeline for each project and breaking it down into smaller tasks, or delegating tasks to team members. Also mention how you ensure that deadlines are met by setting check-in points with team members and clients throughout the process. Finally, emphasize your ability to adapt quickly to changing priorities and timelines as needed.

Example: “I’m very organized by nature, so I use a combination of project management software and my own task lists to keep track of each implementation project. I break down each project into smaller tasks, prioritize them based on their importance, and assign them to team members. I also set check-in points throughout the process to make sure everyone is on track and that deadlines are met. I know how to adapt quickly to changing priorities and timelines, and I’m comfortable with making necessary adjustments to ensure the successful completion of each project.”

19. How do you ensure that data security protocols are followed throughout the implementation process?

Ensuring that data security protocols are followed is a key part of any implementation process. The interviewer is looking to understand how you would handle this crucial part of the job and assess your understanding of the importance of data security. They want to make sure that you are aware of the potential risks and have a plan to mitigate them.

The best way to answer this question is to explain the steps you would take to ensure data security protocols are followed throughout the implementation process. You should mention that you would review and monitor all existing policies related to data security, such as access control measures and encryption methods. Additionally, you could highlight that you would implement additional security measures if needed, such as two-factor authentication or regular audits of user accounts. Finally, you could talk about how you would communicate these protocols to all stakeholders involved in the project.

Example: “I understand the importance of data security and take it very seriously. To ensure that data security protocols are followed throughout the implementation process, I would review and monitor all existing policies related to data security, such as access control measures and encryption methods. Additionally, I would implement additional security measures if needed, such as two-factor authentication or regular audits of user accounts. Finally, I would communicate these protocols to all stakeholders involved in the project, and provide training to ensure that everyone is aware of the protocols and their importance.”

20. Describe a time when you had to adjust your strategy mid-project due to unforeseen circumstances.

Part of being a successful implementation manager is being able to adjust to changing circumstances. You’ll need to be able to recognize both the risks and opportunities in any given situation and come up with a plan to move forward. The interviewer wants to see that you can respond to unexpected situations and come up with creative solutions to keep the project on track.

When answering this question, you want to focus on the steps you took to adjust your strategy. Talk about how you identified the issue and what steps you took to address it. Show that you can think critically and come up with a plan of action quickly. Also demonstrate that you have strong communication skills by explaining how you kept all stakeholders informed along the way.

Example: “In my most recent project, we ran into a major roadblock when the software we were using was not compatible with the hardware. I quickly identified the problem and worked with the technical team to develop a workaround solution. I also communicated the situation to all stakeholders and kept everyone updated on our progress. Ultimately, we were able to find a solution and the project was completed on time and within budget.”

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Strategy & BizOps Guide

• BizOps Context
•      I. Intro
•      II. Role overview
•      III. Big tech vs. Unicorns
•      IV. Breaking in
•      V. Career path
• BizOps role details
•      I. Hard skills
•      II. Soft skills
•      III. Ex: unicorn project
•      IV. Ex: big tech project
• BizOps interview prep
•      I. Case interviews
•      II. Homework assignments
•      III. Fit interviews

Strategy & Biz Ops case interviews

What to expect, sample interview questions and 5 key tips to help you prepare..

Question bank | Full case examples | Prep tips

If you've ever been defeated by a case in a management consulting interview, know that many others, including me, have too.

The good thing about having been in those interviews is that you have experienced a case interview and have a sense of what a case interview looks and feels like. It's an experience that's to your advantage as you approach case interviews in strategy & operations (stratops) interviews.

The stratops case interview is an interactive conversation between you and your interviewer(s). To succeed, structuring your thoughts and thinking aloud are key. These help your interviewer understand your thinking pattern, especially how you prioritize, as many stratops case questions involve selecting the best path for a company from several competitive alternatives.

Similar to a consulting case, some stratops cases require developing a framework and structure with which to explore the issue faced by the company. Others, however, are free-form conversations. However, unlike consulting cases, Strategy & Business Operations cases are more specific to a company and their actual problems and are less likely to go into graphs, charts, and math. Below are some sample questions that demonstrate the types of cases you could get. These are company and industry agnostic so feel free to add in the additional lens of the company or industry you are applying to.

If this feels new to you, feel free to refer to the sample walkthroughs to get a sense of how to frame your thinking and your answer. There is no one answer but make sure to stay structured and answer all parts of the question.

Sample Strategy & BizOps case questions (Top)

Example question #1: our company is interested in investing more money in new online and offline marketing channels to drive growth. how would you go about determining how much to spend and evaluate the effectiveness of new campaigns, example question #2: we currently make operational and financial plans on an annual basis. however, we are hoping to start looking more long term and you have been asked to put together a 5 year and a 10 year forecast, what are the key metrics that you hope to forecast and how would you go about it, example question #3: our company currently works solely on a cost per click model where we make money every time a user clicks on a link to a client’s good. it is heavily dependent on user traffic and we are now thinking about building out new revenue models that would allow us to grow revenue. what are potential models you would suggest, what data do you need, and how would you go about making a decision, example question #4: our company is hoping to grow by moving more downstream of our existing product and owning more of the customer pipeline. to make the move, would you suggest a buy, build, partner or multi pronged strategy, example question #5: we currently have a large set of suppliers that we work with who do not all perform at the same level. moving forward, we hope to differentiate them by coming up with a global partner program to highlight our best partners. how would you go about implementing the program- sample walkthrough provided below., example question #6: our company is interested in opening a new office location with a physical building, how do you go about selecting the city, example question #7: we want to launch a new product but have not been able to find enough external data to help us size the market. what would be your plan of attack to help size the potential market and what types of customer tests would you build to help collect data, example question #8: after a reorg, you’ve been tasked with creating a cohesive team culture and bringing together the teams under one roadmap, what is the structure you would propose including meetings and materials for alignment, example question #9: the company has decided to invest more in competitive research and wants a regular review of the competitive landscape. how do you go about putting together the analysis and what information would you choose to bring in, example question #10: the company is hoping to establish a monthly business review to bring together leaders from different departments and review key metrics. your team has been tasked to take on the project and bring it to life. how would you set up a monthly business review what teams would you involve, what types of metrics would you track, and how would you go about presenting it to get buy in, example question #11: our company really values feedback from frontline teams that work with clients, however, there are too many pieces of data for any one person to sort. how do you go about collecting these ideas and completing the feedback loop to ensure that the ideas are getting to the right product teams and clients feel heard, example question #12: the sales team has been missing their targets for the last two quarters and you have been asked to dig into what could be going on. what are some of the key factors that you would look at to evalue where the problem is.

💡 Tip: Our biz ops interview prep can help

Full Strategy & BizOps case examples (Top)

Below, are answers to two Strategy & BizOps interview questions from Jessie Wang , a McKinsey Associate who previously managed strategy and analytics teams at Indeed and Expedia.

1. Our company is interested in investing more money in new online and offline marketing channels to drive growth. How would you go about determining how much to spend and evaluate the effectiveness of new campaigns?

Step 1: Understand our existing landscape

Key questions to ask:

• What channels do we use today?
• What is our channel mix? Are we focused on online (e.g. SEO, SEM, targeted ads etc) or are we primarily offline (e.g. radio, print etc.)?
• How are our current campaigns performing? How many new users are we acquiring? What is their average spend? How long are they spending with us? What is their overall lifetime value? What is the average ROI for our existing campaigns?

Step 2: Determining how much we should spend

• Meeting break even - We need to understand the customer lifetime value by different segments of customers. Customer segments could include customers by acquisition channel and then segmented for different geographies or campaigns. Once we know the average value the customer will generate in their lifetime, this is the max amount that we can spend to acquire them. The customer lifetime value can be thought about as how much the customer will spend with your company before they churn.
• Strategic value- We can also consider spending over the lifetime value of the customer if there are key competitors in the space or the market has significant market size that we want to go after. At this point, it is an investment.

Step 3: Evaluate the effectiveness

• An effective campaign is one where we have high ROI on customer spend compared to customer acquisition cost. We need to measure this on a per campaign level if possible. If attribution is too difficult at this level, we can also evaluate based on channel or at a geographic level.
• Other measures of success could include driving up the customer lifetime value over time if the campaign is bringing in better customers than what we have today.

Feel free to list the questions that you would need to answer to do more- Because you won’t know the ins and outs of the company, the expectation is more that you would know what questions you want to ask rather than come up with numbers or a correct answer. The interviewer will provide you with more information if they want you to provide more detailed analysis.

Make a primary recommendation and then add in secondary considerations- Your primary recommendation should be what you think the answer is but there are likely other considerations or risks that make your answer more holistic.

2. We currently have a large set of suppliers that we work with who do not all perform at the same level. Moving forward, we hope to differentiate them by coming up with a global partner program to highlight our best partners. How would you go about implementing the program?

Step 1: Understand the program value proposition

• Help us as a company prioritize the partners we should devote more time to and allow us incentivize good marketplace behaviors
• Help our customers understand which partners to work with and how they are performing as not all partners may be equal
• Help our partners gain more recognition and business by standing out from competitors

Step 2: Define the different approaches that we could take

• Tiered approach with guidelines and qualifications at each level
• Key questions to answer include: How often do we review performance and redefine tiers? What metrics do we measure? Do we need a different scale based on partner location, size, focus etc?
• Ranked approach based on a scoring rubric with a clear top and bottom
• Key questions to answer include: Are there enough differentiating characteristics? Does a hierarchy bring more value to the table or does it add confusion? Can all customers access all partners or do partners have specific focuses?
• Badging system for different qualifications
• Key questions to answer include: What are the badges worth including? What is the right number of badges? What scale or threshold should we set to receive a badge?

Step 3: Rollout and go to market

• Determining the criteria - First, we need to work with partners to determine the key criteria and make sure that differences in size, scope, geography are taken into account. These criteria and thresholds also need to be announced publicly to allow new entrants or people who are not our partners today a chance to participate.
• Grace period - After we have defined the criteria, we need to give partners time to meet the standards that we set before we announce.
• Pre-announcement - Before we go to launch, we should check with partners to ensure that there is alignment on the data and results of each criteria and that partners are aware of where they wil be in our partner program. This is also a chance to create joint marketing and communications around what the new title will mean.
• Announcement - Once we are live, we need to continue to update our partner program and create benefits to incentivize our partners to improve in the areas we want.

Relate this to what you know - If you’ve ever used a site like Poshmark or Amazon, you know that sellers often have differentiators that the platform has assigned based on their performance. Poshmark has Ambassadors and Amazon has Best Seller. While these examples may be more consumer focused, the intention is similar to hte partner program mentioned in this case so don’t be afraid to leverage what you may have seen work for other companies!

One step at a time - Candidates often jump to implementation without considering the purpose of the program and the different ways the program could work. By starting from the basic building blocks, it will give you better insights in your go to market strategy.

Case interview prep tips (Top)

Adequate preparation is essential to successfully scaling case questions during your interviews. As you navigate the interview process, these 5 tips will come in handy.

1. Practice, practice and practice

It is almost impossible to wing a case interview. Like Dave Chapelle recently said on My Next Guest Needs No Introduction with David Letterman on Netflix, "it's easy to do something if you've seen it before." A case interview is definitely not something you want to tackle in an interview the first time you see it.

2. Context matters

Case interviews at stratops interviews are nowhere near as difficult as those for management consulting interviews, as they are more straightforward and involve fewer twists than you'd see in a consulting case interview. In fact, while generalist consulting interviews may expect you not to be an expert in the field in which the case is set, for stratops interviews, many companies expect you to have knowledge of the business or industry in which they operate. There is only so much "creativity" you can show about a business for which you are unfamiliar before you end up completely in the weeds with no hope of redemption! Before your interview, get familiar with the industry - trends, challenges, key players - and find out who the company's direct competitors are.

3. Be organized

The interview may take twists and turns, and you will need to find your way back to where you started from to give a good summary and final recommendation. Typically, your responses to the initial case questions lead to subsequent questions. Figure out a system of compiling your responses to each section, so that you can give a cohesive and holistic final response. The worst thing you can do is to contradict your initial stance with your final response.

4. Engage your interviewer

Approach your interview as a conversation rather than as an exam. Have a back and forth going with your interviewer - ask clarifying questions and incorporate the interviewer's responses as you work through the case. Avoid getting into "exam mode" - working on your own and then presenting your interviewer with a final solution.

5. Quantitative skills are important

Depending on the company and the department in which the stratops role reports into, your case interview may include a quant assessment. It could be in the form of mental math questions or a request for you to demo your Excel or SQL capabilities. Brush up and get comfortable with your numbers prowess!

