{"doi":"10.3389/frhs.2025.1698749","title":"Enduring contributions to implementation science: Honoring the legacy of Bryan R. Garner","abstract":"designs, frameworks, pragmatic tools, and ways of thinking about vexing problems. In the following sections, we highlight five of his major contributions to his field of implementation science, before discussing his enduring impact on his teams and collaborators.As an early career researcher, Bryan posed and answered critically important questions about staff turnover. His work in this area reflected his ability to do more with less, by building off existing national initiatives to forge new lines of inquiry. In the early 2000s, most staff turnover studies were cross-sectional in nature and little was known about antecedents of turnover and the effects of turnover on patient outcomes. Bryan capitalized upon a SAMHSAfunded demonstration project [11], which included data from 3,021 adolescent patients, 208 therapists, and 34 organizations, to obtain an R01 titled, Impact, Predictors, and Mediators of Therapist Turnover. His programmatic research culminated in several major contributions to the literature on staff turnover.First, Bryan documented that 31% of substance use therapists and 19% of leaders turned over on an annual basis, rates that were consistent with turnover in other industries [12]. Second, he found that staff attaining competence in evidence-based practice delivery generally remained committed to their organization, with those providers who attained competence having annual turnover rates of less than 5% [13]. Third, he identified an array of multi-level, significant predictors and mediators of turnover including organizational functioning, job satisfaction, psychological climate, and burnout [14,15]. Fourth, he demonstrated that turnover intentions were dynamic and that change in factors like job satisfaction and role clarity predicted turnover intentions [15]. And finally, he documented that staff turnover was not consistently associated with adverse adolescent outcomes as expected and, in some cases, was associated with more positive outcomes [12,16]: these findings challenged prevailing assumptions and suggested that turnover could present an opportunity for positive \"realignment\" of the team. Across this portfolio, Bryan documented multiple \"firsts\" in the SUD treatment field while making substantive contributions to the broader industrial-organizational psychology literature on turnover [17].After demonstrating that antecedents of staff turnover were multi-level, Bryan developed a decades-long commitment to championing the design, development, refinement and evaluation of multi-level, theory-driven implementation strategies. His work was heavily informed by the theory of implementation climate: the idea that for implementation to be successful, the innovation must be expected, supported, and rewarded [18]. To target implementation climate, Bryan frequently deployed multi-level strategies containing both incentivization and facilitation.He posited that facilitation addressed the expected and supported elements of implementation climate, whereas incentivization addressed the rewarded element of implementation climate. His work in this area was characterized by multiple innovations.In the facilitation domain, Bryan developed, evaluated, and widely disseminated the Implementation and Sustainment Facilitation Strategy (ISF) strategy. The ISF strategy is rooted in principles of motivational interviewing and contains a series of facilitator-led exercises designed to help implementation teams anticipate and address common implementation challenges. One of Bryan's R01s, the Substance Abuse Treatment 2 HIV Care (SAT2HIV) trial, tested the effectiveness of the ISF strategy as an adjunct to the real-world strategy used by the Addiction Technology Transfer Centers (ATTCs; didactic workshop + performance feedback + consultation) across 39 HIV service organizations [19,20]. The primary outcome analysis demonstrated that adding the ISF strategy to the ATTC strategy significantly improved implementation effectiveness (defin","journal":"Frontiers in Health Services","year":2025,"id":554409,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9498,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":762066,"name":"James H. Ford","orcid":"0000-0003-3045-2414","position":1,"is_corresponding":false},{"id":315648,"name":"Joseph E. Glass","orcid":"0000-0002-2923-3698","position":2,"is_corresponding":false},{"id":733987,"name":"Heather J. Gotham","orcid":"0000-0003-0401-5990","position":3,"is_corresponding":false},{"id":325627,"name":"Hannah K. Knudsen","orcid":"0000-0002-0137-9337","position":4,"is_corresponding":false},{"id":502770,"name":"Andrew Quanbeck","orcid":"0000-0003-0762-4804","position":5,"is_corresponding":false},{"id":1452218,"name":"Mat Roosa","orcid":null,"position":6,"is_corresponding":false},{"id":602280,"name":"Emily C. Williams","orcid":"0000-0002-8210-6137","position":7,"is_corresponding":false},{"id":479042,"name":"Sara J. Becker","orcid":"0000-0001-9271-2432","position":0,"is_corresponding":true}],"reference_count":42,"raw_metadata":null,"created_at":"2026-07-19T02:54:50.112989Z","pmid":"41210481","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}