To wrap up, the case questions you can expect to receive during the interview will likely be around a current problem the company is facing - growth strategy case, new business or market entry or just about anything the interviewer feels would give a good sense of your stratops skills. While the difficulty level of the stratops cases is on the medium scale when compared with management consulting interviews, you should approach your preparation, and indeed your interview, with the same diligence and professionalism as you would a management consulting case interview!

P.S. Are you preparing for Strategy & BizOps interviews?

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Free Guide to Strategy& Consulting Case Interviews

You want to work at Strategy& and are now faced with the question of how to apply to this consulting company? Then you've come to the right place because in this article we will guide you through the entire application process at Strategy& , the requirements you need to meet, what to expect and what tips and tricks will help you get your job offer from Strategy&. 

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• 1. About Strategy&

In the heart of Strategy&'s legacy is a rich tradition of innovation , dating back to the origins of Booz Allen Hamilton in 1914. Renowned for shaping management consulting and pioneering supply chain management, the firm's 2014 union with Booz & Company and PwC solidified its holistic "strategy-to-execution" approach. Seamlessly integrated into the PwC network, Strategy& leverages its comprehensive capabilities, steering clients through transformative journeys that include averting bankruptcy at Chrysler Corporation and supporting Deutsche Telekom's cloud-based transformation.

As a global leader in strategy consulting, Strategy& has a presence in 60 countries with a workforce exceeding 3000 professionals . Rooted in a storied history of contributing foundational concepts, including supply chain management, the firm aligns seamlessly with PwC's mission, offering comprehensive end-to-end consulting services. Serving as a talent hub, Strategy& is a major recruiter from prestigious business schools, placing emphasis on case interviews to highlight its commitment to analytical prowess and problem-solving skills .

In the dynamic business landscape, the firm's legacy of innovation , unwavering commitment to excellence, and strategic vision continue to shape the trajectory of global strategy consulting, solidifying its enduring influence in the industry. Ranked as the second-largest recruiter from Columbia Business School in the US and the t hird-largest from INSEAD in Europe , Strategy& places a spotlight on the case interview as the focal point of their rigorous selection process, ensuring a commitment to excellence and analytical acumen in their consultants.

• 2. What Strategy& are Looking for

As part of their rebranding, Strategy& was integrated with PwC and they have adopted a set of common values. They have five values that they look for in their candidates :

1. Act with integrity: 

• ​ Expectation: Candidates should demonstrate honesty, transparency, and ethical behavior in their professional interactions.
• Context: Given PwC's historical role as an accounting firm with a focus on financial transparency, integrity is considered a foundational value.

2. Make a difference:

• Expectation: Candidates are encouraged to prioritize actions that create a positive impact on colleagues, clients, and society.
• Context: This value emphasizes a focus on meaningful contributions that extend beyond commercial considerations, aligning with the firm's commitment to societal well-being.
• Expectation: Candidates should excel in case interviews, highlighting their analytical prowess and problem-solving skills.
• Context: Case interviews are a focal point in Strategy&'s selection process, underscoring the importance of analytical thinking in consulting roles.

4. Work together: 

• Expectation: Candidates should exhibit effective teamwork skills and collaborate efficiently in project teams.
• Context: Collaboration is critical in consulting, and the ability to work harmoniously towards common goals is essential for successful project outcomes.

5. Reimagine the possible:

• Expectation: Candidates are expected to think innovatively and identify new ways of working or innovative products.
• Context: In the face of a rapidly changing business world and emerging technologies, Strategy& values individuals who can envision and drive new possibilities for clients.
• 3. Strategy& Application Process

There are four stages to the Strategy& application process :

1. Resume and Cover Letter Submission:

Initiation: The process kicks off with candidates submitting their resumes and cover letters online, presenting an opportunity to showcase their academic achievements and relevant professional experiences.

Expectations: Beyond the academic and professional qualifications, Strategy& is keenly interested in applicants who embody the five core traits integral to the firm's values.

2.   Online Assessments:

Introduction: Adopting PwC's online assessment methodology, this stage involves a trilogy of evaluations: a numerical reasoning test, a games-based assessment, and a video interview.

Timeline: The assessments, spanning over 2 hours, are strategically spread across a 4-week period, offering a comprehensive evaluation of candidates' analytical abilities and suitability for consulting roles.

3. Super Day Style Interviews:

Format: Strategy& introduces a 'super day' style for interviews, streamlining the evaluation process.

First-Round Interviews (Morning): Led by junior consultants, the first round consists of two interviews. It commences with a 15-minute Personal Fit Interview, followed by a case interview question. Prompt feedback and decisions regarding the afternoon session are provided at the end of the morning.

Second-Round Interviews (Afternoon): Senior consultants, including partners and directors, conduct two interviews mirroring the first-round format.

Outcome: Post-second round interviews, candidates receive detailed feedback or, in the case of successful candidates, a coveted job offer.

​ 4.  Final Decisions:

Closure: The application process concludes with candidates receiving conclusive feedback or, for those who have demonstrated exceptional potential, a formal job offer from Strategy&.

In aligning its application process with PwC's online assessments, Strategy& emphasizes a holistic evaluation approach. The 'super day' structure not only expedites the interview process but also ensures candidates receive timely feedback, enhancing the transparency and efficiency of the recruitment journey. This multi-stage process underscores Strategy&'s commitment to identifying and nurturing top-tier talent to further solidify its position as a global leader in strategy consulting .

• 4. Types of Interviews

Strategy& has  two interview formats across their network:  experience/fit questions followed by a case interview question and experience/ fit questions followed by a structured case interview .

• 4.1 Case Interview (Question)

Real-life Scenarios: Strategy& structures its case interviews around real-life client examples. Interviewers often draw from their own client engagements, leveraging familiarity with data and context.

Attributes Assessed:

Approach and structure

Analytical and creative thinking

Application of data

Communication skills

Business acumen

Evaluation Criteria: Success in a case interview is gauged based on a candidate's proficiency across these attributes, determining their capability to fulfill the responsibilities of a Strategy& consultant.

• 4.2 Experience Interview

Preliminary Insights: Conducted prior to the case interview, experience questions delve into a candidate's motivations, past experiences, and decision-making skills.

​Sample Questions:

Why are you interested in Strategy&?

Why are you interested in consulting?

What experience are you most proud of?

What experience do you wish you could do over, and how would you do it differently?

What is a difficult decision you have made in the last year?

What is an example of a time when you showed initiative and leadership?

What aspects of your internship did you like less?

What do you most like to do in your free time?

What attributes would you bring to a case team?

Describe a role where you changed the direction of a team. How did you do it?

Key Strategy: Structuring responses to these questions is crucial, showcasing a thoughtful and strategic approach even when discussing non-business-related topics.

• 4.3 Case Interview (Structured)

Information Pack: In this structured case interview, candidates receive a 15-20 page information pack and 10 minutes to read it. They formulate three high-level questions they wish to address. The interviewer leaves during this reading period.

Evaluation Focus: Similar to traditional case interviews, the emphasis is on evaluating a candidate's decision-making process, considering trade-offs, and assessing the robustness of recommendations.

• 5. Case Interview

Structured Approach: Strategy& follows a well-defined structure for case interviews, reflecting the core elements of the consulting process.

• Situation and problem:   Understanding the context and defining the problem.

Hypothesis validation:  Offering an initial hypothesis and explaining the intention to validate it.

Framework development: Creating a structured framework for analysis.

Root cause analysis: Exploring the framework to identify the root cause of the issue.

Mathematical calculation (sometimes): If relevant, incorporating mathematical calculations.

Creativity test (sometimes): Demonstrating the ability to think creatively and propose alternatives.

Recommendation: Synthesizing findings and providing a clear and concise proposal.

The Strategy& interview process is a nuanced journey, designed to holistically evaluate candidates' analytical prowess, strategic acumen, and adaptability to the intricacies of strategy consulting. This multifaceted assessment requires candidates to navigate real-life scenarios, draw on experience-based insights, and showcase structured problem-solving abilities.

At the inception of the case interview, the scenario is unveiled by the interviewer, presenting a tangible challenge.

An example might be:

"A high street retailer seeks to reduce costs by 30% in response to the Covid-19 pandemic. How would you approach this?"

Candidates embark on this journey by formulating an initial hypothesis, articulating their intention to validate or refute it. Subsequently, a meticulously crafted framework is developed to guide the analysis, adhering to the MECE (Mutually Exclusive, Collectively Exhaustive) principle. Successful exploration of the framework unveils the root cause of the client's issue, allowing for relevant calculations.

The creativity test introduces a layer of complexity, requiring candidates to propose alternatives when faced with client constraints.

For example:

"The client opposes store closures; suggest alternative cost-cutting measures."

This test is iterative, assessing the candidate's ability to think creatively and adapt solutions as per evolving constraints. Culminating the process, candidates synthesize their findings into a clear and concise recommendation, showcasing their ability to distill complex analyses into actionable proposals.

The Strategy& interview process is not merely a gauntlet; it's an opportunity for candidates to demonstrate their strategic thinking and problem-solving prowess in a simulated consulting environment.

• 6. Additional Tips
• 6.1 Fast Maths

Case interviews are pressurized situations where your anxiety levels are heightened and you don’t have the safety net of notes or the internet to fall back on.

For in-person interviews, it is common that one of the questions will have a mathematical element or be a market sizing question included. These require long maths calculations without a calculator . If you haven’t practiced long addition, multiplication, division, or subtraction recently then it is a good idea to do so. Being quick at maths shows your competent quantitative skills and reduces unnecessary pressure during the interview, increasing your overall performance.

• 6.2 Practice

As with maths, practicing case interviews is the best way to improve your performance . Through practice, you will begin to develop a robust approach that satisfies the structure and framework components of the case and you will recognize how to navigate the case successfully.

If you are applying to Strategy& then you are probably applying to other strategy consulting firms too, this practice will be relevant to all the firms you apply to as they all use case interviews in their application process.

• 6.3 Apply Structure to Everything

The key requirement of a candidate in a case interview is the application of structure , specifically with a MECE approach. As mentioned above, you can even apply structure to the FIT questions and it is recommended you do so.

An example answer to the question ‘walk me through your CV’ would be to segment your experience into: 1) Experience relevant to consulting 2) Experience not relevant to consulting and then briefly cover the experience you have in each bucket. This shows you understand what consulting is and what is relevant and also a key skill of a consultant – structured thinking.

If you can demonstrate robust structured thinking in your interview , you will score highly.

• 7. Conclusion

In conclusion, the Strategy& consulting case interview process is a well-structured journey emphasizing analytical skills, strategic thinking, and adaptability . The firm's integration with PwC brings a comprehensive evaluation approach, focusing on values like integrity and teamwork. The 'super day' style interviews efficiently assess candidates, led by both junior and senior consultants.

The case interview follows a defined structure, challenging candidates with real-world scenarios and time-pressured tasks . Success requires mastering fast maths, consistent case interview practice, and applying a structured approach.

Overall, it's not just a hurdle, but an opportunity for candidates to showcase their abilities in line with Strategy&'s commitment to excellence and innovation in global strategy consulting.

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McKinsey Implementation Consultant: What They Do + How to Apply

• Last Updated March, 2022

Former McKinsey consultant

Have you ever wondered what happens after a consulting firm delivers a strategy to a client? Consultants are hired when companies want to achieve major improvements in their business. How does the client achieve these step-function changes recommended in the new strategy? How does the client ensure sustained success in implementation?

The answer is most likely through an implementation consultant.

An implementation consultant works with clients to build capabilities, processes, and systems needed to execute on a strategy. They help bring about large organizational transformations or operational improvements to deliver lasting outcomes. They often help two organizations combine into one seamless organization during mergers or acquisitions.

Working as an implementation consultant is the best way to actually see the results of the work that traditional strategy consulting firms do and to ensure that the strategy delivers on the expected goals and vision.

Sound interesting?

In this article, we’ll tell you about McKinsey’s spin on implementation consulting. We’ll discuss:

• What type of work McKinsey implementation consultants do.
• What type of skills and qualifications McKinsey looks for in implementation consultants.
• The McKinsey implementation consultant role vs. McKinsey strategy.
• The McKinsey implementation consultant interview process.

Let’s get started!

The Work of McKinsey Implementation Consultants

Mckinsey implementation consultant vs. strategy, skills & qualifications of mckinsey implementation consultants, the mckinsey implementation interview process.

The McKinsey Implementation (MI) practice was established to equip clients with the tools and capabilities needed to achieve lasting results from their change or transformation programs or to deliver on their improvement agendas. McKinsey Implementation does not come in after clients have received their strategy from traditional strategy McKinsey work. Instead, they get involved early, as clients embark on change or transformation programs.

As an implementation consultant, you can work in all sectors, including telecommunications, technology, automotive, mining, oil and gas, manufacturing, healthcare, banking and securities, insurance, retail, and consumer goods. McKinsey Implementation has implementation hubs worldwide. You can work anywhere, including the Americas, Asia, Europe, the Middle East, and Africa.

McKinsey Implementation’s consultants are involved at every stage of the project life-cycle from strategy through to execution. They bring a disciplined eye to the impact and sustainability of business improvements.

• As an implementation consultant, you’ll begin working on a project in the very early stages, working alongside traditional McKinsey teams as they develop recommendations.
• You’ll draw on your industry experience to ensure that the recommendations are practical and can be implemented.
• During the implementation stage, you will continue working with the client until the desired results are achieved. Implementation consultants are important at this stage as the client will rely on you to guide them through what can be very difficult and ambiguous times.
• Implementation consultants coach and work closely with clients to help them develop new capabilities and processes to achieve sustainable improvement.
• As an implementation consultant, you’ll manage projects and progress and prepare communications to report back to client and internal leadership.
• You’ll also identify implementation challenges and contribute to solving them through developing practical recommendations.

McKinsey Implementation consultants are typically involved in a wide range of functions including program and project management, performance improvement, coaching and training, and organizational change management.

For more information on the type of work McKinsey Implementation consultants do, visit the their career website . Additionally, you can read stories from McKinsey implementation consultants on the their careers blog .

Nail the case & fit interview with strategies from former MBB Interviewers that have helped 89.6% of our clients pass the case interview.

McKinsey Implementation is not a “backdoor” to McKinsey. The same standard for recruitment and hiring is used for both getting invited to interviews and passing them to get an offer.

McKinsey Implementation puts more emphasis on “real world” experience and developing practical recommendations than McKinsey’s strategy track. McKinsey Implementation typically looks for candidates with a strong industry background and knowledge developed through significant hands-on experience either operationally or through projects. This “in the field” experience enables implementation consultants to develop practical strategic recommendations, develop insightful solutions, drive change, and ensure sustained improvement.

McKinsey Implementation also looks for candidates with great interpersonal skills such as empathy and patience, and the ability to coach and provide guidance to clients. McKinsey Implementation consultants should be comfortable advising and guiding senior clients in complex and uncertain projects or situations, building relationships, and significant client interaction.

Implementation Consultants typically enjoy seeing others succeed and always work to set up clients for success. Successful Implementation Consultants exhibit leadership, integrity, a sharp analytical mind, creativity, and the ability to work with people across all levels in an organization.

Is there a difference between an implementation consultant and a strategy consultant?

There is no big difference in the skill set required – the recruitment team looks for a similar skill set in both types of consultants. The only difference is the emphasis on “real-world’ experience for implementation consultants. This means the interview structure and process are the same for both implementation and strategy consultants. Both interview processes focus on personal experience interviews and cases.

See below for more information on the McKinsey Implementation interview process.

The main difference is the focus of the role and nature of the work. A strategy consultant is typically hired as a generalist and can work on different types of projects playing different roles or delivering on different workstreams. On the other hand, an implementation consultant is hired for a specific skill set or experience they have, e.g, supply chain, operations, or mergers. The nature of work tends to be different as implementation consultants typically work on longer projects and much more closely with clients.

If McKinsey Implementation sounds interesting to you, there are a number of roles you can apply to such as implementation associate, or implementation coach.

As mentioned, the application and interview process for implementation consultants is similar to strategy consultants. Implementation consultants are asked personal experience interview (PEI) or fit questions and case interview questions, typically one of each in an interview.

Candidates typically go through 2 – 3 rounds of interviews:

• First round: 2 back-to-back interviews with consultants from the McKinsey Implementation practice.
• Second round / Final round: 3 back-to-back interviews with associate partners or partners from McKinsey Implementation practice.

One key difference is that the interviewers focus more on the personal experience interview to understand the candidate’s industry knowledge and experience. Additionally, the cases typically focus on McKinsey Implementation projects. Potential candidates are advised to prepare for interviews in a similar way to traditional strategy consulting.

For more information on McKinsey interviews and how to prepare for them, please visit our guide to McKinsey Case Interview & PEI .

– – – – –

In this article, we’ve covered:

• Understanding who an implementation consultant is and what exactly they do.
• Skills and qualifications required to become an implementation consultant.
• The main differences between an implementation consultant and a strategy consultant.
• What to expect during the McKinsey Implementation interview process.

Still have questions?

If you have more questions about becoming an implementation consultant, leave them in the comments below. One of My Consulting Offer’s recruiters will answer them.

Other people looking into implementation consultant roles found the following pages helpful:

• Our Ultimate Guide to Case Interview Prep .
• McKinsey Case Interview .
• McKinsey PEI .

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Designs and methods for implementation research: Advancing the mission of the CTSA program

Soohyun hwang.

1 Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Sarah A. Birken

Cathy l. melvin.

2 Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA

Catherine L. Rohweder

3 UNC Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Justin D. Smith

4 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

Introduction:

The US National Institutes of Health (NIH) established the Clinical and Translational Science Award (CTSA) program in response to the challenges of translating biomedical and behavioral interventions from discovery to real-world use. To address the challenge of translating evidence-based interventions (EBIs) into practice, the field of implementation science has emerged as a distinct discipline. With the distinction between EBI effectiveness research and implementation research comes differences in study design and methodology, shifting focus from clinical outcomes to the systems that support adoption and delivery of EBIs with fidelity.

Implementation research designs share many of the foundational elements and assumptions of efficacy/effectiveness research. Designs and methods that are currently applied in implementation research include experimental, quasi-experimental, observational, hybrid effectiveness–implementation, simulation modeling, and configurational comparative methods.

Examples of specific research designs and methods illustrate their use in implementation science. We propose that the CTSA program takes advantage of the momentum of the field's capacity building in three ways: 1) integrate state-of-the-science implementation methods and designs into its existing body of research; 2) position itself at the forefront of advancing the science of implementation science by collaborating with other NIH institutes that share the goal of advancing implementation science; and 3) provide adequate training in implementation science.

Conclusions:

As implementation methodologies mature, both implementation science and the CTSA program would greatly benefit from cross-fertilizing expertise and shared infrastructures that aim to advance healthcare in the USA and around the world.

Implementation Research: Definition and Aims

The US National Institutes of Health (NIH) established the Clinical and Translational Science Award (CTSA) program in response to the challenges of translating biomedical and behavioral interventions from discovery to real-world use [ 1 ]. By the time the CTSA program was established, hundreds of millions of NIH dollars had been spent on developing evidence to influence a wide swath of clinical and preventive interventions for improving patient-level outcomes (e.g., observable and patient-reported symptoms, functioning, and biological markers). This emphasis on “The 7 Ps”: pills, programs, practices, principles, products, policies, and procedures [ 2 ] resulted in little to show in terms of improved health at the population level. When the CTSA program was first created, comparative effectiveness research was viewed as an important approach for moving the results of efficacy and effectiveness studies into practice [ 3 ]. By comparing multiple evidence-based interventions (EBIs), clinicians and public health practitioners would be armed with information regarding which treatments and interventions to pursue for specific populations. However, establishing the best available EBI among multiple alternatives only closes the research-to-practice-gap by a small margin. How to actually “make it work” (i.e., implementation) in an expeditious and cost-effective manner remains largely uninformed by traditional comparative effectiveness research approaches. The need for implementation research was discussed in the 2010 publication of “Training and Career Development for Comparative Effectiveness Research Workforce Development” as a necessary means of ensuring that comparative effectiveness research findings are integrated into practice [ 3 ]. This translation has not yet been fully realized within the CTSA program.

According to the NIH, implementation research is “the scientific study of the use of strategies to adopt and integrate evidence-based health interventions into clinical and community settings in order to improve patient outcomes and benefit population health. Implementation research seeks to understand the behavior of healthcare professionals and support staff, healthcare organizations, healthcare consumers and family members, and policymakers in context as key influences on the adoption, implementation and sustainability of evidence-based interventions and guidelines [ 4 ].” In contrast to effectiveness research, which seeks to assess the influence of interventions on patient outcomes, implementation research evaluates outcomes such as rates of EBI adoption, reach, acceptability, fidelity, cost, and sustainment [ 5 ]. The objective of implementation research is to identify the behaviors, strategies, and characteristics of multiple levels of the healthcare system that support the use of EBIs to improve patient and community health outcomes, to better address health disparities [ 6 ].

With the distinction between EBI effectiveness research and implementation research comes differences in study design and methodology. This article describes designs and methods that are currently applied in implementation research. We begin by defining common terms, describing the goals, and presenting some overarching considerations and challenges for designing implementation research studies. We then describe experimental, quasi-experimental, observational, effectiveness–implementation “hybrid,” and simulation modeling designs and offer examples of each. We conclude with recommendations for how the CTSA program can build capacity for implementation research to advance its mission of reducing the lag from discovery to patient and population benefit [ 7 ].

Definition of Terms

In this article, we often use “implementation” as shorthand for a multitude of processes and outcomes of interest in the field: diffusion, dissemination, adoption, adaptation, tailoring, implementation, scale-up, sustainment, etc. We use the term “implementation science” to refer to the field of study and “implementation research” in reference to the act of studying implementation. We define “design” as the planned set of procedures to: (a) select subjects for study; (b) assign subjects to (or observe their natural) conditions; and (c) assess before, during, and after assignment in the conduct of the study. With many resources for measurement and evaluation of implementation research trials in the literature [ 8 , 9 ], we focus on the selection and assignment of subjects within the design for the purposes of drawing conclusions about the effects of implementation strategies [ 10 , 11 ]. The goals of implementation research are multifaceted and largely fall within two broad categories: (1) examining the implementation of EBIs in communities or service delivery systems; and (2) evaluating the impact of strategies to improve implementation. The approaches and techniques by which healthcare providers and healthcare systems more generally implement EBIs are via “implementation strategies.” Strategies may target one or more levels within a community or healthcare delivery system (e.g., clinicians, administrators, teams, organizations, and the external environment) and can be used individually or packaged to form multicomponent strategies. Some implementation studies are designed to test, evaluate, or observe the impact of one or more implementation strategies. Others seek to understand implementation context, determinants, barriers, and facilitators that will inform the study design [ 12 ].

Characteristics of Implementation Research Designs

Study design.

Study design refers to the overall strategy chosen for integrating different aspects of a study in a coherent and logical way to address the research questions. Implementation research designs share many of the foundational elements and assumptions of efficacy research. In many experimental and quasi-experimental implementation research studies, the independent variable of interest is an implementation strategy; in other implementation research studies, variables of interest relate to the implementation context or process. Much like an EBI in a traditional clinical trial, the construct must be well-defined, particularly when conducting an experimental study, a topic we will explore in later sections. Three broad types of study designs for implementation research are experimental/quasi-experimental, observational, and simulation. The basic difference among these types is that experimental and quasi-experimental designs feature a well-defined, investigator-manipulated, or controlled condition (often an implementation strategy) that is hypothesized to effect desired outcomes, whereas observational studies are meant to understand implementation strategies, contexts, or processes. Of note, quasi-experiments apply statistical methods to data from quasi-experimental designs to approximate what, from a scientific perspective, would ideally be achieved with random assignment. Whereas quasi-experiments attempt to predict relationships among constructs, observational studies seek to describe phenomena. Simulation may feature experimental or observational design characteristics using synthetic (not observed) data. Table ​ Table1 1 provides a summary of the definition and uses of specific research designs covered in this article along with references to published studies illustrating their use in implementation science literatures.

Design types, definitions, uses, and examples from implementation science

Experimental Designs

Experimental design is regarded as the most rigorous approach to show causal relationships and is labeled as the “gold-standard” in research designs with respect to internal validity [ 34 ]. Experimental design relies on the random assignment of subjects to the condition of interest; random assignment is intended to uphold the assumption that groups (usually experimental vs. control) are probabilistically equivalent, allowing the researcher to isolate the effect of the intervention on the outcome of interest. In implementation research, the experimental condition is often a specific implementation strategy, and the control condition is most often “implementation as usual.” Brown et al. [ 2 ] described three broad categories of designs providing within-site, between-site, and within- and between-site comparisons of implementation strategies. Within-site designs are discussed in the section on quasi-experimental designs as they generally lack the replicability standard given their focus on one site or unit. It is important to acknowledge that other authors, such as Miller et al. [ 35 ] and Mazzucca et al. [ 36 ], have categorized certain designs somewhat differently than we have here.

As research advances through the translational research pipeline (efficacy to effectiveness to dissemination and implementation), study design tends to shift from valuing internal validity (in efficacy trials) to achieving a greater balance between internal and external validity in effectiveness and implementation research. Much in the same way that inclusion criteria for patients are often relaxed in an effectiveness study of an EBI to better represent real-world populations, implementation research includes delivery systems and clinicians or stakeholders that are representative of typical practices or communities that will ultimately implement an EBI. The high degree of heterogeneity in implementation determinants, barriers, and facilitators associated with diverse settings makes isolating the influence of an implementation strategy challenging and is further complicated by nesting of clinicians within practices, hospitals within healthcare systems, regions within states, etc. Thus, the implementation researcher seeks to ensure that any observed effects are attributable to the implementation strategy/ies being investigated and attempts to balance internal and external validity in the design.

Between-site designs

In between-site designs, the EBI is held constant across all units to ensure that observed differences are the result of the implementation strategy and not the EBI. Between-site designs allow investigators to compare processes and output among sites that have different exposures. Most commonly the comparison is between an implementation strategy and implementation as usual. Brown and colleagues emphasize that randomization should be at the “level of implementation” in the between-site designs to avoid cross-contamination [ 2 ]. Ayieko et al. [ 13 ] used a between-site design to examine the effect of enhanced audit and feedback (an implementation strategy) on uptake of pneumonia guidelines by clinical teams within Kenyan county hospitals. They performed restricted randomization, which involved retaining balance between treatment and control arms on key covariates including geographic location and monthly pneumonia admissions. The study used random intercept multilevel models to account for any residual imbalances in performance at baseline so that the findings could be attributed to the audit and feedback, the implementation strategy of interest [ 12 ].

A variant between-site design is the “head-to-head” or “comparative implementation” trial in which the investigator controls two or more strategies, no strategy is implementation as usual, no site receives all strategies, and results are compared [ 2 ]. Finch et al. [ 14 ] examined the effectiveness of two implementation strategies, performance review and facilitated feedback, in increasing the implementation of healthy eating and physical activity-promoting policies and practices in childcare services in a parallel group randomized controlled trial design. At completion of the intervention period, childcare services that received implementation as usual were also offered resources to use the implementation strategies.

When achieving a large sample size is challenging, researchers may consider matched-pair randomized designs, with fewer units of randomization, or other adaptive designs for randomized trials [ 37 ] such as the factorial/fractional factorial [ 38 ] or sequential multiple assignment randomized trial (SMART) design. The SMART design allows for building time-varying adaptive implementation strategies (or stepped-care strategies) based on the order in which components are presented and the additive and combined effects of multiple strategies [ 15 ]. Kilbourne et al. assessed the effectiveness of an adaptive implementation intervention involving three implementation strategies (replicating effective programs [ 39 ], coaching, and facilitation) on cognitive behavioral therapy delivery among schools in a clustered SMART design [ 40 ]. In the first phase, eligible schools were randomized with equal probability to a single strategy vs. the same strategy combined with another implementation strategy. In subsequent phases, schools were re-randomized with different combinations of implementation strategies based on the assessment of whether potential benefit was derived from a combination of strategies. Similar to the SMART design is the full or fractional factorial design in which units are assigned a priori to different combinations of strategies, and main and lower order effects are tested to determine the additive impact of specific strategies and their interactions [ 41 ].

Another between-site design variant, the incomplete block, is useful when two implementation strategies cannot or were not initially intended to be directly compared. The incomplete block design allows for an indirect comparison of the two strategies by drawing from two independent samples of units, one in which sites are randomized to either strategy A or implementation as usual, and the other in which sites are randomized to strategy B or implementation as usual [ 42 ]. The two samples are completely independent and can occur either in parallel or in sequence, and statistical tests are performed for indirect comparison of the impacts of the two strategies “as if” they were directly compared. This requires a single EBI to be implemented and some degree of homogeneity across both of the groups. The incomplete block design is useful when it is not possible to test both strategies in a single study, or when a prior or concurrent study can be leveraged to compare two strategies.

Although the examples of between-site designs are randomized at the site- and organization-level, smaller units within each organization such as the team or clinician may also be randomized to an intervention [ 2 ]. Smith, Stormshak, & Kavanagh [ 18 ] present the results of a study in which clinicians were randomized to receive training or not, and their assigned families were randomized to receive the EBI or usual services. Effectiveness (family functioning and child behaviors) and implementation outcomes (adoption and fidelity) were evaluated after the 2-year period of intervention delivery.

Within- and between-site designs

This design involves crossovers where units begin in one condition and move to another (within-site element), which is repeated across units (or clusters of units) with staggered crossover points (between-site element). This broad class of designs has been referred to as “roll-out” designs [ 43 ] and dynamic wait-list designs [ 44 ]. We use the term “roll-out” to describe within- and between-site designs. The defining characteristic of roll-out designs is the assignment of all units in the study to the time when the implementation strategy will begin (i.e., the crossover). Assignments within roll-out designs can either be random, non-random, or quasi-random. In the context of implementation research, the roll-out design offers three practical and scientific advantages. First, all units in the trial will eventually receive the implementation strategy. Ensuring that all participating units receive the strategy promotes equity and enables all participants to contribute data. Second, the roll-out design allows the research team and the partner organizations to distribute resources required to administer the implementation strategy over time, rather than having to implement in all sites simultaneously as might be done in another type of multisite design. Third, the design allows researchers to account for the effect of unanticipated confounders (e.g., change in accreditation standards that requires use of the implementation strategy) that can occur during the trial period. For example, if some sites start implementation before an external event occurs, and other sites start afterwards, the impact of the event on the implementation process and resulting outcomes can be measured.

A common roll-out design is the stepped-wedge. The stepped-wedge is a specific design in which measurement of all units begins simultaneously at T0 and units cross over from one condition (e.g., implementation as usual or usual care) to the experimental implementation strategy condition following a series of “steps” at a predetermined interval (steps refer to the crossover). The result is a “wedge” below the steps of implementation as usual that can be compared to the wedge above the step representing the implementation strategy condition. The stepped-wedge is illustrated in Fig. ​ Fig.1 1 (panel a).

Roll-out designs: the stepped wedge (panel a) and incomplete wedge (panel b).

A variant of this design is the incomplete (or modified) wedge roll-out design (Fig. ​ (Fig.1, 1 , panel b). The difference from the stepped-wedge is that pre-implementation outcomes measurement begins immediately prior (e.g., 4–6 months) to the step rather than at T0 [ 16 ]. Incomplete wedge roll-out designs might be preferred to the traditional stepped-wedge design because there is less burden on participating sites to collect data for long periods and it allows researchers the option of staged enrollment in the trial if needed to achieve the full target sample in a way that does not threaten the study protocol. In this latter situation, randomization would occur in as few stages as possible to maintain balance and a variable for stage of enrollment would be included in all analyses to account for any differences in early vs. later enrollees. Last, the unit of randomization can be single units, clusters, or repeated, matched pairs [ 45 ]. Smith and Hasan [ 16 ] provide a case example of an incomplete wedge roll-out design in a trial testing the implementation of the Collaborative Care Model for depression management in primary care practices within a large university health system. In that trial, measurement of implementation began 6 months prior to the crossover to implementing the Collaborative Care Model in each primary care practice in a multi-year roll-out.

Quasi-Experimental Designs

Quasi-experimental designs share experimental design goals of assessing the effect of an intervention on outcomes of interest. Unlike experiments, however, quasi-experiments do not randomly assign participants to intervention and usual care groups. This key distinction limits the internal validity of quasi-experimental designs because differences between groups cannot be attributed exclusively to the intervention. However, when randomization is not possible or desirable for assessing the effectiveness of an implementation strategy or other intervention, quasi-experimental designs are appealing. Internal validity is strengthened when techniques of varying strength are used to bolster internal validity in lieu of randomization, including pre- and post-; interrupted time-series; non-equivalent group; propensity score matching; synthetic control; and regression-discontinuity designs [ 46 ].

In the context of implementation research, quasi-experimental designs fall under Brown and colleagues’ broad category of within-site designs. These single-site or single-unit (practitioner, clinical team, healthcare system, and community) designs are most commonly compared to their own prior performance. The simplest variant of a within-site study is the post design. This design is relevant when a site or unit has not delivered a service before, and thus, has no baseline or pre-implementation strategy data for comparison. The result of such a study is a single “post” implementation outcome that can only be compared to a criterion metric or the results of published studies. In contrast to a post design where data are only available after an implementation strategy or other intervention is introduced, a pre-post design compares outcomes following the introduction of an implementation strategy to the results from care as usual prior to introducing the implementation strategy.

To increase power and internal validity of within-site studies, interrupted time-series designs can be used [ 47 ]. Time-series designs involve multiple observations of the dependent variable (e.g., implementation) before and after the introduction of the implementation strategy, which “disrupts” the time-series data stream. Time-series designs are highly flexible and can involve multiple sites in the multiple baseline and replicated single-case series variants, which increase internal validity through replication of the effect. Examples of interrupted time-series studies exist in implementation research that exemplify their practicality for studying implementation (see Table ​ Table1). 1 ). Limitations of this design in implementation research include the challenge of defining the interruption (i.e., when the implementation began) and that the effects of new implementations are unlikely to be immediate. Therefore, analysis of interrupted time-series in implementation research might favor examining changes in slope between pre-implementation and implementation phases, rather than testing immediate changes in level of the outcome after the interruption.

Observational Designs

In observational studies, the investigator does not intervene with study participants but instead describes outcomes of interest and their antecedents in their natural context [ 48 ]. As such, observational studies may be particularly useful for evaluating the real-world applicability of evidence. Observational designs may use approaches to data collection and analysis that are quantitative [ 16 ] (e.g., survey), qualitative [ 49 ] (e.g., semi-structured in-depth interviews), or mixed methods [ 50 ] (e.g., sequential, convergent analysis of quantitative and qualitative results). Quantitative, qualitative, and mixed methods can be especially helpful in observational studies for systematically assessing implementation contexts and processes.

Hybrid Designs

With the goal of more rapidly translating evidence into routine practice, Curran et al. [ 51 , 52 ] proposed methods for blending: 1) design components of experiments intended to test the effectiveness of clinical interventions and 2) approaches to assessing their implementation. Such hybrid designs provide benefits over pursuing these lines of research independently or sequentially, both of which slow the progress of translation. Curran and colleagues state that effectiveness–implementation hybrid designs have a dual, a priori focus on assessing clinical effectiveness and implementation [ 51 , 52 ]. Hybrids focus on both effectiveness and implementation but do not specify a particular trial design. That is, the aforementioned experimental and observational designs can be used for any of the hybrid types. References to hybrid studies in implementation science are provided in Table ​ Table1 1 .

Curran et al. describe the conditions under which three different types of hybrid designs should be used, which helps researchers determine the most appropriate type based on whether evidence of effectiveness and implementation exists. Linking clinical effectiveness and implementation research designs may be challenging, as the ideal approaches for each often do not share many design features. Clinical trials typically rely on controlling/ensuring delivery of the clinical intervention (often by using experimental designs) with little attention to implementation processes likely to be relevant to translating the intervention to general practice settings. In contrast, implementation research often focuses on the adoption and uptake of clinical interventions by providers and/or systems of care [ 53 ] often with the assumption of clinical effectiveness demonstrated in previous studies. The three hybrid designs are described below.

Hybrid Type 1

Hybrid Type 1 tests a clinical intervention while gathering information on its delivery and/or potential for implementation in a real-world context, with primary emphasis on clinical effectiveness. This type of design advocates process evaluations of delivery/implementation during clinical effectiveness trials to collect information that may be valuable in subsequent implementation research studies, answering questions such as: What potential modifications to the clinical intervention could be made to maximize implementation? What are potential barriers and facilitators to implementing this intervention in the “real world”? Hybrid Type 1 designs provide the opportunity to explore implementation and plan for future implementation.

Hybrid Type 2

Hybrid Type 2 simultaneously tests a clinical intervention and an implementation intervention/strategy. In contrast to the Hybrid Type 1 design, the Hybrid Type 2 design puts equal emphasis on assessing both intervention effectiveness and feasibility and/or potential impact of an implementation strategy. In a Hybrid Type 2 study, where an implementation intervention/strategy is simultaneously tested to promote uptake of the clinical intervention under study. Type 2 hybrid designs appear less frequently than the other two types due to the resources required.

Hybrid Type 3

Hybrid Type 3 primarily tests an implementation strategy while secondarily collecting data on the clinical intervention and related outcomes. This design can be used when researchers aim to proceed with implementation studies without an existing portfolio of effectiveness studies. Examples of these conditions are when: health systems attempt implementation of a clinical intervention without comprehensive clinical effectiveness data; there is strong indirect efficacy or effectiveness data; and potential risks of the intervention are limited. National priorities (e.g., the opioid epidemic) may also drive implementation before effectiveness data are robust.

Implementation research is, by definition, a systems science in that it simultaneously studies the influence of individuals, organizations, and the environment on implementation [ 54 ]. The field of systems science is devoted to understanding complex behaviors that are both highly variant and strongly dependent on the behaviors of other parts of the system. Systems science is a challenging field to study using traditional clinical trial methods for various reasons, most notably the complexity involved in the many interactions and dynamics of multiple levels, constant change, and interdependencies. Simulation studies offer a solution for understanding the drivers of implementation and the potential effects of implementation strategies [ 55 ]. Modeling typically involves simulating the addition or configuration of one or more specific implementation strategies to determine which path should be taken in the real world, but it can also be used to test the likely effect of implementing one or more EBIs to determine impact for specific populations.

Agent-based modeling (ABM) [ 56 ] and participatory systems dynamics modeling (PSDM) [ 57 ] have both been used in implementation research to model the behavior of systems and determine the impact of moving certain implementation “levers” in the system. ABM is a method for simulating the behavior of complex systems by describing the entities (called “agents”) of a system and the behavioral rules that guide their interactions [ 56 ]. These agents, which can be any element of a system (e.g., clinicians, patients, and stakeholders), interact with each other and the environment to produce emergent, system-level outcomes [ 58 ], many of which are formal implementation outcomes. As ABM produces a mechanistic model, researchers are able to identify the implementation drivers that should be leveraged to most effectively achieve the predicted impacts in practice. Whereas ABM has wide ranging applications for implementation science, PSDM is an example of a method for a specific implementation challenge. Zimmerman et al. [ 26 ] used PSDM to triangulate stakeholder expertise, healthcare data, and modeling simulations to refine an implementation strategy prior to being used in practice. In PSDM, clinic leadership and staff define and evaluate the determinants (e.g., clinician knowledge, implementation leadership, and resources) and mechanisms (e.g., self-efficacy, feasible workflow) that determine local capacity for implementation of an EBI using a visual model. Given local capacity and other factors, simulations predict overall system behavior when the EBI is implemented. The process is iterative and has been used to prepare for large initiatives where testing implementation using standard trial methods was infeasible or undesirable due to the cost and time involved.

Configurational Comparative Methods

Configurational comparative methods, which are an umbrella term for methods that include but are not limited to qualitative comparative analysis [ 59 ], combine within-case analysis and logic-based cross-case analysis to identify determinants of outcomes such as implementation. Configurational comparative methods define causal relationships by identifying INUS conditions: those that are an Insufficient but Necessary part of a condition that is itself Unnecessary but Sufficient for the outcome. Configurational comparative methods may be preferable to standard regression analyses often used in quasi-experiments when the influence of an intervention on an outcome is not easily disentangled from how it is implemented or the context in which it is implemented – i.e., complex interventions. Complex interventions often have interdependent components whose unique contributions to a given outcome can be challenging to isolate. Furthermore, complex interventions are characterized by blurry boundaries among the intervention, its implementation, and the context in which it is implemented [ 60 ]. For example, the effectiveness of care plans for cancer survivors in improving care coordination and communication among providers likely depends upon a care plan's content, its delivery, and the functioning of the cancer program in which it is delivered [ 61 ]. Configurational comparative methods facilitate identifying multiple possible combinations of intervention components and implementation and context characteristics that interact to produce outcomes. To date, qualitative comparative analysis is the type of configurational comparative methods that has been most frequently applied in implementation research [ 62 ]. To identify determinants of medication adherence, Kahwati et al. [ 24 ] used qualitative comparative analysis to analyze data from 60 studies included in a systematic review. Breuer et al. [ 25 ] used qualitative comparative analysis to identify determinants of mental health services utilization.

Relevance and Opportunities for Application in CTSAs

In the early days of the CTSA program, resources allocated to implementation science were most frequently embedded in clinical or effectiveness research studies, and few had robust, standalone implementation science programs [ 63 , 64 ]. As the National Center for Advancing Translational Sciences (NCATS) and other federal and non-federal sources have increased their investment in implementation science capacity, the field has grown dramatically. More CTSAs are developing implementation research programs and incorporating stakeholders more fully in this process, as reflected in the results of the Dolor et al [ 65 ] environmental scan. Washington University and the University of California at Los Angeles have documented their efforts to engage practice and community partners, offer professional development opportunities, and provide consultations to investigators both in and outside the field of implementation science [ 66 , 67 ]. The CTSA program could take advantage of this momentum in three ways: integrate state-of-the-science implementation methods into its existing body of research; position itself at the forefront of advancing the science of implementation science by collaborating with other NIH institutes that share the goal of advancing implementation science, such as NCI and NHLBI; and providing training in implementation science.

Integrating state-of-the-science implementation methods to CTSAs’ existing bodies of research

Many CTSAs have the expertise to consult with their institution's investigators on the potential role of implementation science in their research. Implementation research consultations involve creating awareness and appropriate use of specific study designs and methods that match investigators’ needs and result in meaningful findings for real-world clinical and policy environments. As described by Glasgow and Chambers, these include rapid, adaptive, and convergent methods that consider contextual and systems perspectives and are pragmatic in their approach [ 68 ]. They state that “CTSA grantees, among others, are in a position to lead such a change in perspective and methods, and to evaluate if such changes do in fact result in more rapid, relevant solutions” to pressing public health problems. Through consultation services, CTSAs can encourage the use of implementation science early (e.g., designing for dissemination and implementation [ 69 ]) and often, positioning CTSAs – the hub for translation – to fulfill their mission by reducing the lag from discovery to patient and population benefit.

Advancing the science of implementation science

The centers funded by the CTSA program are able to conduct large-scale implementation research using the multisite U01 mechanism which requires the involvement of three centers. With the challenges of recruitment, generalizability, and power that are inherent in many implementation trials, the inclusion of three or more CTSAs, ideally representing diversity in region, populations, and healthcare systems, can provide the infrastructure for cutting-edge implementation science. Thus far, there are few examples of this mechanism being used for implementation research. In addition, with the charge of speeding translation of bench and clinical science discoveries to population impact, CTSAs have both the incentive and perspective to conduct implementation research early and consistently in the translational pipeline. As the hybrid design illustrates, there has been a paradigmatic shift away from the sequential translational research pipeline to more innovative methods that reduce the lag between translational steps.

Training in implementation science

NIH has funded several formal training programs in implementation science, including the Training Institute in Dissemination and Implementation in Health [ 70 ], Implementation Research Institute [ 71 ], and Mentored Training in Dissemination and Implementation Research in Cancer [ 72 ]. These training programs address the need to gain greater clarity around the implementation research designs described in this article, but the demand for training outpaces available resources. CTSAs could provide an avenue for meeting the needs of the field for training in dissemination and implementation science methods. CTSA faculty with expertise in implementation research could offer implementation research training programs for scholars on many levels using the T32, KL2, K12, TL1, R25, and other mechanisms. Chambers and colleagues have recently noted these capacity-building and training opportunities funded by the NIH [ 73 ]. Indeed, given the mission of the CTSA program, they are the ideal setting for implementation research training programs.

The field of implementation science has established methodologies for understanding the context, strategies, and processes needed to translate EBIs into practice. As they mature alongside one another, both implementation science and the CTSA program would greatly benefit from cross-fertilizing expertise, infrastructure, and aim to advance healthcare in the USA and around the world.

Acknowledgements

The authors wish to thank Hendricks Brown and Geoffrey Curran who provided input at different stages of developing the ideas presented in this manuscript.

Research reported in this publication was supported, in part, by the National Center for Advancing Translational Sciences, grant UL1TR001422 (Northwestern University), grant UL1TR002489 (UNC Chapel Hill), and grant UL1TR001450 (Medical University of South Carolina); by National Institute on Drug Abuse grant DA027828; and by the Implementation Research Institute (IRI) at the George Warren Brown School of Social Work, Washington University in St. Louis through grant MH080916 from the National Institute of Mental Health and the Department of Veterans Affairs, Health Services Research and Development Service, Quality Enhancement Research Initiative (QUERI) to Enola Proctor. Dr. Birken's effort was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant KL2TR002490. The opinions expressed herein are the views of the authors and do not necessarily reflect the official policy or position of the National Institute for Advancing Translational Science, the National Institute on Drug Abuse, the National Institute of Mental Health, the Department of Veterans Affairs, or any other part of the US Department of Health and Human Services.

Disclosures

The authors have no conflicts of interest to declare.

• Open access
• Published: 23 April 2024

Factors influencing the commissioning and implementation of health and social care interventions for people with dementia: commissioner and stakeholder perspectives

• Rachael Tucker   ORCID: orcid.org/0000-0001-8133-1909 1 ,
• Robert Vickers   ORCID: orcid.org/0000-0002-3031-2940 2 , 5 ,
• Emma J. Adams   ORCID: orcid.org/0000-0002-5444-6951 1 ,
• Clare Burgon   ORCID: orcid.org/0000-0002-4910-9969 2 ,
• Juliette Lock   ORCID: orcid.org/0000-0003-2028-6889 2 ,
• Sarah E. Goldberg   ORCID: orcid.org/0000-0001-5109-798X 1 ,
• John Gladman   ORCID: orcid.org/0000-0002-8506-7786 2 , 3 , 4 , 5 ,
• Tahir Masud   ORCID: orcid.org/0000-0003-1061-2898 3 ,
• Elizabeth Orton   ORCID: orcid.org/0000-0002-2531-8846 2 ,
• Stephen Timmons   ORCID: orcid.org/0000-0002-3731-1350 6 &
• Rowan H. Harwood   ORCID: orcid.org/0000-0002-4920-6718 1 , 3  

Archives of Public Health volume  82 , Article number:  54 ( 2024 ) Cite this article

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Despite several interventions demonstrating benefit to people living with dementia and their caregivers, few have been translated and implemented in routine clinical practice. There is limited evidence of the barriers and facilitators for commissioning and implementing health and social care interventions for people living with dementia. The aim of the current study was to explore the barriers and facilitators to commissioning and implementing health and social care interventions for people with dementia, using a dementia friendly exercise and physical activity-based intervention (PrAISED [Promoting Activity, Stability and Independence in Early Dementia and Mild Cognitive Impairment]) as a case study.

Qualitative semi-structured interviews were conducted with stakeholders from a range of backgrounds including individuals from health and social care, local government, the voluntary and community sector, universities, and research centres in England. The Consolidated Framework for Intervention Research (CFIR) was used to guide the design and analysis.

Fourteen participants took part, including commissioning managers, service managers, partnership managers, charity representatives, commercial research specialists, academics/researchers, and healthcare professionals. Data were represented in 33 constructs across the five CFIR domains. Participants identified a need for greater support for people diagnosed with dementia and their caregivers immediately post dementia diagnosis. Key barriers included cost/financing, the culture of commissioning, and available resources. Key facilitators included the adaptability of the intervention, cosmopolitanism/partnerships and connections, external policy and incentives, and the use of already existing (and untapped) workforces.

Several barriers and facilitators for commissioning and implementing health and social care interventions for people with dementia were identified which need to be addressed. Recommended actions to facilitate the commissioning and implementation of dementia friendly services are: 1) map out local needs, 2) evidence the intervention including effectiveness and cost-effectiveness, 3) create/utilise networks with stakeholders, and 4) plan required resources.

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Introduction

Dementia is a progressive, neurodegenerative, life limiting condition associated with a range of symptoms including memory loss, declining executive function, and associated changes in behaviour and mood [ 5 ]. Over 55 million people live with dementia worldwide [ 43 ] and this is projected to increase to approximately 153 million by 2050 [ 37 ]. The global cost of dementia in 2019 amounted to US$ 1.3 trillion, with costs expected to exceed US$ 2.8 trillion by 2030 [ 43 ]. As the condition progresses, the amount of support required, and thus, care costs also increase [ 3 ]. Therefore, implementing interventions for dementia that focus on maintaining independence and slowing the rate of functional decline to prevent health and social care use and reduce this economic burden is important.

Translating research into practice

The research into practice gap is well documented. It takes an average of 17 years for innovations to be implemented into routine clinical practice [ 7 , 24 ]. Despite many non-pharmacological interventions for dementia demonstrating benefit, a small number are implemented in practice [ 24 ]. Thus, it is crucial to understand strategies that facilitate their implementation.

There is little evidence for translating dementia friendly exercise/physical activity interventions into practice. A systematic review by Groot Kormelinck et al. [ 27 ] identified barriers and facilitators for implementing complex interventions for residents with dementia living in long term care. In this review, only two interventions had an exercise or physical activity component [ 27 ], and due to its setting, may not have identified factors relevant to implementation across a range of health systems.

Commissioning in England’s National Health Service

The National Health Service (NHS) in England is a publicly funded health system providing universal access to healthcare based on clinical need, not ability to pay [ 20 ]. NHS commissioning is complex whereby different services may be specified and paid for by different commissioners, including nationally (NHS England) and locally (e.g. Primary Care Networks and local government). Services may be provided by the voluntary and community sector (VCS), primary and secondary care health services, and support organisations working interdependently [ 36 , 40 ]. However, social care in England is not universally funded, is commissioned by local government, provided by a range of providers, and is means tested [ 39 ]. Commissioning dementia services is therefore also complex [ 29 ]. Such complexities mean many people with dementia and their families are burdened with care costs and inadequate support [ 4 ].

The PrAISED programme

The Promoting Activity, Independence and Stability in Early Dementia and Mild Cognitive Impairment (PrAISED) programme is a complex intervention which aims to keep people living with dementia independent and healthier for longer [ 11 , 25 ]. PrAISED was developed by physiotherapists, occupational therapists, health psychologists, nurses, geriatricians, and carer representatives [ 11 ] and was tested in a feasibility study [ 25 ]. It is a 12-month exercise and activity-based programme consisting of progressive strength, balance and dual task exercises, functional activities and activities of daily living training, risk analysis, advice, and environmental assessment, all delivered using a motivational approach to support long-term participation in physical activity [ 11 ]. The effectiveness of the PrAISED intervention was studied in the PrAISED-2 multi-site, pragmatic, Randomised Controlled Trial (RCT), which took place between September 2018 and January 2023 [ 6 , 28 ]. Before the results of PrAISED-2 were available and in anticipation of an implementation phase, the current study aimed to explore the views of commissioners and stakeholders on this matter and to inform the commissioning and implementation of wider health and social care dementia interventions.

Given the complexities of commissioning, the current study aimed to identify barriers and facilitators for commissioning and implementing health and social care interventions for people with dementia, using a dementia-friendly exercise and physical activity-based intervention (PrAISED) as a case study and to provide recommendations for future implementation.

Ethical approval

The study received research governance approvals and ethical approval from the Bradford Leeds Research Ethics Committee (18/YH/0059; 236099).

Study design

The Consolidated Framework for Implementation Research (CFIR) [ 17 ] was used as a theoretical framework for the study, to guide the methods, such as the development of the topic guide, and for data analysis (see data analysis section). This framework was chosen as it is comprehensive and is commonly used in implementation research enabling comparisons with other studies. Qualitative, semi-structured interviews were used for data collection. Participants were asked to consider PrAISED in their answers, even if they had not been involved in the PrAISED RCT (see Table A1 in Appendix : interview topic guide).

Participant recruitment

Participants were stakeholders involved in the commissioning and delivery of dementia services. An introductory email was sent out to potential participants and/or contacts from pre-existing networks known to the research team. This included individuals working in the NHS/healthcare, social care, local authorities, the VCS, and other key stakeholder organisations concerned with commissioning, implementing, delivering, or promoting activity-based interventions for people with dementia and/or mild cognitive impairment. Participants were provided with an information sheet and a consent form which was completed prior to their interview. Two researchers (RT and RV) conducted the interviews, all of which were carried out, recorded, and transcribed using Microsoft Teams. Any identifiable information was removed from the transcripts and participants were assigned a participant number. A ‘snowball’ (chain-referral) sampling technique was employed to identify additional participants, who were contacted via email.

Data analysis

Data analysis was carried out using codebook thematic analysis [ 13 ]. This type of thematic analysis uses a structured approach with predetermined themes and codes, or a research framework, to guide the analysis [ 13 ]. This study used the CFIR [ 17 ] as a codebook, thus the transcripts were coded according to the CFIR constructs to identify the barriers and facilitators to commissioning and implementing health and social care interventions for people with dementia from the perspectives of the participants.

The CFIR was developed to consolidate published implementation theories into a consistent typology for use in evaluating implementation [ 17 ]. Since its publication in 2009, the CFIR has grown in recognition and is now used widely across mixed method, quantitative and qualitative studies [ 31 ]. The CFIR consists of five domains: intervention characteristics, outer setting, inner setting, characteristics of individuals involved, and process of implementation. Across these domains are 39 constructs, full details are available at Damschroder et al. [ 17 ] or https://cfirguide.org/ .

Approximately halfway through the data analysis, revised CFIR guidelines were published updating constructs and their definitions [ 18 ]. The methodological implications of this publication were considered collectively by the research team, and the team came to a consensus that the new/expanded constructs from the updated CFIR would be incorporated where relevant to the analysis. As per the updated CFIR framework, the research team worked collaboratively to define each domain in this study. The domains and their constructs used in this study are presented in Table  1 . Constructs that were added, revised or renamed after the publication of the updated CFIR are denoted by *.

Data analysis process

NVivo software version 13 [ 38 ] and a CFIR-approved pre-populated template [available at https://cfirguide.org/tools/tools-and-templates/ ] were used to analyse the data; additional constructs were added where appropriate.

Braun and Clarke’s [ 12 ] and Braun et al.’s [ 13 ] thematic analysis steps were amended and/or combined to reflect the methods used in this study (codebook thematic analysis), which had predetermined codes and themes determined by the CFIR framework. Data analysis followed these steps:

Familiarisation (repeatedly reading transcripts and making notes about content)

Preliminary coding (preliminary coding into relevant constructs as per the CFIR codebook [available at https://cfirguide.org/tools/tools-and-templates/ ] and documenting rationale for coding decisions

Revising and revisiting coding/theme development (data revisited to check interpretations and amend if needed as researchers became more familiar with the data)

Finalising codes/themes (codes finalised within the research team)

Producing the report

Although these steps are presented as a sequence, data analysis followed an iterative process, with each step being revisited and revised. The lead author (RT) acted as lead coder for this study. A second coder (RV) reviewed a third of the transcripts to act as a peer-checker and reviewer of coding decisions. To improve understanding and collaborative use of the CFIR framework, the lead coder, second coder and wider implementation study team met weekly to discuss coding decisions.

A total of 14 participants took part in interviews. Participants included commissioning managers ( n  = 4), service managers ( n  = 3), charity representatives ( n  = 1), partnership managers (responsible for developing and managing strategic partnerships between organisations) ( n  = 1), commercial research specialists ( n  = 1), academics/researchers ( n  = 2), and healthcare professionals ( n  = 2), working across a range of settings including universities, research centres, the VCS, health and social care, and local government. Interviews lasted between 25 and 68 min. Of the 40 constructs (39 original CFIR constructs, plus one from the updated CFIR [ 18 ]) (Table  1 ), six had no entries during the analysis. These were: two constructs from the innovation characteristics domain (relative advantage and trialability), one from the inner setting domain (learning climate), two from the individual characteristics domain (self-efficacy and individual identification with organisation), and one from the process domain (executing). The remaining constructs were used as codes and were representative of extracts from the interview transcripts. The most frequently coded constructs were 1) needs and resources of those served by the organisation (outer setting), 2) available resources (inner setting), and 3) cosmopolitanism/partnership and connections (outer setting). Table 2 shows the frequency of coding for each construct (though frequency does not necessarily reflect importance), along with their classification as a barrier, facilitator, or both.

As barriers and facilitators to the implementation of dementia friendly activity-based interventions were identified across all domains, this paper presents each domain and discusses barriers and facilitators within them, before presenting key meta-themes and considerations for the wider commissioning and implementation climate as part of the discussion.

Innovation characteristics

The innovation source, evidence strength and quality, adaptability, complexity, design quality and packaging, and cost, all represented barriers and facilitators. The PrAISED intervention was coproduced with patient and public representatives and healthcare professionals [ 11 ]. Interviewees suggested coproduction was integral to successful implementation as the individual tailoring was seen to enhance participation, and the involvement of healthcare professionals provided reassurance of its effect:

‘…the fact that it’s also being developed with health professionals is something that’s really quite to its favour, because I think we find that people really look for reassurance from medical professionals, so if they know it’s got that medical endorsement, I think for us would be really positive,’ Participant 2 (Activity Manager).

Another facilitator was the innovation’s ability to be adapted to suit local systems. Several participants suggested that implementation would be facilitated and/or would be more likely to be commissioned if the innovation could be embedded within existing services:

‘I think if it’s something that you can almost add on to an existing provision… so you do have some of that skilled workforce, you have that management structure around it… some of the concerns of commissioners is when you end up with lots of small and then potentially vulnerable services… it just helps because you know you've got that capability there that could be mobilised rather than if you're starting from scratch,’ Participant 1 (Commissioner).

Some suggested utilising day services and/or care homes to deliver an intervention like PrAISED would keep costs down, utilise already existing services and upskill existing staff.

Another facilitator was the potential to use other professionals to deliver PrAISED in practice. In the main trial, PrAISED was delivered by occupational therapists, physiotherapists, and rehabilitation support workers. Participants in the current study suggested other professionals, such as exercise instructors, could take on responsibility for delivering a dementia friendly, exercise-based intervention and would be qualified to do so (discussed in greater depth in the individual characteristics domain). Interestingly, this view differed from those of healthcare professionals interviewed as part of a pilot PrAISED service, who felt it was essential healthcare professionals delivered exercise interventions for people living with dementia [ 1 ]. It was suggested this potential adaptation had collateral benefits for cost, and could reduce the demand on the existing workforce, utilise an untapped workforce and improve collaborative working with the local community, for example, leisure centres.

Evidence was a significant factor and facilitator in the commissioning of an intervention like PrAISED:

‘It’s an area that you’ve got to have as much efficacy evidence as possible… that is what is going to determine the success,’ Participant 7 (Commercial Director).

‘If the evidence isn’t there to support it, then it's not going to be there ultimately,’ Participant 12 (Partnership Manager).

One strand of evidence that was particularly pertinent to successful commissioning was the intervention’s ability to deliver cost savings and where these would be visible, for example, in health as opposed to social care budgets. However, this was deemed difficult to evidence. Participants 13 and 14, both commissioning managers, described the importance of interventions delivering cost savings in influencing decisions and allocating funds:

‘If we can start to evidence that this is delaying or improving outcomes… that would help massively… It’s like that invest to save sort of thing, isn’t it? If we can really show some evidence around that… then I think that you've got more of a chance,’ Participant 13 (Commissioning Manager).

‘Delaying need for social care is a really big thing for us. So, if an organisation came and said look, we can prevent people hitting your services for a long time, that's a really big driver for us, and like promoting independence, so, even if people are using our services, they’re using them less and living at home longer,’ Participant 14 (Commissioning Manager).

Also, participants working outside of commissioning recognised how crucial evidence was to the decision-making process:

‘It’s also important to show that there’s evidence… certainly some people in commissioning are a bit swayed by evidence or are very sceptical about things unless there’s evidence,’ Participant 8 (Professor of Dementia Research).

Interestingly, participant 7 described how different ‘levels’ of evidence would be required, depending on the system of delivery. For example, lower-level evidence would be required if the intervention were to be self-funded, as it would be an ‘emotional purchase’ by family members and/or carers, whereas:

‘…if it’s a statutory service provision model [local authority or NHS], then the bar is higher in terms of the amount of certainty that they would need in order to commission it and that might be certainty around patient outcomes, deferred benefit, cost versus benefit, cost benefit analysis… with limited budgets and competing demands for resources, they want to put their bets on the horses that are going to get them the biggest returns. Otherwise, it might fall into that nice to have, but not essential, which is really hard,’ Participant 7 (Commercial Director).

Whilst evidence of RCT outcomes was mostly advocated, other forms of evidence, such as qualitative research, were also important:

‘… it’s about showing real life stories and the positive impact it can have on someone’s life… I think that's really powerful,’ Participant 6 (Sports Development Officer).

Outer setting

Most participants reported that there is a need for dementia friendly activity-based interventions. Participants recognised the benefits of physical activity, and many proactively promoted this. Some reported that there were vast amounts of initiatives which aimed to engage people with long term conditions in physical activity and exercise. However, importantly, these were mostly deemed unsuitable for people living with dementia:

‘You need to have sort of a specific understanding of their needs and what’s going to be most likely to support them into activity and help them to maintain that… often people with dementia, when we're talking to them about some of the services and support that we're providing, they find it a little bit harder to relate to some of the messaging and a bit harder to undertake some of the activities… they need to be communicated in a particular way and they need to take into consideration their ability level and just them as a whole person,’ Participant 2 (Activity Manager).

There were few dementia specific or dementia friendly services currently being provided, though participant 10 reported that there was ‘ an appetite definitely to improve the provision or enhance the provision or create the provision to start with .’ Participants described the post-diagnostic support as lacking, and at worst, absent:

‘We have a gap… the post-diagnostic offer to people with dementia is pretty woeful,’ Participant 8 (Professor of Dementia Research).

Participants described efforts in their organisation and/or local area to provide or promote dementia friendly interventions, such as dementia friendly swimming and golf. However, what was evident across the data was a need to map what was already available, and to evaluate the needs of the local population living with dementia, including marginalised and underserved communities. Participants attempted to address unmet need and deficits in specialist dementia knowledge through training and education for care home and day centre staff, and dementia specialist accreditation. Some described using roles such as social prescribing (referrals from healthcare professionals to local non-clinical services [e.g., volunteering, sports groups etc.] with the aim of holistically improving health and wellbeing [ 14 ]) to engage this population in exercise, and others created dementia hubs and strategies to support local priorities. Participants identified several barriers to engaging their local community of people living with dementia in physical activity. This included fear and anxiety, avoidance of activity perceived as risky, lacking support, poor awareness of available services, and lacking infrastructure and transport links, which were troublesome in rural areas.

Participants considered an intervention like PrAISED to be an important component in addressing the post-diagnostic support gap which could play an important role in preventing health and social care use. This was a particular concern in the face of exponential growth in the number of people living with dementia. For some, this underpinned the demand for services like PrAISED:

‘It is critical because we are very limited in the resources we have, so everything you can do to keep people at the lower levels of care for as long as possible are critical and keep people in their own homes wherever possible… anything that supports that kind of left shift to our demand management is really critical,’ Participant 1 (Commissioner).

Early support was deemed necessary to not only prevent health and social care consumption, but also to enhance quality of life and promote meaningful activity and engagement in all aspects of life.

A significant facilitator to providing dementia friendly services was collaborative working and the formation of partnerships and connections with other organisations and stakeholders. Participants were hopeful that health service organisational changes (to Integrated Care Systems (ICS) [ 16 ] would improve collaborative working and align commissioning priorities across health and social care in England. Despite optimism regarding these new partnerships, there was confusion surrounding the responsibilities of these groups and concerns that this would complicate the commissioning process. Additionally, competing priorities between organisations attempting to work cohesively posed a challenge.

Nonetheless, these partnerships were imperative to effective commissioning. Most participants emphasised the importance of the voluntary sector in the provision of dementia friendly services (if commissioned to do so). Many stakeholders had experience working with charities in the design, delivery and maintenance of dementia services and they advocated for their presence as specialists in dementia. Some suggested these organisations were best placed to deliver services (if appropriately commissioned) as they had the time, resources, and specialist knowledge to do so. Alongside charities and the voluntary sector, stakeholders described collaborations with national sporting agencies such as Sport England and other partnerships, including universities, place-based partnerships, social enterprises, the Fire and Rescue Service, community groups, commercial advisors, professional sports teams, and health and social care organisations. These partnerships were seen to facilitate service sustainability and long-term presence in the community.

Organisational partnerships also facilitated the financing of dementia friendly services. These organisations had grants which could fund services, though these were often short lived. Financing was a significant barrier to the commissioning and implementation of dementia friendly interventions. There were tensions between the responsibility for funding:

‘Personally, I think [the] NHS should give us money towards it if they want us to implement it… it will have a knock-on effect on the admissions because if we reduce falls for a longer period of time, it means they’ve got less operations to do and less throughput of hospitals,’ Participant 4 (Occupational Therapist).

The private versus public funding debate was influenced by several factors. Some reported private financing of services was a feasible method for delivering interventions like PrAISED. In contrast, public funding was regarded as difficult to obtain and was frequently linked to other constructs, such as external policy and incentives, and available resources in the inner setting. The VCS thus frequently bridged the gap, and there was a reliance on this sector, which was not without consequences:

‘It is a difficult one because it it’s one of the areas where there is a lot of reliance on almost free services as in non-funded services so that they're either a charitable or community… which means it’s quite piecemeal and quite localized. So, it’s quite hard,’ Participant 7 (Commercial Director).

In terms of what drove the commissioning and implementation of dementia friendly services in the outer setting, there was little reference to peer pressure, though participant 9 highlighted the importance of being aware of what competing organisations were doing and what services were already available. A more commonly cited construct was external policy and incentives. There were conflicting views on the value of external policy and incentives in influencing the commissioning and implementation of dementia friendly services, where it was seen as sometimes a facilitator and at other times, non-influential:

‘We always say “oh policy drives action,” but it doesn’t always… At the end of the day, policy is slightly important… this is my own view, [NHS] Trusts tend not to buy things because of policy. Trusts buy things because it solves a problem for them,’ Participant 7 (Commercial Director).

However, other participants felt policy acted as a facilitator:

‘The easiest way to get it funded is where actual national policy says you must have X service in place. That’s the easiest thing. And you have ring fenced money… it’s really hard if you don’t have that… if we’ve got a national policy, we do have to respond to it,’ Participant 1 (Commissioner).

They went onto suggest external monitoring, performance management and Key Performance Indicators (KPIs) also facilitated commissioning.

Local strategy and policy were also seen to both facilitate and hinder implementation, as budgets would be allocated accordingly:

‘I think probably the one of the main factors is it being a strategic priority locally, because then you’ve got the buy in from the whole system and at the top. So, if it ain’t a strategic priority, then even if it is really good, it might not continue to be funded because of the things which are meeting those strategic priorities will likely get more resources allocated because budgets will be allocated on what are those strategic priorities,’ Participant 5 (Commissioning Manager).

Financial incentives and penalties which are used across OECD (Organisation for Economic Co-operation and Development) member countries to motivate performance in health systems [ 34 ] were also perceived facilitators:

‘I suppose targets and financial incentives or financial pen- well incentives are better than penalties, but usually in the NHS is about punishment. So, you know some sort of stimulus that’s hard for them to ignore. So simply giving them advice that they should is “well, we can ignore that then.” So, it needs to be a bit of force behind it to make people actually implement things,’ Participant 8 (Professor of Dementia Research).

Inner setting

Participants described a need to shift the culture of commissioning from short to long term. Several participants expressed concern that commissioners focussed on ‘crisis management’ due to the NHS climate, rather than on preventative interventions that would provide cost efficiency savings longer term. It was perceived as more difficult to achieve buy-in to such interventions, as often cost savings were not immediately visible. Physical activity and public health interventions were perceived as key to preventative care, and whilst there was a shift towards these types of interventions, there was still work to be done:

‘…in terms of how much we value we place on physical activity in terms of prevention and treatment for long term conditions… I don’t think we’re quite where we should be with that… the health service has been increasingly crisis weighted and I think that limits how much we think about building in preventative or wellbeing factors into primary services,’ Participant 12 (Partnership Manager).

There was a shift in culture towards collaborative working, both within the inner setting (networks and communications), and outer setting (cosmopolitanism/partnerships and connections). However, inner setting decision making processes remained complex and, at times, posed a barrier to commissioning and implementation. Indeed, for participant 11, they had observed how networks facilitated implementation, but also introduced biases, causing them to question the system:

‘I seem to find if they like something and they have a good relationship with an organisation, funnily enough, that sometimes leads to funding and renewal of funding… it would be nice to think it is a fair process… but I think with a lot of things particularly that are NHS system based is that they're very rigid in what they want them to achieve and although they may say that they’re person-centred, really, they’re system-centred and then the person is expected to fit in with that,’ Participant 11 (Researcher).

As described earlier, there was an identified need for dementia friendly activity-based interventions. For three participants, their views met the criteria for coding under the construct tension for change, as they viewed the current situation as intolerable or requiring urgent change. Nonetheless, this was subject to challenges. It was important for any innovation attempting commissioning and/or implementation to be compatible with the existing local systems. For example, whether the innovation could be embedded or absorbed into existing services (compatibility), which is linked to the adaptability construct (innovation characteristics). This was a significant facilitator for implementation success.

Furthermore, the relative priority of the innovation was both a barrier and facilitator. Priorities within the commissioning cycle could prevent similar services from being commissioned. For example, participant 5 suggested that if a falls prevention programme had recently been commissioned, other dementia friendly activity-based interventions would be a lower priority for commissioning. Moreover, the wider social, political, and economic climate also shifted commissioning priorities; the most recent example being the COVID-19 pandemic, where public health and pandemic management were inevitably given greater priority. Furthermore, organisational rewards, measurement and KPIs acted as incentives to implement innovations, but only if local priorities and strategies deemed dementia care and falls prevention a priority. More so, should the innovation align with the goals and mission statement of the organisation, this too would escalate the priority of commissioning and implementation.

One of the most significant and highly cited barriers to commissioning and implementing dementia friendly services was a lack of available resources. This included workforce, time, capacity, available providers, and most significantly, funding. Appropriate (and long-term) funding to commission, implement and deliver an innovation was difficult to secure. Often, budgets were already allocated and thus, unavailable:

‘The real challenge we have got of course is there isn’t new money, there isn’t spare money,’ Participant 1 (Commissioner).

Considering the vast array of contextual factors represented across the CFIR constructs, it is significant that participants often came back to the topic of resources. This issue was shared across the stakeholders, including those with commissioning responsibilities, who expressed frustration that they were unable to commission innovations:

‘There isn’t a lot of money… this is a really frustrating thing that you get all these people coming to you with some really good things [innovations], but we don’t really have money for spending on these things anymore,’ Participant 14.

In the context of limited resources, the NHS was suggested to be the most suitable provider of a service like PrAISED:

‘The problem for dementia is that much of it falls between health and social care. Social care is so poorly funded that it is difficult to see it doing a great deal… probably for it to become more widespread the way things currently are, it would require NHS commissioning, I think are the only people with any money,’ Participant 8 (Professor of Dementia Research).

In addition to funding, inadequate staffing levels and capacity of existing staff hampered implementation. Staff would be required to take on additional workload or redirect time from other services to implement innovations, which was undesirable. This was also the case for allocating time for training. Some suggested additional staff could be hired to facilitate implementation; however, this was associated with greater costs, temporary contracts, and thus, job insecurity. The demands of a lengthy programme like PrAISED (delivered over 12 months) was deemed unfeasible, as participant 4 described when looking to implement Otago, a home-based balance and strengthening programme effective at reducing falls in over 65 s [ 15 ]:

‘The main thing is time and follow ups. We just can’t… Otago’s 12 months. We can’t do it. We can’t do it,’ Participant 4 (Occupational Therapist).

Although leadership engagement (such as service managers) could facilitate this, resources frequently dictated the success of commissioning and implementing innovations.

Individual characteristics

The characteristics of individuals responsible for commissioning, implementing and delivering interventions like PrAISED, acted as potential facilitators to success. Participants identified areas where knowledge could be instilled to upskill caregivers (formal and informal) to engage people living with dementia in physical activity interventions. Furthermore, the knowledge of and belief in such interventions acted as a driver. Individuals’ stage of change [ 18 ] thus could initiate service development; for example, when asked what a persuading factor in the commissioning and implementation of a dementia friendly intervention could be, participant 6 stated:

‘I wouldn’t need persuading because I’m completely on board with it,’ Participant 6 (Sports Development Officer).

As mentioned earlier (innovation characteristics), many participants suggested the intervention could be delivered by other professional groups, such as exercise instructors, personal trainers, domiciliary care workers and support workers/therapy assistants. This was captured under the other personal attributes construct of the individual characteristics domain. Professional groups outside of physiotherapy and occupational therapy were suggested as potential deliverers of interventions like PrAISED due to their cheaper cost, connections to local communities (e.g., gyms, leisure centres, community groups), and their perceived undervalue as an untapped workforce with relevant skills. Furthermore, difficulty in recruiting clinicians and the pressure existing clinicians were under were acknowledged and thus, alternative groups taking responsibility for an intervention like PrAISED would ease pressure.

Most participants expressed a growing appreciation of exercise professionals in delivering physical activity interventions:

‘…there are thousands of physical activity exercise professionals who are highly qualified… Let’s use that workforce. Why not? You know, they are an untapped workforce and there’s a lot of them out there who are already got those connections in the community… they’ve got those behaviours, skills and those motivational interviewing techniques to work with those individuals and then perhaps to support the carers directly as well as those are being cared for. So huge opportunities there,’ Participant 10 (Project Manager).

Many suggested these members of the workforce were qualified and competent to deliver an intervention like PrAISED, with many having undergone specialist training in long term conditions. Thus, it was not always deemed necessary to have registered clinical qualified healthcare professionals’ oversight, though some suggested clinicians could work collaboratively to oversee the programme with exercise professionals delivering the intervention. The use of an existing, untapped workforce could impact the success of commissioning, though this had implications for the intervention:

‘…with all the pressures in the system, with workforce, the interventions that can be delivered successfully, carefully, safely, but with the lowest level of staff training required are very appealing… what is the lowest level of staff that you could utilize on this without making it unsafe or ineffective?’ Participant 7 (Commercial Director).

Some suggested having non-registered clinical staff delivering the intervention would be the most realistic option for commissioning and implementing a service such as PrAISED.

References to planning the implementation process were mostly dominated by the planning of commissioning. As this work package was not reflecting retrospectively on an implemented service, participants spoke hypothetically about this process. The greatest concern was how to plan the business case or model to facilitate successful commissioning/securement of funding. These concerns were mostly related to other constructs such as financing (outer setting) and available resources (inner setting). Other concerns were regarding the organisational model within local systems, such as commercialisation and licencing and how these would be managed in the future, as this had implications for an intervention’s sustainability. Additionally, participants suggested it was imperative to be cognisant of the commissioning cycle and plan attempted business cases accordingly, as this could affect success. Participant 5 described it as being ‘in the right place, at the right time.’

In the case of the English NHS, having a range of engaged individuals was integral to implementation success. Participants provided several examples, including opinion leaders (e.g., leaders in dementia research, dementia advocates), formally appointed implementation leaders (e.g., project leads, healthy aging leads), external change agents (e.g., opinion leaders, politicians, councillors, commissioners, advisors, television personalities Footnote 1 ), champions (self and/or formally appointed), key stakeholders (healthcare professionals, staff, organisations), and innovation participants (service users and caregivers). These champions were considered key to driving the implementation process, particularly when faced with challenges or decreasing momentum:

‘We do need to have if you want to call [them] falls, champions or dementia champions, if that’s the right word, but more ambassadors or business change agents…. Within those day services who can take a bit of ownership and accountability to ramp up that effort, ’ Participant 9 (Programme Manager [Commissioning]).

‘…it’s enthusiasm and passion for me that’s such an important driver,’ Participant 11 (Health and Activity Researcher).

Reflection and evaluation were critical parts of the implementation process for some participants and was something that needed to be built in as part of the planning process. This was important to not only evaluate implementation success and ‘continuous improvement,’ but to provide lessons for future implementation.

The aim of the current study was to explore the barriers and facilitators to commissioning and implementing health and social care interventions for people with dementia in England, using a dementia-friendly exercise and physical activity-based intervention (PrAISED) as a case study. We found facilitators and barriers mapped onto the CIFR [ 17 ] which showed:

The credibility and cost-saving nature of the intervention was important, along with the ability to adapt it to local provision and skill mix.

Interventions such as PrAISED may fill the post-diagnostic gap, but there needs to be an organisational system that will get them commissioned; this involves collaboration between commissioners, providers and other stakeholders, including dementia advocates and caregivers.

There also needs to be a policy culture that values prevention, prioritises dementia and is willing to commit resource to it to make it work.

The post-diagnostic gap

The post-diagnostic gap is defined as ‘ an umbrella term encompassing the variety of official and informal services and information aimed at promoting the health, social, and psychological wellbeing of people with dementia and their carers after a diagnosis. Integrated treatment, care, and support are the pillars of effective post-diagnosis models,’  [ 23 ], p.21). This was a common theme in this study and is a global problem [ 22 , 26 ], despite efforts designed to address this [ 10 , 35 ].

Consequently, there is a need for innovations that address the service gap. Many participants advocated for physical activity interventions, though they also identified a broader need for psychosocial, emotional, logistical, practical, and peer support. This echoes the findings of Bamford et al. [ 8 ], who identified 20 components of post-diagnostic support, extending across five themes (timely identification and management of needs,understanding and managing dementia,emotional and psychological wellbeing; practical support; and integrating support). Bamford et al. [ 8 ] suggested there is a need for local planning and coordination of such services, and there was evidence of this in this study, though wider barriers to commissioning and implementation had the potential to hamper efforts.

This study’s findings reflect other literature exploring barriers and facilitators to commissioning and implementing post-diagnostic services. Wheatley et al. [ 41 ] identified unsupportive infrastructure, limited proactive, holistic tailored support, and limited capacity and capability as barriers to implementation. They identified strategies to address this, such as creating opportunities for service improvement, facilitating collaborative working, supporting non-specialists (e.g., non-medically qualified healthcare professionals) to deliver dementia care, and the development of ongoing holistic support [ 41 ]. The current study provides evidence that these strategies are being undertaken, though there is more to be done to enhance collaboration and the utilisation of existing workforces.

Some research suggests that physical activity interventions for older people can be delivered safely and effectively by non-clinically registered professionals (e.g., exercise instructors, postural stability instructors) [ 30 ] and can be delivered in novel environments outside of traditional healthcare settings [ 32 ]. Furthermore, a physical activity intervention for older people with cognitive impairment, delivered by exercise instructors, showed promising improvements in physical and cognitive function, quality of life and caregiver burden, though the sample size was small [ 9 ]. Therefore, the delivery of physical activity interventions by these professionals may offer a solution to the commonly cited barrier of available resources, which was recommended by Wheatley et al. [ 41 ].

The culture of commissioning in England

This study identified the need for a policy culture that values prevention. In the UK, prevention of ill health is described as a role for individuals, communities, NHS, social care, public health, and local and national government [ 19 ], and is a global priority [ 42 ]. However, these findings demonstrate the complexities of prevention in practice in a universal publicly funded health system.

Interventions like PrAISED are preventative and they were considered harder to secure commissioning commitment. Participants suggested this was twofold: 1) the benefit of such interventions was not immediately visible, and 2) commissioning was focussed on short term ‘crisis management.’ Participants suggested the underappreciation of preventative services meant interventions that may provide longer term cost savings were harder to gain support for and thus implement. This was coupled with difficulty in evidencing cost savings, particularly as commissioners wanted to be able to evidence specifically where cost savings would be delivered, e.g., health or social care. Despite this, participants with commissioning responsibilities were generally acutely aware of the need for preventative services, with some creating dementia strategies and influencing local priorities to address this. Nonetheless, this has the potential to create fragmentation and inequity across sectors and geographies. Furthermore, despite actions to address this, commissioners were also subject to the barriers to commissioning and implementation identified in this study.

In the wider literature, the discourse surrounding joint commissioning emphasises prevention [ 21 ]. Miller et al. [ 33 ] suggest delaying deterioration and maintaining physical and mental health in older people (and thus, their use of health services) is a commonly cited aspiration in commissioning (e.g., [ 2 ]). However, it appears the ability to exercise this rhetoric is limited in the face of competing priorities and restricted resources (affordability). In this study, the VCS was seen as an able facilitator and provider of preventative care, something earlier suggested by Miller et al. [ 33 ]. While there have been successful examples of this, the issues with demonstrating preventative and rehabilitative services, as well as the need to rebalance the system with such care being integrated [ 2 ], continue to pose challenges in commissioning.

The current study has considered the commissioning and implementation of dementia friendly exercise and physical activity-based interventions using PrAISED as a case study. It has identified key considerations for the future of dementia care, particularly in relation to provision of post-diagnostic support and the culture of commissioning in contemporary healthcare. Furthermore, it has identified barriers (cost/financing, the culture of commissioning, and available resources) and facilitators (adaptability of the intervention, cosmopolitanism/partnerships and connections, external policy and incentives, and use of already existing workforces) to commissioning dementia friendly services. Thus, this study provides insight for stakeholders planning the commissioning, implementation and promotion of dementia services.

Recommendations for commissioning and implementing dementia services

A series of recommendations have been collated based upon the barriers and facilitators identified in this study:

Map out local needs and resources

The needs and resources of the population living with dementia and their caregivers should be identified (including the needs of underserved communities)

Involve people living with dementia and their caregivers in identifying these needs

Map existing services (and how/where the intervention would fit)

Evidence the intervention

Evidence the outcomes of the intervention, including effectiveness and cost-effectiveness (e.g., physical and mental health, psychosocial factors, and financial such as cost benefit analysis, patient and deliverer satisfaction [e.g., qualitative data]), to ensure stakeholders value the innovation and its potential impact to ensure it is commissioned/funded and integrated into routine clinical practice.

Create/utilise networks and partnerships with stakeholders with a role in implementing, commissioning, providing, and promoting dementia friendly interventions

Identify local/organisational priorities, resources, and opportunities for collaboration to facilitate commissioning and implementation

Involve these networks and partnerships in the early stages to plan for sustainability

Plan required resources for delivery (cost, staffing, equipment)

Assess capacity in the local system for non-medical professionals delivering exercise and physical activity interventions (e.g., exercise instructors), where able to do so safely and appropriately.

Strengths and limitations

This study presents the perspectives of a small number of stakeholders thus they will not necessarily represent the views of all stakeholders involved in dementia care or commissioning. As this study was carried out in England, the views may not be representative of stakeholders in other countries and care systems. As this study aimed to investigate the views of those with direct responsibility for commissioning and implementing health and social care interventions, we did not include people with dementia or their caregivers in the interviews. These persons could have important insights into the commissioning and implementation of health and social care interventions for people with dementia; hence, this is a limitation of the study and an area which could be explored in future research.

A strength of the study was the range of perspectives and expertise collected, as all participants were involved in dementia services commissioning and provision. Furthermore, the collective discussion of coding decisions within the wider implementation research team meant a range of perspectives were utilised during data analysis.

This study identified several barriers and facilitators to the commissioning and implementation of health and social care interventions for people with dementia, using a dementia-friendly exercise and physical activity-based intervention (PrAISED) as a case study. Key barriers to commissioning and implementing dementia specific services included their cost/financing, competing commissioning priorities and having available resources. Key facilitators included the adaptability of the intervention, having good partnerships and connections in place, external policy and incentives, and the use of already existing (and untapped) workforces.

Based on the results of this study, four actions are recommended to facilitate the commissioning and implementation of interventions like PrAISED: 1) map out local needs and resources, 2) evidence the intervention including effectiveness and cost-effectiveness, 3) create/utilise networks with stakeholders, and 4) plan required resources. Further research is required to explore the outcomes of proposed recommendations.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available to honour the privacy and confidentiality of participants but are available from the corresponding author on reasonable request.

One participant identified television actress Vicky McClure who had worked extensively with a dementia choir, increasing awareness of the condition (see https://www.ourdementiachoir.com/about-the-choir ).

Abbreviations

Clinical Commissioning Group

Consolidated Framework for Intervention Research

Integrated Care System

National Health Service

National Institute for Health and Care Excellence

Organisation for Economic Co-operation and Development

Promoting Activity, Stability and Independence in Early Dementia and Mild Cognitive Impairment

Voluntary and community sector

World Health Organisation

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Acknowledgements

The authors would like to thank all participants who took part in this research.

This project was funded by the NIHR Programme Grants for Applied Research funding scheme [RP-PG-0614-20007]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

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Conceptualisation: EA, RV, SG, JG, TM, RH Methodology: RV, EA, JG, EO, ST, SG, RH Data collection: RT, RV Data analysis: RT, RV, EA, CB, JL Writing- original draft: RT Writing- review and editing: RT, RV, EA, CB, JL, SG, JG, TM, EO, ST, RH Implementation research expertise: EO, ST, JG All authors reviewed the manuscript and agreed to its submission and publication.

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Correspondence to Emma J. Adams .

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Rachael Tucker is a Scientific Editor at Elsevier Cell Press. The work presented in this paper was carried out whilst RT worked as a Research Assistant at the University of Nottingham. All other authors have no competing interests to declare. The study was funded by the NIHR Programme Grants for Applied Research funding scheme [RP-PG-0614-20007]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

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Tucker, R., Vickers, R., Adams, E.J. et al. Factors influencing the commissioning and implementation of health and social care interventions for people with dementia: commissioner and stakeholder perspectives. Arch Public Health 82 , 54 (2024). https://doi.org/10.1186/s13690-024-01283-8

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Received : 12 December 2023

Accepted : 06 April 2024

Published : 23 April 2024

DOI : https://doi.org/10.1186/s13690-024-01283-8

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